Positive Trends in the Land of Retail and Workplace Clinics

By Clive Riddle, May 29, 2015

Last month, the Robert Wood Johnson Foundation commissioned Manatt Health to issue an excellent 25 page report:  The Value Proposition of Retail Clinics, in which they remind us that “since first emerging on the health care landscape more than 15 years ago, retail clinics are now a common feature, with 10.5 million visits occurring annually at more than 1,800 retail clinics.

The report emphasizes the potential for current and future collaborations between retail clinic organizations and health care systems, noting “to date, more than 100 partnerships between retail clinics and health systems have been formed, linking care between retail sites and primary care medical homes, expanding after-hours care options and enabling health systems to provide patients with alternatives to emergency departments (EDs). In fact, one study estimated that up to 27 percent of ED visits could be handled appropriately at retail clinics and urgent care centers…”

With respect to the growth and scope of the retail clinic market, just this month CVS  Health’s MinuteClinic announced they  “will open more than 100 new clinics this year and anticipates surpassing 1,500 clinics by 2017,” and they have reached  the cumulative “25 Million Patient Visit Milestone.“

With respect to partnerships during the past month, California Healthline discussed: ”Kaiser-Target Partnership Sign of Times” and CVS Health announced clinical affiliations with Ochsner Health System in Louisiana and the University of Mississippi Medical Center, including their Center for Telehealth.

Meanwhile, on the workplace onsite clinic front, Towers Watson this week released their 2015 Employer-Sponsored Health Care Centers Survey report, which polled  137 U.S. employers in which 105 currently offer employer-sponsored health centers, and 15 are planning to offer by 2018, and represent 4.6 million employees.

Here’s some highlights of Towers Watson’s onsite clinic findings:

• 38% of large U.S. employers with onsite health facilities plan to add new centers over the next two years,
• 66% expect to expand or enhance the already broad services they offer by 2018
• Wellness programs are already available at 86% of the centers
• Lifestyle coaching to promote and reinforce behavior changes is currently offered at 63% of the centers
• Half of employer-sponsored health centers now offer some type of pharmacy services, up from 38% in 2012
• 35% offer telemedicine services, with another 12% planning to in the next two years.
• 40% have two to five centers
• 56% have had onsite health centers for over five years
• 55% are open before 8:00 a.m.; 32% are open after 5:00 p.m., and 16% are open on weekends
• 64% outsource managing staffing and services at the health centers
• 23% run the centers themselves
• 18% use local or regional provider groups or health systems
• 75% employers with onsite health centers calculate their ROI, up from 47% in 2012

One free resource for those monitoring activities in this sector, the Workplace & Retail Clinic Bulletin, offering free twice monthly e-newsletters.

Patient Reported Outcomes

By Clive Riddle, May 15, 2015

The National Quality Forum defines Patient-Reported Outcomes (PROs) as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else." They elaborate that “in other words, PRO tools measure what patients are able to do and how they feel by asking questions. These tools enable assessment of patient–reported health status for physical, mental, and social well–being.”

The concept is obviously not new, but has certainly been overlooked at times. In an era with tremendous advances and emphasis in patient engagement, mobile health technologies, patient-centered care, we need to continue to see application of PROs receive the attention they deserve.

Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions, tells us "As our healthcare system moves toward a value-based care model, the role of the patient is becoming increasingly important. We need to reframe the way we think about care to include not only the cost and clinical effectiveness of the treatment, but also the burden of disease and therapy on the patient's perceived sense of well-being. Patient-reported outcomes (PRO) are key to this equation, particularly for patients being treated for high-cost, complex diseases such as cancer or rheumatoid arthritis (RA)."

Dr. Feinberg’s organization is presenting a series of new clinical studies demonstrating the potential role of PRO research in improving the quality and reduce the costs of treatment provided to patients with complex diseases, at the International Society of Pharmacoeconomic and Outcomes Research (ISPOR) annual meeting.

Here's an overview of some of the key findings they will be presenting:

• One study used PRO to demonstrate that rheumatologists significantly underestimated the negative impact of RA disease burden and treatment on their patients' sense of well-being. Understanding this disparity in perceptions can help physicians make effective treatment decisions that lessen the burden on patients – and can sometimes also reduce the costs of their care.
• Another study showed that PRO can be critical to identifying and managing medication access and adherence challenges for high-cost specialty drugs.
• Of a total of 239 oncology and rheumatology patients who were contacted at the time of their initial prescription to provide patient reported outcomes, 28% were identified as having problems that either restricted access or adherence to the drug.
• Armed with this information, interventions and support services were provided to address those challenges. With the support of these interventions, a medication possession ration exceeding 95% was achieved – enabling nearly all patients to initiate or continue treatment.
• A third study  proved the feasibility of collecting PRO at the point of care. In the clinical study involving 3,185 RA patients, PRO data was captured during 90% of physician visits. The participating physicians were then able to utilize the data to inform real-time treatment decisions at the point of care.

Annual Global Oncology Medicine Spending Tops $100 Billion

by Clive Riddle, May 7, 2015 

The IMS Institute for Healthcare Informatics has just released a new report:  Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015 which tells us “total global spending on oncology medicines – including therapeutic treatments and supportive care – reached the $100 billion threshold in 2014, even as the share of total medicine spending of oncologics increased only modestly.” 

The report found that “growth in global spending on cancer drugs – measured using ex-manufacturer prices and not reflecting off-invoice discounts, rebates or patient access programs – increased at a compound annual growth rate (CAGR) of 6.5 percent on a constant-dollar basis during the past five years. Oncology spending remains concentrated among the U.S. and five largest European countries, which together account for 66 percent of the total market, while the rising prevalence of cancer and greater patient access to treatments in pharmerging nations continues to grow and now accounts for 13 percent of the market” 

Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics tells us“the increased prevalence of most cancers, earlier treatment initiation, new medicines and improved outcomes are all contributing to the greater demand for oncology therapeutics around the world. Innovative therapeutic classes, combination therapies and the use of biomarkers will change the landscape over the next several years, holding out the promise of substantial improvements in survival with lower toxicity for cancer patients.” 

Findings shared in the report include: 

• Growth in the U.S. has risen more slowly at 5.3 percent CAGR, reaching $42.4 billion in 2014, representing 11.3 percent of total drug spending compared to 10.7 percent in 2010.
• in the EU5 countries oncology now represents 14.7 percent of total drug spending, up from 13.3 percent in 2010.
• Targeted therapies now account for nearly 50 percent of total spending and have been growing at 14.6 percent CAGR since 2009.
• Within the U.S., two-thirds of Americans diagnosed with cancer now live at least five years, compared to just over half in 1990.
• The availability of new oncology medicines varies widely across the major developed countries, with patients in Japan, Spain and South Korea having access in 2014 to fewer than half of the new cancer drugs launched globally in the prior five years.
• Average therapy treatment costs per month have increased 39 percent in the U.S. over the past ten years in inflation-adjusted terms. Over the same period, patient response rates have improved by 42 percent and treatment duration has increased 45 percent, reflecting improved survival rates.
• Within the U.S., patient out-of-pocket costs have risen sharply for intravenous cancer drugs, increasing 71 percent from 2012 to 2013, reflecting changes in plan designs and increased outpatient facility costs. 

An interactive version of the full report is available via iTunes, but requires am iPad for viewing. Pdf versions of exhibits can be downloaded here. 

Does Patient Satisfaction Matter?

By Kim Bellard, April 24, 2015 

In a provocative article for The Atlantic, Alexandra Robbins posits that we may have a "problem with satisfied patients."  Ah, only in health care...

Ms. Robbins fears that hospitals may be focusing too much on making patients happier, rather than on making them well.  She cites how hospitals are rushing to provide "extra amenities such as valet parking, live music, custom-order room-service meals, and flat-screen televisions," which may help patients have a better experience but which mean resources not going directly to patient care.

She may have a point.

Ms. Robbins' analysis found that hospitals that do poorly on three or more categories of patient outcome measures actually score above average on patient satisfaction.  In her words: "Many hospitals seem to be highly focused on pixie-dusted sleight of hand because they believe they can trick patients into thinking they got better care."

Ouch.

Ms. Robbins cited a 2012 study by Fenton, et. alia, that further quantified the patient satisfaction "problem."   According to their research, patients with the highest satisfaction also have higher odds of inpatient admissions, greater prescription drug expenditures, higher overall expenditures, and higher mortality.

Patient satisfaction is clearly in vogue, as evidenced by CMS unveiling its star ratings on Hospital Compare last week, based on HCAHPS results, and by Medicare's increased focus on value-based payments.  The 2015 HIMSS Leadership Survey found that 87% of respondents listed patient satisfaction as their organization's top priority, higher than even sustaining financial viability (85%).

AHA's official response to the CMS ratings was cautionary: "There's a risk to oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons."

OK, fair enough...so what does AHA propose instead?

Another study on patient satisfaction, by Vanguard Communications, looked at patient reviews of physicians, and also found some unexpected results: "Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases."

I didn't see that one coming.

Vanguard believes that the ratings reflect more about customer service than clinical quality.  Ron Harmon King, Vanguard's CEO, says:  "Does that mean more highly trained specialists deliver poorer customer service? We can’t say with any certainty, although we found a correlation."

The Physicians Foundation 2014 survey found that 42% of respondents did, indeed, list a customer-service related reason for why they were satisfied with their family physician, way ahead of actual treatment related reasons (26%).  

 
Ms. Robbins is thus not alone in being skeptical about patient satisfaction scores.  She backed up her skepticism with a quote from nurse Amy Bozeman: "The patient is NOT always right. They just don’t have the knowledge and training."  

I hate to break it to either of them, but even with all our health care professionals' knowledge and training, our health system's record on quality is pretty dismal.

Look, patient satisfaction is not a perfect measure, nor should it ever be the only measure used, but it has to be an important measure.  I can see patients being initially swayed by amenities or even simple courtesy, neither of which have typically been in abundance in our health system.  But we can't afford to forgo the burgeoning effort to focus on improving patient satisfaction.  At some point we have to trust that patients will see through smiles and nicer waiting rooms, and judge quality based on whether they are actually getting better.

And, in fact, research from Johns Hopkins suggests that patients may not fall for "pixie dusted sleight-of-hand" tricks after all.  The study concluded that:

"Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses...Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores."   

As Abraham Lincoln famously said: "You can fool all of the people some of the time, and some of the people all the time, but you cannot fool all the people all of the time."

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

Vormetric Report: 48% of Healthcare organizations Had Data Breach or Failed Compliance Audit in Past Year

By Clive Riddle, April 16, 2015

Given the Anthem health plan hack in February, and other healthcare organizations that have fallen victim to breaches as of late, surveys offering threat assessments are certainly of interest. Vormetric just released the twenty-page 2015 Vormetric Insider Threat Report, which includes healthcare industry specific data.

How does Vormetric define Insider Threats? "Insider threats are caused by a wide range of offenders who either maliciously or accidentally do things that put an organization and its data at risk. The insider threat landscape is becoming more difficult to deal with as the range of miscreants moves beyond employees and privileged IT staff. It now includes outsiders who have stolen valid user credentials; business partners, suppliers, and contractors with inappropriate access rights; and third-party service providers with excessive admin privileges. Unless properly controlled, all of these groups have the opportunity to reach inside corporate networks and steal unprotected data."

Vormetric's 2015 Insider Threat Report was conducted online by Harris Poll during fall 2014, with 818 global respondents who work full-time as an IT professional with major influence in decision making for their company’s IT. In the U.S., 408 ITDMs were surveyed among companies with at least $200 million in revenue with 102 from the health care industries, 102 from financial industries, 102 from retail industries and 102 from other industries.

Vormetric reminds us that hacker attraction to healthcare is fueled by black market “healthcare records selling for tens to hundreds of dollars, while U.S. credit card records sell for 50 cents or less.” Alan Kessler, Vormetric tells us "healthcare data has become one of the most desirable commodities for sale on black market sites, yet U.S. healthcare organizations are failing to secure that data. An overreliance on compliance requirements and a cursory nod to data protection point to systemic failures that are putting patient data at risk. What's needed is for healthcare organization to realize that compliance is not enough, and to implement the controls and policies required to put the security of their data first."

Among healthcare organization respondents to their survey, 48% encountered a data breach or failed a compliance audit in the last year. 26% of healthcare respondents reported that their organization had previously experienced a data breach. 54% reported compliance requirements as the top reason for protecting sensitive data, and 68% rated compliance as very or extremely effective at stopping insider threats and data breaches.

63 percent of healthcare IT decision makers report that their organizations are planning to increase spending to offset data threats, which was the highest of any segment or region measured in the report.

When asked about the most important reasons for securing sensitive data, the top three responses from the healthcare sector were compliance (55%), implementing best practices (44%) and reputational protection (41%). In comparison to other business sectors the compliance response was 5 percentage points above other industry averages.

Accenture Pegs 2015 Private Exchange Enrollment at 6 Million

By Clive Riddle, April 10, 2015

Accenture has released a new report on private exchange enrollment: Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015, which pegs 2015 total private exhange enrollment at 6 million, up from 3 million in 2014.

Accenture forecasts that enrollment in private health insurance exchanges will grow to 12 million in 2016 and 22 million in 2017. They have gone on record projecting "total enrollment in private exchanges to ultimately surpass state and federally funded exchanges, reaching 40 million by 2018."

Here’s more on Accenture’s findings from their report:

• Accenture concludes that midsize employers, defined as companies with 100 to 2,500 employees, contributed most to the adoption of private health exchanges increase.
• 76 percent of consumers with employer-sponsored coverage see health insurance as a primary factor for continuing to work at their current employer
• Accenture points out that this limits some employers’ ability to drop or defund health coverage.
• Accenture postulates that for such employers, "private exchanges will emerge for some as a compelling model to reduce costs and administrative burden"
• Accenture notes that private exchange enrollment is expected to accelerate in 2017 due to looming penalties for “Cadillac” Plans.
• Accenture  also notes that market funding is growing, citing  Aetna’s bswift acquisition of bswift and Mercer’s equity investment in Benefitfocus
• Accenture further postulates that Accenture expects that "increased compliance requirements .. will drive employers to adopt new models for managing benefits administration."

Prescription Costs Returning to the Wild

By Clive Riddle, March 13, 2015

Numerous studies have been warning that prescription cost increases, domesticated and docile for some time now, have returned to the wild - resurging and rearing their unpleasant head.

During last fall, Evaluate published a new 18-page report , "Budget-busters: The Shift to High-Priced Innovator Drugs in the USA." that addresses the growth of high-end prescription drugs. Evaluate tells us that "the median price of the Top 100 drugs has skyrocketed from $1,260 in 2010 to $9,400 in 2014, representing a seven-fold increase," and that "the average patient population size served by a Top 100 drug in 2014 was 146,000 down from 690,000 in 2010. The number of treatments costing in excess of $100,000 per patient per year rose to seven in 2014 versus four in 2010."

When Segal released their 2015 Segal Health Plan Cost Trend Survey, they stated “Health benefit plan cost trend rates for 2015 are forecast to drop slightly for some coverage, but to increase substantially for prescription drug coverage...…The increase in the cost of prescription drug carve-out coverage for actives and retirees under age 65 is expected to jump to nearly 9 percent. Prescription drug trend for retirees age 65 and older is expected to rise to 7.5 percent, more than twice the rate of retiree medical cost trends. The projected specialty drug/biotech trend rate for 2015 is an exceptionally high 19.4 percent.”

A number of other studies cite similar concerns, and this week Express Scripts weighed in with their annual Drug Trend Report. They state “new hepatitis C therapies with high price tags and the exploitation of loopholes for compounded medications drove a 13.1 percent increase in U.S. drug spending in 2014 – a rate not seen in more than a decade.”

Here’s some key selections from Express Scripts findings:

“Hepatitis C and compounded medications are responsible for more than half of the increase in overall spending. Excluding those two therapy classes, 2014 drug trend (the year-over-year increase in per capita drug spending) was 6.4 percent.”

“Specialty medications – biologic and other high cost treatments for complex conditions, such as multiple sclerosis and cancer – accounted for more than 31 percent of total drug spending in 2014. As Express Scripts forecasted last year, specialty drug trend more than doubled in 2014, to 30.9 percent. Hepatitis C medications accounted for 45 percent of the total increase in specialty spend despite having the second lowest prescription volume among the top 10 specialty conditions. Medicare plans – required to follow Medicare Part D formulary guidelines – were the hardest hit, as their annual specialty drug spend increased 45.9 percent.”

“Spending on traditional classes of medications continues to rise as a result of compounded drugs, which emerged in the top 10 traditional therapy classes for the first time. Despite having the least number of prescriptions among the top 10 classes, compounded medications accounted for 35 percent of the increase in spending, the most of any traditional therapy class of drugs.”

“Drugmaker consolidation and drug shortages also led to increases in traditional drug trend, which rose to 6.4 percent in 2014. Diabetes remains the leading traditional therapy class for a fourth straight year based on total costs; Express Scripts expects double-digit increases in spend in this class over the next three years due to once-weekly oral and injectable drugs in the pipeline.  Cost for medications to treat pain increased 15.7 percent in 2014, due in part to new tamper-resistant formulations for opiates.”

Analysis of Managed Care Organization CEO Turnover Rates

By Clive Riddle, February 6, 2015

MCOL has just conducted an analysis of managed care organization CEO turnover during the past ten years, and found the turnover rates to be surprisingly high, given the importance of management stability and continuity for most organizations. One-fourth of managed care organization CEOs turned over during the past year,  one-third turned over during the past two years, one-half turned over during the past three years, two-thirds during the past five years and only one in seven remain from ten years ago.

That doesn’t mean that all turnover is attributed to firings or resignations.  More than half of the organizations analyzed are part of chain or system in which upward mobility within the organization is often the cause.

The analysis is based upon data from MCOL’s HealthQuest Publishers National Managed Care Leadership Directory, which lists health plans, provider networks, administrative organizations, PBMs, and specialty benefit organizations involved with managed care. The 2015 Directory was recently released. HealthQuest Publishershas released the annual directory since 1994. MCOL acquired HealthQuest Publishers in 2000.

Managed Care Organization CEO Turnover Percentage Compared to 2015 Incumbent

While 926 organizations are listed in the 2015 directory, only organizations also listed in applicable prior years were included in the analysis. Organizations are added or dropped in the directory over time based upon mergers & acquisitions, closures, consolidations and expansions.

The turnover rate percentage for each year, compared to the 2015 incumbent, for the MCOs that were also listed in each applicable year are indicated below. The number of applicable MCOs that are still listed in 2015 of course drops over time due to the factors listed above.

Year	CEO Turnover	Applicable MCOs
2014	25%	741
2013	36%	709
2012	52%	704
2011	61%	658
2010	68%	633
2005	86%	416

While the cause of turnover was not measured in the analysis, and upward mobility or other transfers within the same organization is undoubtedly a significant factor, disruption at the CEO level presents significant challenges for managed care organizations during this disruptive era of healthcare reform, regardless of the reasons for the change.

Lung Cancer Misperceptions: The “Any One Any Lung” Survey

By Clive Riddle, November 21, 2014

Misperception surrounding a disease can impact treatment, care, funding, and more. So it would seem is the case with lung cancer, as just highlighted in a new survey “Any One Any Lung” Survey sponsored by Novartis Oncology. The online survey was conducted by Harris Poll involving 10,111 adults from 10 countries including the U.S., 84% responding that they know little or nothing about lung cancer. The stated goal of the campaign surrounding the survey is to “to raise global awareness of lung cancer as a complex disease that can affect anyone, regardless of gender, age or smoking history.”

Stefania Vallone from the organization, Women Against Lung Cancer in Europe, has this to say in conjunction with the survey: “While patient advocates around the world have played an important role in raising lung cancer awareness, misinformation continues to surround this disease, creating barriers to treatment and patient care and often generating negative attitudes towards patients affected by this disease. We are calling on the general public to help correct misperceptions around lung cancer and highlight the disease for what it truly is, a complex and heterogeneous disease with many causes that can affect anyone, regardless of age, gender or smoking history, and that over the past 30 years has doubled in incidence and mortality rates, especially among women."

Here’s results from the survey that Novartis shared to make their case regarding misperceptions:

• 59% didn't realize that lung cancer causes the most cancer deaths worldwide
• 55% of adults feel that people with lung cancer are mostly or fully responsible for causing their cancer, compared to the levels perceiving the same about people diagnosed with prostate (12%), colon (14%) or breast (11%) cancer.
• 17% believe that all people who are diagnosed with lung cancer are current or former smokers
• 75% immediately think smoking is the cause when they hear someone has lung cancer (approximately 10 – 15% with the disease have never smoked)
• 40% say there is little support or compassion for people with lung cancer in their country
• Only 23% recognize changes in genetic makeup as a cause of lung cancer
• 6% believe no one under the age of 40 can get lung cancer
• 19%) recognize that therapies targeted to a specific change in genetic makeup can be used to treat lung cancer, significantly less than mention chemotherapy delivered directly to into the blood, (68%), radiation (66%), surgery (61%) and therapies that help the body's immune system fight cancer (52%)

Surveying Physicians on Their Views of the ACA

By Clive Riddle, October 17, 2014

The Medicus Firm, a national healthcare recruiting firm has just released results regarding health reform, from their 11th annual Physician Practice Preference Survey. This year’s survey shows an uptick grades doctors give the Affordable Care Act, but a still overall negative review. 2,272 physicians and advanced practice providers from 19 specialties and all 50 states participated in this year’s survey.

When asked to give the ACA an overall grade, 8.6% awarded an “A”, up from 6.3% last year. Meanwhile, 22.35% graded the ACA an “F” this year, down from 30.2% a year ago.

The survey went on to ask doctors to rate the ACA on specific objectives, such as improving efficiency of healthcare, improving access to healthcare, improving quality of healthcare, and decreasing healthcare costs. Medicus reports that “the best and most improved grades were awarded for ‘improving access to healthcare’, with a resounding 23.4 percent giving the ACA an ‘A’ in this objective, up from 11.8 percent last year. Additionally, 27.11 percent of physicians gave the ACA a ‘B’ for improving healthcare access. Only 13.68 percent of respondents failed the ACA in this category, down from 23.6 percent who gave it an ‘F’ last year for this objective. The objective receiving the lowest grades was ‘improving efficiency of healthcare.’ However, even this category showed some improvement over last year. Only about 7 percent of physicians gave the ACA an ‘A’ for improving efficiency, which is up slightly from 5.6 percent last year. Furthermore, 29.73 percent of physicians gave the ACA an ‘F’ for improving efficiency, which is down from 35.4 percent who gave it a failing grade in this category last year.”

It should come as no surprise that from the onset, physicians would view the ACA negatively. Perhaps it should also not be surprising that some of them would view things more positively once the core of the Act was finally implemented. Jim Stone, President of The Medicus Firm, tells us "Physicians seem to have become slightly more positive about the ACA compared to last year's survey. As of last year's survey, the ACA had not yet been fully implemented, although many aspects of the legislation were already in motion. This year's survey was conducted after the ACA was in full effect for several months, and four years after its passage into law. Unfortunately, the grades on the whole are not very positive, so it's good that there is some improvement in physicians' perceptions of the effectiveness of the ACA."

The Medicus Firm isn’t the only organization surveying physicians on their views of the Affordable Care Act. Physicians Practice Magazine conducts the annual Great American Physician Survey, which this year had 1,311 respondents. Their results, announced in August, included this reform question:
“Which statement best describes your personal feelings about the Affordable Care Act, in terms of its effect on patient access to care: [A] I think it’s been great for Americans (18.9%); [B] I think it’s mostly good, but not all good; and [C] I think it has done a disservice to Americans (39.2%).”

Finally, The Physicians Foundation commissioned Merritt Hawkins, a physician search and consulting firm, to conduct a survey of 20,000 physicians, with the resulting report 2014 Survey of America’s Physicians: Practice Patterns and Perspectives released last month. The survey included a question similar to The Medicus Fund’s grading of the ACA, with Merritt Hawkins finding that “when asked about what grade physicians would give the Affordable Care Act (ACA), 46 percent give a D or F grade. Younger (ages 45 or lower), employed physicians were more inclined to give the ACA favorable marks than older (46 or higher), private practice owners. In fact, 63 percent of younger physicians (ages 45 or lower), would give the ACA a grade of C or above.”

Study on Health Plan Shopping – Reluctants, Premiums and Defaulters

By Clive Riddle, October 10, 2014

Vitals – who provide a consumer health information platform including doctor ratings and reviews, has released a study on health plan shoppers in open enrollment season, and lumping many of the shoppers into three categories: (1) The Reluctant; (2) The Premium; and (3) The Defaulter. Vitals study was based on their August online survey of 1,000 adults.

The big takeaways from their survey?

• 80 percent of respondents said they were not planning to switch their insurance this year.
• More than 1 in 5 are dissatisfied with their plan.
• Nearly one-third said they were unhappy with the value for cost of their plan.
• 27 percent were unhappy with customer support services
• 9 percent were unhappy with the lack of quality network doctors and hospitals

So what the heck are Vitals’ trio of Reluctants, Premiums and Defaulters?

Vitals classifies Reluctants as age 30-44 with no dependents and household income under $25k, who are satisfied with their plan provider network but not the plan value. Vitals says “the Reluctant doesn’t want to buy insurance and isn’t satisfied with their plan – if they even have one. They’re more likely to have an HMO to keep costs down, but still say they’re not getting a good value for cost. Over 1 in 4 will switch their health plan during open enrollment this year. Their main gripe: Cost. They index higher for cost increases over the past year and report being surprised more by health care costs this year, compared to last year.”

Vitals classifies Premiums as age 45-60 with dependents and household income over $100k, who also are happiest with the network and unhappiest with plan value. Vitals tells us “the Premium is most likely to have Cadillac-like coverage for their health care. They index higher for employer-provided health care and PPO-type plans, which offer the most flexibility. Premium shoppers are most likely to say they’re happy with their health insurance – only 5 percent will switch during open enrollment! And they uniformly agree they have adequate access to medical care.”

Finally, Vitals classifies Defaulters as any age adult (but often age 60+) with no dependents and household income of $50 - $99k. They define the Defaulter as someone “on cruise control and typically doesn’t review or change their plan from year to year.”

Scorecard on Value Based Payments

By Clive Riddle, October 3, 2014

Catalyst for Payment Reform has just released their second annual National Scorecard and California Scorecard on value based payments and payment reform made to providers by purchasers, funded by The Commonwealth Fund and the California HealthCare Foundation.

The universe they utilized to track and measure provider payments was based on the National Business Coalition on Health’s eValue8 health plan survey platform, in partnership with NBCH and these business coalitions: the Colorado Business Group on Health, HealthCare 21, the Memphis Business Group on Health, the Mid-Atlantic Business Group on Health, the Northeast Business Group on Health, the Pacific Business Group on Health, and the Washington Health Alliance.

What meets their definition of value oriented payments? They say they are in-network payments that are “either tied to performance or designed to cut waste” and that 40% of commercial payments meet this definition. What makes up the other 60%? They say payment types without quality incentives that include “traditional feefor-service (FFS), bundled, capitated and partially capitated payments.”

What comprises the 40% that is value oriented? Quality incentive driven Bundled Payments (0.1%) + Non FFS Shared Savings (0.2%) + Non FFA Non-Visit Payments (0.6%) + Shared Risk (1.0%) + Partial or Condition Specific Capitation (1.6%) + FFS and Shared Savings (2.0%) + FFS Based Pay and P4P (12.8%) + Full Capitation (15.0%) + All Other (6.7%) = 40.0%.

Here’s more of the numbers shared in this year’s scorecard:

• 53% of value-oriented payments put providers at some financial risk if they fail to improve care or spend over budget
• 38% of payments to hospitals are value-oriented,
• 10% of payments to specialists and 24% of payments to primary care physicians are value oriented
• Of these value-oriented payments to physicians, 71% of the total goes to specialists, and 29% to PCPs
• 15% of participating health plans’ patient members are formally “attributed” to a provider participating in a payment reform contract

Humana Study on Workplace Wellness: It’s not just ROI

By Clive Riddle, September 19, 2014 

Humana has just published a 22 page report Measuring wellness: From data to insights which based on their study conducted by the Economist Intelligence Unit, examining “why companies implement workplace wellness, how data influences these programs and identifies obstacles that inhibit program participation.” The study surveyed 225 U.S.-based executives and 630 full-time employees from organizations with workplace wellness programs. 

Beth Bierbower, President of Humana’s Employer Group Segment, tells us “It’s interesting to validate that employers now view ROI as an important, but not exclusive or even primary measure of a wellness program’s success. Employers are now seeing that employee health is important beyond health care costs, it has profound impacts on productivity, retention, workplace engagement and morale.” The report states that instead of asking about ROI, “perhaps the question should be, ‘do we improve health at a reasonable price’ as opposed to ‘do we save money by doing so.’” 

Here are some key findings highlighted from the study:

• Nearly 70 percent of executives consider their organization’s wellness program to be cost effective, even though not all of the outcomes are measurable.
• While 86 percent of executives say improving employee health as an indirect driver of productivity, morale and engagement is their top reason for implementing a wellness program, cost factors are still important, including reducing employee health care costs (66 percent) and controlling medical claims (48 percent).
• About 30 percent of employees rate subsidized gym memberships, onsite health and wellness facilities, and budgeted wellness activity time during business hours, as the three most important services that would motivate participation.          
• 64 percent of employees have used fitness devices to monitor health and capture data, but only 19 percent use them regularly.         
• Two-thirds of executives feel data collection and interpretation is the biggest challenge confronting effective workplace wellness.         
• 53% of survey respondents say their organization collects health-related employee data as part of its wellness program
• The biggest disconnects between executives and employees regarding their perceptions of obstacles to employee participation in wellness programs, were in regards to the statements: “Employees don’t perceive health and wellness as a high priority” (30% of executives agreed vs. 2% of employees); “Employees are concerned that personal information will not remain confidential (43% of executives agreed vs. 27% of employees); and “Employees distrust employer motives” (24% of executives agreed vs. 11% of employees.)     

Clinicians Embracing mHealth – but not so much if patients are involved

By Clive Riddle, September 12, 2014 

Although lagging behind many other service sectors, healthcare clinicians do continue to their march towards the inevitable professional embrace of mobile apps, social media and other web applications – typically as long as that embrace falls short of interacting with their patients. 

Wolters Kluwer Health just released survey results on nurse practitioner use of mobile health, social media and the web. The survey was conducted on their behalf by Lippincott Solutions. 

The survey found that 65% of nurses currently use a mobile device at work for professional purposes at least 30 minutes per day, and 95% of healthcare organizations allow them to consult websites and other online resources for clinical information at work. 

The survey findings also indicated:

• 83% of nurses perceive that their organization's policy allows patient care staff access to web sites, including social media, to access general health information regarding patient conditions
• 48% of respondents that access health information say their organization encourages nurses to access online resources; while 41% allow for occasional use; and 5% only as a last resort
• 89% of healthcare organizations allow nurses to use online search engines at work
• 60% of respondents say they use social media to follow healthcare issues at work
• 86% say they follow healthcare issues on social media outside of work
• 20% of nurses use mobile health apps for two hours or more per day
• Among those who use mobile devices at work, Nurse Managers, at 77%, are more likely to use them than Staff Nurses, at 58% 

But their report notes that “73% of healthcare respondents say that organizational policies strictly prohibit direct patient care staff to have social interaction with patients on social media and social sites, compared to 51% say that organizational policies prohibit direct patient care staff to have access to their organizations’ own social media pages.” 

A Walters Kluwer survey of physicians last year found that 21% of doctors didn’t use smartphones in their practice, 46% used them less than 25% of the day, and 33% used them more than 25% of the day. Regarding use of tablets, 39% of doctors didn’t use tablets in their practice, 37% used them less than 25% of the day, and 24% used them more than 25% of the day. Of those who did use mobile devices at work,  24% use mhealth apps; while 33% used their smartphones to communicate with patients, and  17% used their tablets for patient communication. 

While many integrated systems like Kaiser have structured electronic interaction with patients into their system, basic impediments for many continue to be a lack of reimbursement, as well as legal concerns about doing so. 

Yet it is exactly that interaction that their customers are asking for.  For example, Harris Poll results just released for a survey commissioned by Wellocracy found that 66% of those who have used a wearable mhealth tracker or app in the past 12 months ndicated that they would be interested in receiving personalized feedback on their health data from a trusted health expert, such as a doctor, nutritionist, fitness trainer or licensed lifestyle coach, and of those respondents: 75% would be willing to pay for personalized feedback and coaching from a doctor, and 73% from a nutritionist, nurse or dietician.

Towers Watson 2014 Employer Survey Results

By Clive Riddle, August 22, 2014

Towers Watson has just released results from their annual Health Care Changes Ahead Survey which “offers insights into the focus and timing of U.S. employers’ plans and perspectives related to their health benefits, and their efforts to better manage costs and employee engagement.”

Their headline takeaway? “U.S. employers expect a 4% increase in 2015 health care costs for active employees after plan design changes… If no adjustments are made, employers project a 5.2% growth rate.

Towers Watson’s Randall Abbott tells us “in the current economic climate, affordability and sustainability remain dominant influences on employers’ overall health care strategies. Expense management and worker productivity are equally critical to business results. While employers are committed to providing health care benefits for their active employees for the foreseeable future, persistent concerns about cost escalation, the excise tax and workforce health have led to comprehensive strategies focused on both year-over-year results and long-term viability for health care benefits and workforce health improvement. The emphasis is on achieving or maintaining a high-performance health plan. And CFOs are now focused on a new gold standard: managing health cost increases to the Consumer Price Index. This requires acute attention to improving program performance.”

Here’s some key employer responses from their survey findings:

• 73% of employers said they are somewhat or very concerned they will trigger the excise tax b
• 43% said avoiding the tax is the top priority for their health care strategies in 2015.
• 81% plan moderate to significant changes to their health care plans over the next three years
• Pharmacy-only cost trend is projected to be 5.3% after plan changes (6% before changes)
• 48% are considering tying incentives to reaching a specified health outcome such as biometric targets during the next three years ( 10% intend to adopt it in 2015)
• 37% are considering offering plans with a higher level of benefit based on the use of high-performance or narrow networks during the next three years (7% in 2015)
• 34% of employers are considering telemedicine during the next three years (15% in 2015)
• 33% are considering significantly reducing company subsidies for spouses and dependents during the next three years (10% have already done so; 9% intend to do so in 2015)
• 26% are considering spouse exclusions or surcharges if coverage is available elsewhere during the next three years; (30% already do so; 7% expect to add it in 2015)
• 30& are considering caps on health care coverage subsidies for active employees, using defined contribution approaches during the next three years (13% already have them; 3% are planning them for 2015)
• 50% are considering full-replacement ABHPs (Account Based Health Plans) during the next three years: (17% offer only an ABHP today; 4% intend to do so for 2015, and another 28% are considering it for 2016 or 2017)
• 76% are exploring the use of personalized digital technologies, including mobile health applications and fitness wearables

Towers Watson included a number of questions measuring the private health insurance exchange opportunity:

• 28% have extensively evaluated the viability of private exchanges
• 24% said private exchanges could provide a viable alternative for their active full-time employees in 2016.
• 64% said evidence private exchanges can deliver greater value than their current self-managed model would be a top decision factor
• 34% said adoption of private exchanges by other large companies in their industry would be a top decision factor
• 26% said an inability to stay below the excise tax ceiling as 2018 approaches would be a top decision factor
• 99.5% have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy.
• 77% are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016.

Of course it should be noted Towers Watson has their own private exchange product, OneExchange, that serves more than 1,100 employer clients with active employee and retiree options. Towers Watson just announced that during “the first half of 2014, 45 major U.S. employers launched OneExchange for full-time, part-time or retired employees. This is the largest number of employer implementations outside the typical fall enrollment period in the private exchange’s eight years of operation.” Major new clients they listed included GameStop; International Paper; Northrop Grumman; and the State of Rhode Island.

Healthcare Workers Are More Confident About Their Prospects and the Future

by Clive Riddle, August 8, 2014

Randstad Healthcare, the national healthcare staffing firm, issues a quarterly report on healthcare workers’ confidence, conducted by Harris Poll, based on a survey of physicians, nurses, healthcare administrators and other healthcare professionals. Their just released second quarter 2014 report, which tells us that confidence is up for the second quarter in a row, and that healthcare workers had the highest level of confidence compared to all industries they track.

So what does that mean, that healthcare workers are increasing in confidence, are more confident than other workers, and what exactly is it that they are confident about?

The Randstad Healthcare Employee Confidence Index is a composite of various confidence measures via an online survey. The questions asked address their optimism regarding:

• Their current employers’ outlook
• Ability to find a new job
• Likelihood of retaining existing job
• Availability of other jobs
• Strength of the economy

Key survey findings for healthcare workers included:

• 71% have confidence in the future of their current employer, compared to 54% in the previous quarter.
• 61% have confidence in their ability to find a new job (same as previous quarter)
• 81% say it is not likely they will lose their jobs in the next 12 months, compared to 72 percent in Q1 of this year.
• 28% are likely to look for a new job, compared to 33% in Q1, and 46% in Q4 2013.
• 44% believe fewer jobs are available (compared to 48% previous quarter). 61% are confident they could find a job in the next 12 months.
• 31% say the economy is getting stronger (compared to 29% previous quarter). 33% believe the economy is staying the same, and 37% believe it is getting weaker

Given all the political hubbub about the health care reform, it’s interesting to see that the pivotal ACA implementation year of 2014 actually brought a rise in confidence about job prospects, sector economic strength sand overall economic outlook, for those working directly in the industry. Perhaps this means that insiders don’t view the ACA as all doom and gloom.

State Health Care Prison Spending by the Numbers

by Clive Riddle, July 10, 2014

The State Health Care Spending Project, an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, has been monitoring and analyzing prison healthcare costs for some time, and Pew has just released a new 32-page report: State Prison Health Care Spending: An Examination.

This is on the heels of their report Managing Prison Health Care Spending first released last October, which covered the period of 2001 – 2008, and found that spending sharply increased in most states during that time period. The new report analyzes spending from 2007 – 2011 and found “state spending on prisoner health care increased from fiscal years 2007 to 2011, but it is trending downward from its peak in 2009.”

The new report concludes: “Correctional health care spending poses a fiscal challenge to state lawmakers, though evidence indicates that spending peaked at the end of the last decade. The situation posed by these expenses may be particularly acute in states where older inmates represent a relatively large proportion of the prison population. Corrections officials will be better positioned to manage their systems effectively with access to rigorous, disaggregated spending and health outcomes data that can be used to identify cost drivers and to evaluate the value and impact of cost-containment initiatives.”

Here’s a compilation of various analysis and findings from the new report, by the numbers:

4 key variable characteristics that affect delivery of health care and increase costs include: (A) Prison population trend; (B)  Older inmates, greater expense; (C) Prevalence of disease and mental illness. And (D) Location and inmate transportation.

4 strategies being used to manage costs are: (A) use of telehealth technologies; (B) outsourcing of prison health care, (C) enrollment of prisoners in Medicaid, and (D) appropriately paroling older and/or ill inmates.

37% of health care spending was on general medical care (20% was on hospitalizations; 14% on pharmaceuticals; 14% on mental health; 5% on substance abuse)

39 States saw per-inmate health care spending rise from fiscal 2007-2011, with a median growth of 10%.

41 States experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%.

34 States saw their total correctional health care spending peak before fiscal 2011

40 Of 42 states surveyed experienced a rise in the share of older inmates from fiscal 2007-2011

204% increase in the number of state and federal prisoners age 55 and older

from 1999–2012

$441 million - The amount of California’s decrease in spending from fiscal 2009 to 2011 accounting for most of the national decline of half a billion dollars during that time

$7.7 billion total prison health care spending in fiscal 2011

$8.2 billion total prison health care spending in fiscal 2009

athenahealth Annual PayerView Report Ranks Human Top Plan Again For Providersa

by Clive Riddle, June 6, 2014

athenahealth recently released their 2014 PayerView Report, which ranks “commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers.” For the second year in a row, athenahealth found Humana the top performing plan out of 148 plans analyzed.

Here are their rankings for local and national Commercial plans:

1. Humana
2. HealthPartners
3. BCBS of MA
4. Cigna
5. Group Health Cooperative
6. Capital Blue Cross - PA
7. Care First BCBS - DC
8. Unicare
9. BCBS of NC
10. Neighborhood Health Plan

Four major insights were provided by athenahealth regarding the report:

(1) “ Medicaid's Lackluster Performance Continues - For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as Days in Accounts Receivable (DAR), Denial Rates, and Electronic Remittance Advice (ERA) transparency. “

(2)  “Providers' Burden to Collect on Claims Varies Widely - PayerView data indicates that provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. ..PayerView results reveal that Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection. “

(3) ”Blue Cross Blue Shield Plans Pay Providers the Fastest - As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer Days in Accounts Receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers.”

(4) “Commercial Payers Offer the Most Efficient Enrollments - While Medicaid enrollment proves particularly burdensome, national commercial payers' enrollment proves simplest. “

athenahealth notes that rankings from their report “are derived from athenahealth's athenaNet® database, which to date includes more than 52,000 providers across 50 states. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.”

RWJF Examines Current and Future Coverage Eligibility For the Uninsured – It’s a State by State Issue

By Clive Riddle, May 30, 2014

The Robert Wood Johnson Foundation, in conjunction with the Urban Institute, has just issued a nine-page Issue Brief: Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.

The Urban Institute authors, Matthew Buettgens, Genevieve M. Kenney, and Hannah Recht found that:

• This year, under the ACA, 56% of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP or subsidized private coverage through the new marketplaces.
• In states that expanded Medicaid eligibility under the ACA, 68% of the uninsured became eligible for assistance, compared with 44% in states that have not expanded Medicaid.
• If states that have not expanded Medicaid eligibility were to do so, 71% of their uninsured would be eligible for assistance.
• Among states expanding Medicaid, the ACA is projected to reduce the number of uninsured people by 56%, compared with a 34% reduction among states not expanding Medicaid.
• If the states that have not expanded eligibility were to do so, the number of uninsured in those states would decrease by 59% 

The authors note that the “Medicaid expansion states with the lowest share of uninsured eligible for assistance tend to be those in which Medicaid eligibility for adults had already been expanded above minimum required levels before the ACA.”

Given the state decisions are the determining factor, what is the range of eligible uninsureds in the non-Medicaid expansion states, and where is the low end based? Look South. The Authors state that “with the exception of Wisconsin, the share of the uninsured in nonexpanding states eligible for assistance ranges from 40 percent in Texas to 58 percent in Alaska and Maine. The states with the lowest shares eligible for assistance (Texas, Mississippi, Louisiana, and Georgia) have particularly large shares of residents below 100 percent of FPL. [What’s up with Wisconsin? The authors note that Wisconsin changed its Medicaid Waiver in 2014 and “therefore, Wisconsin resembles a Medicaid expansion state.”]

The top five states (all expansion states) by percentage eligible for any assistance, along with the projected percentage decrease in uninsured under the ACA:

1. West Virginia – 83% Eligible / 76% decrease in uninsureds

2. Kentucky – 82% Eligible / 63% decrease in uninsureds

3. Michigan – 81% Eligible /64% decrease in uninsureds

4. Ohio – 81% Eligible / 65% decrease in uninsureds

5. North Dakota – 80% Eligible / 64% decrease in uninsureds

Conversely, here’s the bottom five states (all non expansion states):

50. Texas – 40% Eligible / 31% decrease in uninsureds

49. Mississippi – 42% Eligible / 31% decrease in uninsureds

48. Louisiana -– 42% Eligible / 32% decrease in uninsureds

47. Georgia – 42% Eligible / 30% decrease in uninsureds

46. Alabama -– 43% Eligible / 28% decrease in uninsureds

Practice Profitability Index: Physicians Bearish on the Year Ahead

By Clive Riddle, May 9, 2014

CareCloud, in partnership with QuantiaMD, has just released their second annual Practice Profitability Index report. The ten-page 2014 report, “intended to serve as an annual barometer for the operational wellbeing of U.S. medical groups in the year ahead,” finds that “U.S. physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014,” as they illustrate with survey results in this portion of an infographic provided in conjunction with the report.

Of course, as the healthcare landscape evolves and trends for integration continues to gradually gather steam, those remaining in private practice may view themselves in an increasingly embattled or even endangered species. Albert Santalo, CareCloud Chairman and CEO  tells us, “physicians are experiencing increasing strain on their practice operations as a result of healthcare reform and government mandates. This strain, in turn, affects patients – including the millions of new ones entering the system as a result of the Affordable Care Act.  Nearly half of physicians say they cannot take on these patients, foreshadowing an access to care issue. Meanwhile, despite the hype about emerging reimbursement models, physicians are most likely to seek improvements through programs that help them engage with their sickest and most vulnerable patients.”

The Practice Profitability Index involves gathering insights via an interactive online questionnaire and related discussion groups. This year, 5,064 physicians participated during March, 2014. Here’s highlights of findings presented in the report: 

• Physicians with a negative outlook increased from 36% to 39% during the past year
• Physician optimists declined from 22% to 19%.
• The detailed breakdown of responses for profitability trending was 5% very positive; 14% somewhat positive; 30% about the same; 29% somewhat negative; 10% very negative; and 12% not sure.
• Their top financial concerns are: declining reimbursements (60%); rising costs (50%); requirements from the Affordable Care Act (49%); and the transition to ICD-10 (43%).
• The percentage of doctors spending more than one day a week on paperwork rose sharply between 2013 and 2014, from 58% to 70%.
• 23% spend more than 40% of their time on administration, up from 15% last year.
• 40% of physicians indicated patient engagement programs hold the greatest promise for improving their practice performance in 2014.
• Other responses for improving performance including new alliances with other providers (21%), ACO participation (11%) and mobile technologies (11%)
• The survey was taken before the minimum one-year delay to the ICD-10 code transition, originally scheduled for October 2014, but at that time 44% did not know whether they would be ready. Another 25% were certain they would not be prepared and faced high transition and upgrade costs.
• Of the 48% of respondents that own their practice, 24% of these physicians are considering selling the practice, up from 21% in 2013. 53% are not looking to sell at all, down from 50% in 20