Your Seven Step Homework Guide for Studying the American Health Care Act

 By Clive Riddle, March 10, 2017

1.       Don’t sweat all the granular details yet. Who knows for certain where the political process will take this proposed Act from here?
 

2.       Watch for the CBO “score” on the Act, which will soon peg estimated cost and volume numbers to what’s being proposed. The CBO score will likely shape discussions from that point forward. The portal for CBO healthcare analysis is www.cbo.gov/topics/health-care.  Here’s two articles about the upcoming CBO score:  Obamacare replacement is hard to score, budget experts say (Washington Examiner) and Nonpartisan Scorekeeper in Hot Seat for GOP’s Obamacare Repeal (Bloomberg).
 

3.       Keep some original sources handy – including a summary from the House’s Energy and Commerce Committee and the s Ways and Means Committee. Also, here’s Paul Ryan’s press release announcing the Act. 
 

4.       Looking for a nice, quick summary of key provisions of the Act? Check out the Association of Health Care Journalists article by Unpacking some key provisions of GOP’s health care bill by Joanne Kenan. Kaiser Health News also has a succinct listing of five key points in comparison to the ACA - Five Ways the GOP Health Bill Would Reverse Course From the ACA by Julie Rovner.
 

5.       Looking for thoughtful analysis of the Act? Check out the Timothy Jost – the oft quoted in national press expert on such matters – in his Health Affairs Blog: Examining The House Republican ACA Repeal And Replace Legislation.
 

6.        Understand some key opposition points from public interest groups: AARP isn’t happy about the increased premium load older individuals would bear in the market, or about Medicare changes. The AMA and AHA don’t like the ultimate reductions in Medicaid and other coverages. Families USA says the only the Healthy and Wealthy will benefit from the bill and also take major issue with the per-capita caps in Medicaid.
 

7.       Getting too tired to read any further? Here’s six selected videos from major organizations discussing the Act.

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:

To Save On Drug Costs, Insurer Wants To Steer You To ‘Preferred’ Pharmacies

Kaiser Health News reports: One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network.

Kaiser Health News

Friday, March 10, 2017

What Hospitals Waste

ProPublica reports: Just outside Portland, Maine, there’s a 15,000-square-foot warehouse that’s packed with reasons the U.S. health care system costs so much: Shelves climb floor to ceiling, stacked with tubs overflowing with unopened packages of syringes, diabetes supplies and shiny surgical instruments that run hundreds of dollars apiece.

ProPublica

Thursday, March 9, 2017

Ryan brings out slideshow to sell GOP healthcare bill

The Hill reports: Jacket off and sleeves rolled up, Speaker Paul Ryan (R-Wis.) on Thursday ditched the podium and delivered a 25-minute TED Talk-like presentation on why the new GOP health bill represents the best, and perhaps only, chance to repeal ObamaCare.

The Hill

Thursday, March 9, 2017

Lawmakers take up Obamacare revision without an independent scorekeeper

The Washington Post reports: Two committees in the Republican-led House have begun drafting sweeping health legislation without the benefit of an objective estimate of its impact from the Congressional Budget Office (CBO) — a reckless move, critics say, considering that they are dealing with the well-being of tens of millions of Americans and an industry that accounts for close to one-fifth of the economy.

The Washington Post

Wednesday, March 8, 2017

Three Key Senators Ask GAO to Investigate Possible Abuses Of The Orphan Drug Act

Kaiser Health News reports: Building on weeks of mounting pressure to address high prescription drug prices, three influential U.S. senators have asked the government’s accountability arm to investigate potential abuses of the Orphan Drug Act.

Kaiser Health News

Tuesday, March 7, 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.

Inaccurate Provider Directories Have a Direct Impact on Patients

By Claire Thayer, March 8, 2017

Provider directories are important tool for consumer engagement with health plans and provider networks. And in many instances, the provider directory is the vehicle for the patients’ first impressions of providers and the network they represent.  The consequences of directory inaccuracies create barriers to care as well as impact patient satisfaction. And while state and regulatory agencies are imposing stiff fines for non-compliance, a new report from the California Department of Managed Care finds that most insurers still have a ways to go in this regard as many have directories that contained “data inaccuracies significant enough to render them unusable.”

A recent special edition of the MCOL Infographic, co-sponsored by LexisNexis Risk Solutions, highlights the impact of directory inaccuracies on patients:

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.

2017 Employer Health Care Strategies and Trends

By Clive Riddle, March 3, 2017

DirectPath and CEB have just released their 2017 Medical Plan Trends and Observations Report, “which analyzed more than 975 employee benefit health plans, highlights the top ten trends in employers’ 2017 health care strategies across three categories – plan design, cost savings mechanisms and care options.”

The 11-page report tells us that “employers are incorporating solutions like health savings accounts (HSAs), wellness incentives, price transparency tools and alternative care options to reduce costs.”

The ten trends they discuss include:

1.     Annual Deductibles Leveling Out

2.     Marginal Change in Prevalence of HDHPs

3.     HSAs Continue to Remain Popular

4.     Specialty Medication to Become More Expensive

5.     Contribution Surcharge Amounts Vary

6.     Wellness Incentives Continue to Increase in Prevalence and Amounts

7.     Plan Comparison Tools Lead to More Savings

8.     Alternative Care Options Remain Affordable

9.     Barriers to Employee Use of Telemedicine

10.  Focus on Higher Quality Health Care

Major findings from their surveys cited in the report include:

·         51 percent of employers offer a price transparency tool to help employees choose the service or product best for them, and 18 percent plan to add such tools in the next three years

·         In a review of price comparison requests, these services resulted in an average employee savings of $173 per procedure and average employer savings of $409 per procedure.

·         While the percentage of organizations with spousal employee contribution surcharges remained static (26 percent in 2017, as compared to 27 percent in 2016), average total surcharge amounts increased dramatically to $152 per month, a more than 40 percent increase from 2016.

·         More than a third of organizations offer telemedicine, but over 55 percent of employees in these companies are not aware of telemedicine availability, and nearly 60 percent of employees who have telemedicine programs do not feel they are easy to access, according to a separate survey recently conducted by CEB.

·         The average cost of specialty drugs that treat rare and complex conditions increased by more than 30 percent for employers surveyed.

·         67 percent of employers surveyed offer HSAs, compared to 15% offering Health Reimbursement Arrangements (HRAs). Employer contributions to HSAs increased almost 10 percent.

·         58 percent of 2017 employer plans offer some type of wellness incentives, up from 50 percent in 2016.

While we’re on the subject of wellness incentives, Humana just released their 2017 Humana Wellness Trends Report, a 20-page document that discusses five trends:

1.     The “connected experience 2.0” revolutionizing wellness strategies: “…As wellness programs begin to integrate these devices and employers gain access to the data, employers will gain insight into what’s driving organizational health costs and how to resolve them.”

2.     Older workforce leads to health, caregiving burdens: “…The U.S. workforce is getting older and retiring later due to the stress of financial burdens, caring for older loved ones and increasing health care costs.”

3.     Financial stress affects productivity: “….Americans identify money as their top stressor, which can reduce employee productivity and contribute to absenteeism, presenteeism and poor health. Research states 37 percent of full-time employees deal with financial issues while working.

4.     Poor sleep leading to errors, low morale: “…Among workers age 30 and older, 74 percent say lack of sleep affects their work performance.”

5.     Workers benefit from mindfulness techniques: “…Research has found a mindful approach may help ease the “effects of stress, anxiety and other negative emotions.”

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’s nominee to run Medicare and Medicaid advances

The Associated Press reports: President Donald Trump’s nominee to run Medicare and Medicaid won committee approval Thursday, clearing her for a final floor vote in the Senate.

AP via The Washington Post, March 2, 2017

Faring Better Than Many ACA Insurers, Molina Backs Health Law ‘Tuneup’

Kaiser Health News reports: Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a few high-profile exits from the online marketplaces. Humana is just the latest, announcing in January that it will stop offering health insurance on the ACA health exchanges at year’s end.

Kaiser Health News,  March 2, 2017

High-Risk Pools Another Sticking Point Among Republicans

Morning Consult reports: Sen. Rand Paul on Wednesday expressed opposition to House GOP leaders’ plan to cover people with pre-existing conditions, highlighting another division that Republicans must overcome to repeal the Affordable Care Act.

Morning Consult, March 1, 2017

Insurers pay twice as much as hospitals for hip and knee implants

Stat News reports: Imagine this: You go to buy a car, but you don’t know who makes it, how other customers feel it’s performing, or how its price compares to other cars in its class.

Stat New, February 28, 2017

Hospitals, Both Rural And Urban, Dread Losing Ground With Health Law Repeal

Kaiser Health News reports: More than a year ago, she lost her job at a nearby rural hospital after it closed and, as Republicans work to dismantle the Affordable Care Act, wonders whether she’ll soon be out of work again.

Kaiser Health News, February 28, 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. 

How Health Plans Impact Revenue Performance and Improve Quality Outcomes

By Claire Thayer, March 2, 2017

The Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA) are now used by over 90% of health plans to measure quality performance.  HEDIS consists of 81 measures across 5 domains of care and address a broad range of important health issues, including:     

• Asthma Medication Use
• Persistence of Beta-Blocker Treatment after a Heart Attack
• Controlling High Blood Pressure
• Comprehensive Diabetes Care
• Breast Cancer Screening
• Antidepressant Medication Management
• Childhood and Adolescent Immunization Status
• Childhood and Adult Weight/BMI Assessment

Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service.  Each year, NCQA publishes The State of Health Care Quality Report to raise awareness on key quality issues and drive improvement in the delivery of evidence-based medicine. This report documents performance trends over time, tracks variation in care and recommends quality improvements.  Additionally, HEDIS data is also incorporated into many health plan ‘report cards’ and increasingly used by consumers and purchasers to track and compare health plan performance.

This week, a special edition of the MCOL Infographic, co-sponsored by DST Health Solutions, focused on strategic trends and key elements of performance improvement for health plans: 

 

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

The Good, the Bad, and the Ugly in Health Care

By Kim Bellard, February 22, 2017

I hate being a patient.

My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family.  The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient.

I offer what I consider the Good, the Bad, and the Ugly of the experience.

The Good:  The People
The various people involved in my care, from the most highly trained physician to the person who delivered meals, were great. I loved my nurses.  I liked my doctors a lot.  The aides, the lab techs, the imaging tech, the transportation specialists -- all of them doing jobs that I wouldn't be able to do -- were each friendly and helpful, taking pride in what they did and how it helped my care. 

The Bad: The Processes
On the other hand, on the lists of criticisms about our health care system, many of its rules and processes truly do deserve a place.  They're like part of an arcane game no one really understands. 

I'll offer three examples:

• ·         Check-in
• ·         NPO
• ·         Discharge

The Ugly: The Technology

Oh, health care technology.  It is equally capable of delighting as it is of frustrating.  It is truly remarkable that the doctor could go up my arm to perform a procedure in my chest, just as the detail an MRI provides is simply astonishing.  

Let's start with the perennial whipping boy, EHRs.  On many occasions, EHRs did not mean that people did not still often have to drag in other electronic equipment or even paper in order for them to do their job.

MRIs are a wonderful technology, but as I was laying in that claustrophobic tube getting imaged, I kept thinking: what the heck are all those clanging noises?  

I was on various forms of monitoring devices, the smallest of which was the size of a 1980's cell phone and still required countless wires attached to numerous leads.  I kept wondering, hmm, have these people heard of Bluetooth?  Do they know about wearables?

My favorite example of ugly technology, though, came when I had to fill out a form, so that it could be faxed to the appropriate department.  

No health care system is perfect.  Every system has its own version of the Good, the Bad, and the Ugly. Our system can do better.  Let's give all those great people working in health care a better chance to help us.

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:

CMS nominee breezes through confirmation hearing

The Hill reports: President Trump's pick to lead the Center for Medicaid and Medicare Services (CMS) cruised through her confirmation hearing Thursday, though Democrats showed frustration at her refusal to offer specifics.

The Hill

Thursday, February 16, 2017

The IRS Has Just Made Obamacare’s Individual Mandate Optional

The Fiscal Times reports: When President Trump signed an executive order shortly after taking office designed to weaken the Affordable Care Act, some questioned whether the instructions to federal agencies to look for ways to ease the law’s burden on businesses and individuals would have any real bite.

The Fiscal Times

Wednesday, February 15, 2017

Amid Obamacare uncertainty, insurance giant Humana plans to leave marketplaces in 2018

Los Angeles Times reports: Humana Inc., one of the nation’s largest health insurers, will stop selling Obamacare health plans next year, the company announced Tuesday. The move threatens to rattle jittery insurance markets and further complicate Republicans’ push to repeal and replace the Affordable Care Act.

LA Times

Tuesday, February 14, 2017

Aetna, Humana end $34 billion merger agreement

CNBC reports: Aetna and rival Humana are terminating their merger, after their $34 billion deal was blocked by a federal court on antitrust grounds. Aetna will pay Humana a $1 billion break-up fee, in accordance with the agreement.

CNBC

Tuesday, February 14, 2017

Drugmaker Marathon ‘Pausing’ Delivery Of $89,000-A-Year Muscular Dystrophy Drug

Kaiser Health News reports: In a surprise move Monday, Marathon Pharmaceuticals told patient advocates that it would “pause” the launch of its drug Emflaza because of pricing concerns expressed by patients and advocacy groups.

Kaiser Health News

Monday, February 13, 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.

The Scourge of Healthcare Ransomware to Loom Larger in 2017

By Clive Riddle, February 17, 2017

CynergisTek has just released Redspin’s annual cybersecurity Breach Report:  2016: Protected Health Information (PHI). Their 21-page seventh annual report “provides in-depth analysis of the causes of PHI breaches reported to the Department of Health and Human Services and the overall state of cybersecurity in healthcare.”

 

The report cites that in 2016 there were:

• ·         325 large breaches of PHI, compromising 16,612,985 individual patient records
• ·         3,620,000 breached patient records in the year’s single largest incident
• ·         40 percent of large breach incidents involved unauthorized access/disclosure
• ·         over a dozen providers reported in media as having been victims of ransomware attacks with PHI breaches

The report lists the largest 2016 hacking attack on providers as affecting Banner Health with 3.62 million patient records breached, followed by 21st Century Oncology with 2.2 million records breached. Of large breaches, they state 78% involved providers, 16% health plans and 6% healthcare vendors.

The report makes particular note of “the scourge of Ransomware” and cite that in 2016 there was $1 billion overall in ransomware payments worldwide impacting all types of businesses and consumers The report cautions this will get worse in 2017, as “late last year, disturbing reports surfaced regarding the rise of ‘ransomware as a service’ (RaaS) – a business model in which malware authors enlist ‘distributors’ to launch the initial attacks (likely weaponized phishing emails) and then share in any profits. The potential accomplices do not need much technical expertise or capital to get started. Some ransomware kits cost as little as $100 dollars.”

Becker's Health IT & CIO Review featured an article: Get ready for hospital ransomware attacks 2.0 also cautions about a growing ransomware threat this year, stating "here are three tactics we've seen in the wild that are likely to become more widespread in 2017. Beyond encryption: 3 ways criminals are making their attacks more disruptive," and they go on to list and describe:

1) Developing ransomware strains that spread like a virus

2) Creating new versions of ransomware that disable the victim systems

3) Turning ransomware attacks into data breach events

The Department of Health and Human Services has weighed in, offering an eight page FACT SHEET: Ransomware and HIPAA, in which they cite “a recent U.S. Government interagency report indicates that, on average, there have been 4,000 daily ransomware attacks since early 2016 (a 300% increase over the 1,000 daily ransomware attacks reported in 2015).

The healthcare ransomware threat certainly isn't focused just on the U.S., and is a global issue. New research based on a Freedom of Information (FOI) request has revealed that 34% of NHS trusts in the UK have suffered a ransomware attack in the last 18 months.

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:

Tom Price Is Confirmed as Health Secretary

The New York Times reports: The Senate early Friday approved the nomination of Representative Tom Price to be secretary of health and human services, putting him in charge of President Trump’s efforts to dismantle the Affordable Care Act.

The New York Times

Friday, February 10, 2017

Obama’s Drug Czar: The Opioid Crisis Must Continue To Be A Federal Priority

Kaiser Health News reports: The GOP is working to repeal and replace the 2010 health law, known for insuring more than 20 million people. And the change could affect another health concern: the nation’s opioid abuse problem.

Kaiser Health News

Thursday, February 9, 2017

Judge, Citing Harm To Customers, Blocks $48 Billion Anthem-Cigna Merger

The New York Times reports: The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds. Judge Jackson wrote in her order that she found the Justice Department’s arguments against the deal persuasive, and that putting Anthem and Cigna together would harm customers.

NY Times

Thursday, February 9, 2017

How Would Republican Plans for Medicaid Block Grants Actually Work?

The New York Times reports: There are only so many ways to cut Medicaid spending. You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.

NY Times

Monday, February 6, 2017

Trump Says Health Law Replacement May Not Be Ready Until Next Year

The New York Times reports: President Trump said in an interview that aired on Sunday that a replacement health care law was not likely to be ready until either the end of this year or in 2018, a major shift from promises by both him and Republican leaders to repeal and replace the law as soon as possible.

NY Times

Sunday, February 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. 

Thinking of Starting a Medicare Advantage Plan? 2019 Starts Now

By Peter Kinhan and Dan Juberg (Lumeris), February 10, 2017

Provider Sponsored Plans and Medicare Advantage are gaining traction as a critical strategy for profitable, value-based care. However, many underestimate the necessary lead time and effort required to move from consideration to activation. Planning for a 2019 launch needs to begin now starting with a detailed market and organizational feasibility study for standing up a health plan.

In recent years, due to increasing cost pressures and competition among providers, many organizations have expressed their ambitions to develop their own health plans, often referred to as provider-sponsored plans (PSPs). Medicare Advantage (MA) is often considered the entry point of choice due to government financial incentives and strong opportunities to drive improvements in both quality and total cost of care for an increasingly aging population.

However, because of competing priorities, many executives struggle to carve out the necessary time to truly evaluate the opportunity. The time is right to look at MA—in terms of the changing political landscape and the surprisingly lengthy lead times required to assess and apply. This means for those that consider an MA plan as part of their future strategy, that process should start today.

There is no doubt the changes in presidential leadership have created political uncertainty when it comes to the healthcare industry. There are more things unknown than known. That said, rising healthcare costs are still a major problem to be solved, but value-based care (VBC) has proven to be and will continue to be a critical part of the solution.

So what could change with this new administration and how could it affect your global Medicare strategy? Let’s take note of the significant changes to Medicare that have been gaining traction in the market to date

 
• MA enrollment continues to grow rapidly. In 2016 there were 17.6 million MA members, which is an increase of more than 200 percent from the number enrolled in 2005.
 
• MACRA and other CMS programs have deployed value based payment methods that are projected to impact up to 125,000 providers in the traditional Medicare market by 2018.

These two trends demonstrate an important shift to VBC, and if one takes Paul Ryan’s “A Better Way,” as an indication of what is to come from a Republican administration, then an assumption is the shift to value-based care will continue —if not accelerate. According to “A Better Way,” Medicare’s “overhaul” would include what Ryan terms “premium support;” a plan to increase competition among providers and allow beneficiaries the freedom to choose where to spend their healthcare dollars. Sometimes called a defined contribution or voucher system, the desired effect of this approach would be to push Medicare further away from its current largely fee-for-service setup by providing increased incentives for beneficiaries to be cost-conscious in their plan selection.

This would likely drive a considerable enrollment increase in the already-growing private MA market; a space that has long been a strong component of Republican plans. As Medicare grows and seeks to control costs, providers can expect a doubling down of population health and a need for health systems to capture a larger share of the premium dollar. MA has always been a critical aspect of organizations’ population health strategy, and with the political changes, that need and opportunity has presumably only strengthened.

Many organizations have been preparing for a migration up the Medicare food chain through the creation of their own health plan. According to Avalere, providers are leveraging their large integrated delivery networks to establish plans at an increasing pace, representing 58 percent of new MA plans entering the program in 2016. Many of these organizations have been developing the necessary competencies by establishing risk-bearing Accountable Care Organizations (ACOs) or accepting delegated risk. Many are confronted with familiar dilemmas. What are the next steps as these ACO agreement periods wind to a close? If launching an MA plan is a couple years down the road, when is the right time to start the “two years from now” process?

The MA application process differs greatly from the Medicare ACO application process and it starts roughly six months earlier. This is a significant undertaking with great opportunity, and large risk. It requires an in-depth analysis and planning and the necessary time to align organizational strategy.

The Notice of Intent to Apply for a 2019 Medicare Advantage contract opens in mid-November 2017. However the real work should begin much earlier than that. A candid evaluation of whether your organization is ready to run its own health plan takes time and thoughtful consideration. And the question isn’t simply just “Can we?” Of equal importance is “Should we? Will the market support it? Will we need partners or help? What kind of optionality should we be considering and planning for?”

Organizations legitimately contemplating starting an MA plan are taking a deep dive to assess their organizational and network readiness, scope out their competitive landscape and determine not only the overall opportunity present in the market but the viability of their organization being able to capitalize on it. Conducting a PSP feasibility study is a crucial first step to setting the wheels in motion for a successful and targeted health plan application and development process.

 
• Key deliverables of a PSP feasibility study should include:
 
• Market Assessment;
 
• Prospective Partner List;
 
• Network Adequacy Analysis;
 
• Go-To Market Product and Network Structure;
 
• Target Market Landscape and Competitive Positioning Strategy;
 
• Organizational Readiness; and
 
• Financial Pro Forma.

Armed with an honest assessment of the critical factors to successfully stand up and operate a health plan, organizations not only better understand their readiness but are also able to act immediately to implement any necessary improvements. Providers should be aware of specific opportunities available, and precisely what it will take for them to actualize them.

As a result of a PSP feasibility study, the executive team will be better informed for the ultimate decision as to whether they should pursue an MA contract. Should a “go” decision result, progressive organizations should then work to develop an implementation plan in tandem with the application process. While the development of a health plan has never been considered easy, this only underscores just how much preparation many successful organizations undergo.

With so many competing initiatives and so much uncertainty in healthcare right now, it can be easy to overlook or delay the analysis of your MA opportunity. However, we contend that with the political changes and continued demographic evolution, it has never been more important to assess this opportunity—and that process needs to start soon if organizations want options for 2019.

Healthcare Bowl 2017: Atlanta vs New England

By Clive Riddle, February 3, 2017

The Atlanta Falcons and New England Patriots square off this Sunday in Houston during a Lady Gaga concert (the halftime show.) But another performance between this two cities is playing out on a daily basis – healthcare indicators. Let’s see how Atlanta vs. New England stack up in a healthcare bowl.

Instead of the venue for this comparison being NRG stadium in Houston, we find ourselves at The Big Cities Health Coalition, a “forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 54 million people they serve.” Their playing field is a Data Platform that features over 17,000 data points across 28 large cities.

Here’s the selected results from their data platform. Let’s score 7 points when one city’s indicator bests the US average and the other city is below the US average, and 3 points the better city when both or neither best the US average. Data is from 2013, and represents Fulton County for Atlanta and the Boston metropolitan area for New England.

• ·         Uninsured Rate: Atlanta 16.9%; Boston 4.4%; US 14.5%. New England takes a 7-0 lead.

• ·         Adult Obesity Rate: Atlanta 25.4%; Boston 21.7%; US 28.3%. New England extends their lead to 10-0.

• ·         Heart Disease Mortality per 100,000:  Atlanta 157.3; Boston 133.6; US 169.8. New England goes up 13-0.

• ·         Diabetes Mortality per 100,000: Atlanta 19.3; Boston 19.4; US 21.2. To close to call. The score at halftime remains New England 13, Atlanta 0.

• ·         Asthma Annual ER visits per 10,000: Atlanta 49.8; Boston 125.8%; No US average provided. Atlanta now trails 13-3.

• ·         Opioid related unintentional drug overdose mortality rate per 100,000: Atlanta: 9.4; Boston 16.8; US 4.2. Atlanta cuts further into the lead, now trailing 13-6

• ·         Smoking: Atlanta 16.0%; Boston 18.4%; US 17.9%. Atlanta ties the score 13-13.

• ·         All Cancer Mortality per 100,000: Atlanta 159.3; Boston 176.1; US 163.2. Atlanta wins 20-13.

There you have it – Atlanta wins the Healthcare Bowl 2017 by a score of 20-13.

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:

Repeal Ripples: Five Obamacare Exchange Chiefs Contemplate An Uncertain Future

Kaiser Health News reports: The health insurance marketplaces created by the Affordable Care Act are in their third year of selling health insurance plans to people who don’t get insurance through work.

Kaiser Health News, January 27, 2017

Senators' ObamaCare replacement bills highlight GOP divide

The Hill reports: As House and Senate Republicans unveiled an aggressive plan to repeal and replace the Affordable Care Act within the next three months, disagreement over two Senate bills introduced this week shows the stark divide within the party over a way forward.

The Hill, January 26, 2017

What President Trump's executive order means for hospitals & physicians: 14 key thoughts

Becker's Hospital Review reports: President Donald Trump signed an executive order on Jan. 20 to reduce the economic burden of the ACA. Fourteen academics and leaders of healthcare companies and hospitals discuss the executive order's implications on hospitals and physicians.

Becker's Hospital Review, January 24, 2017

Judge blocks major health insurance merger

Politico reports: A federal judge has blocked Aetna’s merger with Humana after finding that the health insurers’ $37 billion deal would leave seniors with fewer and costlier options for private Medicare coverage.

Politico, January 23, 2017

Lingering FTC concerns could stall $9.4B Walgreens-Rite Aid merger

Becker's Hospital Review reports: With the deadline fast approaching to close the merger between Deerfield, Ill.-based Walgreens Boots Alliance and Camp Hill, Pa.-based Rite Aid, Federal Trade Commission lawyers still have concerns about the transaction, people familiar with the matter told Bloomberg.

Becker's Hospital Review, January 23, 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. 

Living in a Retro Health Care System

by Kim Bellard, January 26, 2017

Living in the 21st century is cool, right?  We've got smartphones, ultra-thin tablets, the Internet, wearables, Uber, self-driving cars, virtual/augmented reality, drones, digital currency, and all the TV/movies/music you could want available for streaming anytime, anywhere.  It makes Back to the Future II's 2015 look drab by comparison (except maybe for the hoverboards!).   

So why does it seem like so many people are entranced with the 1980's?

Take, for example, the resurgence of vinyl. Vinyl is back, set to become a billion dollar industry (again).  

People are falling in love with cassette tapes again.  Their sales rose 74% in 2016. People are even inventing new ways to listen to old formats.  The Verge reports on Love, "the first intelligent turntable.”  

Retro isn't confined to music.  One of the hottest Christmas presents was the Nintendo NES Classic. Hey, we've got the Today show doing a 1970 retro show, the NFL going crazy with throwback uniforms, and the predicted reemergence of flip phones.  People even want retro computers.  

If any industry would keep its eye relentlessly on the future, you might expect it would be health care.  Few of us would want to go back to what health care was like in the 1980's, and none of us would accept the health care of the 1950's (except maybe those house calls).  

No, in health care we expect the kind of futuristic -- or, at least, modern -- experience that tech-based start-ups are promising.  If health care went retro, why, we'd usually make appointments to see our doctors in their offices instead of seeing them on-demand 24/7, wait long periods in their bland waiting rooms, fill out lots of paperwork, have our white-coated doctor listen to us with their stethoscope, have lots of unnecessary or even harmful tests and procedures, even have our information sent by fax.  No one would want to go back to all that.

Oh, wait -- that is our health care system, for the most part.  It hasn't gone retro because we haven't yet moved past retro.  

Get this: fax machines remain the predominant form of communication in health care, with fax volume hitting new records.  That's not retro, that is insanity.  

Get this: physicians hate their EHRs so much that they are cited as a leading reason for physician burnout, and in their frustration with them physicians are turning to medical scribes to do the inputting.  

Get this: after seeing a consumer revolt in the 1990's against managed care's capitation, small provider networks, and restrictive medical management, they're all back in vogue, in one form or another.

I get retro.  But I do not want to get care in a retro health care system.  

EHRs are a perfect example of how we took something that should revolutionize health care, and turned it into something that not only no one is happy with but that many feel often impedes care, to the point some want to go back to paper records.  We didn't do the wrong thing with EHRs, we just are doing it wrong.

We should be thinking big and bold about how we want our health care system to work in the 21st century.   We should be looking forward, not backward. We have all the technology we need to make our health care experience, well, if not like magic, then certainly more like a 21st century health care should seem.  Let's get there first -- then maybe we can think about how we can do some cute retro to it.  

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

Understanding Impact of Socioeconomic Data on Health Outcomes

By Claire Thayer, January 26, 2017

While advancements in medical technologies have contributed to improved health outcomes, health care systems are increasingly retooling their focus to understanding the basic socio determinants of health, the underlying factors of how socio and economic conditions are correlated to health outcomes of patient populations along with the role of local communities in addressing these issues.  As health care providers undertake more risk with population health management and value-based payment arrangements, health care providers are being held accountable not only health care costs, but also the health of their patient populations.

The CDC outlines some of the factors related to health outcomes as:

• ·         How a person develops during the first few years of life (early childhood development)
• ·         How much education a person obtains
• ·         Being able to get and keep a job
• ·         What kind of work a person does
• ·         Having food or being able to get food (food security)
• ·         Having access to health services and the quality of those services
• ·         Housing status
• ·         How much money a person earns
• ·         Discrimination and social support

This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights many of the key socioeconomic factors impacting health outcomes for patient populations:

 

Additional reading:

Tackling Patients’ Social Problems Can Cut Health Costs, Kaiser Health News, January 23, 2017

Socio Determinants of Health: Know What Affects Health, CDC

Healthy People 2020 – Socio Determinants of Health, Health People.gov

Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report, Robert Wood Johnson Foundation, May 2016

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Family Foundation, November 4, 2015.

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.

2017 MSSP ACOs By The Numbers

by Clive Riddle

CMS has announced their 2017 new and renewing ACOs, so we took a somewhat deeper dive into what comprises this year’s MSSP ACO roster, along with who dropped out. For starters, though, here’s the 2017 totals including the other active ACO types (there are also 9 remaining ACOs in the non-active Pioneer model):

•          MSSP - 480
•          Next generation - 45
•          Comprehensive ESRD (CEC) – 47
•          Total: 572

52 MSSP ACOs participating in 2016 dropped out of the program for 2017. 8 of these started in 2012, 11 in 2013, 22 in 2014, 8 in 2015, 3 in 2016.

For the 480 MSSP ACOs participating in 2017, with respect their track:

•          Track 1 – 438
•          Track 2 – 6
•          Track 3 – 36

17 of these ACOs remain in the non-active Advance Payment program. 45 of these ACOs are the AIM program, and 25 are in the SNF 3 day waiver program.

With respect to geography, when classifying the MSSP ACOs by the primary state they serve (many ACOs serve markets in more than one state), 16 states comprise over two-thirds (68%) of the total:

•          FL 44 ACOs
•          TX 44 ACOs
•          NY 34 ACOs
•          CA 25 ACOs
•          MI 20 ACOs
•          NJ 19 ACOs
•          NC 18 ACOs
•          IL 17 ACOs
•          GA 15 ACOs
•          IN 15 ACOs
•          MD 14 ACOs
•          OH 14 ACOs
•          KY 13 ACOs
•          VA 13 ACOs
•          PA 12 ACOs
•          MA 11 ACOs

With respect to their initial year joining the program, MSSPs break down as follows:

•          2012: 49 ACOs (14%)
•          2013: 63 ACOs (13%)
•          2014: 79 ACOs (16%)
•          2015: 77 ACOs (16%)
•          2016: 97 ACOs (20%)
•          2017: 99 ACOs (21%)

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’s Nominee For Agriculture Has Key Health Role

Kaiser Health News reports: Amid the cacophony of confirmation hearings for Cabinet nominees, President-elect Donald Trump reportedly has settled on former Georgia Gov. Sonny Perdue to fill the final Cabinet-department vacancy: Secretary of Agriculture. Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health.

Kaiser Health News

Friday, January 20, 2017

How Large Employer Health Plans Could Be Affected By Obamacare Overhaul

NPR reports: If you think that you wouldn't be touched by a Republican overhaul of Obamacare because you get health insurance through your job at a big company, think again.

NPR

Thursday, January 19, 2017

Anthem aims for 30% reduction in number of opioid prescriptions by 2019

Becker's Hospital Review reports: Indianapolis-based Anthem said it wants to reduce the amount of opioids prescribed to policyholders by 30 percent by the end of 2019. The insurer said in a Wednesday news release it is also committed to helping its affiliated health plans double the number of consumers who receive counseling as part of medication-assisted therapy for opioid addiction.

Becker's Hospital Review

Thursday, January 19, 2017

Health Law Repeal Could Cost 18 Million Their Insurance, Study Finds

The New York Times reports: Eighteen million people could lose their insurance within a year and individual insurance premiums would shoot upward if Congress repealed major provisions of the Affordable Care Act while leaving other parts in place, the nonpartisan Congressional Budget Office said on Tuesday.

NY Times

Wednesday, January 18, 2017

Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies

Kaiser Health News reports: More than 30 years ago, Congress overwhelmingly passed a landmark health bill aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored. By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.

Kaiser Health News

Tuesday, January 17, 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.

The Similarities Between Health Plans and Subscription Television

By Clive Riddle, January 13, 2017

One can even directly impact if people live or die.  The other merely informs and entertains. Still, as I recently turned on the television to discover my favorite local station currently wasn’t available because of a contract dispute with my satellite television service, it occurred to me that there are significant parallels between health plans and subscription channel services.

I must digress to say it isn’t that easy finding the correct, simple mainstream term to refer to all that is subscription cable television, satellite television, and streaming internet services. With devices now delivering an increasing load of channel viewing, should we even use the term “television“ when referring to subscription services?  Wikipedia provides the term Multichannel video programming distributor (MVPD), which doesn’t exactly roll of the tongue.

Both health plans and subscription channel services, by their very nature, are based upon the volume of subscribers they amass, the monthly subscription revenue they receive, and the network of providers they contract with (be they health care or channels.) Both are significantly regulated. Both are now dominated by mega companies that emerged from acquisitions. Both now try to distinct themselves by offering enhanced engagement through customer portals. Both are evolving and experiencing disruptive innovations and change. Both are experiencing their providers becoming integrated delivery systems (such as ESPN or HBO.)

And both are plagued by contract disputes with their provider networks.

Just this month, Hearst Television local channels were pulled from DirectTV over a contract dispute affecting markets across the country including Sacramento, Kansas City and Pittsburgh. DishTV experienced headlines including Dish loses more subscribers and says there’s no deal yet to bring back Fox, NFL, and Tribune Stations Blacked Out On Dish Network In 33 Markets.  Cable fare no better than satellite on this front. Comcast/Xfinity earlier this year had headline including As Opening Day looms, Comcast-YES flap leaves many Yankees fans shut out and Verizon headlines included Verizon Dumps The Weather Channel in Favor of Looking out the Window.

Does this sound familiar for health plan subscribers? Consider these recent headlines: Blue Cross to drop Texas Health Resources from its network in 2017 after contract dispute; Humana, Tenet Cut Ties over Contract Dispute; Blue Cross, Fairview network spat could affect 170k patients (Minnesota); or NMHS prepares to drop United as negotiations stall (Mississippi).

Is it any wonder that after much ado has been made for health plans investing in “narrow networks”, DISH TV has just introduced its “Skinny Bundle”?

The point is, it can be instructive for health stakeholders to consider the experiences and lessons learned in the subscription channel service arena, and vice-versa.

But one could argue that a significant dissimilarity between health plans and subscription channel services is that while the uninsured rate was cut in half during the past decade, the trend towards “cord cutting” for subscription channel services is growing, with 21.9% of households having been projected to be cable or satellite free by the end of 2016, while the overall U.S. uninsured rate has dipped below 9%. On the other hand, a material portion of these “cord cutters” have recently ventured into internet subscription services offered via Hulu and others that are still under the radar when cable and satellite subscriptions are counted, and for health plans – it remains to be seen what the percentage of uninsured will look like after “repeal and replace” occurs.

But still, it can be interesting to observe the portion of “cord cutters” cobbling together their own network of integrated providers, bypassing an overall subscription service: assembling their own customized collection of HBONow, ESPN, Netflix, Amazon and other channels. Is there a parallel to emerge for the inevitable increased number of post-repeal and replace uninsured?

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.