Aligning Wellness Program Incentives to Increase Use of Digital Health Apps

By Claire Thayer, March 29, 2016

A recent HealthMine survey of 500 insured consumers finds that half of those surveyed are enrolled in a wellness program and one-third received their health device/app as a benefit of their wellness program.  Of those now using digital health tools, most were for tracking fitness and nutrition purposes. Pharmacy and medication tracking apps were used by 28% and 14% of those surveyed; patient portal by 22%, and about 10% indicated they were using apps for prescriptions / medical provider price comparisons.  A bit surprisingly, only 7% were using disease management apps:

More on these findings, including biggest motivators to use digital health apps, are published at HIT Consultant.

Telemedicine and Virtual Visits preferred by close to one-third of consumers

By Claire Thayer, March 17, 2016

Telehealth, quite simply refers to the use of electronic technology to deliver health care and health information between patients and their providers. Use of mobile devices and smartphones for vitual visits and remote patient monitoring alone goes a long ways in terms of enhancing patient engagement. The American Telemedicine Association reports that up to 15 million people used telehealth services in 2015, a 50 percent increase from 2013. 

A new Accenture survey finds that nearly one-third (29 percent) of consumers said they prefer virtual doctor appointments to face-to-face doctor appointments,  compared with just under one-quarter (23 percent) in the 2014 survey.

The survey further finds that both physicians and consumers alike believe that virtual visits provide benefits for patients, such as:

• lower costs:  58% of consumers vs. 62% of doctors
• convenience:  52% of consumers  vs. 80% of doctors
• timely access to care: 42% of consumers vs. 49% of doctors

For providers, plans and health systems evaluating incorporation of telemedicine into overall care delivery systems, ECG Management Consultants offers a few key questions to take into consideration:

• What operational and care delivery challenges is your organization looking to solve?
• How far do your patients live from sites of care?
• What are the demographics and health needs of your organization’s patient population?
• Which services will your contracted health plans reimburse for?
• What is your organization’s capacity and ability to build telemedicine services internally?
• Which companies are the right partners to support your telemedicine services?
• What is the level of technology adoption in your organization, and what are the technology habits of your patient population?

HIMSS: Only 3% of Providers Believe Their Organization is Highly-Prepared for Transition to Value-Based Payment Model

By Claire Thayer, March 14, 2016

The clock is ticking! There’s a lot of incentive for hospitals and physicians to transition to value-based care.  With the onset of the Affordable Care Act, HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. Last week it was announced that  more than 30 percent of Medicare payments are now made through alternative payment models tied to quality outcomes.

The 2016 HIMSS Cost Accounting Survey finds that while the transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces,  a mere 3% of respondents believe their organization is highly prepared to make the transition from fee-for-service to a value-based payment system.

The Top 3 Needs in transitioning to a value-based payment system, identified in the HIMSS Survey:

• Tools to track and evaluate quality of care
• Better communication between disparate providers
• Consistent definition of quality by specific type of disease

Use of Predictive Analytics in Health Care

By Claire Thayer, March 3, 2016

Healthcare payers and providers are increasingly looking for innovative strategies to leverage big data and use of predictive analytics across the organization to manage population health risks, identify claims trends, improve clinical outcomes, reduce costs, etc.  Management of all the data and integration of the systems built up over time is complex at best  - 72% of CIOs surveyed reported using more than 10 platforms or interfaces to extract data, while still relying on traditional sources: Clinical Data from EHRs (95%); Pre-adjudicated administrative, billing and financial data (91%), and post-adjudicated claims data (69%).   Given this, it’s not surprising that many payer organizations are now seriously looking to outsource their IT and analytics related projects - 93% of health plans responding to recent Black Book survey plan to do so by Q1 2017. 

These and issues pertaining to predictive analytics in health care was the focus of a recent MCOL infographoid, highlighted below:

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

How Value-Based Care Ties to Physician Performance

By Claire Thayer, January 28, 2016

A recent survey by the Deloitte Center for Health Solutions finds that over the next 10 years, physicians expect as much as 50% of their compensation will be directly tied to value-based care (VBC). Developing accountability as well as physician support are essential components of VBC payment models. The Deloitte survey highlights these key factors in protecting physicians’ financial interests:

• 61% Limits to total financial risk exposure
• 46% Equitable, performance-based distribution of bonuses from shared savings
• 43% Ability to help set performance goals

Political and technical challenges exist in accurately measuring physician performance. In measuring physician quality, the Agency for Healthcare Research and Quality points out that resolving the issues listed below is critical to getting the consistent and valid results necessary for public reporting:

• Rules for attributing patients to individual physicians
• Methods for aggregating data from different sources
• Methods for creating composite scores
• Calculation of benchmarks and assignment of peer groups for comparing physician performance
• Processes for auditing/validating results

These and other issues on how value-based care ties to physician performance were the focus of a recent MCOL infographoid, highlighted below:

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

Accuracy of Health Provider Directories

By Claire Thayer, December 17, 2015

Health plans participating in the federal exchange program (think Obamacare) and Medicare will be required in 2016 to monitor and maintain online directories.  CMS online directory requirements stipulate that health plans are to communicate with their contracted providers for updates on their ability to accept new patients, changes to street address or phone number, along with any of changes affecting availability to patients.

Penalties will be assessed for inaccuracies discovered in the online provider directory – and the assessment may be steep --up to $25,000 a day, per beneficiary for Medicare Advantage plans, and up to $100 per day for those covered under the federal exchange program.

A recent study into the availability of providers in the Medicaid Managed Care program found that 43% were not participating in the Medicaid managed care plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed.

These and other issues on maintaining accurate information in provider directories was the focus of a recent MCOL infographoid, highlighted below:

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

List of Chronic Diseases for Young Adults – Add Mental Health!

By Claire Thayer, December 13, 2015

When we think about chronic conditions, we typically think about chronic diseases such as cancer, heart disease, diabetes, etc. But rarely is mental health thought of as a chronic condition. According to data in the 2014 National Survey on Drug Use and Health (NSDUH), 11.9 percent of young adults aged 18 to 25 received mental health services in the past year

It’s interesting to note that 42.3 percent of young adults who received mental health services in the past year are receiving prescription medication as their only mental health service.

A recent Health Affairs blog, The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults, identified 5 primary barriers in obtaining needed mental health treatment:

• Stigma
• Inadequate screening by primary care providers
• Trouble finding treatment
• Failure to implement evidence-based therapies
• Slow implementation of research findings

Additional information:

The CBHSQ Report, Substance Abuse and Mental Health Services Administration (SAMHSA). December 8, 2015.

The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults. Health Affairs Blog. October 1, 2015.

Mental Health Myths and Facts. MentalHealth.gov U.S. Department of Health & Human Services.

The Impact of Inaccurate Patient Data

By Claire Thayer, November 18, 2015

Matching of patient records to the correct person is of utmost importance in terms of patient safety and quality of care, yet gets complicated when organizations share their records electronically either with different EHR platforms or across multiple healthcare systems as well as when patients use different settings to receive their care.   The Patient Identification and Matching Initiative, sponsored by the Office of the National Coordinator for Health Information Technology (ONC), focused on identifying incremental steps to help ensure the accuracy of every patient’s identity. A few of the key findings outlined in the ONC’s  Patient Identification and Matching Final Report report suggest:

• Standardized patient identifying attributes should be required in the relevant exchange transactions.
• Any changes to patient data attributes in exchange transactions should be coordinated with organizations working on parallel efforts to standardize healthcare transactions.
• Certification criteria should be introduced that require certified EHR technology (CEHRT) to capture the data attributes that would be required in the standardized patient identifying attributes.
• Certification criteria that requires CEHRT that performs patient matching to demonstrate the ability to generate and provide to end users reports that detail potential duplicate patient records should be considered.

Also referenced in the extensive 85+ page ONC report: One-fifth of CIOs surveyed by College of Healthcare Information Management Executives (CHIME) indicated that at least one patient in the last year suffered an adverse event, due to mis-matched records. While exact cost impact is hard to gauge, one health system reported that poor patient matching is associated with an operational cost of fixing a duplicate record at $60. The overall impact of inaccurate patient data was the focus of a recent MCOL infographoid, highlighted below:

 

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

Transitioning payer reimbursement from volume to value

By Claire Thayer, October 20, 2015

Moving away from traditional reimbursement models based on volume to those aligned more closely with outcomes, cost and quality is easier said than done, but has over-whelming industry support.  Earlier this year, Modern Healthcare spoke with committee members of a new Health Care Transformation Task Force (made up of providers, insurers and employers) who pledged collectively to shift 75% of its members' business into contracts with incentives for health outcomes, quality and cost management by January 2020.

The U.S. Department of Health and Human services has jumped on board the value reimbursement trend as well, setting a goal of tying 30% of traditional fee-for-service Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50% of payments to these models by the end of 2018.  A Deloitte study found that 72% of surveyed health executives said that the industry will switch from volume to value. The Case for Value-Based Care was the focus of a recent MCOL infographoid, highlighted below:

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

A Quick Look at Provider Billing Facts

By Claire Thayer, September 9, 2015

In 2014, the U.S. health care system spent close to $1 trillion on health care, with half of this paid to hospitals, a third toward physicians and clinical services and the remainder on prescription drug spending. Over the next 10 years, CMS projects that health spending will continue its steady upward pace and grow at an average rate of close to 5.8% per year. While perhaps not surprising, examining the validity of claims is proving to be an enormous undertaking, with a recent GAO Report on the Medicare Program estimating that $60 billion (close to 10%) of total Medicare claims paid in 2014 was paid improperly. These and a few other provider billing and payment facts are highlighted MCOL’s infoGraphoid this week:

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

Cadillac tax may hit over 25% of employers starting in 2018

By Claire Thayer, September 2, 2015

One of the provisions of the Affordable Care Act is the high-cost plan tax (HCPT), aka the ‘Cadillac’ tax,  will be imposed on health insurance companies as well as sponsors of self-funded group health plans beginning in 2018.  Plans that exceed cost thresholds will incur the excise tax.  For 2018, cost thresholds are $10,200 for an individual (single coverage) and $27,500 for family. The excise tax is 40% of the amount that exceed these thresholds.

A recent analysis by the Kaiser Family Foundation of the impact of the Cadillac tax on employers summarizes the overall cost for each employee to include:

• The average cost for the health insurance plan (whether insured or self-funded);
• Employer contributions to an (HSA), Archer medical spending account or HRA;
• Contributions (including employee-elected payroll deductions and non-elective employer contributions) to an FSA;
• The value of coverage in certain on-site medical clinics; and
• The cost for certain limited-benefit plans if they are provided on a tax-preferred basis.

This same study estimates that in 2018, over 25% of employers offering health plan benefits may be subject to the Cadillac tax, and by 2028, as many as 42% of employers will incur this excise tax:

As employers look for ways to save costs, the Cadillac tax will have a huge impact on flexible spending accounts (FSAs), with some analysts conjecturing that this could lead to the demise of FSAs, as reported last week on Politico. Expect employers to make benefits changes during the open enrollment season for both this year and next. For more in-depth discussion, the Kaiser Family Foundation’s August 2015 Issue Brief will be insightful.

The Role of Master Data Management in Health Care

By Claire Thayer, August 25, 2015

Health Market Science tells us that Master Data Management (MDM) in health care encompasses everything from patient data to provider data detailing the treatments, procedures, modalities, products and processes which govern and describe patient interactions and outcomes. A recent KPMG survey finds that a slight 10% of health care organizations are effectively using advanced data collection and analytic tools in this regard.  MCOL’s recent infoGraphoid outlined summary findings from the KPMG survey, along with core customer entity types, key barriers to properly implementing data and analytic tools and primary main drivers to MDM:

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.

Accuracy of Provider Directories

By Claire Thayer, July 17, 2015

Beginning in 2016, health plans will face stiff penalties for failing update and monitor their provider directories. Kaiser Health News reports that inaccuracies in provider directories may trigger penalties of up to $25,000 per day per beneficiary for inaccuracies in Medicare Advantage directories while providers involved with plans on the federal exchanges could face penalties of up to $100 per day per affected beneficiary for problems in their directories.

MCOL’s infoGraphoid for this week takes a deeper look into the state of provider directories across the country:

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

Health Plan Member Portals

By Claire Thayer, June 18, 2015

During the months of May and June, MCOL and LexisNexis conducted an e-poll of healthcare professionals on their involvement and insights with health plan member portals.  Respondents were categorized as Health Plan, Integrated delivery Network, Third Party Administrator (TPA), Self-Insured Employer, and Other. Overall, two thirds of the respondents indicated that they currently have a health plan member portal in place, and 43% of those who currently don’t have a health plan member portal in place plan on establishing one within the next 12 months. 

MCOL’s infoGraphoid for this week highlights results from the MCOL / LexisNexis e-poll as well as Cigna’s experience with their CDHP customers’ use of health portals and a recent HIMSS Leadership survey on use of patient portals:

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.

Impact of Stress on Health Risk

By Claire Thayer, May 20, 2015

Stress is prevalent, and at some point, all of us are faced with some type of stress in our lives.  What is considered as a stressful situation to one person may be inconsequential to another.  A recent WebMD study finds that 43% of all adults suffer adverse affects from stress. WebMD tells us that a little stress every now and then is not something to be concerned about. However, it’s the ongoing chronic stress that can cause or exacerbate many serious health problems, including:

• Mental health problems, such as depression, anxiety, and personality disorders
• Cardiovascular disease, including heart disease, high blood pressure, abnormal heart rhythms, heart attacks, and stroke
• Obesity and other eating disorders
• Skin and hair problems, such as acne, psoriasis, and eczema, and permanent hair loss
• Gastrointestinal problems, such as GERD, gastritis, ulcerative colitis, and irritable colon

MCOL’s infoGraphoid for this week takes a look at the impact of stress on health risk, outlining three different types of stress and the impact on both overall physical and mental health:

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.

Four Factors Fueling Demand for Telehealth

By Claire Thayer, May 7, 2015

Telehealth, as defined by the Health Resources and Services Administration, is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. 

MCOL’s infoGraphoid for this week identifies these four factors as the key components fueling the increasing demand for telehealth:

• Reduce Health Care Costs
• Improve Access to Care
• More Productive Workforce
• Better Patient Experience

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.

Provider Networks Referral Leakage

By Claire Thayer, April 16, 2015

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

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

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

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

By Claire Thayer, April 8, 2015

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

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

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

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

Medical Identity Theft Impact on Health Care

By Claire Thayer, March 12, 2015

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

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

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

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

Medicare Obesity Counseling – it’s Free!

By Claire Thayer, March 5, 2015

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

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

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