Entries in Riddle, Clive (322)


CVS Caremark PBM Releases Its Own Report Card and Gives Itself A’s

by Clive Riddle, April 12, 2019

CVS Health’s Caremark PBM has just released their annual Drug Trend Report, and tells is that they “blunted the impact of drug price inflation achieving a negative -4.2 percent price growth for non-specialty drugs and a 1.7 percent price growth for specialty drugs. Furthermore, 44 percent of CVS Caremark's commercial PBM clients saw their net prescription drug prices decline from 2017 to 2018.”


In the 12-page report, CVS Caremark notes that while medical costs have increased by 14% since 2013, their member average cost per 30-day Rx decreased 8.4% during that time, from, $11.96 to $10.95. They also remind us Non specialty brand AWP increased 8.1% last year, and specialty brand AWP increased 7.6% last year, while overall U.S. inflation increased 1.9%.

CVS Caremark reports that specialty drugs account for 1% of their Rxs, but 45% of their pharmacy spend.  They cite specialty drug cost growth as the number one trend to keep on your radar going forward. The rest of the top five trends:

2) Integrated management of specialty drug spend that falls under the medical benefit, given 45% of the specialty spend falls under medical benefits

3) Addressing pharma manufacturer innovations in marketing and product protection to reduce market competition

4) Strategies to improve medication adherence for chronic disease patients

5) Identifying “bad actors” through analytics


Got $285k for Healthcare Costs in Your Retirement Years?

By Clive Riddle, April 5, 2019

West Health and Gallup this week released a 44-page report: The U.S. Healthcare Cost Crisis, with survey results that addressed “the impact of the high cost of healthcare on personal finances, individual healthcare choices and the level of satisfaction with the U.S. healthcare system.”

The survey found “that despite 45% of respondents reporting fears of bankruptcy if a major health event strikes, 1 in 4 skipping a medical treatment due to costs and Americans collectively borrowing an estimated $88 billion to cover healthcare costs in the past year.” The report also tells us that: 

  • When given the choice between a freeze in healthcare costs for the next five years or a 10% increase in household income, 61% of Americans report that their preference is a freeze in costs
  • 76% expect their costs for healthcare will increase even further in the next two years
  • 26% have deferred a treatment
  • 12% borrowed money to pay for healthcare in the past year, including nearly 3 million borrowing $10,000 or more
  • 23% cut back on household spending due to healthcare costs
  • Only 36% of  doctors discuss costs with them in advance of procedures, tests or treatment plans, and 34% discussed costs of prescriptions 

But the concern rightfully is heightened for seniors (age 65+) who have the most immediate and more complex healthcare needs overall, and finite financial resources: 

  • 31% of seniors will be unable to pay for basic healthcare in the next 12 months (41% with annual household income <$60,000)
  • 29% will be unable to pay for medicine in the next 12 months (42% with annual household income <$60,000)
  • 38% said a major health event could lead to bankruptcy 38%  (45% with annual household income <$60,000) 

Fidelity this week released their annual analysis of out of pocket Medicare expenses and funds required for medical expenses with a couple retiring today. 

According to Fidelity, “a 65-year old couple retiring in 2019 can expect to spend $285,000 in health care and medical expenses throughout retirement, compared with $280,000 in 2018. For single retirees, the health care cost estimate is $150,000 for women and $135,000 for men.” Fidelity tells us that “while there’s no surprise that health care costs are a top financial concern in retirement, the past two years combined have seen a slower rise (3.6 percent) than in the previous two (2015-2017), which saw the estimate grow to $275,000 from $245,000 (up a total of 12.2 percent). Even without the same rate of growth, some retirees are still surprised by today’s cost of health care.” 

Fidelity healthcare prescription isn’t surprising – they advocate building savings to cover the expenses, through HSAs:


Cigna Study: More Stressed + Less Rested + Less Family & Friends Time = America

Cigna has released their 2019 360 Well Being Survey: Well and Beyond, a 15-page report “that explores perceptions of well-being across five key indicators – physical, family, social, financial and work – in 22 countries, including the United States.” Their findings indicate applicable measure for the U.S. are all getting worse – not better. Jose Quesada, Cigna’s Chief Medical Officer, International Markets tells us “we’re seeing high incidences of stress, poor sleep quality and less time connecting with loved ones, which all can have a profound impact on one’s physical health.”

Overall the study found "the global well-being index remained largely steady at 62.0 points, closer to 2017 levels, with a marginal improvement from 2018’s decline;" and that "geographically, India, Saudi Arabia, Nigeria and Indonesia showed the strongest improvement in overall wellness with a rise of between 2.1 and 4.4 points, while the US, New Zealand, Taiwan and Singapore showed slight drops, with New Zealand reporting the largest fall." 

The survey results for Americans include:

  • Only 28% reported being at a healthy weight
  • 33% know their Body Mass Index (BMI)
  • 60%+ know their blood pressure
  • Four of five Americans report feeling stressed
  • Only 25% report employer assistance/support f in managing stress – down 17% from 2018
  • 61% said their employer did not provide or sponsor any workplace wellness program
  • Only 35% report they get sufficient sleep at night, down six points from 2017
  • 32% report having “good quality sleep,” down eight points from 2017
  • 45% attested to feeling excellent/very good about the amount of time spent with family, compared to 51% in 2017
  • 62% of Americans spend sufficient time with friends, down five points from 2018



An Innovative Acquisition for HCA

by Clive Riddle, March 15, 2019

Nashville-based HCA Healthcare has just announced that HCA will become the majority owner of the parent company of Galen College of Nursing, one of the largest educators of nurses in the nation.  HCA, of course, is one of the nation’s leading providers of healthcare services, comprising 185 hospitals and approximately 1,800 sites of care.

The announcement states that “The innovative new strategic partnership brings together two of the top nursing organizations in the country in order to increase access to nursing education and provide career development opportunities in nursing to improve patient care. With 94,000 registered nurses, HCA Healthcare is one of the largest employers of nurses in the country, with nurses holding positions from bedside caregivers in a variety of healthcare settings to leadership positions throughout the organization.”

Hospital funding and partnerships for nursing education certainly isn’t new. For example, here’s a website providing a state-by-state listing of 123 such hospital arrangements, which they acknowledge is only a partial list.

But what is innovative is to move beyond strategic partnerships with an outright acquisition.  Not only does the move create synergy for HCA’s staff career development, it should also serve as a burse recruitment tool for HCA, in an environment where hospitals compete for nursing staffing.

Furthermore, this perhaps signals that healthcare organizations will continue to peek and climb further out-of-the-box with acquisitions beyond traditional M&A of other healthcare providers.  Deloitte, in a discussion of the Health Plan of Tomorrow that is the subject of an upcoming webinar, writes that "buy, share or build? is a question many health plan leaders will face as they begin this transformation journey. And accessing these capabilities may require an industry-agnostic approach. As new players break the rules around who plays what role in the industry, health plans may need to turn to want might today be considered strange bedfellows: competitors, providers, manufacturers, technology companies, transactional sector companies, and/or other industries for answers."

The same holds true for healthcare providers as for health plans.  And so HCA and Galen seem to be pairing up on a transformative journey as well.


We’re #1! Healthcare Leads the Way in Travel and Wait Times

by Clive Riddle, March 8, 2019

Altarum recently released a six page report: Travel and Wait Times are Longest for Health Care Services and Result in an Annual Opportunity Cost of $89 Billion” which compiled data for the Bureau of Labor Statistics’ American Time Use Survey. Their study found “waiting times for health care services in particular were much higher than the other service categories, over twice the length of the next closest, veterinary services.”

Alturm reports that “the time spent traveling and waiting for health care services on a day when an individual got care was over 50% of the time spent actually receiving care—45 combined minutes traveling & waiting vs. 76 minutes receiving care (data not shown). Among all time spent on health care related activities (self-care, assisting others, receiving professional care, waiting and travel), travel and waiting for care accounted for 19.7% of the total time spent, on average over two minutes a day or an hour per month.”

Altarum outs a price tag and all this traveling and waiting: “When quantified by applying an individual’s hourly wage as an approximate measure of the economic cost of time spent, travel and waiting costs averaged $89 billion dollars annually from 2006 thru 2017.”  But the really sad news is that “despite significant investments in the United States over this period in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements in these data from 2006 to 2017.” 

Vitals, recently acquired by WebMD, has annually released a report on physician wait times, Their most recent report tells us that where you’re traveling to or from makes a big difference in physician waits. Wisconsin has the shortest average wait time of 13 minutes 23 seconds while Alabama comes in as the longest with 22 minutes 19 seconds.  Your wait in Seattle averages 14 minutes 38 seconds (second shortest city– three seconds longer than Milwaukee) while a wait in El Paso comes in as the longest at 26 minutes 50 seconds. 

Vitals also reports that “30 percent of people reported they’ve walked out of an appointment due to long waits. What’s more, 1 in 5 report they’ve changed doctors because of long wait times.”