Entries in Riddle, Clive (271)

Friday
Oct132017

A Dozen Things To Know About The Trump Healthcare Executive Order and Elimination of CSR Payments

A dozen Things To Know About The Trump Healthcare Executive Order and Elimination of CSR Payments
 

by Clive Riddle, October 13, 2017

 

1.       Attorney General Jeff Sessions issued a legal opinion to HHS and the Treasury Department that that money appropriated to HHS “cannot be used to fund” Cost Sharing Reduction (CSR) payments.
 

2.       The Trump administration has filed notice to the U.S. Court of Appeals for the D.C. Circuit, “that the Department of Health & Human Services (HHS) has directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation for ‘refunding internal revenue collections.” they were not formally appropriated by Congress.
 

3.       Health Plans still have to provide marketplace subsidized discounts to low-income customers. Without CSR reimbursement, one must assume participating plans will raise premiums as soon as feasible.
 

4.       A CBO report indicates the decision to end CSR payment payments is likely to cost the federal government more than making the payments due to ACA required subsidies to cover anticipated premium increases.
 

5.       The health plans most impacted by the CSR elimination include mostly Blue Cross and Blue Shield companies and insurers focused on Medicaid, such as CenteneCorp. and Molina Healthcare Inc.
 

6.       CSR lawsuits are likely. Impacted health plans may sue. The Hill reports attorneys general from California and New York say they are prepared to sue the Trump administration to protect health-care subsidies that the White House said would be cut off.
 

7.       As Sam Baker, Axios healthcare editor posts, “Congress can solve this. University of Michigan law professor Nicholas Bagley, an expert on this issue, told me that if Congress appropriates the money for these subsidies, they would begin flowing again immediately.”
 

8.       The Trump Executive Order does not equate to immediate changes. As healthcare policy expert Timothy Jost posts in Health Affairs, the Executive Order “is a direction to draft rules. Under the Administrative Procedures Act these agencies will first have to publish proposed rules and then receive and respond to public comments before publishing the rules in final form. The fact sheet accompanying the order acknowledges that regulations will proceed through notice and comment rulemaking. This will likely take months. Indeed, rulemaking will likely be proceeded by studies by the affected departments, and any proposed and final rules will likely have to be reviewed by the Office of Management and Budget. Therefore, changes are unlikely to affect plans beginning on January 1 of 2018, although some changes may take effect mid-year.”
 

9.       The executive order instructs the Department of Labor to expand the availability of association health plans under the Employee Retirement Income Security Act of 1974 (ERISA).
 

10.   The executive order instructs the Departments of Labor and HHS to pursue expanded Availability of Short-Term, LimitedDuration Insurance.
 

11.   The executive order instructs the Departments of Labor, Treasury and HHS to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.
 

12.   As Timothy Jost notes in another Health Affairs post, small employers already received expanded ability regarding HRAs in 2016, when “Congress adopted in Title XVIII of the [21st Century] Cures Act a new type of arrangement, the Qualified Small Employer HRA (QSEHRA), that is effectively an exception to the HRA prohibition, but only for small employers — employers that have fewer than 50 full-time equivalent employees and therefore are not subject to the large employer mandates. These employers may pay or reimburse employees through a QSEHRA for premiums for health insurance that qualify as minimum essential coverage.” Thus the Executive Order would have more impact on larger employers.

 

 
Friday
Oct062017

The Impact of Time and Money on The Physician – Patient Relationship

The Impact of Time and Money on The Physician – Patient Relationship
 

by Clive Riddle, October 6, 2017

 

The “physician-patient relationship remains strong but cost may challenge its future,” is the headline takeaway offered by The Physicians Foundation, who just released findings from their second biennial patient survey. Their 45-report discuss analyzes survey responses from a nationally representative sample of 1,747 adults, ages 27-75, who had two visits with the same doctor in the past year.

 

We are told “89 percent of consumers are fearful that the rising cost of healthcare will adversely impact them in the future. In particular, over half (56 percent) of patients say the cost of prescription drugs and pharmaceuticals directly contributes to rising healthcare costs. In fact, because of cost, 25 percent of patients surveyed said they did not fill a prescription and 19 percent have skipped doses of their medicine…..Fifty seven percent of healthcare consumers feel they are one sickness away from being in serious financial trouble. And 75 percent of consumers are concerned with their ability to pay for medical treatment if they were to get sick or injured, an increase from the first survey issued in 2016 when 62 percent were concerned.”

 

What do consumers think is driving increased costs? The Foundation says “eighty-eight percent of consumers look to pharma companies and the way they price drugs as the main reason for rising healthcare costs. Other factors that consumers feel contribute to rising healthcare costs include absence of free markets (24 percent) and fraud (23 percent).” 33% of consumers say they have debt because of medical costs, with 30% of those with debt owing $5,000 or more.

 

Time is the other major concern. The Foundation states that “only 11 percent of patients and 14 percent of physicians report that they have all the time they need together. This signals a significant challenge to providing high quality care, especially when 90 percent of patients feel the most essential element of a quality healthcare system is a solid physician-patient relationship.”

 

The Foundation goes on to report that “65 percent of patients feel that time is always or often limited with the physician, however only half of physicians feel similarly. Yet the same number of patients (53 percent) and physicians (52 percent) are of a common mindset in terms of workload – believing physicians to be at full capacity.” 

 

But despite the pressures from time and money, 95% of patients said they were satisfied with their overall primary doctor relationship, including 64% who said they were very satisfied. 5% said they think about changing their primary doctor all the time, and 15% said they thought about that often.

 
Thursday
Sep282017

Studies on Prescription Drugs and Social Media

By Clive Riddle, September 29, 2017

Given that prescription drugs are perhaps the most direct-to-consumer marketed U.S. healthcare service, and pharmacies perhaps the most retail oriented distribution of health care services, social media would seem to have the greatest influence on pharmaceuticals than other healthcare sectors. PrescribeWellness this week released results of its 2017 Pharmacy Social Media Survey, which "looked at how Americans choose their pharmacy, what pharmacy services they most value, and their interest in interacting with their neighborhood pharmacists online and through social media."

Here’s what the shared from their findings:

  • 37% look to Google when looking for a pharmacy, versus 34% relying on word of mouth
  • Another 18% look to Facebook to choose a pharmacy
  • 32% look for a pharmacy with a useful website
  • 78% would consider following their pharmacist on social media— and 48% already do
  • 42% percent wish their pharmacist were more active on social media.
  • 47% say their preferred social network for interacting with their pharmacist is Facebook
  • 15% prefer Twitter in this regard and 12% prefer Instagram (12 percent)
  • 34% are interested in their pharmacist’s website
  • 25% would be interested in a pharmacy email newsletter.
  • 54% would be more inclined to use a product that their pharmacist recommended on social media

Respondents say the top benefits of following their pharmacist on social media include:

  • Deals and promotions – 58 percent
  • New offerings or services – 39 percent
  • Healthcare news – 37 percent
  • Relevant news and tips about health and wellness – 37 percent
  • Seasonal vaccine reminders – 31 percent

62% use their pharmacy’s website, with 61% using the site for refill requests; 47% for online orders; 29% for medication reminders; 29% for a medication list; 20% for online appointments; and 19% to access messages from their pharmacists, 40% say their pharmacy has a mobile app, which they use to place refill requests (48%), receive refill reminders (38%) and place orders (38%).

Moving on from pharmacies to pharmaceutical companies, earlier this year, the Journal of Medical Internet Research published to paper: Direct-to-Consumer Promotion of Prescription Drugs on Mobile Devices: Content Analysis, which sought to “investigate how prescription drugs are being promoted to consumers using mobile technologies. We were particularly interested in the presentation of drug benefits and risks, with regard to presence, placement, and prominence.”

Of the mobile communications they examined, 41% were product claim communications, 22%) were reminder communications, and 37were help-seeking communications (includes information about the medical condition but not the drug name. 69% linked to branded drug websites indicating both benefits and risks, 25% linked to a landing page listing benefits but no visible risks, and 6% linked to a landing page listing risks but no visible benefits.

The Frontiers in Pharmacology journal last December published the article Perspectives for the Use of Social Media in e-Pharmamarketing which among other things concluded that "in November 2015, American Food and Drug Administration (FDA) has encouraged the use of social media to improve communication and information exchange in health promotion and public health (U.S. Food and Drug Administration Social Media Policy, 2015). Foreign studies show that one in four interactions with doctor, patient, and healthcare providers in the United States is a digital contact. Patient education through social media is therefore an opportunity for the pharmaceutical industry to gain confidence in the company and increase the awareness of consumer when choosing a product. In this way, customer acquires knowledge about health, diseases, and treatment. In various social media channels it is possible to find information on any drug. This information is available on: websites of a manufacturer, social network brand fanpages, portals for white staff specialists. According to a study, conducted by Comscore, patients who are familiar with drug brand website often followed the recommendations for its use (20% of patients). Internet advertising also influenced the use of a drug (13.5% of patients; ROI Media, 2016). E-pharmamarketing activities in social media and in the network tend to increase. It is estimated that in the year 2016 the US pharmaceutical companies allocate for this purpose 2.48 billion dollars.”

Friday
Sep222017

NCQA Releases 2017-2018 Health Plan Ratings

NCQA Releases 2017-2018 Health Plan Ratings
 

By Clive Riddle, September 22, 2017

 

The National Committee for Quality Assurance (NCQA) has just released its 2017-2018 Health Insurance Plan Ratings. NCQA reports that they evaluated 1,429 health plans and rated 1,062: 498 private (commercial), 386 Medicare and 178 Medicaid.

 

NCQA’s ratings are based on a scale of 1.0 to 5.0, and they state their system is similar to the CMS Star Rating approach for Medicare Advantage plans. NCQA tells us that “the overall rating is the weighted average of a plan’s HEDIS and CAHPS measure ratings, plus accreditation standards (if the plan is accredited by NCQA), rounded to the nearest half point. Accreditation standards are given 10 percent of the weight of the valid HEDIS and CAHPS measures that a plan submits. The overall rating is based on performance on dozens of measures of care and is calculated on a 0–5 (5 is highest) scale in half points. Performance includes three subcategories (also scored 0–5 in half points): Consumer Satisfaction, Prevention and Treatment.” If you really want to get into the weeds regarding their methodology, you can click here to review their 16-page methodology report.

 

NCQA share that the “Top Ten States with the Highest-Rated Health Plans (receiving a 4.5 or 5.0 out of 5 rating) for Three-Year Average:

1.     Massachusetts

2.     Rhode Island

3.     Maine

4.     New Hampshire

5.     Wisconsin

6.     Minnesota

7.     Hawaii

8.     New York

9.     Vermont

10.  Iowa

 

NCQA also tells us that “high and low performers Are rare: of the 1,062 rated plans, 103 (10%) received a top rating of 4.5 or 5.0 out of 5. Twenty-three (2%) earned the ratings of 1.0 to 2.0.

 

Digging into their website, we compiled this list of health plans with 5.0 overall ratings for Private, Medicaid or Medicare:

 

·         BCBS MA (Private)

·         Johns Hopkins US Family MD (Private)

·         Kaiser Northern California (Private)

·         Tufts MA, NH, RI (Private)

·         Jai Medical Systems MD (Medicaid)

·         Group Health Plan MN, WI (Medicare)

·         Gundersen Health Plan IA, WI (Medicare)

·         Kaiser Southern CA (Medicare)

·         Kaiser Northwest OR, WA (Medicare)

·         Kaiser Washington (Medicare)

·         Kaiser Hawaii (Medicare)

·         Medical Associates Health Plan WI (Medicare)

·         Medical Associates Health Plan IL, IA (Medicare)

 

On the flip side, here’s the plans we identified with ratings of 2.0 or less:

 

·         Cigna NM  (Private 2.0)

·         Cigna Utah (Private 2.0)

·         Connecticut General NM (Private 2.0)

·         Human Puerto Rico (Private 2.0)

·         Anthem BCBS Nevada (Private 2.0)

·         Triple S Salud PR (Private 1.5)

·         UnitedHealthcare of Texas (Private 1.5)

·         Tokio Marine Pacific Guam (Private 1.0)

·         Union Health Service IL (Private 1.5)

·         Aetna Better Health IL (Medicaid 2.0)

·         Family Health Network IL (Medicaid 2.0)

·         Health Plan of Nevada (Medicaid 2.0)

·         South Florida Community Care Network (Medicaid 2.0)

·         Aetna Better Health NJ (Medicaid 1.5)

·         Community Care Alliance IL (Medicaid 1.5)

·         Cook Children's Health Plan TX (Medicaid 1.5)

·         Affinity NY (Medicare 2.0)

·         Atrio (Medicare 2.0)

·         Community Care Alliance IL (Medicare 2.0)

·         Elderplan NY (Medicare 2.0)

·         Gateway KY, NC, OH (Medicare 2.0)

·         Group Health Inc. NY (Medicare 2.0)

·         Inland Empire CA (Medicare 2.0)

·         Meridian IL (Medicare 2.0)

·         United Healthcare of New York (Medicare 2.0)

·         Virginia Premier (Medicare 2.0)

·         VNS Choice NY (Medicare 2.0)

 

To be fair to the above plans rated 2.0 and less, there were 367 NCQA evaluated but did not rate due to only partial or no data available – and it is quite possible that a number of these would have received low ratings as well.

 
Friday
Sep152017

Nine Things to Know About Current Opioid Misuse from a New SAMHSA Report

By Clive Riddle, September 15, 2017

 

The HHS agency  SAMHSA (Substance Abuse and Mental Health Services Administration) has released a new 86-page report: Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health, which among other things provides an updated peek at opioid misuse during the past year.

 

 

 

Here’s nine things to know from the report:

1. In 2016, approximately 11.8 million people aged 12 or older misused opioids in the past year,         representing 4.4 percent of this population.

2. About 891,000 adolescents aged 12 to 17 misused opioids in the past year, representing 3.6 percent of adolescents.

3. About 2.5 million young adults aged 18 to 25 misused opioids in the past year, representing 7.3 percent of young adults.

4. 8.4 million adults aged 26 or older misused opioids in the past year, representing 4.0 percent of this age group.

5. In 2016, approximately 11.5 million people misused prescription pain relievers in the past year, making it the predominant means of opioid misuse.

6. Among people aged 12 or older in 2016 who misused prescription pain relievers in the past year, the most commonly reported reason for their last misuse of a pain reliever was to relieve physical pain (62.3 percent.)

7. 53.0 percent of people who misused pain relievers in the past year reported that they obtained the pain relievers the last time from a friend or relative.

8. Another 36.8 percent of people who misused pain relievers in the past year indicated that they obtained pain relievers the last time through prescription

9. Another 6.0%  people who misused pain relievers in the past year bought the last pain reliever they misused from a drug dealer or stranger.