Humana Study Measures Claims Costs and Absence Rate by level of Wellness Program Engagement

By Clive Riddle, May 2, 2014

Humana has released findings from their HumanaVitality Health Claims and Productivity Impact Study of Humana employees. HumanaVitality is a joint venture between Humana Inc. and Discovery Holdings, Ltd. That serves 3.5+ million members and “is a data-driven wellness and rewards program that motivates members to make healthier life choices.”

Humana touts that “the two-year study found improved health, as shown through lower health care costs and fewer unscheduled absences, among employees who actively participated in the HumanaVitality program.”

Here’s their specific findings:

• Unengaged members in both years averaged $53 more per month spent on health care claims than members who were engaged in HumanaVitality both years.
• The largest impact on health care costs was on members with lifestyle-related chronic conditions like high blood pressure or diabetes. Engaged members with these conditions had 60 percent lower health claims costs than unengaged members with these conditions.
• Another way of stating this: Unengaged members with lifestyle-related chronic conditions had 101% higher claims costs than the total population, while engaged members with these chronic conditions had 41% higher claims costs than the total population
• Unscheduled absences were 56.3 percent higher among unengaged members in both years than engaged members
• Members who were unengaged the first year but engaged the second year had 29% higher unscheduled absence and an average of $28 per month in claims costs than members who engaged both years

Humana shared this about the study methodology: “This study was performed on a cohort of Humana associates that were on a Humana employee medical health plan for a full 12 months in at least two consecutive plan years over the study period. The study was conducted by Humana actuaries for the following time period: Baseline Year (July 2010 – June 2011), Year 1 of the HumanaVitality program (July 2011 – June 2012) and Year 2 of the HumanaVitality program (July 2012 – June 2013). Only Humana employees were included in the study; individuals with high cost claims (>= $ 150,000 in the Baseline Year, Year 1 or Year 2) were removed from the sample. The final sample size was 13,046 members in the Year 1 analysis and 16,296 members in the Year 2 analysis.”

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.

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).”

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

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

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.

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.”

Physicians: Unhappy Campers in Affordable Care Act Land

By Clive Riddle, November 22, 2013

Jackson & Coker, the healthcare staffing company, has just released survey results on current physician views of the ACA, in their 33-page report- Survey: Physicians on the Affordable Care Act. The results shouldn’t be that surprising – physicians aren’t happy campers in this brave new world.

Jackson & Coker highlighted these findings from their survey, which yielded 3,072 self-selected practicing physician respondents from a survey were emailed to subsets of a database totaling 277,778 physicians, which included physicians who have been placed by Jackson and those who have not:

• 80 % believe those patients with current coverage will wind up paying higher healthcare costs
• 765 said overall healthcare costs would go up due to the new health reform law
• 73% said patients would have less choice in picking their doctor
• 66% said they would have to spend more time on administrative duties
• 61% said their opinion of the law has changed for the worse
• 60% said the quality of patient care would be negatively impacted
• 57% said the law would have a negative impact their treatment decisions for patients
• 56% support repealing or defunding the law
• 44% said they would not participate in the Exchange

The general population’s view of the Act often boils down to political perspectives. Physicians would not seem to be immune from red and blue polarization. Indeed, a Mayo Clinic study published in the Journal of General Internal Medicine June 25, 2013 issue: Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation, addressed this issue, and concluded “significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.”

The Mayo Clinic authors reported that “(41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA …respectively), as were physicians reporting a salary …or salary plus bonus … compensation type…..Those who agreed that addressing societal health policy issues are within the scope of their professional obligations …, who believe physicians are professionally obligated to care for the uninsured / under-insured …, and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage …., were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it.”

But beyond the impact of political persuasions and social viewpoints raised in the Mayo Clinic study, it would seem some fundamental business interests are driving the Jackson & Coker results, that boil down to these three things:

1. Concerns about impact on reimbursement levels
2. Issues regarding access to participation in applicable plans
3. Concerns about “hassle factor” of administrative requirements

MedPage Today this week published an article that seems to support these points: Docs Unhappy With ACA Exchange Plans resulting from their press coverage of the AMA’s Interim Meeting Conference. They cite Steven Larson, MD, board chairman of the California Medical Association: “the patients nor the physicians know if they're in network or not," and state “it has been a common complaint thus far, as plans have been slow to report or update provider networks for exchange plans.” With respect to reimbursement, they note “some providers have reported rates as much as 70% below what commercial plans pay, with negotiations starting at Medicaid payment levels.”

The MedPage Today article cites another survey from last month with similar results: “the Medical Group Management Association reported 55.5% held an ‘unfavorable’ or ‘very unfavorable’ view of the impact the ACA's health insurance exchanges on them,” and concludes “with these stories starting to mount, the fear is that patients -- with their insurance card in hand -- either won't be able to find a doctor who is seeing patients with that plan, or will have to travel great distances to find someone who does.”

Certainly, as with the Exchange website enrollment, much needs to still get sorted out with respect to the status of provider networks with participating Exchange plans across the country.

Checking out 16,275 Patient Health Apps

By Clive Riddle, November 1, 2013

The IMS Institute for Healthcare Informatics, part of IMS Health, this week released  their report: Patient Apps for Improved Healthcare: From Novelty to Mainstream, which examined all 16,275 apps directly related to consumer patient health and treatment (out of a total 43,689 health care apps,  of which 7,407 are for health care professionals) available from the Apple ITunes store.

Murray Aitken, executive director of the IMS Institute for Healthcare Informatics had this to say after releasing the report: “The movement toward digital therapeutics is clear. Mobile health apps have the potential to drive a disruptive shift in patient engagement and healthcare delivery. Harnessing the power of apps has become a focal point of innovation, yet barriers remain to their broad and systematic use by providers and patients. Development of clear evidence on the benefits of driving positive behavioral changes and improving health outcomes will be key to breaking through the barriers.”

The IMS analysis involved categorizing apps based on providing one or more of these functionalities:

• Inform:  Provide information in a variety of formats (text, photo, video)
• Instruct:  Provide instructions to the user
• Record: Capture user entered data
• Display: Graphically display user entered data/output user entered data
• Guide:  Provide guidance based on user entered information, and may further offer a diagnosis,  or recommend a consultation with a physician/a course of treatment
• Remind/Alert: Provide reminders to the user
• Communicate: Provide communication with HCP/patients and/or provide links to social networks

Here’s some key points from their 65 page report:

• More than 90% of healthcare apps reviewed by the IMS Institute scored less than 40 out of a possible 100 for functionality, based on 25 screening factors.
• While 10,840 of the 16,275 apps reviewed can provide and display information, less than half of those can also provide instructions and approximately 20% can also capture user-entered data.
• More than 50% of available healthcare apps have been downloaded fewer than 500 times.
• Five apps account for 15% of all downloads in the healthcare category
• Patients over the age of 65 are among the top users of healthcare resources, yet  only 18% of the elderly U.S. population use smartphones, compared with 55% of consumers age 45-54

The report identifies these four issues that must be address, ”in order for apps to move from novelty to mainstream”:

1. There must be recognition of the role apps can play in healthcare by payers and providers, as well as regulators and policymakers.
2. Security and privacy guidelines and assurances established among providers, patients and app developers.
3. A systematic evaluation of apps to inform their appropriate use.
4. The effective integration of apps with other aspects of patient care.

Survey on Consumer Engagement and Health Tracking

By Clive Riddle, October 25, 2013

Partners Healthcare’s Center for Connected Health, commissioned Harris Interactive to survey 2,000+ consumers on health engagement and tech driven tools to monitor health and wellness, in conjunction with the launch of the Center’s new Wellocracy program.  They found that almost half of respondents (48%) say they have trouble staying motivated to live a healthy life, and less than a fourth (22%) are very confident that they can keep track of their own health.

Joseph C. Kvedar, MD, the founder and director of the Center for Connected Health tells us, "there are dozens of activity and health trackers on the market today, and literally thousands of health apps available for consumers. Yet, instead of getting people moving towards a healthy lifestyle, most feel paralyzed by all these choices and the technology can be dizzying. "We know that if we give people -- young and old -- insights into their health and help them understand how lifestyle choices impact quality of life, they feel more accountable, engaged and live a healthier, more active life. Integrating 'self-health' tools like activity and nutrition trackers and sleep monitors into our daily lives, we can learn from our own behaviors and make positive changes to take charge of our health. We're taking these devices and apps, personalizing the experience and helping people figure out the right health technologies, the right strategy and the right inspiration to get on the right track to health and wellness."

Here’s finding the Center has shared from the survey results:

• 68% of consumers agree that encouragement from friends and family is important for them to achieve health goals
• 65% of consumers believe that using a health tracking device, website or app would be beneficial,
• 32% felt these tools would help them stay motivated to meet health and fitness goals
• 31% believe the tools would provide accountability
• 27% felt the tools would help them stay in control of their health

• 86% believe that feeling informed about their own health is empowering
• 59% of women and 56% of men aged 35-44 reported that it is hard to stay motivated to live a healthy life
• 52% and 51%, respectively of women and men aged 35-44 wished they could make better use of technology to keep track of their health
• 55% of women and 49% of men aged 18-44 believe that easy tracking  is essential to achieving health-related goals
• 48% of women and 42% of men aged 18-34 reported that encouragement from family and friends is essential
• 42% of women and only 20% of men aged 45-54 reported that support and tools from their healthcare provider is essential
• 19% of women and 17% of men aged 35-44 are very confident in their ability to keep track of their own health
• 25% of women and 21% of men aged 55 and over are very confident in their ability to keep track of their own health

• 56% of all consumers  have never used any type of health tracking device, app or website
• Adults aged 18-34, were most likely to use diet (23%) or fitness apps (26%) on their phones
• 7% of adults aged 55 and over reported ever using a diet app and only 3% have used a fitness app on their phone
• 35-44 year olds were the age group reporting the highest use of digital activity pedometers (19%)
• 5% of adults aged 18 and over reported ever using a sleep tracker

While these results are encouraging for engagement initiatives, we need to remember that they survey indicates more than half of consumers have never used any such tool – even a website.

Consumer Surveys: Finding a Doctor, and Finding Out About Electronic Medical Records

By Clive Riddle, October 4, 2013

Two studies released this week examine aspects of consumer-physician relationships.  The American Osteopathic Association conducted a survey on consumer physician selection. AOA found that “word of mouth” is still the reigning tool for physician selection even in this digital age. Once consumers have selected a doctor, their physician’s may not be doing all that much to communicate with them or educate them about digital health records, Xerox concluded in their fourth annual study on electronic medical records.

The AOA survey found the top five resources adults utilize when selecting a physician for themselves or a loved one  to be:

• Word of mouth, i.e. family, friends, coworkers (65.9%)
• Insurance provider directory (51.9%)
• Physician rating websites, i.e. Vitals, Healthgrades (22.8%)
• Hospital website (10.8%)
• Consumer review websites, i.e. Yelp (10.5%)

Here’s an interesting finding  about younger adults that embrace the digital age more than they order counterparts:  “when selecting a physician for themselves, younger adults are much more likely to use “word of mouth” than older adults (77.1% among 18-29 year olds, 64.6% among 30-49 year olds and 59.8% among 50-79 year olds).”

Regardless of the tools used, the AOA survey found the most important factors in the selection decision to be:

• Acceptance of insurance plan (83.3%)
• Bedside manner/empathy (60.5%)
• Proximity of office to home, work or school (57.4%) 
• Convenient office hours (42.9%)
• Medical specialty (37.5%)

The AOA survey also addressed de-selection, with the top reasons for leaving a doctor being:

• moved out of the area (34.7%)
• didn’t feel physician was a good fit (33.9%) 
• changed insurance provider (21.2%)
• physician retired or moved (19%)

Meanwhile, Xerox found that “only 29 percent of those who have a doctor have been informed their medical records will be converted to digital format. While this shows a 13-point improvement from four years ago, the survey results continued to show that the majority of Americans (83 percent) have concerns, such as security, about EHRs and less than one-third (32 percent) want their medical records to be digital (compared to 82 percent and 26 percent in 2010, respectively).”

Here’s the infographic Xerox released with the survey results:

Annual Census Report on Health Insurance Coverage: What Will this Report Look Like After 2014?

By Clive Riddle, September 19, 2013

The U.S. Census Bureau has just released their annual report: Income, Poverty, and Health Insurance Coverage in the United States: 2012. This year’s 88-page report was “compiled from information collected in the 2013 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC). The CPS-ASEC was conducted between February-April 2013 and collected information about income and health insurance coverage during the 2012 calendar year.”

The key takeaway? “The percentage of people without health insurance coverage declined to 15.4 percent in 2012 ─ from 15.7 percent in 2011. However, the 48.0 million people without coverage in 2012 was not statistically different from the 48.6 million in 2011.”

Here’s some summary figures compiled from the report:

	2011%	2012%	2011#(mil)	2012#(mil)
Uninsured	15.7%	15.4%	48.0	48.0
Private Coverage	63.9%	63.9%	197.3	198.8
Public Coverage	32.2%	32.6%	99.5	101.5

Here’s the respective demographic from each category with the greatest improvement in percentage change in uninsured from 2012 over 2011, compiled from the report:

• Family Status: unrelated subfamilies -5.3%
• Race: Asia -1.7%
• Age: under age 25 -0.5%
• Nativity: foreign born naturalized citizen -0.9%
• Region: Midwest -0.8%
• Work Experience: Did not work at least one week -0.9%

Finally, here’s a breakdown of the percentage of the total population covered by more specific coverage categories for 2011 and 2012; the totals add up to more than 100% due to dual coverage:

	2011%	2012%
Employment based	55.1%	54.9%
Direct-purchase	9.8%	9.8%
Medicare	15.2%	15.7%
Medicaid	11.5%	11.3%
Military	4.4%	4.4%
Uninsured	15.7%	15.4%

The big question is, what will this report look like two years from now, when the 2014 data is compiled?

NBGH Annual Survey: Consumer Driven Plans, Private Exchanges and Seven-Percent

By Clive Riddle, September 6, 2013

The National Business Group on Health recently released findings from their annual benefits survey addressing plan design and cost issues for 2014. What did they conclude after getting results from 108 large employer organizations? The cost of providing health benefits will rise 7% (third consecutive year projected at that  rate); employers continue to further embrace consumer driven plans; and there is potential interest in exchanges – particularly private exchanges.

Regarding consumer driven care:

• 36% of respondents said consumer driven plans were the most effective tactic to control rising costs
• 72% offer at least one CDHP
• 22% planning to implement a total replacement CDHP next year, up from 19% this year

Meanwhile, NBGH President Helen Darling tells us “Private exchanges are another option some employers are considering. In the last year, there has been an increase in the number of private exchanges that are being launched. And while some employers are considering private exchanges for active employees sometime in the future, very few (3%) are considering eliminating health care coverage entirely,” said Darling.

41% responded that COBRA participants might find public exchanges to be the most cost effective option. 26% felt some pre-65 retirees might opt to join exchanges, while 20% believe that some part-time employees will do so.

The survey also covered these topics:

• 44% currently have an on-site clinic in at least one of their locations, with 9% are expecting to build a clinic next year
• 66% will cover surgical interventions for the treatment of severe obesity in 2014
• 36% will cover FDA-approved medications and intensive, multi-component behavioral interventions for participants with a BMI of more than 30
• 89% offer a tobacco cessation program
• 77% offer telephonic or on-site health coaching
• 55% offer on-site weight management programs
• 88% conduct health assessments
• 83% do biometric screenings

Ten things to know about 2013 Health Savings Account Data

By Clive Riddle, August 9, 2013

Devenir has just released their 2013 HSA Research report. The survey data was collected in July 2013 and primarily consisted of the top 50 HSA providers in the health savings account market, with all data being collected for the June 30th, 2013 period.  The six page executive summary provides some great, concise data, which includes these ten takeaways:

1. The total number of HSA accounts rose to more than 9.1 million with assets totaling nearly $18.1 billion.
2. This represents a year over year increase of 29% for both accounts and assets for the period of June 30th, 2012 to June 30th, 2013.
3. The average account balance halfway through 2013 grew to $1,981 from $1,879 at the end 2012, over a 5% increase.
4. When you eliminate identified zero balance accounts that average rises to $2,228, an almost 3% year over year increase.
5. Current average account balances by the year the account was opened range from $5,117 for accounts opened in 2005 to $1,192 for accounts opened in 2012 (and $775 for accounts opened this year to date).
6. Total contributions to HSA accounts from June 2012 to June 2013 are estimated to have reached $16.7 billion, with accountholders retaining about 23% of those contributions.
7. Debit cards represent 74% of all withdrawal transactions, with an average of 5.1 annual debit card withdrawals per account for an average $124.48 per transaction.
8. Currently 14% of HSA assets are comprised of investments .
9. HSA investment assets reached an estimated $2 billion in June, up 14% from the end of 2012 and 26% year over year. The average investment account holder has a $10,484 average total balance (deposit and investment account).
10. Devenir projects that year-end 2013 assets will total $20 billion, and 2015 HSA assets will reach $29.3 B, comprised of $4.2B in investments, and $25.2B in deposits.

I only wish our family’s HSA account balance was followed by a capital “B” as well.

PhRMA’s Consumer Health Survey: Honest Answers Indicate a Long Ways to Go

By Clive Riddle, August 2, 2013

The Pharmaceutical Research and Manufacturers of America (PhRMA) – just released findings from their new annual “From Hope to Cures” survey, which “explores Americans’ attitudes on personal health and medical concerns.”  What did PhRMA have to say about their new report?  President John J. Castellani, tells us "a patient-centric dialogue is crucial to improving health outcomes. The Health Survey findings will help also inform efforts to address major health challenges such as chronic disease, improved prevention and wellness activities and enhanced patient adherence to prescribed therapies.”

What do I get out of the report? The respondents were surprisingly honest (in many surveys consumers tend to rate themselves more on top of their health behaviors.) Large percentages don’t seem to be as engaged as some other studies have led us to believe.

58% say there are paying more attention to their health compared to a few years ago. This means 42% of consumers are not stepping up their game.  Here’s the depressing part – consider these percentage who said they are paying more attention to these health behaviors:

• 57% - eating a healthy diet
• 54% - maintaining a healthy weight
• 48% - reducing stress
• 41% - exercising regularly
• 37% - taking medicine as prescribed
• 37% - getting plenty of sleep
• 35% - seeing doctor regularly
• 33% - monitoring blood pressure
• 23% - moderating alcohol

Okay – so if over 40% are NOT paying more attention to their diet or weight, and well over 50% are NOT paying more attention to the other above listed behaviors, the must be because they are in pretty good shape already, so they don’t need to pay even more attention – right?

So, when asked to describe their health for the year, these percentages responded good or great:

• age 18-34 - 71%
• age 35-49 - 61%
• age 50-64 - 53%
• age 65+    - 56%
• overall       - 61%

So almost 30% in the prime of their life say their health isn’t good, and almost half above age 50 say the same. Wouldn’t that be cause for large numbers to be paying more attention to some of these health issues?

The survey covered a number of other topics, which were probably of bigger concern to PhRMA in tying consumer perceptions to their mission, but the above disconnect with consumer engagement is what engaged me.

Consumer More Generous This Year with Expressing Health Plan Satisfaction

By Clive Riddle, June 28, 2013

J.D. Power has just released their excellent annual Health Plan Study of Satisfaction.  I got a different major takeaway from the study than did the folk at J.D. Power, although I also agree with their conclusions. Their take is in the context of the impending health exchange environment: “With such alternative healthcare purchasing choices as public and private exchanges--or cutting coverage altogether--taking shape among employers, health plans risk losing group business unless they improve employer satisfaction.” 

The J.D. Power study “is based on responses from 5,857 employers, with quotas to assure an adequate distribution of small, medium and large companies. The study was fielded in April and May 2013. …The study, now in its fourth year, measures six key factors that affect employer satisfaction with health plans: employee plan service experience; account servicing; program offerings; benefit design; problem resolution; and cost. Health plans are ranked in two employer segments: fully insured employers (health plan assumes the risk of providing health coverage for insured events); and self-funded employers (employers bear the risk associated with offering health benefits).”

Richard Millard, J.D. Power’s senior director of the healthcare practice  tells us “health plans need to understand the importance of satisfaction in order to limit the erosion of their business from employer-sponsored coverage to alternative channels where employees have more choices. Those health plans that focus on closing the satisfaction gap across key performance factors are more likely to retain employer-sponsored group contracts."

J.D. Power notes that “nearly one-fifth (15%) of employers say they "definitely will not" or "probably will not" continue sponsoring coverage in five years. Among employers in both segments, there is a 90-point gap in overall satisfaction scores between employers that intend to offer coverage in the future and those that intend to discontinue coverage.”

They go on to point out that “in both the fully insured and self-funded segments, employer satisfaction with program offerings, such as preventive health programs, disease management or wellness initiatives, is a key area of differentiation between employers that intend to offer coverage in the future and those that intend to drop coverage.  In the program offerings factor, the gap in satisfaction scores between fully insured employers that intend to offer coverage in the future and those that intend to drop coverage is 104 points--705 among employers that intend to offer coverage, compared with 601 among those that intend to drop coverage. Among self-funded employers, the gap in satisfaction scores between those that intend to offer coverage in the future and those that intend to drop coverage is also 105 points--689 among employers that intend to offer coverage, compared with 584 among those that intend to drop coverage.”

All good point as 2014 hovers over health plans. But what I found interesting was that health plan satisfaction scores improved significantly almost across the board for plans, compared to their 2012 study. I compiled their 2012 results with the current results J.D Power made available:

Overall Customer Satisfaction Index Scores
(Based on a 1,000-point scale)

Fully Insured Employer Segment	2013	2012
HCSC	741	697
Cigna	737	689
Kaiser	737	718
Aetna	724	670
Fully Insured Segment Average	709	675
WellPoint/Anthem	707	658
UnitedHealthcare	703	663
Humana	693	691
Self-Funded Employer Segment
Cigna	707	643
Self-Funded Segment Average	696	665
Aetna	694	682
WellPoint/Anthem	692	631
UnitedHealthcare	669	662

What is the cause of the rise in satisfaction? The 2011 overall rate full insured was 696, so the rate dropped in 2012, and rebounded even higher in 2013. What are the implications of this improvement in satisfaction as the health exchange landscape takes shape?

Here’s a graphic J.D. Power provided on fully insured satisfaction results:

Health Sector Economic Indicators – Altarum Institute

By Clive Riddle, April 12, 2013

Altarum Institute each month issues Health Sector Economic Indicators Briefs through its Center for Sustainable Health Spending. The brief cover health care spending, utilization, prices, and employment, and are worth perusing each time. 

Altarum’s Charles Roehrig, Director of the Center, had this to say about their current assessment of health care in the economy:  “Health spending has remained at about 18 percent of gross domestic product since mid-2009, but health employment continues to slowly increase as a share of total employment.  Expanded coverage under the Affordable Care Act should push these figures upward, but an improving economy will push in the other direction as non-health spending and jobs accelerate. We look forward to tracking how these forces play out.”

Here’s the current pulse of the health care economic sector from Altarum’s just issued April briefs, which incorporate February and March 2013 data:

• National health care spending in February 2013 grew 3.9% relative to February 2012
• Health care price growth rose to 1.7% in February 2013 compared to February 2012, two-tenths above January 2013 reading
• This was still the second lowest rate of price increase since 1.3% growth recorded in December 1997.
• The 12-month moving average price growth at 1.9% in February 2013 is the lowest since the same figure recorded in November 1998.
• In February 2013, health spending increased to a seasonally adjusted annual rate of $2.89 trillion, slightly higher than its value of $2.88 trillion in January.
• The health spending share of the gross domestic product was steady at 18.0% in January 2013, up from 16.4% at the start of the recession in December 2007.
• Health spending by category in February 2013: Hospital – 32%; Physician & Clinical – 19%;  Prescriptions – 10%; Nursing Home – 5%; Dental – 4%; Home Health – 3%; Other personal healthcare – 11%; Other health spending – 16%
• Year-over-year, hospital prices rose to 2.6% in February (from 2.0% in January). Physician and clinical services rose 0.8%, barely above the low 0.6% January print.  Prescription drugs saw price growth tumble to 0.8%, from 4.0% as recently as August 2012, and the lowest since 0.7% in June 2007.
• Implicit per capita health care utilization averaged 1.3% growth over the last 12 months.
• Health care employment rose by 23,000 jobs in March 2013, somewhat below the 24-month average increase of 24,000
• Health care represented 10.74% of total employment in March 2013, compared to 10.67% a year ago and 9.49% in December 2007.

The Alzheimer's Elephant

by Clive Riddle, March 22, 2013

There are so many large, aging elephants in the national room: Social Security, Medicare and Alzheimer's to name three leading the herd. They keep growing larger - we can see it happening in real time - and we've seen it coming for quite some time. Decades ago Ken Dychtwald coined the term Age Wave, referring to the massive shift and implications of the ballooning senior segment of our population.

Robert Egge, the Alzheimer's Association's VP of Public Policy has this to say about Alzheimer's: "Alzheimer's disease steals everything – steadily, relentlessly, inevitably. With baby boomers reaching the age of elevated risk, we do not have time to do what we have always done. The National Institutes of Health needs to reset its priorities and focus its resources on the crisis at our doorstep, and Congress must fully fund implementation of the National Alzheimer's Plan to solve the crisis."

The  Alzheimer's Association this week released 2013 Alzheimer's Disease Facts & Figures, an annual report – this year spanning 71 pages – designed to serve as “a statistical  resource for U.S. data related

to Alzheimer’s disease, the most common type of dementia,  as well as other dementias.”

Here’s some ten key points to consider about the state of Alzheimer's one can glean from the report:

1. Alzheimer's disease is the sixth leading cause of death in the United States and is the only leading cause of death without a way to prevent, cure or even slow its progression.
2. 1 in 3 seniors dies with Alzheimer's or another dementia.
3. Based on 2010 data, Alzheimer's was reported as the underlying cause of death for 83,494 individuals
4. In 2013 an estimated 450,000 people in the United States will die with Alzheimer's.
5. Among 70-years-olds with Alzheimer's disease, 61% are expected to die within a decade. Among 70-year-olds without Alzheimer's, only 30% will die within a decade.
6. More than 5 million Americans are living with Alzheimer's disease.
7. Without the development of medical breakthroughs that prevent, slow or stop the disease, by 2050, the number of people with Alzheimer's disease could reach 13.8 million.
8. In 2012, there were more than 15 million caregivers who provided more than 17 billion hours of unpaid care valued at $216 billion.
9. Due to the physical and emotional toll of caregiving, Alzheimer's and dementia caregivers had $9.1 billion in additional health care costs of their own in 2012.
10. The total payments for health and long-term care services for people with Alzheimer's and other dementias will total $203 billion in 2013, the lion's share of which will be borne by Medicare and Medicaid with combined costs of $142 billion.

Here's a breakdown provided in the report of 2013 Health and Long-Term Care Services expenditures by source:

• Medicare: $107 billion (53%)
• Medicaid:  $35 billion (17%)
• Out-of-Pocket Costs: $34 billion (17%)
• Other Sources - private insurance / uncompensated - $27 billion (13%)
• Total: $203 billion

We’ve all heard the trope “an elephant never forgets.” The irony is, we as a nation are conveniently forgetting the elephant in the room that that in the long term, will rob us of our capacity to remember. 

High Deductible PPO Plans Versus CDHPs

By Clive Riddle, March 8, 2013

United Benefit Advisors has just released results of their annual health plan survey, with responses from 11,711 employers sponsoring 17,905 health plans nationwide, with results applicable for small to midsize companies. The survey includes a focus on Consumer Driven Health Plan (CDHP) vs. PPO comparisons of premiums, deductibles and enrollment. Their study found that “Consumer-driven health plans (CDHPs) -- high-deductible health plans (HDHPs) often paired with health savings accounts (HSAs) or health reimbursement accounts (HRAs) -- are not achieving long-term savings greater than what would be reached by raising the deductible on traditional PPOs.”

Unlike most national large employer benefit consulting firms, UBA – whose survey concentrated on smaller firms – is not bullish on account based plans, and would rather place their bets on straight PPO plans with a higher deductible. Although one could argue, it might be easy to make a stripped down high deductible PPO health plan yield immediate lower costs than a CDHP that has account administration costs, up-front wellness benefits and other bells and whistles. That doesn’t necessarily mean the PPO HDHP would be the best long term solution for an employer’s and employee’s objectives, unless immediate premium costs is the only concern.

UBA CEI Thom Mangan tells us “Employers are turning to CDHPs as a cost-cutting solution against the relentless upward spiral of health care costs. However, our research shows that small-to midsize businesses in particular, who may be considering these plans may first want to consider increasing the deductible on the plans they already have to achieve the same initial savings. Or, prior to implementing a CDHP plan, employers should build a culture of health and wellness in their workplace that drives employee behavior towards quality, low cost medical care and prescription drugs.”

Here’s some of the data UBA has shared from their findings:

• Nearly 60 percent of the 11,711 employers surveyed said they plan to offer a CDHP in the next five years
• PPOs remain the dominant plan type with 61.7 percent of U.S. employee enrollment
• The greatest savings of a PPO over a CDHP was achieved with a deductible of $2,000-$2,999, where PPO cost per employee was $7,811 and CDHP was $8,859, a savings of $1,000 per employee.
• Savings created by CDHPs over the plans they were replacing or HSA, averaged 1.75 percent in 2012, a significant reduction from prior years.
• Enrollment also decreased to 15.6 percent (a 1.8 percent decrease from 2011), and nationwide enrollment among employers with 1,000 or more employees dropped substantially from 15.9 percent in 2011 to 11.3 percent in 2012.
• The area of the country that has seen the biggest increase in CDHP growth is Minnesota, which saw the percent of employees enrolled in CDHPs increase from 15.5 percent in 2010 to 37.1 percent in 2012, a rate 18.4 percent higher than the national average in those same years.
• Other areas with rapid CDHP growth include Indiana, Virginia and the Northeast region. The only western state to see CDHP popularity increase was Oregon, where percent of employees enrolled in CDHPs increased from 12 percent in 2010 to 20.3 percent in 2012.
• Overall, CDHP enrollment in the west is the lowest in the country with only 7.7 percent of employees covered, a slight increase from 7 percent in 2011 and 4.6 percent in 2010. HMOs account for 31.3 percent of the market in the west.