State Employee Benefit Plans Provide Insight Into Overall Group Benefit Trends

By Clive Riddle, July 20, 2017 The Summer 2017 edition of Data, Segal Consulting’s publication providing research findings on public sector employee benefits, presents findings from their 2017 State Employee Health Benefits Study. As states are one of the largest employers, and their benefit decision making is directly impacted by policy makers, monitoring the pulse of state employee benefit plans provides insight into benefit trends for group coverage as a whole. Andrew Sherman, Segal’s National Director of Public Sector Consulting, tells us “health benefits have become more important to state leaders as the cost of coverage outpaces overall inflation, placing budget pressure on health plan funding and underscoring the need for ongoing cost-management efforts. Examining what other states offer can be helpful for these leaders when they make difficult decisions about potential changes in coverage.” The 23-page issue exclusively presents their study which involved a review of the websites for all 50 states and the District of Columbia in the fourth quarter of 2016, capturing medical, prescription drug, vision and dental plan information, as well as wellness and tobacco-cessation programs, including 105 PPOs/POS plans, 83 HDHPs/CDHPs, 149 HMOs/EPOs and five indemnity plans. One insight from the study was “there are stark geographic discrepancies to where it is offered. According to the study, 13 Southern States offer HDHP/CDHPs, compared to just two in the Northeast. They are offered in eight states in the Midwest and seven in the West.” This equates to 22% of the states in the Northeast, 76% in the South, 67% in the Midwest and 54% in the West offering consumer driven plans. Single premium increases averaged 8% for HMO/EPO plans, 10% for PPO/POS plans and 14% for HDHP/CDHP plans. The average single monthly premium was $780 for HMO/EPO plans, $713 for PPO/POS plans and $563 for HDHP/CDHP plans. Single deductibles averaged $194 for HMO/EPO plans, $483 for PPO/POS plans and $1,997 for HDHP/CDHP plans. For the prescription benefit, single copayments averaged $9 for generic, $29 for brand formulary, $53 for brand non-formulary, and $101 for specialty drugs.

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

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: Millions More Uninsured Could Impact Health Of Those With Insurance, Too Much has been written lately about how individuals’ health could suffer if they lose insurance under the health proposals circulating in the U.S. House and Senate. But there is another consequence: creating millions more people without insurance could also adversely affect the health of people who remain insured. Kaiser Health News. Friday, July 14, 2017 Senate Republicans Unveil New Health Bill, but Divisions Remain Senate Republican leaders on Thursday unveiled a fresh proposal to repeal and replace the Affordable Care Act, revising their bill to help hold down insurance costs for consumers while allowing insurers to sell new low-cost, stripped down policies. The New York Times Friday, July 14, 2017 U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud Hundreds of people nationwide, including dozens of doctors, have been charged in health care fraud prosecutions, accused of collectively defrauding the government of $1.3 billion, the Justice Department said on Thursday. The New York Times Thursday, July 13, 2017 Nursing Homes Move Into The Insurance Business Around the country, a handful of nursing home companies have begun selling their own private Medicare insurance policies, pledging close coordination and promising to give clinicians more authority to decide what treatments they will cover for each patient. Kaiser Health News. Thursday, July 13, 2017 Fewer exchange plans available in 2018, CMS says The Centers for Medicare and Medicaid Services has released what it calls further proof the Affordable Care Act is failing in data showing a 38 percent decrease in the number of health plans available in the individual market for the upcoming open enrollment period compared to this year. Healthcare Finance News. Monday, July 10, 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.

Medicaid Patient Satisfaction: High Despite Naysayers and Longer Wait Times

By Clive Riddle, July 13, 2017 The July 10 , 2017 Research Letter published in JAMA, A National Survey of Medicaid Beneficiaries’ Expenses and Satisfaction With Health Care, and authored by researchers at the Harvard T.H. Chan School of Public Health frames the issue like this”: “some policymakers have argued that Medicaid is a broken program that provides enrollees with inadequate access to physicians. While numerous studies demonstrate that Medicaid increases access to care, the literature has less frequently focused on patient satisfaction among Medicaid enrollees themselves. We analyzed a newly released government survey examining Medicaid beneficiaries’ experiences in the program.” Co-author Michael Barnett, assistant professor of health policy and management at Harvard Chan School, tells us “the debate on the future of Medicaid has largely marginalized a crucial voice: the perspective of enrollees. Our findings confirm that Medicaid programs are fulfilling their mission to provide access to necessary medical care.” The authors used the Medicaid Consumer Assessment of Healthcare Providers and System (CAHPS) survey administered by CMS. Here’s their summary of results: “Medicaid enrollees gave their overall health care an average rating of 7.9 on a 0 to 10 scale. Forty-six percent gave their Medicaid coverage a score of 9 or 10, while only 7.6% gave scores under 5. Ratings were similar in Medicaid expansion and nonexpansion states (7.8 vs 7.9; P = .54). Ratings were slightly higher for older adults and dual-eligible beneficiaries, but similar in the fee-for-service and managed-care groups. Overall, ratings ranged from 7.6 to 8.3 across all demographic groups.” Access was also addressed:  physician access, 84% of enrollees reported that they had been able to get all the care that they or their physician believed was necessary in the past 6 months, and 83% reported having a usual source of care. The mean percentage of beneficiaries able to get all needed care was significantly higher in Medicaid expansion states than in nonexpansion states (85.2% vs 81.5%; P < .001). Overall, only 3% of enrollees reported not being able to get care because of waiting times or physicians not accepting their insurance. Two percent reported lacking a usual source of care because 'no doctors take my insurance.' This level of patient satisfaction comes despite a study published in the May 2017 Health Affairs: Outpatient Office Wait Times And Quality Of Care For Medicaid Patients which found Medicaid patients were 20 percent more likely than others to wait 20 minutes or longer, with the median Medicaid wait time for Medicaid patients 4.6 minutes past their scheduled appointment time, compared to 4,1 minutes for the privately insured. 18 percent of visits for Medicaid patients has a wait time of more than 20 minutes, compared to 16.3 percent for privately insured patients. The concern stated with the study is the wait time would impact the Medicaid satisfaction rates measured in the CMS Consumer Assessment of Healthcare Providers and System (CAHPS). Yet the new survey findings would indicate otherwise. Medicaid satisfaction rates were also measured last summer, under a survey commissioned by AHIP, which found: ·         87 percent were satisfied with their Medicaid coverage and benefits ·         Medicaid managed care plan member had higher satisfaction with their benefits (85 percent) in comparison to those enrolled in traditional Medicaid fee-for-service programs (81 percent); ·         9 percent) said they are dissatisfied with their coverage; and ·         83 percent were highly satisfied with their level of access to doctors when needed.

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

by Claire Thayer, July 7, 2017

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:

GOP leader says he'll rework health bill, but offers Plan B

Senate Majority Leader Mitch McConnell says he plans to produce a fresh bill in about a week scuttling and replacing much of President Barack Obama's health care law. But he's also acknowledging a Plan B if that effort continues to flounder.

AP News

Friday, July 7, 2017

States Move To Tighten Medicaid Enrollment, Even Without A New Health Law

No corner of the health care system would be harder hit than Medicaid, the federal-state health insurance program for the poor, if Republican leaders in Congress round up the votes to repeal major portions of the Affordable Care Act.

NPR News

Thursday, July 6, 2017

CMS won't delay controversial managed care requirements

The CMS is moving forward with controversial provisions from the mega managed-care rule that expands federal oversight over Medicaid programs after refusing several states' requests to delay implementation.

Modern Healthcare

Thursday, July 6, 2017

Should GOP Health Bill Prevail, Say Bye-Bye To Insurance Rebates

If Senate GOP leaders have their way, the check may not be in the mail. Many consumers collected unexpected rebates after the Affordable Care Act became law, possibly with a note explaining why: Their insurer spent more of their revenue from premiums on administration and profits than the law allowed, so it was payback time.

Kaiser Health News

Wednesday, July 5, 2017

What Tax Breaks? Those Promised In GOP Plans Go Mostly To Top 1%

There’s much talk on Capitol Hill about the tax cuts included in the Republican health plans, but unless you are a frequent user of tanning beds or have personal wealth that puts you in the top 1 percent, you might not feel much effect from them.

Kaiser Health News

Wednesday, July 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.

Healthcare 2017 Viewed Through Brokers’ Lens

by Clive Riddle, July 7, 2017

With the onset of the ACA at the start of this decade, if one asked how brokers would view the world of healthcare seven years later, some would have answered “who cares – they will become irrelevant.” But flash forward to 2017 and here they are, continuing to play the role they have always played, even though the landscape has certainly shifted. Despite disintermediation, public exchanges, technology and a host of other challenges, brokers remain at bat, swinging away.

BenefitsPRO has just released they annual broker survey, with responses from 350 brokers representing the spectrum of industry sectors. One might have thought brokers of all people, would firmly be in the camp of ACA repeal, 50% “would like to see the ACA retained and repaired, while 28 percent prefer a gradual repeal and replace, and 22 percent want it repealed and replaced immediately.”

One insight is that brokers business has evolved so that the public exchange market isn’t a material part of their business. When asked, “how have state exchanges’ struggles impacted your business,” 48% said there was no effect, 35% replied it hurt a little or significantly, and 17% said it helped a little or significantly.” The individual market has gravitated away from brokers, with 34% not involved, 37% reporting minimal demand, and less than ten percent stating “enrolling individuals on the public exchange is worth the effort.” Private exchanges aren’t a dominant force at this point, as “nearly 6 in 10 of those responding say they do not have a private exchange partner for enrollment and benefits administration.”

While technology has facilitated some disintermediation, brokers continue to attempt to enhance their value offering a personal touch that online tools can’t offer. The survey report noted that 53 “percent of respondents say meeting in a group setting at the worksite is the primary enrollment technique, while 36 percent cited one-on-one meetings in the workplace. However, 39 percent say their top method is using an electronic enrollment tool independently.”

But losses of individual and other health insurance market share have been offset by growth in the voluntary benefit sector, with 57% identifying with the statement that “they will use voluntary benefits to offset anticipated commission losses from health insurance this year.”

Looking toward the future, consolidation looms large, just as in all other healthcare sectors, as “27% expect their organization to acquire or merge with another broker/agent organization,” while 14% “ look for another broker/agent to acquire their organization” and “14% also say their company will leave the health insurance brokerage business.”

Brokers focus for the future includes 84% “promoting ancillary insurance coverage,” 58% “promoting health plan consumer engagement and health and wellness programs,” 43% “promoting third-party consumer engagement and health and wellness programs, while 53% will be concerned about the threat of “the new wave of disruptive companies entering the industry.” A particular innovation they are concerned with is payroll companies with direct benefits distribution, with 57% viewing this a concerning.

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:

Trump further disrupts Obamacare repeal efforts

Just three days after running a widely praised meeting among GOP senators devoted to repealing Obamacare, President Donald Trump threw Senate Majority Leader Mitch McConnell's already ailing bill into further chaos Friday.

Politico. Friday, June 30, 2017

Men Wrote The Senate Health Care Bill. This Woman Could Stop It.

As Majority Leader Mitch McConnell (R-Ky.) tries to negotiate his way to a health bill that can win at least 50 Republican votes, there is one woman in the Senate who could stop the bill cold. She isn’t even a senator. Elizabeth MacDonough is the Senate’s parliamentarian, the first woman to hold that post, which involves advising senators on the chamber’s byzantine rules and procedures.

Kaiser Health News. Friday, June 30, 2017

Just 17 Percent Of Americans Approve Of Republican Senate Health Care Bill

Americans broadly disapprove of the Senate GOP's health care bill, and they're unhappy with how Republicans are handling the efforts to repeal and replace the Affordable Care Act, according to a new NPR/PBS NewsHour/Marist poll.

NPR. Wednesday, June 28, 2017

From Birth To Death, Medicaid Affects The Lives Of Millions

Medicaid is the government health care program for the poor. That's the shorthand explanation. But Medicaid is so much more than that — which is why it has become the focal point of the battle in Washington to repeal and replace the Affordable Care Act, also known as Obamacare. NPR. Tuesday, June 27, 2017

Tuesday, June 27, 2017

Senate And House Take Different Plans To Scrap Individual Mandate

The Affordable Care Act’s tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, called the individual mandate, plays a vital function: nudging healthy people into the insurance markets where their premiums help pay for the cost of care for the sick. Kaiser Health News. Monday, June 26, 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. 

Top Challenges Facing Healthcare Executives

By Claire Thayer, June 29, 2017

Complying with government requirements and mandates continues to be one of the top challenges healthcare executives face along with health insurance affordability. Healthcare providers rank quality and patient safety outcomes, electronic health records,  privacy and cybersecurity as top priorities for their organizations.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, offers highlights of these and other pressing concerns for healthcare executives today:

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 Goes to the Mall

by Kim Bellard, June 29, 2017 It's either auspicious or ironic: decades after other retail industries, health care is coming to the mall. These are not, generally, good days for the malls.  We've all seen strip malls that were never finished or that have simply fallen on hard times, but in recent years those stalwarts of American shopping -- enclosed malls -- are sharing that fate.  Credit Suisse says that 20-25% of the 1,100 U.S. malls will close over the next five years. The Wall Street Journal predicts that "the mall of the future will have no stores."   They cite malls filling empty spaces with churches, schools, even offices or apartments.  E.g., Ford is leasing 240,000 square feet at a suburban Detroit mall for new offices. The New York Times had a similar report on the changes to malls.  As one developer told them, "Dining and entertainment is the new anchor — not Sears, not Macy’s."   One thing that many agree upon: malls of the future will include: health care. Another Wall Street Journal article focused specifically on health care moving to malls, and included several examples: ·         Dana-Farber Cancer Institute has leased 140,000 square feet of a 286,000 square foot Boston-area mall, which also has several other health and wellness tenants. ·         The Maury Regional Cancer Center has been in the Columbia Mall (Columbia, TN) since 2012. ·         The Biggs Part Mall in Lumberton NC has Southeastern Regional Medical Center as a key tenant. ·         UCLA Health operates primary care centers in the Village at Westfield Topanga. ·         Vanderbilt Health has been part of the One Hundred Oaks mall in Nashville TN since 2009. Other examples include Cedar Sinai (The Runway at Playa Vista -- LA) and Prime Healthcare (Plymouth Meeting -- Philadelphia), according to Bloomberg.   Johns Hopkins Medical President Gill Wylie told Bisnow that he watches retail vacancies for opportunities: "We do urgent care and primary care.  So I'm sitting there thinking, 'Gee if all these Staples end up closing, there might be space out there.'"  They've already snapped up four former Blockbuster locations for urgent care facilities.   Mr. Wylie said he also pays attention to big department stores and malls, citing their infrastructure, parking, and ADA compliance as givens.   Fady Barmada, of Array Advisors, led the conversion of New York City McDonald's to an urgent care center, and noted that: "Health systems know that, by co-locating themselves with well-used and well-attended retail facilities, they can increase the visibility of their facilities and become platforms for the creation of unique and interesting programs." But moving to retail locations won't, in itself, make health care organizations more patient-centered.  To do that, they'll have to make the patient experience easier (if not always enjoyable), give them clear choices, and truly treat them like valued customers. Moving is easy.  Changing is hard.   This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

A virtual tour of new studies on virtual visits

By Clive Riddle, June 23, 2017 The Advisory Board reports that “up to 77% of consumers would consider seeing a provider virtually—and 19% already have,” according to just published results from their Virtual Visits Consumer Choice Survey of 4,879 U.S. consumers, “designed to better understand the tradeoffs that consumers make when they need different types of care.” The survey found consumers “would be willing to consider a virtual visit in each of the 21 primary and specialty care scenarios tested,” with over 70% of respondents interested in “a prescription question or refill, pre-surgery and select post-operation appointments, receiving ongoing results from an oncologist, and ongoing care for chronic condition management. Select pregnancy checkups, weight loss or smoking cessation coaching, dermatology consults, and psychologist consults also ranked among top offerings.” The survey also addressed consumer telehealth concerns, with 21% citing care quality as their top concern, “followed by the provider not being able to diagnose or treat them virtually (19%), meaning they would have to go to the physical clinic anyway. Only 9% of respondents said they had no concerns about virtual visits.” The current issue of Annals of Family Medicine includes the article “Patient Perceptions of Telehealth Primary Care Video Visits, in which co-authors from the National Academic Center for Telehealth, Thomas Jefferson University conducted “in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center.” They found that “all patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical exam.“ The May 1, 2017 North Carolina Medical Journal includes the article A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes which describes a study of the “diabetes telemedicine program funded by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust was offered in 13 sites in eastern North Carolina, including federally funded Community Health Clinics. A telemedicine team offered interdisciplinary care in the primary care provider's (PCP's) office without the patient needing to travel. The interdisciplinary team included a clinical pharmacist, dietician, behavioral therapist, and physician specializing in diabetes. The PCP referred the patient to 1 or more disciplines depending on the patient's needs. The program targeted underserved rural adults with uncontrolled type 2 diabetes.” The study found that “92% of telehealth patients were ‘very satisfied’ with their care and 83% agreed that telemedicine made it easier to get care.” Referring physicians (vs direct consumer demand) may indeed be the potential driving force for telehealth, at least in rural settings. The current issue of the Journal of the American Board of Family Medicine includes the article Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services. A survey of 1,557 Family Practitioners found "15% reported using telehealth services during 2014, and that FPs using telehealth were:  26% more likely to be located in a rural setting; 40% more likely to work in a practice with <6 FPs; 22% less likely to work in a privately-owned practice; and 76% less likely to provide general primary care to patients. Of the FPs using telehealth: 22% used it 1-2 times, and and 26% using it 3-5 times; 55% used telehealth for diagnosis and/or treatment; 68% used telehealth to refer patients to specialists; and 28% used telehealth to refer patients to mental health providers. Still, a rosy future telehealth market is projected according to Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey results released this month, with health systems cited as a primary driver. They report that “seventy-six percent of U.S. hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018. Drivers for the rapid adoption growth include the desire to improve access to care, improve care coordination, increase efficiency, prevent readmissions and expand population health programs. In addition, 69 percent of organizations that currently have consumer telehealth programs are planning to expand their offerings, and 76 percent of organizations without consumer telehealth indicate it is a high strategic priority for their organizations.”

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:

The Health 202: McConnell will be a legislative wizard if health care passes

Senate Republicans have finally revealed their plan to revamp the Affordable Care Act. Now, they're just trying to pass it. There will be lots of twists and turns along the path to an anticipated vote next week -- and it's by no means assured the GOP will get there.

The Washington Post

Friday, June 23, 2017

Senate Health Care Bill Includes Deep Cuts to Medicaid

Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law’s mandate that most Americans have health insurance.

New York Times

Thursday, June 22, 2017

Who Wins, Who Loses With Senate Health Care Bill

Republicans in the Senate on Thursday unveiled their plan to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step towards achieving one of the Republican party's major goals.

NPR

Thursday, June 22, 2017

Despite A Growing Appetite, Buffet-Style Flat-Fee Clinics Shutter In Seattle

In recent years, a small but growing number of practices embraced a buffet approach to primary care, offering patients unlimited services for a modest flat fee instead of billing them a la carte for every office visit and test. But after a pioneering practice shut its doors earlier this month, some question whether “direct primary care,” as it’s called, can succeed.

Kaiser Health News

Tuesday, June 20, 2017

GOP, Dem governors call for changes in House health bill

A group of Republican and Democratic governors are echoing President Donald Trump’s criticism of a House GOP health care bill, saying it threatens coverage for the most vulnerable. Instead, they’re asking Senate leaders to work together on an overhaul of Democrat Barack Obama’s health care law.

Associated Press

Friday, June 16, 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. 

A Dozen Takeaways From PwC’s Medical Cost Trend: Behind the Numbers 2018 Report

By Clive Riddle, June 16, 2017 PwC’s Health Research Institute has released Medical Cost Trend: Behind the Numbers 2018, their twelfth annual report projecting the growth of private sector medical costs in the coming year and identifying the leading trend drivers. The findings are largely based upon PwC’s annual Health & Well-being Touchstone Survey results, which draws from responses of 780 employers from 37 industries, and have also just been released. Here’s a dozen takeaways from this year’s 32 page Behind the Numbers report, and 114 page Touchstone Survey report: 1.       PwC’s HRI projects a 6.5 percent growth rate for next year, a half percentage point increase from the estimated 2017 rate.   2.       This growth rates steadily decreased from 11.9% in 2007 to 6.5% in 2014, and has fluctuated slighly above or below that figure since then   3.       PwCs provides this definition of their projected medical cost trend: the “increase in per capita costs of medical services that affect commercial insurers and large, self-insured businesses. Insurance companies use the projection to calculate health plan premiums for the coming year.”   4.       PwC's HRI has identified three major inflators expected to impact medical cost trend in the coming year: (A) Rising general inflation impacts healthcare. As the U.S. economy heats up, a rise in general inflation during 2016 and 2017 will likely put upward pressure on wages, medical prices and overall cost trend in 2018; (B) Movement to high-deductible health plans is losing steam. The wave of growth in high-deductible health plans, employers' go-to strategy in recent years to curb health spending, may be plateauing; and  (C) Fewer branded drugs are coming off patent. Employers may have less opportunity to encourage employees to buy cost-saving generics in 2018.   5.       PwC's HRI has identified two major deflators expected to impact medical cost trend in the coming year: (A) Political and public scrutiny puts pressure on drug companies. Heightened political and public attention could encourage drug companies to moderate price increases; and (B) Employers are targeting the right people with the right treatments to minimize waste. They are doubling down on tactics such as prescription quantity limits and exploring new technologies such as artificial intelligence to match people with the best treatment.   6.       The report also cites these healthcare drivers affecting the 2018 cost trend:  Technology and treatment innovation: Provider and Plan Consolidation; Government regulation; and Evolving Payment models.   7.       The report allocated these proportions of costs by component for 2018: Pharmacy 18%; Inpatient 30%; Outpatient 19%; Physician 29%; Other 4%   8.       The Touchstone Survey cites that “Medical plan costs have continued to increase, but employers expect that the rate of increase will start to slow. Plan design changes contributed towards slightly lower-than-expected increases in 2016;” and that “the average increase in 2016 was 6.8% before plan design changes and 3.6% after plan design changes. In 2017, participants expect to see a 6.0% increase before plan design changes and a 3.2% increase after plan design changes.”   9.       The Touchstone Survey notes that “participants appear to be in a "wait and see" mode – rather than considering broader and more transformational changes, they continue to use traditional cost-shifting approaches to control health spend;” and that “57% of participants expect to continue to increase employee contributions in the next three years, while 38% (29% for Rx) plan to increase employee cost-sharing through plan design changes.”   10.   The Touchstone Survey finds that “participants are increasing contributions in the form of surcharges for spouse, domestic partner and dependent coverage. This may be contributing towards a decrease in enrolled family size and slowing the rise in net employer spend.”   11.   The Touchstone Survey also finds that “participants are utilizing High Deductible Health Plans (HDHPs) more and Preferred Provider Organizations (PPOs) less, although PPOs remain more popular among employees. PPOs are the highest-enrolled plan 44% of the time, compared to 46% in 2016 and 60% in 2009. HDHPs are the highest-enrolled plan 34% of the time, up from 32% in 2016 and 8% in 2009.”   12.   The Touchtone Survey found that employer interest in population health is strong but private exchange interest is waning. They report that “79% offer wellness programs compared to 76% in 2016, and 63% offer DM programs compared to 56% in 2016;” while  “8% of participants are considering moving their active employees to a private exchange; 2% have already done so. Interest seems to have dropped off as the discussions on public exchanges and ACA have increased. However, 36% of participants who offer retiree medical coverage are considering moving pre-65 retirees to a private or public exchange.”

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:

Senate likely to miss its Obamacare repeal deadline

Politico reports: Senate Republicans are getting dangerously close to missing their deadline to hold a Senate health care vote by month’s end, potentially derailing fulfillment of their 7-year-old campaign promise to repeal Obamacare. Friday, June 16, 2017

Cleveland Clinic jumps into insurance biz with Oscar Health

Modern Healthcare reports: While many health insurers are fleeing the individual market, health system Cleveland Clinic is jumping into the insurance business head first with the New York-based startup Oscar Health. Thursday, June 15, 2017

Price Clashes With Senators Over Path to Combat Opioid Crisis

Morning Consult reports: Health and Human Services Secretary Tom Price says combating the opioid crisis is one of his top priorities, a goal that has bipartisan support on Capitol Hill.

Thursday, June 15, 2017

Descent Into Secrecy: Senate Health Talks Speak To Steady Retreat From Transparency

Kaiser Health News reports: Congress struggling to finish a huge budget reconciliation bill. A GOP president pushing a major overhaul of federal payments for health insurance that could transform the lives of sick patients. Wednesday, June 14, 2017

With or without Washington, states are already remaking Medicaid

Politico reports: Medicaid is now the biggest health program in the country, covering more than 70 million people, or 1-in-5 Americans. Spending surpassed $545 billion in 2015. Yet Medicaid, “the other M,” is often overshadowed by Medicare. Monday, June 12, 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.

Centura Health Shares Strategies for Reducing Readmissions in Bundled Payment Arrangements

By Clive Riddle, June 9, 2017 Two experts from Centura Health, the Colorado based healthcare system shared their organization’s strategies in reducing readmissions in bundled payment arrangements for total hip and knee replacements, as part of a panel presentation in a HealthcareWebSummit event held this week on “Advanced Strategies in Appropriately Reducing Bundled Payment Arrangement Readmissions.” Centura’s Kristen Daley, Group Director – Value Based Programs, and Brenda Lewis, RN, MBA-HCM, CCM, ACM Group Manager – Care Coordination started by providing context from the literature for total hip arthroplasty (THA)  and total knee arthroplasty (TKA): ·         5.6% of THA and 3.3% of TKA require Readmission within 30 days of discharge ·         Unplanned Readmissions Costs for Medicare Patients = $17.5 Billion/Year ·         THA costs: $17,103/Readmission ·         TKA costs : $13,008/Readmission Daley and Lewis reminded us that elevated patient risk factors for these readmissions come from increased age; male gender; african american race; and medical co-morbidities including obesity, chronic pulmonary disease, bleeding disorders, cancer history, and psychiatric illness. They cited the leading complication for readmissions is infection: (12.1% of unplanned 30 day readmission) and the many other causes including: systemic: pulmonary, cardiac and circulatory; joint specific:  dislocation, fracture, malposition; hematoma, falls; failure to mobilize; increased pain and social determinants. They noted 50% of these readmissions are unrelated to the patient’s index arthroplasty. Here is Daley and Lewis’ summary of their readmissions reduction strategies: ·         Team Approach: All Providers and Caregivers Engaged, Communicating, and on the same page ·         Every Patient receives preoperative medical evaluation/optimization by Perioperative Hospitalists ·         Perioperative Hospitalists round post-op and collaborate on discharge with the Surgeon ·         Robust Care Coordination Program ·         Prepare Patients for Efficient Discharge ·         Front-Load Discharge Planning ·         Partner with Acute Case Management Team ·         Promote use of Preferred Partners ·         Extend Patient Management Post-Discharge They have undertaken the following to prepare patients for the transition from hospital to home: ·         Begin Education Preoperatively and Re-emphasize throughout Hospitalization ·         Embed Care Coordinator into Joint Education Class ·         Utilize LACE Tool to Assist to Identify Risk of Readmission (The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge) ·         Provide Detailed Discharge Instructions ·         Educate patients on Wound Care, DVT Signs ·         Help patients with understanding Pain Management ·         Emphasize importance of Post-op Rapid Mobilization and Physical Therapy

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:

Democrats home in on opioid crisis in bashing proposed Medicaid cuts

Health and Human Services Secretary Tom Price defended the White House’s proposed cuts to Medicaid in its 2018 budget blueprint before a pair of congressional committees on Thursday, parrying blows from Democrats furious over spending reductions they say President Trump pledged on the campaign trail never to approve. StatNews. June 8, 2017

If Insurance Market Crashes, Can Lawmakers Put The Pieces Back Together?

In his high-stakes strategy to overhaul the federal health law, President Donald Trump is threatening to upend the individual health insurance market with several key policies. But if the market actually breaks, could anyone put it back together again?

Kaiser Health News. June 8, 2017

Anthem Will Exit Health Insurance Exchange in Ohio

Anthem, one of the nation’s largest insurers and a major player in the individual insurance market created by the federal health care law, announced Tuesday that it would stop offering policies in the Ohio marketplace next year. NYTimes. June 6, 2017

Feds To Waive Penalties For Some Who Signed Up Late For Medicare

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the health law’s marketplaces. That decision can leave them facing a lifetime of enrollment penalties. Kaiser Health News. June 6, 2017

VA to adopt new electronic health records system in bid to improve care

Veterans Affairs Secretary David Shulkin said Monday the department will be overhauling its electronic health records, adopting a commercial product used by the Pentagon that he hopes will improve care for veterans and reduce wait times for medical appointments.

Stat News.  June 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. 

In your member enrollment process leaving you exposed?

By Claire Thayer, June 2, 2017

In September last year, the Government Accounting Office released a new study on findings from its undercover enrollment eligibility testing of federal and selected state marketplaces. As part of the study, GAO submitted 15 fake applications for subsidized coverage through the federal Marketplace in Virginia and West Virginia and through the state marketplace in California. GAO’s applications tested verifications related to (1) applicants’ making required income-tax filings, and (2) applicants’ identity or citizenship/immigration status. Through this extensive under cover testing process, GAO found that eligibility determination and enrollment processes continue to remain vulnerable to fraud.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, highlights some of findings presented in the GAO report: 

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

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:

The Fate of 16.8 Million Medicaid Enrollees Rests On 20 GOP Senators From 14 States

The Senate is on the verge of debating legislation to repeal and “replace” the Affordable Care Act, and Medicaid is on the chopping block. Huffington Post, June 2, 2017

Trump Rule Could Deny Birth Control Coverage to Hundreds of Thousands of Women

The Trump administration has drafted a sweeping revision of the government’s contraception coverage mandate that could deny birth control benefits to hundreds of thousands of women who now receive them at no cost under the Affordable Care Act. The New York Times, June 1, 2017

Ohio Sues 5 Major Drug Companies For 'Fueling Opioid Epidemic'

The state of Ohio has sued five major drug manufacturers for their role in the opioid epidemic. In the lawsuit filed Wednesday, state Attorney General Mike DeWine alleges these five companies "helped unleash a health care crisis that has had far-reaching financial, social, and deadly consequences in the State of Ohio." NPR, May 31, 2017

How plan for California gov't health care might be funded

A pending state Senate bill would provide government-funded universal health care for California's 39 million residents. The bill faces a Friday deadline for passage out of the Senate if it is to be considered by the state Assembly. ABC News, May 31, 2017

Drug Rebates Reward Industry Players — And Often Hurt Patients

Medicare and its beneficiaries aren’t the winners in the behind-the-scenes rebate game played by drugmakers, health insurers and pharmacy benefit managers, according to a paper published Tuesday in JAMA Internal Medicine. Kaiser Health News, May 30, 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. 

Nine Things to Know About J.D. Powers 2017 Member Health Plan Study Results

By Clive Riddle, June 2, 2017

J.D. Powers has just released their 2017 Member Health Plan Study Results. J.D. Powers tells us this 11^th annual study “measures satisfaction among members of 168 health plans in 22 regions throughout the United States by examining six key factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service. The study also touches on several other key aspects of the experience including plan enrollment and member engagement.” The study is based on responses from 33,624 commercial health plan members and was fielded in January-March 2017.

The study assigns scores to each plan based on the above criteria based upon a possible 1,000 point scale. Here are nine things to know about their findings:

 1.     J.D. Powers found that “Integrated delivery systems dominate rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—outperform traditional health plans on every factor measured in the study.”

 2.       Even though narrow networks have often been presented negatively in the media, the study found otherwise: “Regardless of product choice, members who were presented with lower-cost narrow network options were significantly more satisfied with their health plan versus those who were not offered such an option or did not know whether it was offered. However, just 33% of respondents say they were offered a narrow network option.”

 3.       J.D. Powers found that “the effect of payer-provider alliances is mixed: Aetna, Cigna, Anthem, and many other providers have begun to offer commercial products in collaboration with specific providers in the past few years.”

 4.       Satisfaction is highest among health plan members in the five regions: Maryland (723); East South Central (722); California (716); Michigan (716); and Ohio (714).

 5.       Satisfaction is lowest among members in the Colorado (676) and Northeast (682) regions.

 6.       The highest score achieved by any major plan was 794 (Kaiser in Maryland.)

 7.       Kaiser by far had the most regional top scores for major health plans with six: (California, Colorado, Maryland, Northwest, South Atlantic, Virginia)

 8.       The lowest score achieved by any major plan was a tie between Coventry (Aetna) in the Heartland region, and Blue Cross Blue Shield Montana in the Mountain region, both with 653. Given the regional average in the Mountain region (706) was higher than in the Heartland (693), the tiebreaker for Bottom performer would go to BCBS Montana.

 9.       UnitedHealthcare and subsidiaries by far had the most bottom regional bottom scores for major health plans with thirteen:  (Colorado, Delaware/WV/DC, East South Central, Florida, Maryland, Michigan, New Jersey, New York, Northwest, Ohio, Pennsylvania, Southwest, Virginia)

Here are the top and bottom performers of major health plans for each of J.D. Powers 22 defined regions with their respective scores, along with the average score for the region:

California

Top: Kaiser 780

Average: 716

Bottom: Aetna 683

Colorado

Top: Kaiser 725

Average: 676

Bottom: United 661

Delaware/WV/DC

Top: Highmark 712

Average: 691

Bottom: United 666

East South Central (AL, KY, LA, MS, TN)

Top: BCBS Tennessee 735

Average: 722

Bottom: United 684

Florida

Top: AvMed 733

Average: 702

Bottom: United 694

Heartland (AR, IA, KS, MO, NE, OK)

Top: Wellmark BCBS Iowa 723

Average: 693

Bottom: Coventry (Aetna) 653

Illinois-Indiana

Top: Health Alliance Medical Plans 723

Average: 708

Bottom: Coventry (Aetna) 666

Maryland

Top: Kaiser 794

Average: 723

Bottom: United 693

Massachusetts

Top: BCBSMass 707

Average: 703

Bottom: Cigna 664

Michigan

Top: Health Alliance Plan of Michigan 750

Average: 716

Bottom: United 672

Minnesota-Wisconsin

Top: Unity Health Plans 737

Average: 695

Bottom: Cigna 679

Mountain (ID, MT, UT, WY)

Top: SelectHealth 727

Average: 706

Bottom: BCBS Montana 653

New Jersey

Top: Horizon BCBS 712

Average: 705

Bottom: United 693

New York

Top: Capital District Physicians Health Plan 755

Average: 702

Bottom: Oxford (United) 658

Northeast (CT, ME, NH, RI, VT)

Top: BCBS Vermont 725

Average: 682

Bottom: Harvard Pilgrim 666

Northwest (OR, WA)

Top: Kaiser 751

Average: 697

Bottom: United 644

Ohio

Top: Medical Mutual of Ohio 720

Average: 714

Bottom: United 695

Pennsylvania

Top: UPMC 739

Average: 702

Bottom: United 672

South Atlantic (GA, NC, SC)

Top: Kaiser 791

Average: 707

Bottom: Aetna 696

Southwest (AZ, NV, NM)

Top: BCBS AZ 704

Average: 693

Bottom: Health Plan of NV (United) 661

Texas

Top: NA

Average: 710

Bottom: Aetna 686

Virginia

Top: Kaiser 769

Average: 702

Bottom: United 699

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:

Top News From the Past Week as reported from key news services, and compiled by MCOL

Patient, Doctor Groups Say New CBO Score Reveals Health Care Bill's Flaws

Health care groups that represent doctors and patients are warning members of Congress that the House Republicans' plan to overhaul the Affordable Care Act would hurt people who need insurance most. NPR. Thursday, May 25, 2017

Senate to Start Drafting Health Care Bill Despite Policy Debates

Senate staffers will start to draft legislation that would repeal and replace significant parts of the Affordable Care Act next week, GOP senators said Thursday, despite the many differences among members of the caucus over policy. Morning Consult. Thursday, May 25, 2017

10 key points from the CBO report on Obamacare repeal

Here are some key facts and figures from the new CBO report on the American Health Care Act, the House-passed bill to repeal and replace Obamacare. CBO stressed the uncertainty of its estimates, given that it's hard to know which states would take up the chance to opt out of certain key parts of Obamacare. Politico Wednesday, May 24, 2017

Tab For Single-Payer Proposal In California Could Run $400 Billion

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. Kaiser Health News Tuesday, May 23, 2017.

Trump budget: $800 billion in Medicaid cuts

Donald Trump's budget that is expected to be unveiled on Tuesday will include $800 billion in cuts to Medicaid -- a move that underscores the President's resolve to significantly downsize the federal program even as Republican lawmakers are clashing over the issue in Congress. CNN Monday, May 22, 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.

Rise of the Drones

By Kim Bellard, May 24, 2017

For those of us of a certain age, we expected to be living in a Jetsons-type world, complete with flying cars.  That hasn't happened, but it is starting to appear as though the skies may, indeed, soon be full of flying vehicles.  It's just that they may not have people in them. 

Welcome to the brave new world of drones.

Many people may have viewed drones as a toy akin to radio-controlled airplanes. We're beyond that now.  Last summer PwC asked "Are commercial drones ready for take-off?"  They thought so, estimating the total available market for drone-enabled services at $127b

This is not going to all be about getting your books, or your socks, or even your new HD television faster.  It is going to impact many industries -- including health care.

And that impact has already started to happen.

Zipline International, for example, is already delivering medical supplies by drone in Rwanda.  They deliver directly to isolated clinics despite any intervening "challenging terrain and gaps in infrastructure."  They plan to limit themselves to medical supplies, but not only in developing countries; they see rural areas in the U.S. as potential opportunities as well.  Last fall they raised $25 million in Series B funding.  

Drones are also being considered for medical supply delivery in Guyana, Haiti, and the Philippines.   

And drone delivery is already being tested in more urban areas.  The Verge reported that Swiss Post, its national postal service, is working with two hospitals in Lugano to ferry lab samples between them. 

Similarly, Johns Hopkins has been testing drone transport of blood supplies, concluding that it is "an effective, safe, and timely way to get blood products to remote accident or natural catastrophe sites, or other time-sensitive destinations."

Airbus is developing the A-180 drone specifically to deliver medical supplies, especially for emergencies.  Its cargo capsule is "capable of transporting everything from medicine and antivenin to supplemental blood and even organs." A company called Otherlab is going a different direction.  Wired reports that their drone will deliver its package -- then decompose, making it ideal for deliveries to humanitarian crises (or to battle sites, since Darpa helped fund them).  

Lest we focus too narrowly on the concept of drones delivering medical supplies, argodesign has proposed a flying ambulance, which could be operated as a drone or by a pilot.  If you've ever seen ambulances stuck in traffic and felt sorry for the patients relying on them, such ambulances could be the solution -- arriving faster and to locations regular ambulances could not reach.  

But for real impact, let's go back to Amazon.  CNBC's Christina Farr broke the news last week that Amazon was considering getting into the pharmacy business. Put rapid delivery -- especially with drones -- together with lower and more transparent prices, and it is no wonder that the stocks of CVS and Walgreens took a hit when the news broke about Amazon's new interest.

Health care has been all-too-much a story of waiting.  That's quickly changing, with telemedicine, WebMD, retail clinics, and -- soon -- 3D printing and health care robots.  We can add health care drones to the list, allowing 30-minutes-or-less kinds of promises that we haven't even begun to tease out yet.

Bring on the drones!

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

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:

House May Need to Vote Again on GOP Obamacare Repeal Bill

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority. Bloomberg News Friday, May 19, 2017

Price pushes Congress to follow Trump plan for more FDA user fees

HHS Secretary Tom Price pressed Congress to heed President Donald Trump's call to make the FDA rely more on industry fees — and less on taxpayer dollars — for product evaluations, as lawmakers continue work on extending the agency's user fee programs.

Politico. Wednesday, May 17, 2017

Hatch Says He’s Open to Keeping Obamacare’s Individual Mandate

Sen. Orrin Hatch (R-Utah) on Wednesday said he wouldn’t be opposed to delaying the repeal of the individual mandate in the Affordable Care Act, making him one of the most senior Republicans to float the idea. Morning Consult. Wednesday, May 17, 2017

UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. Kaiser Health News. Wednesday, May 17, 2017

Bipartisan bill will be reintroduced to force pharma to justify price hikes

A bipartisan group of lawmakers will re-introduce a bill on Tuesday that would require drug makers to justify their pricing and provide a breakdown of their expenses before raising prices on some medicines. StatNews. Monday, May 15, 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.