The Facts of Managed Care

By Clive Riddle, January 10, 2020

The MCOL Managed Care Fact Sheets have just been updated, an ongoing online feature provided since the 1990s. Here’s some highlights:

Overall national managed care penetration is now 75.4%. Here’s a breakdown by payor segment, based on 2019 data: 

Sources: (see Note 1)

Here is the total national managed care enrollment by coverage type, based on 2018 data:

Health Maintenance Organization (HMO):  94.8 million

Preferred Provider Organization (PPO):    165.8 million

Point of Service (POS):                                 4.8 million

High Deductible Health Plan (HDHP):        15.6 million

Total*                                                          81.0 million

* The above total enrollment exceeds the total actual national managed care population due to double counting of A) spouses and dependents who have dual coverage; and B) HDHP plans that are also classified as PPO, HMO or POS

Sources: (see Note 2)

And here is major national health plans enrollment as of September 30, 2019:

United Health Group:  49.4 million

Anthem:                       41.0 million

CVS Health (Aetna):    22.8 million

Humana:                      16.6 million

CIGNA HealthCare:     17.1 million

HCSC:                         16.0 million

Centene*:                    15.3 million

Kaiser Permanente:    12.2 million

Wellcare*:                     6.4 million

Molina:                          3.3 million

*Centene/Wellcare Enrollment is reported separately, prior to public reporting of combined membership from merger

Source: Compiled by MCOL from company financial reports

The Managed Care Fact Sheets also include:

• National HMO Enrollment Graph
• Medical Cost Components
• Premium Rate Increase Trends Graph
• 2020 Premium Rate Increase Estimates

Notes

1: National Managed Care Penetration sources:

• MCMS Fast Facts: www.cms.gov/fastfacts/
• Kaiser Family Foundation State Health Facts Total Medicaid MCO Enrollment http://kff.org/other/state-indicator/total-medicaid-mco-enrollment/
• People Enrolled in Medicare and Medicaid, Fact Sheet March 2019, CMS Medicare-Medicaid Coordination Office  https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf    
• Tricare Prime Beneficiaries: https://www.tricare.mil/About/Facts
• Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey,  2018, Division of Health Interview Statistics, National Center for Health Statistics   https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf   
• U.S. Census Bureau Quick Facts, United States  https://www.census.gov/quickfacts/fact/table/US/PST045216

2. National Managed Care Enrollment sources:

• 2018 PayerDigest Series, Sanofi Managed Care Digest Series www.managedcaredigest.com
• Health Coverage State-to-State, 2019  www.ahip.org/wp-content/uploads/StateDataBook_2019-FINAL.pdf

What's Predicted in Healthcare for the Dawn of a New Decade

by Clive Riddle, January 3, 2019

As we enter 2020, what are prognosticators sensing the start of the new decade will bring forth in the healthcare arena? Here's nine recent HealthSprocket lists that peek into year ahead:

Deloitte offers these ten overall Healthcare and Life Sciences Predictions 2020:

1. Health consumers in 2020: Informed and demanding patients are now partners in their own healthcare
2. Health care delivery systems in 2020: The era of digitized medicine - new business models drive new ideas
3. Wearables and mHealth applications in 2020: Measuring quality of life not just clinical indicators
4. Big Data in 2020: Health data is pervasive- requiring new tools and provider models
5. Regulation in 2020: Regulations reflect the convergence of technology and science
6. Research and Development in 2020: The networked laboratory - partnerships and big data amidst new scrutiny
7. The pharmaceutical commercial model in 2020: Local is important but with a shift from volume to value
8. The pharmaceutical enterprise configuration - the back office in 2020: Single, global, and responsible for insight enablement
9. New business models in emerging markets in 2020: Still emerging, but full of creativity for the world
10. Impact of behaviors on corporate reputation in 2020: A new dawn of trust

Becker's Hospital Review summarized these S&P 7 healthcare trends to watch in 2020 with a financial marketplace perspective: 

1. Changes in healthcare may speed up
2. Industry disruption will continue
3. Rating deterioration will continue
4. Mergers among payers and other players will pressure pricing
5. M&A activity in the healthcare industry will remain elevated
6. Opioid litigation settlements will accelerate
7. Medical device makers will see a stable 2020

On the life sciences front, Syneos Health offers these Pharma Trends for 2020: 

1. The Many Points of Care - shifting away from where clinic exists to wherever patient goes
2. Better, By Design - big shifts in clinical research user experience
3. The Trust Deficit - initiatives to win trust back from people
4. Patient Value - patient-centricity
5. Digital Amplification and Innovation - digital experiences taking another big step forward
6. The Value Evaluation - to show initial population-relevant data and defend value against constant change
7. Answering to Real World - get ahead of both regulatory requirements and payer expectations
8. Connected Communications - personal communications that understand where people are in their individual journeys
9. Rapidly Changing Life Experience - Our world is changing and aging faster than ever before
10. New Strategic Blueprint - resetting focus on core assets, building ROI models around the yield of data investments

And Managed Healthcare Executive adds the pharmaceutical benefit perspective with Eight Trends Expected to Shape Managed Care Pharmacy in 2020:

1. Continued shift to value-based care
2. Increased integration of medical and pharmacy benefits
3. Drug prices will continue challenging patients, payers, and providers
4. Medication systems will gain connectivity
5. Precision medicine will mature
6. Ongoing emphasis on social determinants of health (SDoH)
7. Pharmacists emerge as primary care providers.
8. Consumers will become more cautious about prescribed medications

With respect to life sciences and healthcare, the Cleveland Clinic published their annual Top 10 Medical Innovations for 2020:

1. Dual-Acting Osteoporosis Drug
2. Expanded Use of Minimally Invasive Mitral Valve Surgery
3. Inaugural Medication for Transthyretin Amyloid Cardiomyopathy
4. Therapy for Mitigation of Peanut Allergies
5. Closed-Loop Spinal Cord Stimulation
6. Biologics in Orthopaedic Repair
7. Antibiotic Envelope for Cardiac Implantable Device Infection Prevention
8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients
9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer
10. Drugs for Heart Failure with Preserved Ejection Fraction

Turning to technological oriented trends, Health Data Management lists these 8 Healthcare trends that will rock medical care in the 2020s:

1. Artificial intelligence
2. Digital health tools
3. Imaging technology
4. Data sharing and interoperability
5. Patient communication and engagement
6. Payer evolution
7. Precision medicine
8. Virtual or remote care

In the same vein, Forbes published 9 technology trends that will transform medicine and healthcare in 2020:

1. AI and Machine Learning
2. Robotics
3. Computer and Machine Vision
4. Wearable Tech
5. Genomics
6. 3D Printing
7. Extended Reality (Virtual, Augmented and Mixed Reality)
8. Digital Twins
9. 5G

How does all this shape health policy? The Hill tells us there will be Five health care fights to watch in 2020:

1. Drug pricing
2. Surprise billing
3. ObamaCare
4. Medicare for All
5. Vaping

And finally, here's a summary of Seven Quick Takes on Healthcare Trends Shaping 2020 previously posted in mcolblog:

1. Election Year Policy Angst
2. Expanding Impact of Medicaid Expansion
3. One More Year for SDoH Before ROI Naysayers
4. Viral Value Based Payment
5. Health Technolytics - Healthcare Analytics + Technology
6. Morphing Point of Care and Coverage
7. Behind the Veil of Pricing Transparency and the CMS Final Rule

Happy New Year and New Decade!

Corrective Lens Needed for 2020 Healthcare Vision

By Clive Riddle, December 19, 2019

How did two decades of the new Millennium already fall into the rear view mirror? Weren’t we just bracing healthcare organizations for all the fallout that was supposed to emanate from Y2K?

It’s a shame we don’t have corrective lens that can adjust for hindsight, as we attempt to seek 20/20 vision into 2020 and beyond. None the less, here’s seven quick takes on trends that should shape our new year:

1. Election Year Policy Angst - Its not just Democrat vs Trump policy proposals – it’s also what fallout is coming from the forever legal saga surrounding the ACA, congressional proposals, state proposals and ballot initiatives, and lobbying clout. A lot is at stake and a lot is uncertain.
2. Expanding Impact of Medicaid Expansion - While Medicaid Expansion policy falls under the above discussion, the impact of Medicaid Expansion is a category unto itself: the coverage disparities between states; the resulting funding disparities for hospitals; the health improvement metrics where expansion is firmly in place; the transformation of dominant product mix for health plans and much more.
3. One More Year for SDoH Before.. - Speaking of impact of Medicaid Expansion, growth of Social Determinant of Health initiatives were totally fueled from that source. Good vibes are abundant from the embrace of SDoH by plans and providers, which will continue to reach a crescendo. Then a year from now, as always happens with shiny new trends, naysayers and boo birds will start to emerge questioning the ROI.
4. Viral Value Based Payment - No end seems to be in sight for value based payment models and arrangements. They will continue to spread and mutate into new forms.
5. Health Technolytics - The rapid evolution of healthcare technology platforms, devices and analytics will continue to make healthcare organization analytic capabilities more powerful and impactful. Will the humans in the organization be able to keep pace?
6. Morphing Point of Care and Coverage - the lines drawn for where people get their care continue to blur with telehealth, retail sites, mergers of cross-industry forces, e-commerce and other disruptors. Where is this all headed? One thing is certain – disruption will abide.
7. Behind the Veil of Pricing Transparency - CMS hospital pricing transparency regulations will have more of an operational impact in 2020 – and what new pricing transparency initiatives lie ahead for other healthcare stakeholders? (see Election Year Policy Angst)

Is there a trend or issue for 2020 that could potentially have a significant impact for healthcare stakeholders that might be flying under some organizations’ radar? That’s the question posed in the current issue of MCOL ThoughtLeaders.  Some of the above takes are reflected in the ThoughtLeader panel’s responses. Here’s some key snippets they shared:

Patrick Horine, CEO, DNV GL Healthcare says “the push for more transparency of healthcare providers has reached an all-time high. The demands for transparency of pricing, coverage, costs, performance quality raises many challenging questions and concerns as to what should be shared.”

Hank Osowski, Managing Partner, Strategic Health Group tells us “there exists a curtain of uncertainty that is masking what could potentially be one of the most impactful and disruptive periods in the industry’s history. This uncertainty is driven by two dynamics which will help to determine our future: a ruling on the constitutionality of the Affordable Care Act (“ACA”) and the likely turmoil to be created by the elections of 2020. The healthcare industry may not be prepared for the disruption. “

Mark Lutes, Chairman, EpsteinBeckerGreen notes that “an important emerging trend is attention to serious illness management (“SIM”) in the subacute settings—ideally the home. The trend is embryonic yet terribly important — both from quality and cost perspectives. There are significant opportunities to improve patient satisfaction and to optimize the application of resources by focusing on the development of appropriate care models.”

Neal Hogan, Director, BDC Advisors, shared that “value based payment (which looks a lot more like the traditional fee-for-service model than risk) seems to be a signpost on the road to population health---if that is where our system is truly heading. We need to start matching the reality to the rhetoric so we can be clear about how to win in an era of consumerism and transparency.”

William DeMarco, Founder and President, Pendulum HealthCare Development Corporation, comments: “the issues that are under the radar for many organizations who see only one or two options, are the vast variety of CMS models which are emerging and reemerging in different forms that are altering reimbursement as well as delivery of care.”

And Lindsay Resnick, Executive Vice President, Wunderman Thompson Health, summarizes that we should “expect the healthcare community to step-up efforts in cross-industry collaboration. While we’ll continue to see vertical and horizontal M&A reshape the landscape, collaborative partnerships will thrive.”

Tracking the Evolution of Top Health Trends and Issues During the Trump Era

By Clive Riddle, December 13, 2019

Every December, the PwC Health Research Institute - like many other organizations – releases their compiled list of the top health issues from their perspective, for the coming year. This year their headline question posed from their list is “will digital start to show an ROI?” PwC hasn’t been married to the Dave Letterman Top Ten format – this and last year they identified six key issues, two years ago it was a dozen, three years ago they did pick ten.

 Here’s a summary of their top six issues for 2020 from their 53-page report:

1. A looming tsunami of high prices – “facing a tsunami of high-priced gene and cell therapies and ever-rising provider prices in 2020” stakeholders will pursue “creative ways to finance care, spread risk and ensure that their money is paying for value.”
2. Regulation trumps policy – “the outcome of the 2020 election is unlikely to bring about profound” change but the election will determine the fate of Trump policies on Medicaid, ACA, pricing transparency and trade.
3. Consumers inch closer to DIY healthcare – Consumers will “finally reap benefits from the enormous investments in data collection, storage and analysis that have been made by the US health industry.”
4. US health organizations are seeking opportunities overseas and through innovation. Beware of the tax risks.
5. A whole new you: Deals as makeovers – with “strategic deals not to just grow larger but instead to expand into new identities with platforms anchored in value, innovation, customer experience and population health.”
6. Equity and inclusion, not just diversity, as a business imperative – “health companies will align diversity, equity and inclusion initiatives with business goals and identify blind spots.”

So, using the PwC annual list as a yardstick, how has a view of the top healthcare issues for coming year evolved during the Trump years? Using previous Healthsprocket lists that summarized the PwC issues, here’s how they viewed the coming year for 2019, 2018 and 2017:

PwC: 6 top health industry issues of 2019

1. Digital therapeutics and connected care reshape the life sciences industry
2. The Affordable Care Act in 2019: Still Alive
3. Your company’s new, upskilled health worker of the future is you
4. Tax reform has only just begun for healthcare companies
5. Creating the Southwest Airlines of healthcare
6. Private equity: Healthcare’s new growth accelerator

PwC: Top 12 health industry issues of 2018

1. The healthcare industry tackles the opioid crisis
2. Social determinants come to the forefront
3. Price transparency moves to the statehouse
4. Natural disasters create devastation that lasts long after the event passes
5. Medicare Advantage swells in 2018
6. Health reform isn't over, it's just more complicated
7. Securing the internet of things
8. Patient experience as a priority and not just a portal
9. Meet your new coworker, artificial intelligence
10. Healthcare's endangered middlemen: PBMs, wholesalers
11. Real-world evidence a growing challenge for pharma
12. Tax reform moves forward

PwC - Top 10 health issues for 2017

1. Under a new administration, the fate of the ACA remains unclear
2. Pharma’s new strategic partner? Patients
3. Easing the training wheels off value-based payment
4. Insert your card here for healthcare
5. Paging Dr. Drone: It’s time to prepare for emerging technologies
6. The battle against infectious diseases sparks invention
7. Rx cauliflower: Nutrition moves to population health
8. Putting the brakes – gently - on drug prices
9. A year of new partnerships and collaborations
10. Preparing medical students for work in a value-based world

Fifteen Things to Know from the 2019 America’s Health Rankings Report

By Clive Riddle, December 6, 2019

Vermont is number one in health, Mississippi is in last place, and New York gets most improved. Smoking is down, obesity is up, along with diabetes, drug death, and suicides. Fortunately the supply of mental health providers is increasing as well. These indicators and countless more come courtesy of the 2019 America’s Health Rankings Annual Report.

 

The United Health Foundation, affiliated with UnitedHealth Group, has released their 118-page 2019 America’s Health Rankings Annual Report, marking their 30th annual study that "has grown from ranking states across 16 measures of health to 35 measures in 2019." This year’s report was developed in partnership with the American Public Health Association.

The Foundation share these key findings from their report:

1. In the past year, improvements have been made in lowering the rates of smoking (decreasing 6%), children in poverty (decreasing 2%), and increasing the supply of mental health providers (increasing 5%).
2. In the past two years, infant mortality has declined, resulting in 1,200 fewer deaths (decreasing 2%).
3. Obesity prevalence among Americans is now at 30.9%, up 11% since 2012.
4. Diabetes is now at 10.9% of the U.S. population, up 4% in the past year.
5. The rate of drug deaths increased 37% from 14.0 to 19.2 deaths per 100,000 – equating to more than 53,000 additional deaths over a three-year period.
6. The suicide rate increased 4% nationally in the past year, and is up in a total of 30 states.
7. Smoking among adults has decreased 45% since 1990. Today, 16.1% of adults report that they smoke.
8. Infant mortality has decreased 43% since 1990, with declines in all 50 states.
9. Obesity has increased 166% over the past 30 years, from 11.6% to 30.9%.
10. Diabetes has reached the highest prevalence since 1996, increasing 148% among adults.
11. The national suicide rate has increased 17% since 2012.
12. Drug deaths have increased 104% since 2007.
13. Vermont topped the list of healthiest states in 2019, followed by Massachusetts (No. 2), Hawaii (No. 3), Connecticut (No. 4) and Utah (No. 5).
14. Mississippi ranks No. 50 this year, followed by Louisiana (No. 49), Arkansas (No. 48), Alabama (No. 47) and Oklahoma (No. 46).
15. New York has made the most progress since the Annual Report was first released in 1990, improving 29 ranks from No. 40 to No. 11.

A Current Snapshot of Medicare Advantage, PDP Medicare Employer Group Enrollment

by Clive Riddle, November 22, 2019

As of November, Medicare Advantage now serves 22,584,367 enrollees. Another 709,746 are enrolled in related plans (Dual, Cost and PACE), for a total of 23,294,113 Medicare enrollees in managed plans. 88.3% of these total managed enrollees have Prescription Drug Plan coverage. Another 25,626,600 Medicare enrollees not in managed plans have PDP coverage.

14.1% of Medicare Advantage enrollees are in Special Needs Plans. 20.1% of Medicare Advantage enrollees are in Employer Plans. 18.5% of Medicare PDP only enrollees are in Employer Plans. Below is the CMS November 2019 enrollment contract summary report: 

Speaking of Employer plans, Mark Farrah Associates has just released a brief: Trends in Employer Group Medicare Advantage Enrollment. For the employer group segment, they identified the top five MA payers by group enrollment (Oct. 2019 data) to be:

• UnitedHealth: 1,387,052
• CVS/Aetna: 913,490
• Kaiser: 550,331
• Humana: 510,956
• BCBS Michigan: 378,890

These top five payers comprise 83.7% of total Employer Group MA enrollment, and “all 5 of the leading group MA health plans achieved double-digit growth in membership since December 2016.” Enrollment is also concentrated by state, with the top ten states (20% of the states) comprising 63.9% of Employer Group MA enrollment, with California on top with 622,404 enrollees followed by Michigan with 405,415.

Overall, they note that “employer group MA enrollment has increased by almost 321,000, a 7.7% increase, since December 2018. Moreover, group market enrollment has increased by approximately 1.3 million members since December 2016.”

Affordability and Coverage of Prescription Drugs for Seniors: A Gallup Poll and a KFF Study

by Clive Riddle, November 15, 2019

West Health and Gallup have just released results from a new survey on healthcare costs that found 13.4% of U.S. adults had “a friend or family member [who] passed away after not receiving treatment for their condition due to their inability to pay for it.” That percentage decreases with age: 16.9% under age 45, 12.4% between age 45 and 64 and 6.6% age 65%+  knew someone passing away.

That might seem counter-intuitive, given the greater frailty of seniors, but greater income levels compared to those under age 45, combined with stable coverage (Medicare) factor in. By income the percentages were 18.5% under $40k annually, 11.1% between $40k to $100k, and 9.1% over $100k.

Prescription drugs pricing was a particular focus in the survey, and “89% of U.S. adults report that drug prices are either ‘much higher’ or ‘somewhat higher’ than what consumers should be paying for them.” The survey found “28% of women vs. 18% of men have been unable to pay for prescription drugs;’ and that “medication insecurity skyrockets to 42% among those with annual household incomes of under $40,000.”

Today’s seniors have something the previous generation did not –the availability of  Medicare prescription drug coverage to help insulate from drug costs, and Kaiser Family Foundation has just released a new study: Medicare Part D: A First Look at Prescription Drug Plans in 2020.

Here’s eight things to know from KFF’s study:

1. The average Medicare beneficiary will have a choice of 28 PDPs in 2020, a 29% increase from 2017
2. A total of 948 PDPs will be offered in 2020, an increase of 202 PDPs since 2017.
3. Among the 20 PDPs available nationwide, average premiums will range sixfold from a low of $13 per month for Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts Medicare Choice.
4. Two-thirds of Part D enrollees without low-income subsidies will have premium increases in 2020 if they stay in their same plan, and one-third will have premium decreases.
5. The estimated national average monthly PDP premium for 2020 is projected to increase by 7% to $42.05
6. In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and specialty drugs, and cost sharing other than the standard 25% coinsurance, similar to 2019.
7. 86% of PDPs will charge a deductible, with most PDPs charging the standard deductible of $435 in 2020.
8. Among all PDPs, median cost sharing is $0 for preferred generics and just $3 for generics, but $42 for preferred brands and 38% coinsurance for non-preferred drugs plus 25% for specialty drugs

Telling Tooth to Power: J.D. Power 2019 Dental Plan Satisfaction Report

by Clive Riddle, November 8, 2019

J.D. Power has just released its 2019 Dental Plan Satisfaction Report, which found that “customer satisfaction with dental plans increased in 2019, driven by year-over-year increases in coverage and communication experience,” with an overall satisfaction score in 2019 of 772 (on a 1,000-point scale) increasing from 768 in 2018.

The study found that DentaQuest (810 score) ranks highest, Blue Cross Dental/Blue Shield Dental (806 score) ranked second and HumanaDental (780 score) ranked third. The study noted “while most dental care providers included in the study typically provide insurance coverage through the customers’ employer, DentaQuest largely provides government plans.” Their report is based on survey responses from 1,400+ dental plan members.

The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey found that “among firms offering health benefits in 2019, 59% of small firms and 92% of large firms offer a dental insurance program to their workers separate from any plan included in their plan,” and that “sixty­three percent of firms offering a dental program to their workers make a contribution toward the cost of the coverage.”

The recently released 2020 Segal Health Plan Cost Trend Survey found that dental PPO plans were projected at 3.8% premium increases, dental maintenance organization plans at 3.5% increases, dental reference priced plans at 3.0% and dental FFS/indemnity plans at 4.1% increases. The report notes that dental benefits have "remained relatively unchanged for decades."

Here are the detailed results from the J.D. Power Dental Plan Satisfaction Report:

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Google to acquire Fitbit in $2.1B deal, challenging Apple

Google plans to acquire wearables maker Fitbit in a deal valued at $2.1 billion, the companies announced Friday. Fitbit's stock soared more than 16% on the news.

Healthcare Dive

Friday, November 1, 2019

IBM, Mayo Clinic, Geisinger among 25 finalists for $1.6M CMS artificial intelligence challenge

Out of more than 300 artificial intelligence proposals, the Centers for Medicare & Medicare Services (CMS) picked 25 organizations for the next stage of its AI challenge including IBM, Booz Allen Hamilton and Mayo Clinic.

Fierce Healthcare

Thursday, October 31, 2019

Hospitals Take Shot At Opioid Makers Over Cost Of Treating Uninsured For Addiction

While thousands of cities and counties have banded together to sue opioid makers and distributors in a federal court, another group of plaintiffs has started to sue on their own: hospitals.

Kaiser Health News

Tuesday, October 29, 2019

Firms Seeking Top Workers Find They Can't Offer Only High-Deductible Health Plans

Everything old is new again. As open enrollment gets underway for next year's job-based health insurance coverage, some employees are seeing traditional plans offered alongside or instead of the plans with sky-high deductibles that may have been their only choice in the past.

NPR

Tuesday, October 29, 2019

Uber lands EHR deal with Cerner

Uber Health is now available on Cerner's EHR platform, allowing U.S. providers and Cerner clients to schedule non-emergency medical transportation for their patients in the ride-hailing giant's first EHR integration.

Healthcare Dive

Monday, October 28, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Measuring Telehealth Satisfaction: J.D. Power Study Finds Early Adopters Love It

by Clive Riddle, November 1, 2019

Telehealth use has progressed to the point where J.D. Power now has added the category to items included in their consumer satisfaction studies. The J.D. Power 2019 Telehealth Satisfaction Study finds that while “nationwide consumer adoption of telehealth services has been stubbornly low, with just 10% of healthcare consumers having used such services,” among those early adopters who are using telehealth, customer satisfaction with the experience ranks among the highest of any consumer category studied by J.D. Power.”

Greg Truex, Managing Director, Health Intelligence at J.D. Power offers this perspective: “Early attempts at trying to convince consumers to bank via their phone failed, and initiatives were abruptly canceled. Now, with mobile banking apps having grown to become the third-most-used application among consumers, we expect telehealth to follow a similar path. Telehealth offers an alternative avenue to receive quality care that is cost efficient and accessible. Once providers and payers refine the formula for awareness and adoption, telehealth will change the landscape of how affordable and quality care is delivered.”

J.D. Power found “the overall customer satisfaction score for telehealth services is 851 (on a 1,000-point scale), and is 900 or higher among 46% of telehealth users.,” and that “these customer satisfaction scores are among the highest of all healthcare, insurance and financial services industry studies conducted by J.D. Power. Only direct banking customer satisfaction ranks higher, with an average score of 855.”

Among direct-to-consumer brands, Teladoc ranked highest with a score of 870. Followed by Doctor on Demand (867) and MDLIVE (847). Among payers of health plan-provided telehealth services, Humana ranks highest with a score of 864, followed by Kaiser (863) and Cigna (862).

 

Additional J.D. Power study findings included:

• 65% of telehealth users used the service because they received a positive recommendation from others, including friend, family or colleague (22%); health plan (21%); primary care doctor (20%); employer (18%); or health plan, hospital, or another provider (15%).
• Among consumers who have not used telehealth, 29% indicate that telehealth is not available to them and 37% say they do not know if it is offered by their health provider or health system.
• Self-reported availability is lowest in rural areas (25%).
• 84% of telehealth users were able to completely resolve their medical concern(s) during their visit 
• 73% of users did not experience any issues or problems during their service.
• 49% of users say there were no barriers that made using telehealth difficult.
• 87% of users describe the enrollment process as somewhat/very easy.
• Users averaged 44 minutes for their entire experience, including: 17 minutes to complete the enrollment process, 9 minutes to wait for a physician or nurse practitioner and 18 minutes for the actual consultation. 

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Pharma Sells States On ‘Netflix Model’ To Wipe Out Hep C. But At What Price?

When a long, black bus bearing the logo of drugmaker AbbVie rolls through Washington state next year, it will promote a new effort to eradicate hepatitis C infections.

Kaiser Health News

Friday, October 25, 2019

Feds owe health insurers $1.6 billion in unpaid subsidies, judge rules

A federal judge this week ordered the federal government to pay about 100 health insurance plans a total $1.6 billion in unpaid subsidies.

Modern Healthcare

Thursday, October 24, 2019

Health system margins rebounded last year but trail 2015 levels

Major U.S. health systems rebounded on their operating margins last year by an average of 13%, but they still average at 30% below 2015 levels, according to a Navigant analysis released Wednesday.

Healthcare Dive

Wednesday, October 23, 2019

Premiums for popular Obamacare plans to drop 4 percent

Premiums for key plans sold on HealthCare.gov will drop by 4 percent on average next year, with several states seeing double-digit declines, the Trump administration said this morning.

Politico

Tuesday, October 22, 2019

UPS flies further into healthcare with CVS, AmerisourceBergen, provider partnerships

UPS Flight Forward, the logistics provider's drone subsidiary, has sealed partnerships with CVS Pharmacy, AmerisourceBergen, Kaiser Permanente and the University of Utah Health System to deliver healthcare supplies via drone.

Healthcare Dive

Tuesday, October 22, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Thirteen Things to Know About the State of Vaping Use and Healthcare

By Clive Riddle, October 22, 2019

The CDC recently released numbers on vaping prevalence and health issues, which has been compiled along with their Electronic Cigarette Infographic Fact Sheet, to yield these thirteen things to know:

1. As of October 8, 2019, 1,299 confirmed and probable lung injury cases associated with use of e-cigarette, or vaping, products were reported nationally
2. As of that date, 26 deaths have been confirmed in 21 states
3. The median age of patients who have died is 49 years, ranging from 17 to 75 years old.
4. 76% of users reported using THC-containing products, with or without nicotine-containing products;
5. 32% of users reported exclusive use of THC-containing products;
6. 58% of users reported using nicotine-containing products, with or without THC-containing products
7. 13% of users reported exclusive use of nicotine-containing products.
8. 70% of users are male.
9. 80% of users are under 35 years old.
10. 15% of users are under 18 years old
11. 21% of users are 18 to 20 years old.
12. As of 2015, among all adult users 11.4% had never been regular cigarette smokers, but for age 18-24 40.0% had never been regular cigarette smokers
13. In 2018, 4.9% of middle school and 20.8% of high school students had used e-cigarettes in the past    30 days, compared to a 2017 study citing 2.8% of all adults

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Google nabs ex-Obama official DeSalvo for new chief health role

Google has hired ex-Obama administration official Karen DeSalvo as its first chief health officer, further solidifying its investment in the $3.5 trillion industry by rounding out its healthcare team.

Healthcare Dive

Friday, October 18, 2019

Whistleblower Alleges Medicare Fraud At Iconic Seattle-Based Health Plan

Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Kaiser Health News

Friday, October 18, 2019

Surprise Settlement In Sutter Health Antitrust Case

Sutter Health has reached a tentative settlement agreement in a closely watched antitrust case brought by self-funded employers, and later joined by the California Attorney General’s Office.

Kaiser Health News

Thursday, October 17, 2019

Medicare, Medicaid hospital payment cuts to hit $252.6B, industry study finds

Reductions in federal payments to hospitals will total $252.6 billion from 2010 through 2029, reflecting the cumulative impact of a series of legislative and regulatory actions, according to a new study from Dobson DaVanzo & Associates, a health economics and policy consulting firm.

Healthcare Dive

Wednesday, October 16, 2019

New study: Full-scale 'Medicare for All' costs $32 trillion over 10 years

The study from the Urban Institute and the Commonwealth Fund found $32.01 trillion in new federal revenue would be needed to pay for the plan, highlighting the immense cost of a proposal at the center of the health care debate raging in the presidential race.

The Hill

Wednesday, October 16, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Getting More Precise About Precision Medicine

By Clive Riddle, October 16, 2019

The October Care Intervention Edition of Care Analytics News profiled Dr. Jen Buhay, Precision Medicine Clinical Program Manager for The US Oncology Network. The term “Precision Medicine” can sound straight-forward, yet for those not directly involved in this arena, there is not always a clear understanding of its current scope.

So the first question asked of Doctor Buhay was simply “What is Precision Medicine?” she replied: “In the simplest terms, Precision Medicine is the “right test for the right patient at the right time.” But the practice of Precision Medicine is not so simple. A physician must choose from an array of complicated tests that are appropriate for a diagnosis and the creation of a treatment plan for their patient in a timely manner. That’s a lot of separate data and time points to manage for one patient, so how do we connect these individual patients together with their own personalized sets of tests and outcomes to improve population health?”

It can also help to take a glimpse of the background of someone in the field. Jen leads biomarker testing, education, and operational efforts at The US Oncology Network, “to support personalized patient care for oncology. Previously, she led precision medicine initiatives in a community hospital setting and worked as a laboratory scientist for commercial and academic molecular diagnostic laboratories. Dr. Buhay holds a PhD in Integrative Biology (molecular genetics and computational biology) from Brigham Young University, an MS in Biology from Eastern Kentucky University, and a BS in Animal Behavior from Juniata College. She is board-certified as a Molecular Biologist through the American Society for Clinical Pathology.”

Dr Buhay cites breast cancer as an area where Precision Medicine can really help, and “has resulted in the development and evolution of standard biomarker testing guidelines, risk assessment and screening protocols, and treatment plans that are now widely recognized and used. This clinical application of Precision Medicine has resulted in the avoidance of unnecessary and ineffective testing and treatment, rapid identification of targeted treatments with good responses in similar populations, and the proactive screening of families at high risk for breast cancers.”

Regarding future potential, Jen says “the big picture comes together in Precision Medicine when clinical outcomes are linked to the biomarker testing choices, disease screening methods, and targeted treatment plans for large groups of patients as part of clinical trials and translational research. With the analysis of “big data” comes new and updated biomarker testing recommendations, patient care models, disease screening protocols, and treatment guidelines by professional medical societies. These guidelines reflect the most recent technological advances in laboratory science from the bench to the bedside, and this information is continually evolving with new studies leading to better survival rates, increased detection, and improved treatments for future patients. Precision Medicine efforts will continue to expand across many diseases as more physicians learn the lessons of how breast cancer incorporated biomarker testing, disease screening, and targeted therapies into standard practices and guidelines for the betterment of individuals, families, and populations.”

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Sutter, Kaiser among hospitals hit by Northern California blackouts

The blackouts created by the Pacific Gas & Electric (PG&E) utility in Northern California have led to numerous hospitals relying on their backup generators for power.

Healthcare Dive

Friday, October 11, 2019

Amazon Textract now HIPAA-eligible as tech giant expands AI portfolio

Amazon Textract, a machine learning service that automatically extracts selected text and data from scanned documents, is now HIPAA-eligible, Amazon Web Services announced in a blog post Thursday.

Healthcare Dive

Friday, October 11, 2019

How HHS wants to update anti-kickback rules to support value-based care

HHS on Wednesday issued long-anticipated proposed rules to update anti-kickback and physician-referral regulations so they do not interfere with physicians' ability to participate in value-based payment arrangements.

The Advisory Board

Thursday, October 10, 2019

VCU Health Will Halt Patient Lawsuits, Boost Aid In Wake Of KHN Investigation

VCU Health, the major Richmond medical system that includes the state’s largest teaching hospital, said it will no longer file lawsuits against its patients, ending a practice that has affected tens of thousands of people over the years.

Kaiser Health News

Wednesday, October 9, 2019

Waste gobbles up 25% of US healthcare spending, JAMA study finds

The estimated cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion, or about 25% of the total healthcare spending, according to a report in JAMA issued Monday.

Healthcare Dive

Monday, October 7, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

High Deductible Plans, Absentee Employer Contributions and the Burden of Employee Cost Sharing

By Clive Riddle, October 11, 2019

Much is being said about the increasing burden of employee health insurance cost sharing, which continues to far outpace employee wage increases and other cost of living indexes. The prevalence of high deductible plans is often cited as a significant factor adding to this burden. Perhaps not enough is being said about the prevalence of employers that do not make any or adequate account contributions for such high deductible plans, and the role of these absentee employers in adding to the employee burden.

The current issue of MCOL's ThoughtLeaders asks "What are the stakeholder implications going forward arising from employee health plan cost sharing increasing at twice the rate of wages during the past decade?”

Lindsay Resnick, EVP at Wunderman Thompson Health opens his response by telling us the implications "can be summed-up on one word: OOPS…Out Of Pocket Spending. As corporate stakeholders – providers, payers, pharma and employers – joust in a ‘Game of Thrones’ battle over payment schemes, network configurations, price manipulation, and bureaucratic machinations, what about the ultimate stakeholder, America’s healthcare customer. For them, healthcare has become an amalgam of medical, financial and lifestyle transactions where they’re searching for value and grappling with mind-numbing personal decisions."

Natasha Elsner, Research Manager, Deloitte Center for Health Solutions comments that "high-deductible plans—that have become a common benefit option—are blunt instruments: they can discourage utilization of both low-value and high-value services, and such plans can be particularly challenging for people with ongoing health care needs, as well as those with low and even moderate incomes."

Dudley E. Morris, Senior Advisor, BDC Advisors notes that "compared to the press attention paid to Medicare-For-All, the escalating cost of large employer health plan insurance for working families is something of an elephant in the room in terms of the current political discourse."

A couple of weeks ago Kaiser Family Foundation released its 2019 Employer Health Benefits Survey,  Their comprehensive report found that “"despite the nation’s strong economy and low unemployment, what employers and workers pay toward premiums continues to rise more quickly than workers’ wages and inflation over time. Since 2009, average family premiums have increased 54% and workers’ contribution have increased 71%, several times more quickly than wages (26%) and inflation (20%)."

Section Eight of their 238-page report covers “High-Deductible Health Plans with Savings Option.” They found that 28% of firms offering health benefits offer a HDHP with a HRA (Health Reimbursement Account) or Health Savings Account (HSA). 30% of covered workers are enrolled in an account based HDHP (20% in 20140; with 7% in HRAs and 23% in HSAs. The average general deductibles for HDHP/HRAs was $2,583 for single, and $5,335 for family, and the average firm contribution being $1,713 for singles (67% of the deductible) and $3,255 for family (61% of the deductible.) The HRA employer contribution could certainly be worse (although it should be noted HRAs are not portable after the employee leaves the company.)

The problem is that for HSAs, the contribution is worse, and that’s where most of the enrollees are. The average general deductibles for HDHP/HSAs was $2,476 for single, and $4,673 for family, and the average firm contribution being $572 for singles (23% of the deductible) and $1,062 for family (23% of the deductible.)  It isn’t that all employers are miserly -  the KFF report notes that “there is considerable variation in the amount that employers contribute to savings accounts.”

But the bigger problem beyond employer contributions averaging under one fourth of the deductible requirement, is that 55%pf employers offering qualified HDHP/HSA plans do not make any contribution. Many of these employers are small businesses, meaning the percentage of total employees receiving a contribution is better, but still – 25% of total single employees receive no contribution and 26% of families receive no contribution.

Looking at the contributions on a total dollar basis for all HSAs, the Devinir Midyear HSA Market Statistics & Trends report found that 31% of 2019 HSA contributions come from employers (52% from current employees, 13% from individuals, and 3% from IRA rollovers and Other.)

The problem caused by Absentee Employers and Miserly Employers when it comes to account contributions, is that the true promise and potential of consumer choice and engagement in health care decision making is severely compromised when the consumer doesn’t have the financial resources to make and engage in the options available. It is one thing for a consumer to make selections taking cost into consideration when they have an account that can fund an adequate portion of the cost involved – and their decisions involve allocating those funds and retaining any savings for future healthcare needs. If is quite another to make those decisions when they are burdened by deductibles that have skyrocketed over the past decade without the backing of adequate employer account contributions and don’t have the personal resources to cover that gap.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Why Hospitals Are Getting Into The Housing Business

One patient at Denver Health, the city’s largest safety net hospital, occupied a bed for more than four years — a hospital record of 1,558 days. Another admitted for a hard-to-treat bacterial infection needed eight weeks of at-home IV antibiotics, but had no home.

Kaiser Health News

Friday, October 4, 2019

Humana's chief strategy officer: Insurance giant is shifting to be a healthcare company

Insurance giant Humana operates a mail-order pharmacy, has more than 230 owned or alliance primary care clinics and a large home health care provider, Kindred at Home. And the payer continues to build out capabilities to address members' social determinants of health.

Fierce Healthcare

Thursday, October 3, 2019

Trump signs executive order bolstering MA in pushback on 'Medicare for All'

President Donald Trump signed an executive order in Florida on Thursday he said would bolster the Medicare program as numerous Democratic presidential candidates seek to expand the program beyond seniors, a move Trump said would jeopardize the entire program.

Healthcare Dive

Thursday, October 3, 2019

US vaping illnesses top 1,000; death count is up to 18

The number of vaping-related illnesses has surpassed 1,000, and there’s no sign the outbreak is fading, U.S. health officials said Thursday.

The Associated Press

Thursday, October 3, 2019

Walmart To Give Workers Financial Incentives To Use Higher-Quality Doctors

Worried its employees aren’t getting good enough care from doctors in their insurance networks, Walmart next year will test pointing workers in northwestern Arkansas, central Florida and the Dallas-Fort Worth area toward physicians it has found provide better service.

Kaiser Health News

Thursday, October 3, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Taking the Healthcare Time Machine to 2040 – Two Separate Peeks into the Future

by Clive Riddle, October 4, 2019

Several days ago, I – like numerous others – received a mysterious email from Robert Pearl, MD informing us that “It’s 2040 and the U.S. health system is the best in the world.” He asks, “How did it happen?” and informs us “that question is more difficult to answer than what happened.”

The mystery quickly solved itself, as his new article in Forbes was released that same day: “It’s 2040: How Did American Healthcare Become The Best In The World?” Doctor Pearl quickly explains his thought experiment posed in his email and in the opening of his article: “As far-fetched as this outcome may seem, the purpose of the question is to consider what, specifically, could spark major change in U.S. healthcare. Below are 12 possibilities, each based on the comments and credentials of recent Fixing Healthcare [his podcast] guests.”

So remember – his list derived from his podcast guests isn’t the specific fixes, but rather what movements caused the fixes to happen:

1. Global Disruption
2.  Twenty-first Century Tech
3. The Power Of Moments
4. Bright Spots
5. Transparency: "was it because doctors and hospitals were required to disclose their pricing and quality outcome data"?
6. Healthcare Voting: after "Americans exercised their rights at the polls and demanded change from elected officials?"
7. Consumerized Care: after "doctors, hospitals and health plans put patients first, resulting in a more consumer-centric and affordable form of healthcare"?
8. Battling Burnout
9. Modern Heroes: "was American healthcare saved by a new batch of medical visionaries?"

10.  Social Determinants: "did public health advances in U.S. society lead to better outcomes and greater life expectancy"?

11.  Patient Power: "did patients band together online and use their collective voice to inspire major healthcare changes?"

12.  Internet Reliability: "did sweeping internet regulations help people avail themselves of reliable information and the best medical care possible?"

Now that we’ve considered what might drive healthcare change into 2040, let’s peek into another examination of 2040 done earlier this year by the Deloitte – entitled: Forces of change – The future of health, and opens like this: “The future of health will likely be driven by digital transformation enabled by radically interoperable data and open, secure platforms. Health is likely to revolve around sustaining well-being rather than responding to illness. Twenty years from now, cancer and diabetes could join polio as defeated diseases. We expect prevention and early diagnoses will be central to the future of health.”

We are told that “By 2040 (and perhaps beginning significantly before), streams of health data—together with data from a variety of other relevant sources—will merge to create a multifaceted and highly personalized picture of every consumer’s well-being;” and that “consumers—armed with this highly detailed personal information about their own health—will likely demand that their health information be portable.”

Deloitte says they “anticipate that by 2040 successful companies will identify and compete in one or more of the[se] new business archetypes:

Data and Platforms:

• ·         Data conveners (data collectors, data connectors, and data securers)
• ·         Science and insights engines (developers, analytics gurus, insight discoverers)
• ·         Data and platform infrastructure builders (core platform developers, platform managers and operators)

Well-being and care delivery

• ·         Health products developer (application developers, inventors/innovators, manufacturers)
• ·         Consumer-centric health/virtual home and community (virtual health providers and enablers, and wellness coaches)
• ·         Specialty care operators (world-class health centers, event-specific facilities)
• ·         Localized health hubs

Care enablement

• ·         Connectors and intermediaries (enterprise tool developers, supply chain designers and coordinators, delivery service providers)
• ·         Individualized financiers (N of 1 insurers, catastrophic care insurers, government safety net payers)
• ·         Regulators (market leaders and innovators, government regulators and policy makers)

So what should we do armed with this glimpse into 2040? Deloitte advises "as stakeholders prepare for the future of health, they should consider the following actions:"

• ·         Build new businesses
• ·         Forge partnerships; and
• ·         Appeal to the newly empowered health consumer

As for me, my primary objective will be to still be alive to see what happens.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Vaping-Related Illnesses Climb to 805, C.D.C. Says

The latest weekly tally includes 275 more reports of patients sickened, in 46 states. There are now 12 deaths linked to vaping-related lung injuries.

The New York Times

Friday, September 27, 2019

Senate approves delay in planned DSH cuts

The Senate approved a delay in $4 billion in planned cuts to Medicaid disproportionate share hospital (DSH) payments set to go into effect in November.

Fierce Healthcare

Thursday, September 26, 2019

Uber And Lyft Ride-Sharing Services Hitch Onto Medicaid

Arizona Medicaid Director Jami Snyder heard many complaints about enrollees missing medical appointments because the transportation provided by the state didn’t show or came too late.

Kaiser Health News

Thursday, September 26, 2019

Amazon launches pilot of virtual employee medical service Amazon Care

Amazon is piloting a new virtual health service benefit for employees and their families in the Seattle region. Calling it Amazon Care, the tech giant said the service combines "the best of both virtual and in-person care" by offering virtual visits, in-person primary care visits at patients' homes or offices and prescription delivery.

Fierce Healthcare

Tuesday, September 24, 2019

Walmart announces plan to build healthcare workforce, offering education for $1 a day

As Walmart moves deeper into primary care, the retail giant wants to ensure there is a skilled healthcare workforce to fill critical roles in its 20 care clinics.

Fierce Healthcare

Tuesday, September 24, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Healthcare Consumers on Technology and Decision Making: A Dozen Things To Know from a UnitedHealthcare Survey

by Clive Riddle, September 27, 2019

As healthcare consumers are about to embark into a decade, a new survey tells us they are turning even more to technology for health information, decision-making and purchasing. UnitedHealthcare has released results from their fourth-annual Consumer Sentiment Survey, which “examines Americans’ attitudes and opinions about multiple areas of health care, including open enrollment preparedness, technology and transparency trends and health literacy.” United tells us the study focuses on three areas: 1) Open Enrollment Preparedness; 2) Technology & Transparency Trends; and 3) Health Literacy & Consumer Preferences.

 

Here’s a dozen takeaways from the survey:

1. A new-high 37% have used the internet or mobile apps to comparison shop for care (14% in 2012), including 50% of Millennials
2. 46% cited a health care professional, such as a doctor or nurse, as the first source of information about specific health symptoms or ailments, and 20% first use the internet or a mobile app
3. 39% who shopped online changed the facility or care provider (or both) as a result
4. 64% “never” know the Rx costs before leaving the doctor’s office; 21%  “sometimes” know and 11% always know the price.
5. 45% said they would be interested in their physician using AI in care decisions (including 55% of Millennials); and 28% were uninterested
6. For those interested in AI support for physicians, 46% were motivated by the potential for a more accurate diagnosis; 31% cited the potential to reduce human error; and 15% hoped for faster treatment decisions
7. 39% would likely use telemedicine in the future to access care (up 2 from 2016)
8. 75% of those with benefits say they are prepared for the fall’s open enrollment season (down 2 points from last year) including 84% of Gen-Xers and 78% of Baby Boomers, but just 69% of Millennials and 44% of Gen-Z.
9. 36% devote less than one hour to open enrollment; 27% spent between one and three hours; and 23% said more than three hours.
10. 55% check if their doctors are in-network for the health plan they intend to select
11. 59% successfully defined plan premium, 53% defined the meaning of deductible, while 335 could define out-of-pocket maximum and 21% define co-insurance
12. 66% preferred speaking directly with a customer service representative to resolve health plan issues; and 10% preferred a self-service option through an app or online.