Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

U.S. House Republicans to vote on Obamacare repeal

Reuters reports: U.S. House Republicans moved ahead on Friday with legislation aimed at dismantling Obamacare, despite concerns about not having a replacement for the healthcare program and the potential financial cost of repealing President Barack Obama's landmark law.

Reuters

Friday, January 13, 2017

Trump’s HHS Nominee Got A Sweetheart Deal From A Foreign Biotech Firm

Kaiser Health News reports: When tiny Australian biotech firm Innate Immunotherapeutics needed to raise money last summer, it didn’t issue stock on the open market. Instead, it offered a sweetheart deal to “sophisticated U.S. investors,” company documents show.

Kaiser Health News

Friday, January 13, 2017

CVS slashes price of substitute EpiPen auto-injectors to $109.99

Stat News reports: CVS Health announced Thursday morning that it has cut the price of two-packs of epinephrine auto-injectors to $109.99 — roughly the price that brand-name EpiPen shots were selling for eight years ago, before their escalating price became a hot political issue.

Stat News

Thursday, January 12, 2017

Sylvia Burwell urges need for Medicare to have drug price negotiating power

Healthcare Finance News reports: Giving Medicare authority to negotiate drug prices is the best way to keep those spiraling costs under control for the program's recipients, departing Health and Human Services Secretary Sylvia Burwell said Monday.

Healthcare Finance News

Tuesday, January 10, 2017

UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion

The New York Times reports: UnitedHealth Group, one of the largest and most diversified health insurance companies in the United States, said on Monday that it planned to buy Surgical Care Affiliates, a chain of outpatient surgery centers, for about $2.3 billion. The deal is expected to close in the first half of 2017.

NY Times

Monday, January 9, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Walgreens CEO: Obamacare Replacement Shouldn't Be To 'Detriment' Of U.S.

Forbes reports: Whatever the Republican Congress and Donald Trump's White House create to replace the Affordable Care Act, Walgreens Boots Alliance hopes it “will not be to the detriment of [U.S.] citizens,” the company’s top executive said Thursday.

Forbes

Friday, January 6, 2017

Only 20 Percent Of Americans Support Health Law Repeal Without Replacement Plan

Kaiser Health News reports: The Republican strategy of repealing the Affordable Health Care Act before devising a replacement plan has the support of only one in five Americans, a poll released Friday finds.

Kaiser Health News

Friday, January 6, 2017

Medicare Failed To Recover Up To $125 Million In Overpayments, Records Show

Kaiser Health News reports: Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

Kaiser Health News

Friday, January 6, 2017

Ryan Says Obamacare Replacement Bill Will Be Done in 2017

Morning Consult reports: House Speaker Paul Ryan says legislative work on repealing and replacing the Affordable Care Act will be completed this year, but exactly when the transition takes place on insurance exchanges is still to be determined.

Morning Consult

Thursday, January 5, 2017

Commonwealth Fund study finds parallels in uninsured rate decline, other economic gains and ACA implementation

Healthcare Finance News reports: The vast majority of adults who enrolled for health insurance during the first open enrollment period would likely not have held coverage without the Affordable Care Act expansions, finds a new study from the Commonwealth Fund.

Healthcare Finance News

Thursday, January 5, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant Infections

NPR reports: The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

NPR
Thursday, December 22, 2016

Cleveland Clinic CEO Toby Cosgrove named as contender for Trump's VA pick

Modern Healthcare reports: Cleveland Clinic CEO Dr. Toby Cosgrove was among prospective cabinet picks who met with President-elect Donald Trump on Tuesday. Cosgrove is reportedly a contender to lead the Veterans Affairs Department.

Modern Healthcare
Wednesday, December 21, 2016

Senate report shows Martin Shkreli is just as bad as you think he is

USA Today reports: Staggering hikes — in some cases higher than 5000%— in prices of prescription drugs threaten the health and economic stability of Americans who can't afford vital medicines, a congressional report warned Wednesday.

USA Today

Wednesday, December 21, 2016

Health Exchange Enrollment Jumps, Even as G.O.P. Pledges Repeal

The New York Times reports: About 6.4 million people have signed up for health insurance next year under the Affordable Care Act, the Obama administration said Wednesday, as people rushed to purchase plans regardless of Republican promises that the law will be repealed within months.

The New York Times
Wednesday, December 21, 2016

Women Doctors May Be Better For Patients’ Health

Kaiser Health News reports: When a patient goes to the best hospital, he or she usually hopes for a doctor who is knowledgeable and experienced. Something else to wish for? A woman physician.

Kaiser Health News
Monday, December 19, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 Feds Extend Healthcare.Gov Deadline To Dec. 19, Citing Late Rush

USA Today reports: Federal regulators Thursday night extended the midnight deadline for Affordable Care Act insurance by four days, as consumers fought to get through to call center operators and log onto Healthcare.gov to buy insurance that takes effect Jan. 1.

USA Today, December 16, 2016

G.O.P. Plans to Replace Health Care Law With ‘Universal Access’

The New York Times reports: House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.

The New York Times, December 16, 2016

 

CMS debuts new ACO model for dual-eligibles

The federal government has introduced a new accountable care organization model aimed at working with states to provide better quality, lower cost care for people enrolled in both Medicare and Medicaid.

Fierce Healthcare, December 15, 2016

Obama administration blocks states from cutting off grants to Planned Parenthood

The Washington Post reports: The Obama administration took steps Wednesday to block states from cutting off federal family planning grants to Planned Parenthood, finalizing a rule that is to take effect just days before the inauguration of President-elect Donald Trump.

The Washington Post, December 14, 2016

Aetna CEO takes stand to defend deal with Humana

In his turn on the witness stand in the Aetna-Humana antitrust trial, Aetna CEO Mark Bertolini sparred with Justice Department lawyers about the central debates surrounding the acquisition—including whether the deal will deliver on its promised efficiencies.

Fierce Healthcare, December 13, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

The State of Provider Directory Accuracy

By Claire Thayer, December 13, 2016

Despite a federal mandate for all plans in the health insurance marketplace be required to have current and accurate provider directories, many health plan enrollees are finding that when it comes time to call a provider for their specialty visit or find a new primary care physician willing to take new patients, the information in the directory is often out of date or missing vital information.

We’ve posted a couple of infographics on this topic, one on the Accuracy of Health Provider Directories which outlined data points that CMS requires health plans to monitor and maintain on a monthly basis and the State of Provider Directory Accuracy Across the U.S. which outlined provider penalties that could be incurred for inaccuracies.

Last week, The New York Times published an in-depth article, Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors, highlighting from the consumer perspective just how frustrating the experience can be when you’re the patient shopping for health coverage and trying to find a physician willing to accept new patients.

While health plans participating in the health insurance marketplaces were to be subjected to penalties for directory inaccuracies starting in 2016, research by the New York Times found that while many directories are still incomplete, inaccurate or missing information, so far no plans have been fined or kicked off the enrollment sites for having poor doctor directories, said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which would enforce the rules. A Health and Human Services Department survey of Medicare plans for those 65 and older that was released in October found errors in nearly half of the listings in doctor directories .

Last week, the MCOL Infographoid, co-sponsored by LexisNexis Health Care, offered a deeper look at the provider directory requirements on a state by state basis in the State of Provider Directory Accuracy, highlighted below:

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, December 9, 2016

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

1. 5 quick ways a new HHS secretary could change health policy
Kaiser Health News reports: Prospective Health and Human Services secretary Tom Price, currently the chairman of the House Budget Committee, brings a distinctive to-do list to the agency. And, if confirmed by the Senate, he will have tremendous independent power to get things done.
Kaiser Health News via the Washington Post, December 9, 2016

2. HHS Chief Warns Senate Democrats of ‘Chaos’ Under ACA Repeal
Morning Consult reports: The nation’s top health official spoke with Senate Democrats Thursday about the repeal of the Affordable Care Act, warning that undoing the law without having a replacement ready could be disastrous.
Morning Consult, December 8, 2016

3. These drug price hikes cost taxpayers millions
Stat News reports: Drugs to treat cancer, high blood pressure, and seizures experienced large price spikes in 2015, costing taxpayers millions of dollars in added Medicare spending, according to new data released by the federal Centers for Medicare and Medicaid Services.
StatNews, December 8, 2016

4. Health Insurers List Demands if Affordable Care Act Is Killed
The NY Times reports: The nation’s health insurers, resigned to the idea that Republicans will repeal the Affordable Care Act, on Tuesday publicly outlined for the first time what the industry wants to stay in the state marketplaces, which have provided millions of Americans with insurance under the law.
New York Times, December 6, 2016

5. Insurers’ Flawed Directories Leave Patients Scrambling For In-Network Doctors
Kaiser Health News reports: Penny Gentieu did not intend to phone 308 physicians in six different insurance plans when she started shopping for 2017 health coverage.
Kaiser Health News, December 5, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, December 2, 2016

1. The drug industry’s stake in Trumpcare is bigger than you think
StatNews reports: The upcoming fight over repealing and replacing the Affordable Care Act promises to shake up hospitals and insurers, but drug makers also stand to gain — or lose — a lot.
StatNews, December 2, 2016

2. 2,000+ physicians: 'The AMA does not speak for us' in supporting Price for HHS
Becker's Hospital Review reports: More than 2,000 physicians signed an open letter railing against the American Medical Association's support for Rep. Tom Price, MD, R-Ga., chairman of the House Budget Committee, as secretary of HHS.
Becker's Hospital Review, December 1, 2016

3. U.S. House Passes 21st Century Cures Legislation
Healthcare Informatics reports: The U.S. House of Representatives today passed sweeping, bipartisan legislation, called the 21st Century Cures Act, comprised of a $6.3 billion package of medical innovation bills including $4.8 billion to the National Institutes of Health as well as $1 billion in state grants to fight opioid abuse.
Healthcare Informatics, November 30, 2016

4. Price’s Appointment Boosts GOP Plans To Overhaul Medicare And Medicaid
Kaiser Health News reports: President-elect Donald Trump’s selection of Rep. Tom Price to head the Department of Health and Human Services signals that the new administration is all-in on both efforts to repeal the Affordable Care Act and restructure Medicare and Medicaid.
Kaiser Health News, November 29, 2016

5. CMS nominee set up Indiana’s unusual Medicaid expansion
The Washington Post reports: A decade ago, when Indiana had one of the lowest rates of health insurance coverage in the nation, then-Gov. Mitch Daniels (R) turned to a health policy consultant named Seema Verma to help insure more of the state’s poor and working poor.
The Washington Post, November 29, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, November 18, 2016

1. Study Finds Nearby Retail Clinics Don’t Drive Down ER Visits
Kaiser Health News Reports: Even if there’s a retail health clinic less than a 10-minute drive away, consumers are just as likely to go to the emergency department for low-level problems like bronchitis or urinary tract infections, a recent study found.
Kaiser Health News, November 18, 2016

2. The ultimate Q&A about health care under a Trump presidency
The Washington Post reports: While it's pretty much a given that the Affordable Care Act won't survive a Trump presidency and Republican Congress in its current form, there are sweeping implications of reversing a law that has reached in so many ways into our health care system.
The Washington Post, November 17, 2016

3. Former Valeant and Philidor Executives Charged in Kickback Scheme
The New York Times reports: A secret relationship had made the two men rich: one, the head of a mail-order pharmacy, the other, an executive at a major pharmaceutical company who had promised to funnel millions of dollars to his partner in exchange for receiving millions of his own.
The New York Times, November 17, 2016

4. Landmark report by Surgeon General calls drug crisis ‘a moral test for America’
The Washington Post reports: A landmark report released Thursday by U.S. Surgeon General Vivek H. Murthy places drug and alcohol addiction alongside smoking, AIDS and other public health crises of the past half-century, calling the current epidemic “a moral test for America.”
The Washington Post, November 17, 2016

5. More than 1 million sign up for ObamaCare, HHS says
The Hill reports: More than 1 million people have registered for ObamaCare coverage for 2017 since the sign-up period began Nov. 1, the Obama administration announced Wednesday.
The Hill, November 16, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Changing the conversation from wellness to total wellbeing

By Claire Thayer, November 10, 2016

This week, Robin Bouvier from Aon’s Health Transformation Team, spoke in a HealthcareWebSummit webinar, co-sponsored by WebMD Health Services, on More than Meets the ROI: The Value of Investing in a Healthy Workforce.   Today’s forward thinking companies are moving towards a culture of health and changing the conversation about employee wellness from a ‘benefit’ to instead looking at health as a business imperative that’s integrated across all aspects of the organization.

Robin shares some perspective on general health of the workforce and somewhat surprisingly, the younger generations are not necessarily healthier:

	Baby Boomers (1946-1964)	Generation X (1965 -1978)	Millennials (1979-1996)
Tobacco Use	18%	21.1%	26.5%
Obesity	33.3%	32.8%	30.9%
Depression	16%	16%	20%
Debt	$29,317	$30,039	$23,332

Robin tells us that wellness is evolving to an all encompassing, total wellbeing approach: “Wellbeing means having the appropriate resources, opportunities and commitment needed to achieve optimal function, health and performance for the individual and the organization.” Total wellbeing interconnects:

• Emotional – attitudes and everyday living

• Physical – energy to complete daily living tasks

• Financial – confidently manage everyday and future finances

• Social – connections to others

Robin cited recent study findings of the impact of total wellbeing:

• 81% less like to seek out new employer in next year

• 41% less work missed because of poor health

• 69% of consumers say wellbeing programs health them get or stay healthy

• 22% more profitable as organizations

• 10% higher customer ratings

• ½ point higher performance rating by supervisor

From the new Aon Hewitt 2016 Financial Mindset Study, Robin identifies employee needs by financial stage as:

• Security: 30%

• Foundation: 25%

• Growth: 36%

• Freedom: 9%

It’s Complicated – Navigating Health Care Integrated Delivery Networks

By Claire Thayer, October 7, 2016

Integrated delivery networks (IDNs) are vast and complex. In the U.S. alone, there are more the 626 IDNs operating at 44,000 sites, employing over 412,000 health care providers.  Some IDNs are groups of hospitals, some are regional, some have facilities scattered throughout the country and even internationally – think Kaiser Permanente and the Mayo Clinic – both long standing traditional IDNs. More and more health systems are taking on risk management for their patient populations and in doing so, are looking for ways to collaborate with health plans and providers and related entities to align efficiencies in overall patient care management.  In the not to distant future, expect to see most provider organizations involved at some level with an IDN. 

Navigating IDNs and understanding the scope of their reach is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

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.

What Health Plans Should Know About Marketing Costs

By Claire Thayer, September 29, 2016

Getting your message in front of the right audience sounds easy enough, but can be quite complicated for health plans during open enrollment season as well as throughout the year for member outreach.  A recent study of administrative expenses for Blue Cross Blue Shield finds that the 26.5% of total PMPM expenses is attributed directly to sales and marketing activities.  Being judicious and figuring out best practices for member engagement, when to contact members, identifying the healthcare CEO of the household, what language members speak at home, etc. requires marketing tools with intelligence capabilities to optimize campaign initiatives.

Helping health plans to keep their marketing costs down is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

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.

Workplace family monthly health premiums rise to $1,512; deductibles up 12% in 2016

By Claire Thayer, September 15, 2016

In 2016, employer-sponsored health insurance covered half of the non-elderly population.  For the 18th year in a row,  the Kaiser Family Foundation & Health Research & Educational Trust (HRET) published findings from its annual survey of employers reflecting trends of employer sponsored health benefits on premiums, employee cost-sharing, wellness programs and employer opinions in the 2016 Employer Health Benefits Survey.  Here are a few highlights:

• The average premium for single coverage in 2016 is $536 per month, or $6,435 per year.
• The average premium for family coverage is $1,512 per month or $18,142 per year
• The $18,142 average family premium in 2016 is 20% higher than the average family premium in 2011 and 58% higher than the average family premium in 2006
• Among those with a general annual deductible for family coverage, the percentages of covered workers with an average aggregate general annual deductible are 61% for workers in HMOs, 64% for workers in PPOs, and 77% for workers in POS plans
• The share of covered workers in plans with a general annual deductible has increased significantly over time: from 55% in 2006, to 74% in 2011, to 83% in 2016, as have the average deductible amounts for covered workers in plans with deductibles: from $584 in 2006, to $991 in 2011, to $1,478 in 2016
• Eighty-three percent of firms offering health benefits in 2016 offer only one type of health plan. Large firms are more likely to offer more than one plan type than small firms (53% vs. 16%)
• Enrollment remains highest in PPO plans, covering just under half of covered workers, followed by HDHP/SOs, HMO plans, POS plans, and conventional plans.
• Forty-eight percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (15%), POS plans (9%), and conventional plans (< 1%)
• Nearly all (more than 99%) covered workers work at a firm that provides prescription drug coverage in their largest health plan.
• Sixty-one percent of covered workers are in a self-funded health plan.
• Twenty-four percent of large firms (200 or more workers) that offer health benefits to their employees offer retiree coverage in 2016, similar to recent years.
• Among large firms that have a health risk assessment, 54% offer an incentive to employees to complete the assessment

Says KFF President and CEO Drew Altman, “We’re seeing premiums rising at historically slow rates, which helps workers and employers alike, but it’s made possible in part by the more rapid rise in the deductibles workers must pay.”

 

More info:

• Summary of findings is here
• Entire report with over 200 exhibits in 14 different sections is here
• News release is here
• Health Affairs article is here

High Drug Prices, Complexity of Drug Development and What the Market Will Bear

By Claire Thayer, August 30, 2016

The escalating cost of prescription drugs is of concern for all of us and impact stakeholders all across the health continuum: patients, payers, providers, as well as policy makers.   A recent Consumer Reports study, Is There a Cure for High Drug Prices?, offers these 5 reasons drug costs are ballooning:

• Reason #1: Drug Companies Can Charge Whatever Price They Want
• Reason #2: Insurance Companies Are Also Charging You More
• Reason #3: Old Drugs Are Reformulated as Costly ‘New’ Drugs
• Reason #4: Generic Drug Shortages Can Trigger Massive Price Increases
• Reason #5: Specialty Drugs Are Costing All of Us

This week, the Journal of the American Medical Association (JAMA) released an in-depth article, The High Cost of Prescription Drugs in the United States, which explores literature from January 2005 to July 2016 for sources of drug prices in the U.S., justification and consequences of high prices and possible solutions.  The authors conclude that “high drug prices are the result of the increasing cost and complexity of drug development but also arise in large part from the approach the United States has taken to the granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a level not observed in other industrialized nations.”

Among overall study findings:

• In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations.
• In the United States, prescription medications now comprise an estimated 17% of overall personal health care services.
• The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents.
• The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies.
• The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products.
• Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs.
• Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.

Health Benefit Costs for Large Employers – Up 6% again in 2017

By Claire Thayer, August 12, 2016

This week, the National Business Group on Health released their Large Employers’ 2017 Health Plan Design Survey, with the ‘good’ news that the overall health benefit costs were only expected to increase 6%.  Says Brian Marcotte, president and CEO of the National Business Group on Health, “interestingly, current estimates have health insurance premiums for the average public exchange plan increasing by at least 10%, about twice what large employers are projecting for next year. This is a clear indication that the employer-based health care model continues to be the most effective way to provide health insurance coverage to employees and their families.”

Spending on pharmaceuticals and specialty drugs are contributing factors in the overall growth of health care benefit costs.  The survey reports that overall, 80% of employers placed specialty pharmacy as one of the top three highest cost drivers, followed by high cost claimants (73%) and specific diseases and conditions (61%).

The survey offers highlights of what employees will see during their upcoming open enrollment:

• Telehealth services on the rise: Nine in 10 employers (90%) will make telehealth services available to employees in states where it is allowed next year, a sharp increase from 70% this year.
• Consumer-Directed Health Plans (CDHPs) increase slightly: Overall, 84% of employers will offer a CDHP in 2017, up from 83% this year. In addition, more than one-third of employers (35%) will only offer CDHPs to employees in 2017, a slight increase from 33% this year.
• Spousal surcharges leveling off: One in three employers (33%) will have surcharges in place for spouses who can obtain coverage through their own employer, roughly the same as this year. A few employers will exclude spouses when other coverage is available through an employer.
• Expanded options at Centers of Excellence grow. The use of Centers of Excellence will grow from 79% this year to 85% in 2017. The largest increases will be for bariatric surgery (up 15 percentage points), transplants and fertility treatments, both up 8 percentage points.
• Tools to manage care: Eight in 10 respondents (80%) plan to offer nurse coaching for care and condition management while 72% will offer nurse coaching for lifestyle management. Nearly two-thirds (65%) will provide employees with self-service decision-making tools to help them become better health care consumers.

Connecting individuals to complex health care fraud schemes

By Claire Thayer, July 25, 2016

The U.S. Department of Justice has been busy in tracking down and convicting criminals in health care fraud related crimes.  This week, the U.S. Department of Justice announced its largest criminal healthcare fraud case against individuals in $1billion Medicare fraud scheme. This follows U.S. Department of Justice news on June 22, 2016, of an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings.  In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act.  This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount. 

An OIG report published earlier this year found that in FY 2015, FBI efforts resulted in over 625 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 144 health care fraud enterprises.  These and other findings are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

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.

Cost of a data breach in health care reaches $355

By Claire Thayer, July 19, 2016

The Ponemon Institute released a few new reports this summer on the cost of data breaches as well as ability of companies to adequately mitigate online incidents and cyber attacks. While the reports cross all major industries, noted below are a couple of important highlights pertaining to healthcare.

In terms of analyzing external threats that arise outside the company’s traditional security perimeter, and use of online channels – email, social media, mobile apps, or domains, as primary attack vehicles, a July 2016 Ponemon Institute report finds that only 29 percent of respondents in health and pharma believe they indeed have the necessary tools and resources to mitigate external threats:

In addition to concerns on how best to mitigate external threats, the Ponemon Institute’s  2016 Cost of a Data Breach Study finds that the average global cost of a data breach per lost or stolen record reached $355 for healthcare, compared to $158 for all industries. 

The complete Ponemon Institute 2016 Global Cost of a Data Breach Study includes:

• The average costs and consequences related to experiencing a data breach incident.
• Seven global mega trends in the cost of data breach research.
• The most common factors that influence and can limit the cost of a breach.

Factors attributed to medication non-adherence

By Claire Thayer, July 12, 2016

Medication non-adherence has a huge impact on overall public health. Isolating factors attributed to nonadherence presents opportunities for providers and pharma organizations to not only step up to improve patient health outcomes, but also eliminate wasted medications. An Express Scripts study on this topic found that 69% of medication nonadherence is due to behavioral issues, for a variety of reasons such as forgetfulness or procrastination, 16% of nonadherence was due to cost, and 15% say that medication side effects contributed to non-adherent behaviors.

These and other findings are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

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.

Insurance spending on behavioral health: Up for Mental Health / Down for Substance Use

By Claire Thayer, June 7, 2016

The June 2016 issue of Health Affairs takes a deep dive into behavioral health from several different vantage points, including public and private health spending, veteran’s mental health service use, quality measurement, mental illness and gun violence, drug monitoring, suicide prevention, along with trends in media coverage.

Here are a few highlights of several of the articles in the June 2016 issue:

On the health spending spectrum, a long-term longitudinal Health Affairs study finds a increase in the total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014. While the share of spending for substance use disorder treatment financed by private insurance, Medicare, and Medicaid showed almost no increase, was 45 percent in 1986 and 46 percent in 2014.

Another article in the June 2016 issue examines gun violence, gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence.

State prescription drug monitoring programs were reviewed based on findings from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings. In this study overview, researchers found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids.

Blue Shield of California Releases Executive Pay Report

By Claire Thayer, May 31, 2016

This week, Blue Shield of California released its first report on executive pay, thanks in part to a state audit that raised questions on the amount of executive pay and large cash reserves, along with mounting public pressure to be more transparent on executive compensation.  It pays to meet incentive plan goals - the CEO’s compensation jumped 40% in less than two years in doing so. 

The report includes components of the executive compensation program –including base salary and incentives tied to short and long term goals. Compensation paid to their top ten executives is listed, details on the CEO's individual pay package, along with comparison of how their exec pay ranks compared to their peers (Centene, Aetna, United, Anthem, Humana and Kaiser).

For further reading:

Blue Shield of California 2015 Executive Compensation Summary [May 2016]

Blue Shield ‘Lifts The Veil’ On Executive Pay [Kaiser Health News, May 26, 2016]

Blue Shield reveals executive compensation [BenefitsPro, May 27, 2016]

How are health plans meeting behavioral health needs of members?

By Claire Thayer, May 23, 2016

There’s been a lot of awareness about mental health lately, especially during the month of May – officially recognized as Mental Health Month, via Mental Health America .  In the spirit of this awareness, AHIP recently released a new 28-page issue brief on behavioral health benefits and mental health coverage from collective case studies of 11 member health plans. This new issue brief, Ensuring Access to Quality Behavioral Health Care: Health Plan Examples, identifies innovative approaches to these key areas:

• Awareness and Education
• Identification and Outreach
• Timely access to care
• Quality measurement
• Evidence-based clinical criteria
• Care Coordination and integration
• Programs targeting opioid use

Health Plans profiled in the report include:

• Anthem
• Beacon Health Options
• Blue Shield of California
• CareFirst
• Cigna
• Health Care Service Corporation
• Health Partners
• Highmark
• Humana
• Kaiser Permanente
• Wellcare

To read this complete Issue Brief: Ensuring Access to Quality Behavioral Health Care: Health Plan Examples