Provider Networks Referral Leakage

By Claire Thayer, April 16, 2015

Containing patient referrals within a provider network is easier said than done, even with electronic health records.  According to Joel French, CEO of SCI Solutions, "more than 25 percent of orders and referrals from employed providers leak out of network."  Chief Financial Officers across the country cite referral leakage as a top concern. According to a recent survey, 51% of CFOs list reducing network leakage as the most successful methods for generating future revenue growth. 

MCOL’s infoGraphoid for this week takes a look at some of the root causes of referral leakage as well as identifies seven ways to contain the leakage:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

New Interactive Tool to Monitor U.S. Health Care Spending

By Claire Thayer, April 8, 2015

A week or so ago, The Peterson Center on Healthcare and the Kaiser Family Foundation unveiled a cool new interactive tool for public access to measure quality and cost components of the country's health care system on their new site, The Peterson-Kaiser Health System Tracker.  “This interactive tool provides up-to-date information on U.S. health spending by federal and local governments, private companies, and individuals. It was developed by analysts at the Kaiser Family Foundation using data from the National Health Expenditure Account and will be updated annually with each data release.”  Using the Health Spending Explorer interactive tool, data can be tracked as far back as 1960, with most recent data as of 2013 (which will be updated annually).  Search by single year, compare two years, or customized you own parameters.  Here are a couple of examples, comparing all types of services and hospital spending by health insurance and out-of-pocket costs in 1993 and twenty years later in 2013.

In addition to the option to use the interactive feature to create your own reports, the “Chart Collections” section has a bunch of charts and supporting slide decks to choose from:

Drilling down to the question of “How do health expenditures vary across the population?” here are a couple of related supporting slides available for download:

In addition to the interactive tool and chart collections, The Peterson-Kaiser Health System Tracker site provides access to their Insight Briefs and regular blogs.

Medical Identity Theft Impact on Health Care

By Claire Thayer, March 12, 2015

According to findings from The Fifth Annual Study on Medical Identity Theft, published by the Medical Identity Fraud Alliance, the number of patients affected by medical identity theft increased nearly 22 percent in the last year, an increase of close to half a million since 2013. Many of us by now have heard about the massive Anthem breach, affecting up to 80 million people and considered to be the largest security breach involving a major health organization. Anthem notes that "the information accessed may have included names, dates of birth, Social Security numbers, health care ID numbers, home addresses, email addresses, employment information, including income data."  However, while, yes, the breach at Anthem was massive, they’re far from alone! 

Since 2009, 109 health-plan related security breaches have been reported to the Department of Health & Human Services Office for Civil Rights.  Breaches affecting 500 or more individuals is public information and accessible directly via the aptly named Breach Portal, where you can search by covered entity, state, type of entity (i.e., health plan, healthcare provider, etc), individuals affected, breach submission date, type of breach (theft, hacking/IT, improper disposal, etc., location of breached information).

MCOL's infoGraphoid this week highlights health plan related security breaches since 2009 and how patients found out that their medical identity was exposed:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Medicare Obesity Counseling – it’s Free!

By Claire Thayer, March 5, 2015

The Center for Disease Control and Prevention shows alarming obesity trend rates among the elderly population within the United States.  Thirty-six percent of men aged 65-74 are considered obese, along with slightly over 44% of women in this same age bracket, as highlighted on the CDC’s FastStats for Older Persons’ Health web page:

These findings continue to trend upward from the data previously available from the National Center for Health Statistics that found more than one-third of older adults aged 65 and over were obese in 2007–2010. 

Consider that over the next thirty years, the number of U.S. older adults is expected to more than double, rising from 40.2 million to 88.5 million. Primary care providers are critically important in helping to reverse these trends. The Kaiser Family Foundation reminds us in an article published this week, Few Seniors Benefiting From Medicare Obesity Counseling, that the Affordable Care Act included a new Medicare benefit offering face-to-face weight-loss counseling in primary care doctors’ offices. Doctors are paid to provide the service, which is free to obese patients, with no co-pay.  Surprisingly, as reported in USA Today, a mere 1% of Medicare's 50 million beneficiaries have used the free counseling benefit.

Predictable savings when health plan members are engaged in preventative care

By Claire Thayer, February 12, 2015

There are many approaches to patient care intervention, in terms of managing chronic disease. Several years ago an important study, that is still widely referenced, finds that some of the most successful patient care intervention approaches include those that are customized for each individual patient, allow for intensive time commitment in terms of time multi-disciplinary teams spent face-to-face with patient, and use of technology that is highly interactive with patients.  These approaches to engaging patients in preventative care, along with the payoff in financial savings and health outcomes is the focus of MCOL's infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here

The Value of Maternity Management in Mitigating Legal Risk

By Claire Thayer, February 4, 2015

Almost 85% of women in the U.S. receive maternity services when giving birth. According to a report presented by Childbirth Connection, "Maternity Care and Liability: Pressing Problems, Substantive Solutions," childbirth is the nation's leading reason for hospitalization and most expensive hospital condition. It is also estimated that 19 of 3,000 hospital births result in an adverse outcome. The importance of maternity management in mitigating legal risk is the focus of MCOL's infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Population Health Management - Integration of Medical and Pharmacy Benefits

By Claire Thayer, January 22, 2015

A new Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics LLC (Prime) study examined yearly medical costs of 1.8 million members of Blue Cross® and Blue Shield® (BCBS) independent companies, whose pharmacy benefit services were divided between “carve-in” and “carve-out” benefit options.  This study finds that members integrating the pharmacy benefits experienced:

• 9% fewer hospitalizations
• 4% fewer emergency room visits
• 11% lower medical costs

HealthPartners, in their Pharmacy Integration Study, estimated that integrating medical and pharmacy benefits can save a group with 9,000 continuously enrolled members more than $1 million per year.  These and other data points are featured in MCOL’s infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Pitfalls with Health Care Provider Data

By Claire Thayer, December 11, 2014

A U.S. Senate Committee investigation report finds that Medicare paid 478,500 claims attributed to deceased physicians, totaling up to $92 million, from 2000 to 2007. The U.S. Postal Service reports that at least 25-30% of the demographic and contact information for health care providers changes every year. The cost of bad or outdated provider data is estimated at $26 billion annually. These and other data points are featured in MCOL’s infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Health Care Fraud Detection: Intersection of Data and Linking Analytics

By Claire Thayer, November 19, 2014

LexisNexis tells us that three key elements of successful link analysis are Big Data, Super Computing and Social Network Definition and that the three big data necessary for successful link analysis include claims data, provider data and member data.  In August earlier this year, LexisNexis hosted a webinar, Moving Fraud Prevention Forward: The Intersection of Data and Linking Analytics.  Throughout this webinar, the audience engaged in several polling questions - these questions, along with the audience responses are featured in MCOL’s infoGraphoid this week:

MCOL's weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

US Healthcare Spending Waste, Unnecessary Cost, and Fraud

By Claire Thayer, November 5, 2014

The United States spends almost $3.8 trillion annually on healthcare – or 18% of GDP. Of this amount, almost one-third of healthcare spending is estimated to be attributed with waste, unnecessary services and fraud. MCOL’s infoGraphoid this week highlights some of the major types of waste, estimated number of unnecessary surgeries, new healthcare fraud investigations and more:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Population Health Management Costs & Risks

By Claire Thayer, October 15, 2014

Chronic disease is defined as a long-lasting condition that can be controlled but not cured.  In the United States alone, 75% of our healthcare spending is now directed towards the treatment of chronic disease.  Studies find that almost 50% of this population copes with at least one chronic condition.  MCOL’s infoGraphoid this week highlighted these trends, along with a recent study published in the journal Health Affairs  on the cost impact of disease management and components of Pepsico’s wellness program focused on reducing employee costs and hospital readmissions:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Kaiser Family Foundation’s 2014 Employer Health Benefits Survey

By Claire Thayer, October 2, 2014

Findings from the latest Kaiser Family Foundation’s annual survey of employer-sponsored health benefits are now available in the 2014 Employer Health Benefits Survey. This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and employer opinions.  Here are a few of the key findings pertaining to trends in premium rates and worker contributions:

• Average annual family premium: $16,834, a 69% increase since 2004 and doubled since 2002
• Workers contribution to premiums: $4,823
• Workers average deductible: $1,217, up 47% since 2009

The complete report, all 275 pages, includes comprehensive analysis, findings and lots and lots of charts! 

Problems with Accuracy in Health Plan Member Data

By Claire Thayer, September 24,2014

LexisNexis illustrates the types of problems encountered with accuracy in health plan member data in MCOL’s infoGraphoid this week:

Wondering if your member data is current and complete? LexisNexis offers a no-cost evaluation. MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and eleased each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

The $10 Billion Search for Healthcare Innovation

By Claire Thayer, August 12, 2014

The hunt is on for the discovery of innovative ideas to change the delivery of health care at all levels.   Kaiser Health News published a great summary of this massive quest in this article: Washington's $10 Billion Search For Health Care's Next Big Ideas.  Funded by the new health care law, experiments are taking place in every state in the country with oversight provided by the newly created Center for Medicare and Medicaid Innovation.  Kaiser Health News tells us that the center’s ten-year, $10 billion budget is the largest ever devoted to transforming care. In several states the office is working to overhaul medicine for nearly all residents — not just those with government Medicare and Medicaid coverage.

In addition to seeking out new payment and service delivery models, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS and categorizes these Innovation Models into seven areas:

• Accountable Care
• Bundled Payments for Care Improvement
• Primary Care Transformation
• Initiatives Focused on the Medicaid and CHIP Population
• Initiatives Focused on the Medicare-Medicaid Enrollees
• Initiatives to Speed the Adoption of Best Practices
• Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

So far, the American Hospital Association has received $75.8 million towards it’s innovation initiatives, Johns Hopkins Univeristy has received $32 million, followed by several others receiving close to $25 million. Here’s a look at the Top 10 Recipients of the new Innovation Dollars:

week, HealthSprocket, the home for healthcare lists of all kinds, featured a couple of its recent lists on health care innovation:

• Healthcare Innovation Thought Leaders to follow on Twitter
• Jenn Lisak: 3 Keys to Crowdsourcing That Drive Innovation in the Healthcare Industry

If you’re looking for an easy way to stay current on healthcare innovation trends and initiatives, Health Policy Publishing has a new monthly newsletter, Healthcare Innovation News, dedicated solely to this topic, with feature articles contributed by leading national experts and executives in the field; Thought Leader insights; Industry Briefs; profile of a key individual involved with healthcare innovation initiatives; plus more.

Readers can get a free sample issue of the 12-page monthly Healthcare Innovation News publication here. And, if you’re simply wanting to stay in the loop on news and other general announcements pertaining to healthcare innovation, the bimonthly Healthcare Innovation Bulletin, also available from Health Policy Publishing, is accessible for free here, at any time.

One in 5 million Americans now covered by Medicaid

By Claire Thayer, July 7, 2014

The Affordable Care Act (ACA) has had a huge impact on Medicaid enrollment and spending since the expansion of Medicaid eligibility to include almost all adults with incomes at or below 138% of the federal poverty level effective January 1, 2014. The Kaiser Family Foundation recently released, Medicaid Moving Forward, a concise fact sheet summarizing current enrollment, spending and other trends for the Medicaid program.  Lots of data is packed into this fact sheet, here are a few of the important highlights:

Who Does Medicaid Cover?

• Over 66 million Americans now receive their health coverage through the Medicaid

• Medicaid and Children’s Health Insurance Program (CHIP) cover more than 1 in every 3 children

• In June 2013, over 28 million children were enrolled in Medicaid and 5.7 million were enrolled in CHIP

• The ACA expanded Medicaid to nearly all adults under age 65 with income at or below 138% FPL, effective January 1, 2014.

• As of June 2014, 27 states, including DC, were expanding Medicaid, three states were actively debating the issue, and 21 states were not moving forward

What does Medicaid Cover?

• inpatient and outpatient hospital services;

• physician, midwife, and nurse practitioner services;

• early and periodic screening, diagnosis, and treatment (EPSDT) for children up to age 21;

• laboratory and x-ray services;

• family planning services and supplies;

• federally qualified health center (FQHC) and rural health clinic (RHC) services;

• freestanding birth center services (added by ACA);

• nursing facility (NF) services for individuals age 21+;

• home health services for individuals entitled to NF care;

• tobacco cessation counseling and pharmacotherapy for pregnant women (added by ACA);

• non-emergency transportation to medical care

How do Medicaid Beneficiaries Get Care?

• Most Medicaid beneficiaries obtain care from private office-based physicians & other health professionals.

• Safety-net health centers and hospitals also play a major role in serving the Medicaid population.

• Over half of Medicaid beneficiaries nationally, mostly, children and parents, are enrolled in comprehensive managed care organizations (MCO) that contract with states on a capitation, or risk, basis to deliver Medicaid services

• A smaller but still significant number of beneficiaries are enrolled in Primary Care Case Management (PCCM) programs

How much does Medicaid cost and how is it financed?

• In FY 2012, Medicaid spending on services totaled about $415 billion

• Administrative costs accounted for 5% of overall program spending.

• Two-thirds of all spending on services was attributable to acute care

• 30% of all spending on services was associated with long-term care.

• Supplemental payments to hospitals that serve a disproportionate share of Medicaid and uninsured patients, known as “DSH,” accounted for about 4% of spending

• Medicaid payments for Medicare premiums and cost-sharing on behalf of dual eligible beneficiaries totaled 3.5%.

Source: Medicaid Moving Forward, The Henry J. Kaiser Family Foundation, June 17, 2014.

Additional Issue Briefs that might be of interest:

Katherine Young and Lisa Clemans-Cope and Emily Lawton and John Holahan, Medicaid Spending Growth in the Great Recession and Its Aftermath, FY 2007-2012, The Henry J. Kaiser Family Foundation, Issue Brief, July 3, 2014.

Samantha Artiga and Robin Rudowitz, Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers, The Henry J. Kaiser Family Foundation, Issue Brief, January 29, 2014.

Enrollment in Federal Marketplace & 2014 Premium Tax Credits

By Claire Thayer, June 23, 2014

Last week, the Department of Health and Human Services published an in-depth research brief that examined 19,000 Marketplace plans for 2014 and analyzed data on the change in the premium cost associated with the tax credit for Marketplace plan selections made through the Federally-Facilitated Marketplace (FFM) during the initial open enrollment period.

The complete study, PREMIUM AFFORDABILITY, COMPETITION, AND CHOICE IN THE HEALTH INSURANCE MARKETPLACE, 2014 is accessible on the HHS site here: http://aspe.hhs.gov/health/reports/2014/Premiums/2014MktPlacePremBrf.pdf

Study highlights and selected charts are provided below:

For additional information, download the full research report, PREMIUM AFFORDABILITY, COMPETITION, AND CHOICE IN THE HEALTH INSURANCE MARKETPLACE, 2014. Interested in learning more about public and private health insurance exchanges? Health Policy Publishing’s Health Insurance Marketplace News – might be just what you’re looking for! Request a complimentary sample issue: http://www.healthinsurancemarketplacenews.com/

Consumer Driven Healthcare and the Mobile Market

By Claire Thayer, May 28, 2014

This week, Jeff Bakke, Chief Strategy Officer at Evolution1 participated in a live Healthcare Web Summit webinar event, “A Fresh Approach to CDH: 5 Ways to Get In It to Win It.” His presentation focused on important market drivers increasing consumer driven health demand, industry challenges, post-reform opportunities, along with emerging trends in the marketplace, including the explosive growth in the mobile market. Here's a screenshot from one of his slides on Evolution1’s growth in the mobile market:

 

Jeff’s presentation also touched upon HSA trends, mobile adoption, defined contribution and the exchanges.  If you missed this informative session, with Evolution1 partner, Surency Life and Health, the complete 60-minute webcast is now available On-Demand here.

Portrait of a LinkedIn User

By Claire Thayer, May 12, 2014

A few weeks ago, LinkedIn announced that it reached 300 million registered users, with almost two-thirds of these members located outside the United States. So, just what does the typical LinkedIn user look like? Power+Formula has a nice infographic on user demographics in their new Portrait of a LinkedIn User 2014 Edition.  A complete copy of the infographic is shown below, and highlights include:

• 81% are using the Free LinkedIn version
• 43% spend 0-2 hours a week on LinkedIn
• 42% use LinkedIN to build new relationships with potential customers
• 41% use LinkedIn to increase marketing presence
• 60% use the LinkedIn Company page feature to share status updates with company followers
• 36% Rank LinkedIn as “Extremely” important in efforts to develop or grow business

 

The full infographic is available here:

http://www.powerformula.net/wp-content/uploads/2014/05/2014-LinkedIn-Infographic.png

Net Gain of 9.3 Million American Adults with Health Insurance Coverage

By Claire Thayer, April 18, 2014

While the big news this week focused on the success of President Obama and the ACA enrolling 8 million Americans for health insurance through the federal marketplace, a new study from RAND estimates that there was actually a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.

The RAND survey, “drawn from a small but nationally representative sample, indicates that this significant uptick in insurance coverage has come not only from enrollment in the new marketplaces established under the Affordable Care Act (ACA), but also from new enrollment in employer coverage and Medicaid.”

A summary of the new RAND report is available for free here, with highlights below:

• Of the 40.7 million who were uninsured in 2013, 14.5 million gained coverage, but 5.2 million of the insured lost coverage, for a net gain in coverage of approximately 9.3 million. This represents a drop in the share of the population that is uninsured from 20.5 percent to 15.8 percent.
• The 9.3 million person increase in insurance is driven not only by enrollment in marketplace plans, but also by gains in employer-sponsored insurance (ESI) and Medicaid.
• Enrollment in ESI increased by 8.2 million.
• Medicaid enrollment increased by 5.9 million. New enrollees are primarily drawn from those who were uninsured in 2013, or those who had “other” forms of insurance, including Medicare, retiree health insurance, and other government plans.
• According to our estimates, 3.9 million were covered through the state and federal marketplaces as of mid-March 2014. This figure does not fully capture the enrollment surge that occurred in late March.
• Among the 7.8 million people who were enrolled in off-marketplace individual market plans in early 2014, 7.3 million were previously insured; 5.4 million were previously insured through an individual market plan.

The complete RAND study is available for download at no charge here.

Looking for an easy way to keep up on what’s happening in the health insurance marketplace? Health Policy Publishing now has several free resources on this topic, including Health Insurance Marketplace News,  a twelve page monthly newsletter; a free bimonthly e-newsletter, Health Insurance Marketplace News Bulletin; a related Linkedin Group; Conferences; HIX Directory; and HIX Learning Kit. Learn more: http://www.healthinsurancemarketplacenews.com/resources.html

Content Marketing Dominates Social Media Trends in 2014

By Claire Thayer, March 12, 2014

There continues to be a very strong focus on Content Marketing as a vehicle for educating current customers as well as for attracting new business opportunities. White papers and sponsored emails are considered the two top tactics for generating leads, along with sponsored webinars, according to a recent survey conducted by Business.com of more than 500 of its active pay-per-lead advertisers on questions related to lead generation tactics and strategies.  Specific to White Papers, more than 50 percent of those surveyed said white papers are a “valuable” or “extremely valuable” source of leads:

This week, Business 2 Community posted their 13 Social Media Marketing Trends in 2014, on the top of the list -- content marketing -- 

As you consider your White Paper strategy, here a few good resources that might be helpful:

• Curiosity Journalism: The Newest Trend In Content Marketing
• Creating Valuable Content – An Essential Checklist
• Content Marketing Checklist: 13 Things You Must Do Before You Publish Content

We of course would love to engage with you in a conversation about our own ideas  to help you power your White Paper strategies! Drop your contact info here at any time and we’ll send you a few ideas to think about!