The Colossal Ship - The SS Rx Costs – makes a Course Correction

by Clive Riddle, April 17, 2014

Course corrections on mammoth shipping lines don’t happen in an instant – you watch them develop over a period of time. The same can be said for pharmaceutical costs as well as the entire healthcare sector, and the IMS Institute for Healthcare Informatics tells us we’re witnessing a slow correction right now.

Costs that have been stabilized this decade are gradually starting to tick upwards. The IMS Institute has just released a study: Medicine Use and Shifting Costs of Healthcare: A Review of the Use of Medicines in the United States in 2013 which found that “total dollars spent on medications in the U.S. reached $329.2 billion last year, up 3.2 percent on a nominal basis and a rebound from the 1.0 percent decline in 2012…  Total spending on U.S. medicines increased 1.0 percent on a real per capita basis in 2013, while the use of healthcare services overall rose for the first time in three years.”

This doesn’t mean that costs are about to go crazy in an upward spiral just yet – remember that this is a big ship. Instead, Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, tell us  “following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. healthcare system – even in advance of full implementation of the Affordable Care Act.  Growth in medicine spending remains at historically low levels despite a significant uptick last year, and continues to contribute to the bending of the healthcare cost curve.”

So what is driving this gradual correction? The IMS Institute identifies these factors:

1. The reduced impact of patent expiries (“Patent expiries in 2013 contributed $19 billion to lower medicine spending, compared with $29 billion the previous year.”)
2. Price increases for branded products added $4 billion more in spending growth last year compared to 2012
3. Higher spending on innovative new medicines (“while 36 New Molecular Entities launched in 2013, the largest number in a decade”)
4. Greater use by patients of the healthcare system  (“Overall utilization of healthcare services grew slightly as consumers returned to the healthcare system – primarily through more office visits to specialist physicians as well as outpatient treatments – following several years of self-rationing. “)

The IMS Institute shared these other key findings from their report:

• The number of patient office visits to primary care physicians fell by 0.7 percent in 2013.
• Visits to specialists increased by 4.9 percent overall and by 9.5 percent for seniors.
• Patients filled an average of more than 12 retail prescriptions last year, up nearly 2 percent year over year.
• Those aged 65 and over filled an average of 28 prescriptions annually, down slightly from 2012.
• Overall spending on medicines remained concentrated in traditional small-molecule pills dispensed through retail pharmacies.
• But higher spending growth was seen in biologics and specialty drugs – particularly in retail and mail-order settings.
• A total of 27 new oncology drugs have launched in the past three years.
•  Additionally, clusters of innovation are transforming patient care in hepatitis C, multiple sclerosis and diabetes, as well as stroke and acute coronary syndrome.
• Seventeen orphan drugs – developed for patient populations of fewer than 200,000 individuals – launched in 2013, the most in any year since the passage of the Orphan Drug Act in 1983.
• Patients with insurance are incurring higher out-of-pocket costs for healthcare services despite lower co-pays for many prescriptions and additional discounts for preventive medicines.
• Prescription drug costs paid by most patients are declining, with average out-of-pocket costs falling below $5 for 57 percent of all retail prescriptions filled.
• At the same time, 30 percent of total patient out-of-pocket costs relate to just 2.3 percent of prescriptions, often high-cost specialty medicines.
• Twenty-three percent of prescriptions now carry no out-of-pocket costs, a dramatic rise in 2013 driven by common preventive medicines that include oral contraceptives.

Want to get more detail? The report can be downloaded as an app via iTunes.

Hacking a Better Health System

By Kim Bellard, April 9, 2014

Who knew hacking might help us reinvent our health care system?

I must be old-fashioned, or at least not a true techie, because I still thought of hacking as a bad thing.I was thus surprised to read in The Wall Street Journal that “hackathons” are a trend for the good in health care. 

For others who are also behind this particular curve, hackathons are intense, all-night (or more) sessions when a small groups of programmers band together to attack tough specific problems with concentrated coding efforts.

The Journal article highlighted MIT’s Hacking Medicine’s Grand Hackfest, which is part of MIT’s Hacking Medicine initiative.  MIT has been at this since 2011, seeking synergies between MIT’s technical expertise and the vaunted Boston-area medical community.  They believe hackers can help health care with: Scaling Medicine, Accelerating Data, Identifying and Tackling Big Opportunities, Hacking Ethos for Lean Medical Innovation, and Infecting Non-Life-Scientists with the Mission. 

Pretty lofty list of goals.

Health 2.0 has their own version, which they call Code-a-thons.  They offer some $6.5m in prizes in their developer challenge, and have several events and challenges scheduled in the next few months.

Goodness knows that health IT has never been known for being either nimble or on the cutting edge, so some fresh blood with new perspectives certainly seems like a good idea, right?  As one clinician whose mobile app benefited from solutions suggested at the MIT hackathon said, "Sometimes when you are too close to something, you stop seeing solutions, you only see problems.  I needed to step outside my own silo.''

Not to be outdone by Boston, New York-Presbyterian Hospital recently held what they claim was the first Hackathon for New York Hospitals, which the specific aim of helping them improve myNYP, their patient portal. Out on the other coast, UCLA-Berkeley has had three iterations of their own version, Hacking Health. 

Just to rub us oldsters’ noses in it, there’s an organization called YTH (youth + tech + health) that believes the “#selfie generation” can do better. They just hosted their own Health Hackathon in conjunction with their YTH Live 2014 conference.     

The trend is not limited to the United States.  The British National Health Service has NHS Hack Days, in Canada there is Hacking Health, and in Europe there’s CPH Health Connect HackDay in Copenhagen and Hacking Health Stockholm.

Looking back at last fall’s healthcare.gov debacle, or more recent reports of similar issues with various state exchanges, one has to wonder if they just should have held a hackathon.

PwC’s 6^th Annual Digital IQ Survey found that healthcare CEOs were far ahead of other industries in championing information technology as an integral part of their strategy.  I rather doubt that many health systems or payors are using hackathons for their big mainframe-based systems – like eligibility, billing, claims payment, or (most) EHRs – but mobile efforts are natural targets for this kind of approach. 

There’s no shortage of targets.  Payors are finding ways to use mobile technology to cut administrative costs, engage members, and manage patients’ care. Still, in a recent Robert Half Technology survey of CIOs, health care led the pack in lacking a mobile strategy.

No wonder they might be looking for hackers.  

It’s great to bring in new ways of attacking the many problems of health care, but I do worry what happens when they hit the may brick walls health care has.  I’ve been seen several instances where non-health care companies – especially financial services firms -- dipped in to health care, thinking they could bring their expertise to bear, only to be shocked at how messy much of the data is. 

What I like best about the hacking in health movement is twofold – bringing in new kinds of expertise and an attitude that problems can be solved.  Those have been sorely missing in health care.  Or, as Mark Twain once put it, “all you need in this life is ignorance and confidence, then success is sure.” 

Hack away!

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

April Fool’s Day Brings Some Humor to Healthcare

By Clive Riddle, April 4, 2014

The first of April marked the annual issuance of satirical lists from healthsprocket, zinging a range of current topics in the business of healthcare, which I can’t resist repeating.

First, let’s visit a list of predictions of future major news items, in a list entitled -  Top Healthcare Headlines from Tomorrow's News

1. Healthcare.gov server achieves singularity, assumes control of planet
2. Obesity Problem eliminated in United States thanks to Congressional Act to expand BMI ranges
3. Exchange enrollment count after March 31st deadline exceeds 400 million, last minute inclusion of uncovered domestic pets credited with enrollment surge
4. Influenza eradicated after development of oral vaccine distributed in Starbucks Coffee
5. National consulting lobby urges Congress and states to adopt new, confusing and conflicting healthcare legislation - say lack of new laws since Affordable Care Act is stifling consultant job creation
6. Medicare officially re-named "Johnsoncare" in keeping with Obamacare precedent
7. Health Plan of San Mateo declared second largest plan in nation after Kaiser-BlueCrossBlueShield-UnitedHealthcare-Human-Aetna-Cigna-HealthNet-Molina-Centene merger

Here’s another list looking into the future, this time predicting what big problems lie ahead a year from now, with the Top Five Healthcare Crises Predicted for 2015:

1. Acute Shortage of available new healthcare acronyms
2. Global climate change causes the Cloud holding all healthcare big data to disappear
3. Demand for health coaches exceeds supply, causing raid on NFL, NBA and MLB staffs
4. Healthcare exchanges finally end up working smoothly, causing a wide-scale chain reaction of pundits and politicians heads to explode on national television
5. Lack of funding causes medical homes to downsize to medical apartments

And one more list about upcoming events, this time narrowing the focus to upcoming month, as we consider Healthcare scandals that will surface later this year:

1. The "two ferns" in the Obama -Zach Galifianakis healthcare.gov interview were secretly switched out with alternative plants provided by medical marijuana lobby
2. Major healthcare analytics platform discovered to be vintage Magic 8-Ball
3. Move by major Health Savings Account (HSA) administrators to convert all accounts to bitcoins proves disastrous
4. Jointly funded XBox, Wii and Playstation study finding health benefits of exercise and fresh air to be vastly overrated, revealed to be based on SimCity and not actual data
5. High speed disclaimers at end of prescription television ads discovered to be spoken in Klingon language

Speaking of the “Two Ferns” video, next we look at a list that addresses the White House media blitz to promote signing up in the health insurance marketplaces, with New Television Shows Created to Attract the Young Invincibles to Obamacare:

1. How I Met Your Health Plan - A previously uninsured guy spends nine seasons explaining to his kids how he finally got coverage after years of searching
2. CSI: Covered Singles Insurance - Each week, investigators track down an uninsured single twentysomething, and bring their health coverage to justice
3. The Amazing Race - Young uninsured individuals hurry to sign up in a plan before the open enrollment deadline, despite obstacles placed in their path
4. Modern Family - Different dependent coverage scenarios are explored in each episode
5. Once Upon a Time - Evil witches try and convince the population to hold out for their fairy tale past of fee for service medicine, house calls, low costs, and happy doctors and patients

And finally, no discussion of the Affordable Care Act is complete without a few zombies thrown in the mix, as demonstrated by the healthsprocket list Upsides for the Affordable Care Act after a Zombie Apocalypse:

1. Web traffic will not overwhelm healthcare.gov
2. Annual ACA expenditures will come in under budget
3. That stubborn "young invincibles" demographic won't be so important
4. Consumer engagement strategies can be significantly simplified
5. More of the population will be walking and less sedentary

March Brings Three Different Slices of Health Plan Consumer Experience Ratings

by Clive Riddle, March 28, 2014

This month, three annual proprietary consumer experience studies have yielded separate slices of the health plan consumer experience. J.D. Power, Temkin Group and Saatmetrix have all weighed in, and each shed favorable light on Kaiser Permanente, among other plans.

J.D. Power released results from their eighth annual Member Health Plan Study, in which they provide member satisfaction index rankings by region. Their 2014 Member Health Plan Study is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States. The study was fielded in December 2013 and January 2014.  

J.D. Power ranks satisfaction on a 1,000 point scale. Satisfaction is highest among health plan members in the California and Michigan regions (in a tie); the Indiana-Illinois and Mid-Atlantic regions (in a tie); and the East South Central and South Atlantic regions (in a tie). Satisfaction is lowest in the New England, New York-New Jersey and Southwest regions. 

Top ranked plans by region, according to the J.D. Power study, were compiled in healthsprocket, in these regional lists:

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Southern United Stated

• Kaiser Foundation Health Plan (784) ranks highest among health plan members in the South Atlantic region (which includes Georgia, North Carolina and South Carolina) for a fifth consecutive year
• AvMed Health Plans and Humana (in a tie at 690 each) rank highest among health plan members in the Florida region, AvMed ranks highest in the Florida region for a third consecutive year
• Cigna (689) ranks highest among health plan members in the East South Central region (which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee)
• Aetna (677) ranks highest among health plan members in the Texas region

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Eastern US

• Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Mid-Atlantic region (which includes Maryland, Virginia and Washington, D.C.)
• Capital District Physicians Health Plan (727) ranks highest among health plan members in the New York-New Jersey region
• Geisinger Health Plan (705) ranks highest among health plan members in the Pennsylvania region for a third consecutive year
• Tufts Associated Health Plans (681) ranks highest among health plan members in the New England region (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Midwestern US

• Health Alliance Plan of Michigan (711) ranks highest among health plan members in the Michigan region for a seventh consecutive year
• Dean Health Plan (703) ranks highest among health plan members in the Minnesota-Wisconsin region
• Medical Mutual of Ohio (697) ranks highest among health plan members in the Ohio region
• Health Alliance Medical Plans (692) ranks highest among health plan members in the Indiana-Illinois region
• Wellmark Blue Cross Blue Shield of Iowa (680) ranks highest among health plan members in the Heartland region (which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Western US

• Kaiser Foundation Health Plan ranks highest among health plan members in the California region for a seventh consecutive year, with a score of 756
• Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Northwest region region (which includes Oregon and Washington)
• Kaiser Foundation Health Plan (703) ranks highest among health plan members in the Colorado region for a seventh consecutive year
• SelectHealth (698) ranks highest among health plan members in the Mountain region (which includes Idaho, Montana, Utah and Wyoming) for a fifth consecutive year
• Blue Cross Blue Shield of Arizona (675) ranks highest among health plan members in the Southwest region (which includes Arizona, New Mexico and Nevada

Temkin Group pronounced the health plan industry “mediocre” and bestowed the highest customer experience rankings to Kaiser Permanente and Humana respectively, in releasing results from their fourth annual ranking of companies based on a study of 10,000 U.S. consumers that “examines the quality of the customer experience delivered by 268 organizations across 19 industries: airlines, appliance makers, auto dealers, banks, car rental agencies, computer makers, credit card issuers, fast food chains, grocery chains, health plans, hotel chains, insurance carriers, Internet service providers, investment firms, parcel delivery services, retailers, software firms, TV service providers, and wireless carriers.”

Bruce Temkin, managing partner of Temkin Group, tells us "consumers give pretty bad ratings to most health plans, as this entire industry needs a customer experience makeover.  Overall, the health plan industry averaged a 56% rating in their study and tied for 17th place out of 19 industries.

Temkin ratings by plans included in the survey were:

1. Kaiser Permanente (68%)
2. Humana (63%)
3. Medicare (62%)
4. TriCare (62%)
5. United Healthcare (59%)
6. Blue Shield of California (58%)
7. Aetna (57%)
8. Health Net (55%)
9. CIGNA (54%)
10. Anthem (BCBS) (53%)
11. CareFirst (BCBS) (48%)
12. Medicaid (45%)
13. Highmark (BCBS) (44%)
14. Empire (BCBS) (42%)
15. Coventry Health Care (41%).

Temkin noted that Humana (+12 points), Blue Shield of California (+7 points), and United Healthcare (+5 points) improved the most between 2013 and 2014. Coventry Healthcare (BCBS) (-18 points), TriCare (-9 points), Empire (BCBS) (-7 points), and Highmark (BCBS) (-6 points) declined the most since 2013. Kaiser Permanente with their 68% rating, was in 109th place overall out of 268 organizations across 19 industries. Humana, with a rating of 63% placed 160th overall. Coventry Health Care (BCBS) was in last place across all 268 companies in the ratings with their score of 41%.

Satmetrix Systems released results for their 2014 Satmetrix® Net Promoter® Benchmarks which measure and rank customer loyalty more than 219 brands across 22 U.S. industry sectors, including financial services, insurance, technology, online services, retail stores, electronics, travel and hospitality, and telecommunications. The Satmetrix Net Promoter Benchmark rankings are based on survey responses from more than 24,000 U.S. consumers nationwide who indicated they had significant experience with a company's products or services in the previous 12 months. A company's Net Promoter Score is based on customers' likelihood to recommend the company's product or service. The score is the percentage of customers who are promoters, rating the company 9 or 10 on a 0 to 10 point scale, minus the percentage who are detractors, rating 6 or lower.

The Satmetrix study for the health insurance sector followed these nine companies:

• Aetna
• Anthem
• BlueCross BlueShield of Florida
• BlueCross BlueShield of California
• Cigna
• Humana
• Kaiser
• Medicare
• United Healthcare

Like J.D. Power and Temkin, Satmetrix found Kaiser Permanente to be a dominant force, leading the health insurance category for the fourth consecutive year  and “improving to an all-time high [Net Promoter Score] score of 40 points. The provider rated highest on a number of important key loyalty drivers, as patients appreciated its service features, company reputation and the feeling that Kaiser Permanente acts in their personal best interest.” Kaiser’s score was 23 points higher than the industry average. Like Temkin, Satmetrix ranked Human in second place: “with a score of 32 points, Humana saw significant improvement from 2013, moving up 14 points to beat out last year's second place finisher, Medicare (27 points).”

Seated Behind a Health Plan Dashboard

By Clive Riddle, March 21, 2014

Spring has sprung, and if your fancy lightly turns to thoughts of health plans, and in fact you are driven towards such thoughts, a dashboard can be useful. You may be in luck, as Sherlock Company provides a summary from their health plan dashboard as part of their complementary publication, Plan Management Navigator.

Here’s what Sherlock Company reports in their just released March 2014 issue of the Navigator, about the trailing three months ended December 31, 2013, for health plans participating in their dashboard program. Health plans in their Dashboard universe are comprised of Blue Cross Blue Shield and Independent/ Provider-Sponsored Plans.

Health Plan reported “an increase in health revenues of 8.7%. Revenues for Medicaid grew most rapidly, increasing by 17.2%. Medicare Advantage revenue growth followed at 4.7%, while Indemnity product revenues increased 2.7%. ASO/ASC and Managed Care revenues fell by 6.2% and 4.3%, respectively. Overall, membership increased 1.1% for all health lines. Enrollment in Managed Care fell 1.1%, while increasing 1.6% for Indemnity. ASO/ASC membership declined 0.4%.”

“Membership grew in both Medicaid and Medicare by 4.6% and 4.2%, respectively. Both Managed Care and  Medicaid experienced the largest price increases, both at 3.5%. Indemnity followed with a price increase of 1.1%. Medicare Advantage products had a price decrease of 2.3%, while ASO/ASC posted a decline of 5.3%.”

“Health benefit ratios for health lines deteriorated by 2.0 percentage points to 90.0%. Managed Care and Indemnity had the largest increases of 5.4 percentage points and 4.5 percentage points, respectively. The number of scripts per person increased by 0.4 to 9.5 on an annualized basis. E/R visits per thousand members fell 13.4 to an annual rate of 241.8 per thousand, while hospital days also increased by 21.2 days to 335.1 days per thousand. The administrative expense to premium ratio increased 0.6 percentage points to 11.8%, while the administrative costs per member per month increased 2.3% to $34.76. Claims volumes increased 0.87 to 17.7 per member per year, while inquiries per member grew 0.34 to 1.9 per member per year. Staffing ratios fell 0.32 FTEs per 10,000 members to 21.1.”

You can click here if you’d like to subscribe to Sherlock Company’s complementary Plan Management Navigator, which includes additional articles full of great health plan data, benchmarks, and insights like those provided in the Dashboard Summary.

Content Marketing Dominates Social Media Trends in 2014

By Claire Thayer, March 12, 2014

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

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

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

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

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

That's Not the Way I Always Heard It Should Be

by Kim Bellard, March 11, 2014

Now that the initial open enrollment period under ACA is drawing to a close, we’re starting to hear more about how the enrollment is going, and the news is not encouraging.

The Administration has touted that 4 million have gotten coverage through the exchanges – still several million short of their goals – but they claim to not know much about whether ACA’s impact on the uninsured rate.  Fortunately, outside organizations are helping to fill in some of the gaps. 

The McKinsey Center for U.S. Health System Reform released the results of their individual market enrollment survey, with results from February 2014.  Only 27% of those who had obtained new coverage in 2014 reported having been previously uninsured.  Even more discouraging, only 10% percent of all previously uninsured now reported having coverage.  The faint sign of hope in the numbers is that both numbers are up sharply from previous surveys – 11% and 3%, respectively – but I doubt anyone who supported ACA’s passage thought they were signing up for only helping 10% of the uninsured.

Adding insult to injury, only three-quarters of those with new coverage reported actually having paid their premium, confirming reports that health insurers had warned about.  And that percentage was only 53% among the previously uninsured, which does not inspire much confidence that they will remain insured for very long.

Perceived affordability remains the key barrier to buying coverage, even though 80% of those citing it were actually eligible for subsides, a crucial fact that two-thirds were unaware of.

One glimmer of good news is that Gallup reports that the uninsured rate has, in fact, dropped, down to 15.9% (versus 17.1% in 4Q 2013).  To be fair, though, their results showed spikes in late 2013, and the 1Q 2014 results are on par with 1Q 2013 and 1Q 2011.  Coverage through an employer dropped two percentage points from 4Q 2013, while both individual coverage and coverage through Medicaid were up by slightly under 1%.  

The Urban Institute released their own survey results on ACA enrollment, conducted in December 2013.  Among all adults 18-64, 12% reported having looked for information on health plans in the marketplace (Orwellian for “exchanges”), with another 17% planning to do so.  More significantly, among the uninsured still only 19% had looked, another 33% thought they would look – and 23% had not heard about the marketplaces.  The comparable numbers for those below 138% of the federal poverty level were 13%, 25%, and 27%, respectively, highlighting that the most vulnerable groups are not getting the message.

The picture isn’t really rosy anywhere.  The people who were already in the individual market continue to be buffeted by changes in the rules of the road.  For example, there is Administration’s executive decision to allow subsidies for policies purchased outside the marketplaces, in recognition that some consumers may have been too frustrated by the marketplace websites to buy from them. 

Then there is the “bare bones plans” mess.  After the uproar last fall about people having to lose their health plans because they didn’t meet ACA minimum standards, the Administration belated announced a one year delay in the enforcement of those standards, and has just extended that delay for yet another year, potentially meaning they won’t apply until 2016.   

It’s anyone’s guess about what has happened with premiums in the individual market.  A recent analysis by the Robert Wood Johnson Foundation in selected states found (with the exception of Alabama) more competitive markets and premiums, while a report from the Manhattan Institute last fall found an average increase of 41% (much due to benefit changes), and a study by the presumably objective Society of Actuaries last spring also expected significant increases, especially for younger consumers.

Any employer with a health plan or 401k plan – or any state Medicaid director – could have warned us that voluntary enrollment typically leaves lots of eligible people not taking action..  We should have taken the approach many 401k plans have adopted – “automatic enrollment.” Driven by disappointing participation in 401k plans, the federal law was changed to allow employers to automatically enroll employees in their 401k plan, with a default contribution rate.  Employees could still opt-out, or change the default contribution level, but employers have found that participation rates are higher and average contribution rates are higher under this approach.  What’s not to like?

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

How do you Define Population Health?

By Clive Riddle, March 7, 2014

This week, the inaugural issue of Population Health News was published. In their Thought Leaders Corner, a number of members of their national advisory board answered the question – how do you define population health? Here’s what the experts had to say:

Fred Goldstein, M.S., Founder and President of Accountable Health, LLC; and Executive Director of Population Health Alliance says “A population health management program is one that strives to address health needs at all points along the continuum of health and well-being through the participation of, engagement with and targeted interventions for the population. The goal of a population health management program is to maintain or improve the physical and psychosocial well-being of individuals through cost-effective and tailored health solutions.” (Fred cites this description is from Population Health Alliance, formerly the Care Continuum Alliance)

Thomas Graf, M.D., Chief Medical Officer, Population Health and Longitudinal Care Service Lines at Geisinger Health System offers this definition:  “Population health is the ability to define and understand the health status of every individual patient and proactively deploy medical resources to support those patients, whether it is to push resource to them where they are, or effectively connect them to the optimal resource in a patient specific manner, accelerated by technology.”

Paul Grundy, M.D., MPH, FACOEM, FACPM, the Global Director of Healthcare Transformation for IBM and President of the Patient-Centered Primary Care Collaborative (PCPCC) elaborates that  “population Health is ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group.’ For me, the ability to deliver population health requires a place in the delivery system that acts as the system integrator where the data flow about the population and is held accountable. We ask the house of primary care to give us a set of principles for this system integrator that is known as the patient-centered medical home (PCMH).  The medical home is defined as a ‘healthcare setting that facilitates partnerships between individual patients and their personal providers and when appropriate, a patient’s family. It lies at the center of the effort to address population health through the provision of integrated and coordinated, team-based care. It is a delivery organization that fosters clinician-led primary care with comprehensive, accessible, holistic and evidence-based coordination and management. PCMH builds the infrastructure through which data flow and is held accountable as the system integrator for POPULATION HEALTH.”

David Nash M.D., MBA, Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University observes that "population health recognizes that the social determinants of healthcare, like poverty and education, are the key drivers of a society's well-being. Medical care is responsible for 15% of a society's quality of life.”

Vince Kuraitis, J.D., MBA, Principal and Founder of Better Health Technologies, LLC explains that “definitions of population health usually focus on improving the health and health outcomes of a population. That said, the understanding and point of view of population health managers will vary greatly. Consider three highly variable factors in populations: 1. What's the COMPOSITION of YOUR POPULATION? The answer will vary depending upon whether you are a health plan, a physician practice, an employer or the government. 2. How STABLE is your population? How long do you expect it to remain with you? If you are a health plan, you will expect 18% to 20% annual churn in membership and an average tenure of around three years. If you are Medicare, your members will be with you for the rest of their lives. 3. Are you at FINANCIAL RISK for the health of your population? Upside risk? Downside risk? What are the details?   These factors will affect the economics of a population and in turn, the type and timing of potential interventions. Population managers will consider ROI as a primary metric for evaluating success. While this might seem narrow, it's very real. For example, if you are a health plan, you are more likely to invest in a congestive heart failure disease management program that has potential to identify patients and interventions that will keep patients from being admitted to a hospital within the next one to three years. If you are Medicare, you might consider a diabetes prevention that promises to reduce eye or foot problems over the course of 15 years.”

Finally, Al Lewis, Founder and President of the Disease Management Purchasing Consortium International, Inc. informs us that “population health is the provision of free (or financially incentivized) health-related tests, education and support services to groups who are (rightly or wrongly) believed—due to demographics, claims history or even company/health plan policy—to be at risk for chronic disease or chronic disease exacerbations absent those interventions, whether or not such interventions are requested by the employee or member.”

The second issue of Population Health News will include additional responses from Population Health Thought Leaders. Stay tuned.

mHealth on my Mind

by Clive Riddle, February 28, 2014

With the HIMSS14 gargantuan annual conference being held this week in Orlando, the spotlight has been shining bright on mHealth and other health information technology as of late.  In conjunction with the conference HIMSS Analytics released results from their 3rd Annual HIMSS Analytics Mobile Survey.

Here’s some highlights shared in their report:

• 59% of respondent stakeholders have a mobile technology plan; another 29% are developing a plan.
• Of those with a policy in place, here’s what the policies addressed: (1) 82% listed Means of securing devices (i.e. storing information on device); (2) 78% listed Use of personal devices for clinical/work use; (3) 71% listed Management of lost/stolen devices; (4) 71% listed Ability to access data from remote locations 71.43%; (5) 63% listed Types of apps approved for use ; (6) 45% listed Brand/version of device 44.90%
• Respondents scored HIPAA highest as the federal legislation with the most nHealth impact; Meaningful Use was second
• 95% use at least one security tool to secure data on mobile devices;  Of those with security tools, 94% used Passwords; 71% used encryption measures; and 69% used remote wipe capability
• 83% indicate their physicians use mobile technology to facilitate at least some patient care.
• 71% indicated their nurses used mobile technology to facilitate at least some patient care
• Clinicians are most likely to use technology to support patient care by either: Looking up patient information (69%); or Looking up non personal health information (65%). Rounding out the top five responses were  Use for education/training purposes (49%);  Clinical notifications (42%) and Secure communications regarding patients (39%)
• The top five tools used to engage patients/consumers in their healthcare were (1) App-Enabled Patient Portals (56%);  (2) Telehealth Services (52%);  (3) Provide Remote Monitoring Devices (36%);  (4) Prescribing Apps (23%); and (5) Discharge Kit with Mobile Technology (13%)

On another front, moving to specific, Citrix released ranking of the Top 10 Mobile Health Apps By Number of Network-Connected Subscribers, which was posted in Healthsprocket as follows:

1. Runtastic
2. My Fitness Pal
3. RunKeeper
4. Weight Watchers
5. Nike+
6. Map My Run
7. Pregnancy
8. Period Diary
9. Lose It!
10. Baby Bump

I'll Take My Care To Go

By Kim Bellard, February 17, 2014

I have to admit that when fast food restaurants first got into drive-throughs, I didn’t really see the point.  Well, I missed that one: they now do 60-70% of their business via the drive-through, changing the architecture, menu, and consumer expectations of the fast food industry along the way.  Aside from pharmacies, I haven’t seen drive-throughs impact health care yet, but one doesn’t have to be much of a seer to recognize that that the need to actually visit providers’ offices for health care is quickly being whittled away.

Let’s start with kiosks, which are increasingly providing quick alternatives for some services that used to require consumers to visit their doctor.  For example, in the news recently was a deal higi did with Rite Aid, which will put higi’s kiosks in some 4,000 Rite-Aid stores.  higi already has kiosks in Publix and Whole Foods.  Their approach features kiosks that allow consumers to measure and track their vitals, while gamifying that mundane process.  They combine all the measures into a single “higiscore” that consumers can easily track, and also offer some community features.

higi is not alone in the kiosk business.  There’s SoloHealth, which claims 40m annual user engagements, driven in large part due to its deals with Walmart/Sam’s Club and Safeway, as well as some deals with health insurers, such as Wellpoint and HCSC.        

Not unlike higi, SoloHealth offers quick self-service screening options, but the deals with insurers have them offering information on health plan options as well, a move that is not without critics due to the perceived privacy concerns. 

HealthSpot goes the other screening kiosks one better by also offering video visits with board-certified physicians.  They’ve been doing deals with provider organizations.  HealthSpot also recently teamed up with telepharmacy – there’s another wrinkle! – vendor MedAvail Technologies to create an all-in-one Redbox-type system. 

Of course, non-office visit alternatives are broader than kiosks, especially “virtual visits” offered via phone or computer.  Parks Associates recently found over 25% of American households have used some kind of virtual care, and predict that will grow to 65% by 2018. 

Examples of virtual visit vendors include TeleDoc, American Well, and MDLive.  TeleDoc has been offering a telephone-based physician consult service for years, and now also offers a video consult service. 

American Well started with email physician consults, added video consults, and recently went beyond its traditional payor partners to offer a direct-to-consumer option at $49/visit.  American Well notes that its services are available via web, kiosk, and mobile – and, in fact, says that 60% of its video visits are from mobile devices.  MDLive is the most recent newcomer of the bunch, but has a wide range of tele-services and some serious backers, including Sutter Health and John Sculley.  

Kiosks themselves may end up being a niche offering along the continuum of points-of-care, as the video consults are already available on computers and mobile devices and as more and more biometric measures can be done via remote monitoring and apps – why drive to a kiosk when you get do the same things at home or on your phone?  After all, health related apps are booming, and include screening and diagnostic tools.  The stethoscope app, for example, has been around for several years and has proved popular with both consumers and – surprisingly -- physicians. 

So we’ve got sophisticated bio-metric screenings at your convenience in a wide number of retail settings and, increasingly, via mobile devices, plus we’ve got physicians available literally in the palm of your hand.  That’s not all.  IBM’s Watson is teaming up with “social health management” vendor Welltok to help answer consumers’ health and wellness questions without the assistance of a physician – or any live person. 

All these new options for receiving care and medical advice remind me again about how much behind the curve traditional health insurance and health providers are. 

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

Stakeholder Views on Trends, Winners and Losers for 2014

By Clive Riddle, February, 14, 2014

MCOL recently conducted its annual Future Care e-Poll, asking stakeholders their perspective of trends, winners and losers for the coming year and beyond. Here’s a sneak peek at some of the results from the soon to be released report on this year’s findings. The full report still being compiled addresses additional e-poll questions, breaks down responses by stakeholder category and compares results to previous years.

Here’s a table of how respondents view the business trend that will have the greatest overall impact in 2014. The Affordable Care Act of course dominates all other issues, and even more so than last year, when exactly half of respondents list it as the trend with the greatest impact.

Affordable Care Act Implementation	61.1%
Government Spending Cuts	9.7%
Consumerism Initiatives	6.9%
Effects of the Economy	6.9%
Increased Consumer Cost Sharing	5.6%
Compliance Issues	4.2%
Other	2.8%
Advances in Health Care Technology	1.4%
Population Health and Wellness Initiatives	1.4%

Below is an infoGraphoid MCOL published earlier this week illustrating the e-poll results on this question. The designer of this graph informed me it looked like a green Pac-Man (the ACA respondents) vomiting a rainbow (of all the other respondents.)

Regarding winners and losers, here’s what stakeholders thought 2014’s fortunes would bring to other stakeholders:

Losers:

Hospitals – 56% say Hospitals are the big losers (only 18% said better off; 26% the same)

Physicians – 53% view Physicians as worse off (only 8% said better off; 38% the same)

Employers  - 52% think Employers are worse off (only 15% said better off; 33% the same)

Consumers  - 51% placed them in the losers column (34% said better off; 15% the same)

Status Quo:

Pharmaceutical – 60% see Pharmaceutical organizations as staying the same (29% said better off; only 11% said worse off)

Winners:

Health Plans – 47% say Health Plans as the big winners (29% said they will stay the same; 24% said they will be worse off)

It’s interesting that the stakeholder that the ACA was designed to benefit – the Consumer – is not viewed by stakeholders as the biggest beneficiary. It’s also interesting that last year respondents didn’t view health plans fortunes near as positive – at the start of 2013, 27% replied health plans would be better off;  34% said the same; and 39% said worse off.

Practice Priorities for Physicians to Thrive in ACA, Receive Higher Reimbursement

By Cyndy Nayer, February 7, 2014

The promise of value, outcomes, and payment reform are foundational within the ACA (Affordable Care Act) legislation, sometimes called Obamacare.  In order to achieve these reforms, electronic medical records, value-based designs, wellness incentives, expanded coverage through Medicaid, and new entities such as patient-centered medical homes (PCMH) and accountable care organizations (ACO) have been established. The health insurance exchanges (HIX) are now called health insurance marketplaces [and these are often confused with HIE, which are health information exchanges - basically a data repository of claims and predictive analysis]. The new HHS website is improving Healthcare.gov, and it contains with rules and financial information for physicians, employers, and individuals.

These are important changes for physicians and practice management teams to know as they will impact not only how you invoice but how your patients react to prevention, wellness, chronic care management, and more.  It will be imperative for practice managers to understand the limitations from the new insurance plans.  On the other hand, due to the previous updates in the ACA from 2010 till the present, many prevention screenings, refills on chronic care management, and educational opportunities (such as those for obesity and diabetes) are covered at lower costs to the patients or at no-cost.

The shift to accountability in care starts, first, with the provider-patient relationship. TPatients, in some of the new health plans, can receive lower costs for prevention screenings (annual exams for Medicare recipients, as an example).  New individual coverage for patients age 19-26 comes with their parents’ policies.  Others, particularly those who do not receive coverage through their current employer, began purchasing policies through the exchanges and coverage this year..   Successful practices have been asking about insurance changes and ask about the date that the new plan begins coverage.

Additional revisions in the ACA have removed limits on pre-existing conditions, leveled the premiums for women (who were previously classified as higher risk on the basis of their gender), and called for comparative effectiveness research for treatments.

Given the enormity of change, physicians and their practice members and staff may be confused about what some key concepts mean generally and how they relate to their medical practices.  Practices need to be familiar with key concepts in order to diagnose and treat people according to the new insurance plan requirements. Key to success are the changes in reimbursement that are included and what measures of quality, value and outcomes are fundamental to the success of practice management. 

A high-level overview of these concepts and their impact is included in a white paper we have developed that can help you and your practice team be better prepared for the new patients and the new reimbursement requirements. Click here to request and download the white paper.

HealthshareTV – New videos added this week

By Claire Thayer, January 31, 2014

MCOL’s HealthshareTV site has thousands of videos covering important topics for business leaders.  Select from over thirty-five categories, including Accountable Care, Benefits, Consumer Driven, Health Insurance Exchanges, Health Reform, Medicaid, Predictive Modeling, readmissions, Trends, and more.   Here are some of the new videos added this week:

We hope you’ll visit the site regularly, and while there, be sure to search Featured Videos, check out the Editor’s Picks, or sign up for the HSTV Newsletter!

Effectiveness of SMS in healthcare

By Krista Burris, January 28, 2014

Healthcare is at a tipping point and as such, unprecedented efforts are being made to improve health outcomes and foster efficiencies in healthcare delivery. What seems promising with the current reform and transformation efforts is the convergence of existing mass markets influencing healthcare innovation. For example, leveraging mobile phones to track, monitor, and engage patients in lifestyle and self-health management. Mobile text messaging communication in particular has proven to be an effective way to foster desired behavior change in patients and improve the way in which care is delivered by capturing important data that is actionable.

The need for improving outcomes and creating efficiency becomes increasingly important in the context of the coverage expansion in the Affordable Care Act where millions of Americans will enter the system, utilizing more healthcare resources. In particular, the Medicaid expansion is projected to result in a total of 75.6 million enrollees for 2014, an increase of roughly 19.5 million as a result of the ACA[i]. Leveraging mobile text message communication to facilitate convenient and efficient communication among patients and providers, as well encouraging desired behavior change by providing patients with educational tools to improve health outcomes, is encouraging to achieve on the triple-aim objective of healthcare reform[ii].

The opportunities to innovate using mobile technologies among the low-income and underserved populations are robust. A review of several research publications as well as surveying key constituents within the healthcare ecosystem serving these populations[iii], it is clear that the unmet needs plaguing the healthcare safety-net and contributing to waste include poor appointment attendance[iv], poor medication adherence[v], and poor health literacy[vi].

Extending the successes of current mobile text message patient engagement strategies to each of these unmet needs has the potential to reduce waste and inefficiencies in the system by improving health literacy and self-health management of low-income and underserved populations.

SMS text-messaging has shown a positive impact on fostering the desired behavior change in patients. A review of existing studies show that text messaging can support improvement in appointment attendance, increased medication adherence, and enhanced literacy through educational content outreach.

SMS text message appointment reminders

Patients failing to attend their scheduled doctor visits contribute to inefficiencies and misused resources[vii]. In general it is found that a reminder, whether it be by text or phone, is helpful in improving attendance, however SMS technology is a more cost-effective approach[viii].

A 2012 study analyzing the effect of SMS text reminders to reduce nonattendance for hospital outpatient visits found a significant difference in the attendance rate of patients who received a text reminder compared to patients who received no reminder[ix]. The results concluded that the attendance rate for patients who received text message reminders over the 4 month period were significantly higher (79.2%) compared to the attendance rate of those who received no reminder (35.5%).

Another study measuring the impact of SMS appointment reminders for outpatient clinic visits in Brazil found that text message reminders reduced nonattendance rates, improving patients’ care and ensuring the right care at the right time[x]. The nonattendance reduction rates for appointments at the four outpatient clinics studied were 0.82% (p= .590), 3.55% (p= .009), 5.75% (p= .022), and 14.49% (p= < .001).  These results suggest that text is an effective and efficient way to ensure patients attend their scheduled clinic visits and do not have interrupted care.

SMS text message medication reminders

Patients’ failure to adhere to their medication regimen can lead to unnecessary disease progression and complications. This contributes to waste in the healthcare system including preventable visits to the emergency room and increased utilization of other healthcare resources. Researchers have evaluated the impact of SMS text reminders on promoting medication adherence. The results are promising, suggesting text as an efficient and effective way to ensure patients take their medication.

The World Health Organization conducted a review of trials and studies that evaluated the effectiveness of mobile text medication reminders for HIV patients on anti-retroviral therapy drugs[xi]. The overall conclusion was that patients who receive text message reminders had a significantly higher adherence rate to their medications compared to patients that did not receive any kind of reminder. For conditions such as HIV where medication adherence is critical in preventing or stalling disease progression towards AIDS, as well as other comorbidities, the use of SMS technology can enable proper compliance of medication needs.

A study reviewing SMS reminders for diabetic patients concluded that text reminders improves adherence to oral antidiabetics[xii]. In the study 56 patients were confirmed to receive text reminders to take their medication, compared to 48 patients who received no reminder. Medication of both groups was measured using Real Time Medication Monitoring (RTMM) of oral antidiabetics in terms of (1) days without dosing; (2) missed doses; (3) doses taken within predefined standardized time windows. Patients' experiences were surveyed through questionnaires. The results found that patients who received reminders had a higher rate of adherence including a higher rate of taking their medication in the predefined time interval of receiving the reminder. The study also concluded through the patient survey questionnaire that patients found the reminders helpful.

SMS text message delivering educational content

SMS text-based education is emerging as an effective way to engage patients in better self-care. Lack of education around basic health information leads to approximately $106 billion to $238 billion in economic burden each year[xiii].  Text message outreach with educational content can be an efficient way to improve patients’ health literacy.

The Center for Connected Health in Boston reported in a study that text messaging improved treatment adherence and self-care for dermatology patients suffering from atopic dermatitis[xiv]. In the study, 25 patients received daily text messages over a period of six weeks. The text messages included treatment reminders and educational content pertaining to their health condition. At the end of the six week study, patients reported and improvement of treatment adherence of 72% and roughly 68% of the patients reported an improvement in self-care behaviors to help their conditions.

Two other studies evaluated the use of text messaging in improving self-care and desired behavior change for Type 1 diabetic patients[xv]. One study tailored text message communication to self-management goals, as well as untailored content such as newsletters and tips from other patients. The results showed that the patients enrolled in the text program were engaged in interacting with the technology. The participants seemed to enjoy the community aspect of the technology through the ability to connect with their provider and peers. The second study evaluated the use of text message technology among families of children with type 1 diabetes. In this study, the parents received informational messages pertaining to their children’s care needs. The study results concluded that the text messages were helpful and aided in better dialogue between parent and child around the disease condition.

Ensuring proper self-care is important for patients living with chronic disease as much of the care needed to manage these diseases occurs outside of the clinic and provider supervision. Providing patients with easy and consistent access to information to better understand their conditions and comply with proper care practices can lead to improved health outcomes.

Conclusion

Mobile text communication can be a cost-efficient and effective way to engage patients in the desired behavior change to improve appointment attendance, medication adherence, and self-care management of disease. As the healthcare system transitions to a focus on improving health outcomes, engaging patients in the management of their health is critical. SMS text messaging is a low-cost way to facilitate engagement and enhance the health literacy of individuals living with chronic conditions and other health challenges.

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[i] National Health Expenditures Projections 2010-2020. Forecast Summary. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2010.pdf.

[ii] The triple-aim is a framework developed by the Institute for Healthcare Improvement to address experience of care, population health (improving outcomes), and per capita cost of healthcare services; It is generally accepted that the Affordable Care Act uses the triple-aim as a core principle to design healthcare transformation: “Moving toward the “triple-aim”: The Affordable Care Act and the implications for payment and quality reform”. http://www.ehcca.com/presentations/pfpsummit6/dentzer_1.pdf.

[iii] Feedback from the healthcare community includes discussions with senior leadership of San Francisco Community Clinic Consortium, including St. Anthony’s Foundation.

[iv] Kaplan-Lewis, E. Percac-Lima, S. “No-show to primary care appointments: why patients do not come.” Journal of Primary Care and Community Health. July 2013. http://jpc.sagepub.com/content/early/2013/07/26/2150131913498513.abstract.

Anecdotal feedback from St. Anthony’s Foundation reported an approximate $250 loss in revenue from each no-show appointment.

[v] Nichol, M.B. Knight, T.K. Priest, J.L. Wu, J. Cantrell, C.R. “Nonadherence to clinical practice guidelines and medications for multiple chronic conditions in a California Medicaid population.” Journal of the American Pharmacist Association. 2010. http://japha.org/article.aspx?articleid=1043767.

[vi] Somers, S. Mahadevan, R. “Health Literacy: implications of the Affordable Care Act.” The Institute of Medicine, Center for Health Care Strategies, Inc. 2010. http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/Commissioned%20Papers/Health%20Literacy%20Implications%20of%20Health%20Care%20Reform.pdf.

[vii] Hasvold, P.E. Wootton, R. “Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review”. Journal of Telemedicine & Telecare. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21933898.

[viii] Chen, ZW. Fang, LZ. Chen, LY. Dai, HL. “Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial.” http://www.ncbi.nlm.nih.gov/pubmed/18196610.

[ix] Prasad, S. Anand, R. “Use of mobile telephone short message service as a reminder: the effect on patient attendance.” International Dentistry Journal. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22251033.

[x] da ,Costa TM, Salomão, PL. Martha, AS. Pisa, IT. Sigulem, D. “The impact of short message service text messages sent as appointment reminders to patients' cell phones at outpatient clinics in São Paulo, Brazil.” 2010. http://www.ncbi.nlm.nih.gov/pubmed/19783204.

[xi] Sharma, P. Agarwal. P. “Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection.” The WHO Reproductive Health Library. The World Health Organization. 2012. http://apps.who.int/rhl/hiv_aids/cd009756_sharmap_com/en/index.html.

[xii] Vervolet, M. van Dijk, L. Santen-Reestman, J. “SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored” In J Med Inform. 2012;81(9); 594-604. http://www.ncbi.nlm.nih.gov/pubmed/22652012.

[xiii] Vernon, JA. Trujillo, A. “Low Health Literacy: Implications for National Health Policy.” Rep. Washington: George Washington University, 2007. http://sphhs.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyReport10_4_07.pdf

[xiv] Pena-Robichauz, V. Kvedar, J. Watson, A. “Text Message as a Reminder Aid and Educational Tool in Adults and Adolescents with Atopic Dermatitis: A Pilot Study.” Dermatology Research and Practice. 2010. http://www.connected-health.org/programs/dermatology/research-materials--external-resources/text-messages-as-a-reminder-aid-and-educational-tool-in-adults-and-adolescents-with-atopic-dermatitis-a-pilot-study.aspx.

[xv] Franklin, V. Greene, A. Pagliari, C. “Patients’ engagement with ‘Sweet Talk’- A text messaging support system for young people with diabetes.” Journal of Medical Internet Research. 2008. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483928/#!po=2.50000.

Wangberg, SC. Arsand, E. Andersson, N. “Diabestes education via mobile text messaging.” Journal of Telemedicine and Telecare. 2006. http://www.ncbi.nlm.nih.gov/pubmed/16884582. 

Mobile Opens, Desktop Opens and Webmail Opens

By Claire Thayer, January 22, 2014

 A new report on email marketing by Litmus, shows that in November 2013, mobile opens surpassed the 50% mark for the first time, with 51% of all emails now being opened on mobile devices, with most of these occurring on iPhone, Android and iPad mobile devices.   Webmail opens trend down from 25% to 20% while desktop opens saw a slight downward trend from 33% to 29%. Here’s a summary graphic:

For more info on trends in Mobile Opens, Desktop Opens and Webmail Opens, check out the full year end summary on the Litmus-email-client-market-share-2013-infographic here.

2014 TOP 10 Watchlist

By Lindsay Resnick, January 21, 2014

Here's what's on this year’s radar screen for leading healthcare companies.

1. Obamacare 2.0 Robust post-enrollment learning agenda to understand which customers came into the market, who stayed out, how they shopped, what’s their mix of risk, and new competitors to look out for.
2. Risk Management Millions of underserved, high-risk health care consumers with unmanaged illness entering the insurance and medical delivery systems shiny new health insurance ID cards and pent-up demand for care.
3. Quality Outcomes Providers of healthcare putting skin in the game with pay-for-performance risk sharing schemes moving healthcare toward outcomes-based financing system based on quality and clinical results.
4. Chronic Care Next generation care management to deal with chronic medical conditions accounting for $3 out of every $4 of the country’s $2.8 trillion health care bill and 17 million boomers turning 65 over next 5-years.
5. Personal Wellness  Consumers changing health attitudes and behavior to improve quality of life and find ways to reduce personal health expenditures as they are forced to take more individual healthcare responsibility.
6. Connected Data Gathering, analyzing and interpreting consumer data to understand variations among market segments to develop a complete snapshot or “360° view” of customers to achieve true member engagement.
7. Retail Healthcare Benefit standardization, regulatory constraints and price transparency commoditizing markets and neutralizing brands means new approaches to awareness, acquisition, activation, retention and loyalty.
8. Mobile Health Always-on consumers expect any desired information or service is available on any device at a person’s moment of need; a mobile lifestyle now defines a customer’s way of connecting and interacting.
9. Socialnomics Social media driven consumer communities for collaboration and communication that cut across every market segment and every aspect of the customer relationship, from sales to product to service.
10. Customer Centricity It’s the new selling: engaging health insurance consumers with a superior, loyalty-based user experience; it’s guided by customer insights, cross-functional metrics, and championed by the C-Suite.

Keep a close watch on these impact trends to proactively managing change and stay ahead of your competitors.

Health Engagement and MLK

By Cyndy Nayer, January 21, 2014

It’s Martin Luther King Day 2014. The sun is shining and the quotes are flowing on the media.  Each year I seek one of his quotes to guide my efforts:

Human progress is neither automatic nor inevitable... Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.[1]

I continue to seek the comfort of his timeless words because rest does not come easy to an innovator, a “change agent,” just as it does not come easy to a country in need of predictability and trust. The trial-and-error distress of health care transformation feels like a weight on the US business and health care delivery systems.  In an era of uncertainty, the goal of health improvement has been a sidebar.  The Affordable Care Act suffers from a tiresome rollout on a dysfunctional website, but the real malaise is the weariness of those who see promise in the accessibility of care by all. At these moments, Dr. King’s words inspire the courage to persevere.

In order to create predicable, sustainable business growth in the health care sector AND the general business community, we must aim for engagement of all the health care users and providers in order to achieve better health.  Better health care is a tool, just as better jobs, better education, and better roads are tools towards economic security.  These goals are not held solely in the health care delivery sector nor the US or state governments.  The power of better health lives in all of us.

We need health engagement across all of the stakeholders. Consumer-driven must not be “consumer choice” without consumer input.  Patient-centered cannot be decided around the patient without the patient and/or patient-family input.  Provider reimbursement must not fall only on the physicians and hospital networks, but to all of us to create the economic justice that will support the long-term change.

From packaging data and purchasing services, from bundling payments to building centers of excellence to increasing jobs, each strategy must address the question, “will this build better health?”  If we are to build this vision of health, which, by definition demands the alignment of goals for all of those that touch “health care,” then we must define the alignment needed and disconnects that exist.  Some of the most obvious are:

1. In an era of high-deductible health plans, asking the patient/consumer to adhere to a treatment regimen that is unaffordable;
2. Ignoring depression or anxiety in the treatment of a chronic condition, which can derail the success of a patient to get to optimal health;
3. Changes in evidence and safety recommendations that take years to get to the primary care physician and his/her staff;
4. Misaligned payments, such as fee-for-service in primary care when the goals are adherence to lifestyle and treatment regimens—this misalignment drives up total costs without regard to patient or provider commitment;
5. Purchasing health services, devices, communication, and treatments without holding the vendors accountable for outcomes, and most especially accountable for improved engagement and adherence in high-cost condition management.

These obvious disconnects are the rationale for recasting the Health Value Continuum as an engagement framework with defined goals, from waste reduction (paying for readmissions, paying for emergency care with no emergency, and paying for risk appraisals with low participation) to organizational performance, and ultimately to community sustainability (wherein there is measurable improvement in health and economic risk). 

In short, getting to health, wealth and performance demands engagement and accountability for our own health and wealth.  Our personal commitments must be mirrored in the organizational accountability from the providers, systems and payers.  These personal and system commitments should reflect in the policy improvements that will support interoperable technology, innovation, and reduction of food deserts, among other lofty goals.  Can we get there?  We can, with the faith that we are on the road to better lives, as Dr. King envisioned.  Our faith and courage will take us to the health quality and efficiencies that every community in the US needs and deserves.

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[1] http://www.brainyquote.com/quotes/authors/m/martin_luther_king_jr.html

Grading the Emergency Care System

By Clive Riddle, January 17, 2014

For the first time since 2009, the American College of Emergency Physicians (ACEP) issued their report card on the emergency care system at the state and national levels. Our grades have slipped. Their 149-page report “America’s Emergency Care Environment: A State-by-State Report Card” — examines 136 different emergency system measures in five categories, as follows:

Category	% of Overall Grade	2009 National Score	2014 National Score
Access to Emergency Care	30%	D-	D-
Quality and Patient Safety	20%	C+	C
Medical Liability Environment	20%	C-	C-
Public Health and Injury Prevention	15%	C	C
Disaster Preparedness	15%	C+	C-
Overall	100%	C-	D+

The point ACEP wishes to illustrate through the report is that the current health care system, as well as the health reform environment rely heavily upon the nation’s emergency care delivery, and the state of emergency care is not necessarily up to the task going forward.

ACEP President Dr. Alex Rosenau, tells us “there were more than 130 million emergency visits in 2010, or 247 visits per minute. People are in need, but conditions in our nation have deteriorated since the 2009 Report Card due to lack of policymaker action at the state and national levels. With so much changing in health care, emergency care has never been more important to our communities. This Report Card is a call to action.”

In the report’s state-by-state rankings, these states stand out at the top and bottom five:

District of Columbia (1st, B-) Massachusetts (2nd, B-) Maine (3rd, B-) Nebraska (4th, B-) Colorado (5th , C+)

Kentucky (47th, D) Montana (48th, D) New Mexico (49th, D) Arkansas (50th, D-) Wyoming (51st, F)

What to do about these poor grades? Here are the recommendations made in the report:

1. Protect access to emergency care as health care reforms are implemented.
2. Support programs that recognize the pivotal role emergency medicine plays in care coordination and transitions of care.
3. Reduce the incidence of hospital crowding and boarding of admitted patients in the emergency department.
4. Enact federal and state medical liability reforms that enhance timely access to quality care, particularly those that provide appropriate liability protections for EMTALA-mandated care.
5. Increase coordination and regionalization of specialized emergency services and support funding of federally authorized regional pilot programs.
6. Devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness.
7. Continue to increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment.
8. Continue pursuit of state laws that help reduce the number of preventable deaths and injuries, particularly those that address traffic-related injuries and fatalities.
9. Expand access to standardized and user-friendly state and/or federal prescription drug monitoring programs to decrease unintentional deaths by drug overdose.
10. Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged areas and in rural areas.
11. Support emergency medicine research, including basic, clinical, and translational research into improving the delivery of emergency care services.

The Locked-Up Potential of Healthcare Consumers

By Clive Riddle, January 10, 2014

It’s become a common theme in healthcare surveys – the consumer has all this potential in our era of health reform, and much is riding on the consumer in the healthcare reform equation, but to-date that potential remains largely locked up.

Altarum Institute’s Center for Consumer Choice in Health Care  has just released findings from their latest semi-annual Altarum Institute Survey of Consumer Health Care Opinions.  Let’s listen to what what Wendy Lynch, Director of Altarum’s Center author of their study has to say about that: “It’s a positive sign that people are open to asking their doctors about costs and involving themselves in their health care decisions. But overall, the study shows that people still have their head in the sand when it comes to what they think they can control. They have more power than they realize just by asking questions; now they just need to use it. Consumers still believe that problems in health care are the fault of insurance companies or government and underestimate what they can do themselves.”

Well said, Wendy Lynch.

Here’s some of Altarum’s findings from their eighteen-page report on the study:

“One-third would like to make a shared decision with their doctor, and 43% want to make the final decision with some professional input. Fewer than 10% of consumers prefer the doctor to have the final say in decision making… There appears to be a recent decline in the percent of consumers who want to be completely in charge of their decisions, from more than 30% in fall 2011 to 16% in fall 2013.”

“35% [of  consumers] sometimes forget to take their medicine, and 28% did not take their medication within the past 2 weeks. When examining rates by age, younger respondents were more likely to forget or skip medications.” [46% of ages 25-34 sometimes forget, and 35% of this group skipped in past two weeks]

“63% of consumers reported that a doctor has ever invited them to choose among different medications or treatments. A larger share (83%) reported that they have received a doctor’s recommendation for a specific course of action.”

“Four out of five consumers (79%) use input from friends and relatives to guide them in their health care provider choices. More consumers tapped into online sources compared to prior years, nearly one-third (32%) reported that they use online ratings of a doctor’s bedside manner or waiting time, and 27% use online quality ratings. Only 16% indicated that they look at cost information to assist them in selecting a doctor, and use of advertisements remains low at 7%.”

“The majority of consumers indicated that they would be comfortable approaching their doctor about the cost of health care services. Four out of five are either somewhat or very comfortable asking about price. Only 15% and 4% are somewhat and very uncomfortable, respectively. Despite these high comfort levels, fewer than half (46%) of all respondents reported that they have ever asked how much a visit would cost before going to the doctor.”

“Only 6% felt very confident and 29% were somewhat confident that they could take steps to find less expensive care. Nearly half (47%) were uncertain and 18% were not at all confident that they could reduce costs. They appeared to be slightly more convinced that they could shop for better doctors, if not better prices. Just a little more than half (52%) felt that they could compare information to select a more qualified health care provider, while 39% were uncertain and 9% were not at all confident.”

“20% of individuals who strongly agreed with the statement “There is nothing I can do to affect the cost of health care” also reported that they are overweight, they use tobacco, or they do not exercise. Only 13% of patients who reported none of those unhealthy behaviors agreed with the same statement.”

“Three out of five (44%) reported that they sometimes choose to go without health care due to financial concerns. Additionally, 27% respondents reported that the main reason why they are currently employed is to receive health insurance benefits. In general, cost seemed to be more prohibitive for younger respondents.”

“Only 5% of consumers are certain that they will have the recommended savings needed to cover health expenses after they retire. On the other hand, more than 80% are either unsure or unlikely to have enough money set aside for health care post-retirement.”

Can the Consumer Choose Wisely in 2014?

By Clive Riddle, January 3, 2014

The just released January 2014 issue of Medical Home News includes a profile of Paul Keckley, PhD, in which he is asked this question: “Looking back on your years as a health care analyst, what has been this country’s major achievement and what has been its greatest disappointment in terms of health care delivery?” His answer: “Greatest disappointment: the consumer is ignorant about the health system, even after all the fuss for and against health reform. Greatest positive: data-driven healthcare!!”

In August 2013, Kaiser Family Foundation released new survey results that the Wall Street Journal summarized as:  Consumers Remain Baffled By Health Law, Poll Shows. At the end of the year, things got no better. Consider findings from a December 2013 Consumer Reports survey of consumers regarding the Affordable Care Act which found:

• 38% of respondents indicated they felt LESS informed over the course of the past month.
• 48% thought the ACA established a government-run health plan
• 36% thought the new law allowed the government to control their selection of doctors
• 30% believed the law set up government panels that would dictate decisions about end-of-life care
• One-quarter or less of respondents correctly identified the above as false statements.

But Paul Keckley’s point wasn’t just that consumers are confused about reform – rather that they are confused about the entire system, in spite of reform. And there a plethora of survey results previously cited in mcolblog postings to back that up.

George Van Antwerp, in blogging his 2014 healthcare predictions, posts that “consumer engagement in healthcare will continue to be the elusive Holy Grail.”

It is difficult to engage someone who is confused, and ignorant about the system. The consumer might feel as if they are in the scene at the end of Indiana Jones and the Last Crusade, confronted with a hundred different goblets, with only one being the true Holy Grail, as they try to navigate their health choices, and fear that the Guardian of the Holy Grail won’t be telling them that they “have chosen wisely.”