Entries in Riddle, Clive (271)

Friday
Jul072017

Healthcare 2017 Viewed Through Brokers’ Lens

by Clive Riddle, July 7, 2017

With the onset of the ACA at the start of this decade, if one asked how brokers would view the world of healthcare seven years later, some would have answered “who cares – they will become irrelevant.” But flash forward to 2017 and here they are, continuing to play the role they have always played, even though the landscape has certainly shifted. Despite disintermediation, public exchanges, technology and a host of other challenges, brokers remain at bat, swinging away.

BenefitsPRO has just released they annual broker survey, with responses from 350 brokers representing the spectrum of industry sectors. One might have thought brokers of all people, would firmly be in the camp of ACA repeal, 50% “would like to see the ACA retained and repaired, while 28 percent prefer a gradual repeal and replace, and 22 percent want it repealed and replaced immediately.”

One insight is that brokers business has evolved so that the public exchange market isn’t a material part of their business. When asked, “how have state exchanges’ struggles impacted your business,” 48% said there was no effect, 35% replied it hurt a little or significantly, and 17% said it helped a little or significantly.” The individual market has gravitated away from brokers, with 34% not involved, 37% reporting minimal demand, and less than ten percent stating “enrolling individuals on the public exchange is worth the effort.” Private exchanges aren’t a dominant force at this point, as “nearly 6 in 10 of those responding say they do not have a private exchange partner for enrollment and benefits administration.”

While technology has facilitated some disintermediation, brokers continue to attempt to enhance their value offering a personal touch that online tools can’t offer. The survey report noted that 53 “percent of respondents say meeting in a group setting at the worksite is the primary enrollment technique, while 36 percent cited one-on-one meetings in the workplace. However, 39 percent say their top method is using an electronic enrollment tool independently.”

But losses of individual and other health insurance market share have been offset by growth in the voluntary benefit sector, with 57% identifying with the statement that “they will use voluntary benefits to offset anticipated commission losses from health insurance this year.”

Looking toward the future, consolidation looms large, just as in all other healthcare sectors, as “27% expect their organization to acquire or merge with another broker/agent organization,” while 14% “ look for another broker/agent to acquire their organization” and “14% also say their company will leave the health insurance brokerage business.”

Brokers focus for the future includes 84% “promoting ancillary insurance coverage,” 58% “promoting health plan consumer engagement and health and wellness programs,” 43% “promoting third-party consumer engagement and health and wellness programs, while 53% will be concerned about the threat of “the new wave of disruptive companies entering the industry.” A particular innovation they are concerned with is payroll companies with direct benefits distribution, with 57% viewing this a concerning.

Friday
Jun232017

A virtual tour of new studies on virtual visits

A virtual tour of new studies on virtual visits
 

By Clive Riddle, June 23, 2017

 

The Advisory Board reports that “up to 77% of consumers would consider seeing a provider virtually—and 19% already have,” according to just published results from their Virtual Visits Consumer Choice Survey of 4,879 U.S. consumers, “designed to better understand the tradeoffs that consumers make when they need different types of care.”

 

The survey found consumers “would be willing to consider a virtual visit in each of the 21 primary and specialty care scenarios tested,” with over 70% of respondents interested in “a prescription question or refill, pre-surgery and select post-operation appointments, receiving ongoing results from an oncologist, and ongoing care for chronic condition management. Select pregnancy checkups, weight loss or smoking cessation coaching, dermatology consults, and psychologist consults also ranked among top offerings.”

 

The survey also addressed consumer telehealth concerns, with 21% citing care quality as their top concern, “followed by the provider not being able to diagnose or treat them virtually (19%), meaning they would have to go to the physical clinic anyway. Only 9% of respondents said they had no concerns about virtual visits.”

 

The current issue of Annals of Family Medicine includes the article “Patient Perceptions of Telehealth Primary Care Video Visits, in which co-authors from the National Academic Center for Telehealth, Thomas Jefferson University conducted “in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center.” They found that “all patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical exam.“

 

The May 1, 2017 North Carolina Medical Journal includes the article A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes which describes a study of the “diabetes telemedicine program funded by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust was offered in 13 sites in eastern North Carolina, including federally funded Community Health Clinics. A telemedicine team offered interdisciplinary care in the primary care provider's (PCP's) office without the patient needing to travel. The interdisciplinary team included a clinical pharmacist, dietician, behavioral therapist, and physician specializing in diabetes. The PCP referred the patient to 1 or more disciplines depending on the patient's needs. The program targeted underserved rural adults with uncontrolled type 2 diabetes.” The study found that “92% of telehealth patients were ‘very satisfied’ with their care and 83% agreed that telemedicine made it easier to get care.”

 

Referring physicians (vs direct consumer demand) may indeed be the potential driving force for telehealth, at least in rural settings. The current issue of the Journal of the American Board of Family Medicine includes the article Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services. A survey of 1,557 Family Practitioners found "15% reported using telehealth services during 2014, and that FPs using telehealth were:  26% more likely to be located in a rural setting; 40% more likely to work in a practice with <6 FPs; 22% less likely to work in a privately-owned practice; and 76% less likely to provide general primary care to patients. Of the FPs using telehealth: 22% used it 1-2 times, and and 26% using it 3-5 times; 55% used telehealth for diagnosis and/or treatment; 68% used telehealth to refer patients to specialists; and 28% used telehealth to refer patients to mental health providers.

 

Still, a rosy future telehealth market is projected according to Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey results released this month, with health systems cited as a primary driver. They report that “seventy-six percent of U.S. hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018. Drivers for the rapid adoption growth include the desire to improve access to care, improve care coordination, increase efficiency, prevent readmissions and expand population health programs. In addition, 69 percent of organizations that currently have consumer telehealth programs are planning to expand their offerings, and 76 percent of organizations without consumer telehealth indicate it is a high strategic priority for their organizations.”
 
Friday
Jun162017

A Dozen Takeaways From PwC’s Medical Cost Trend: Behind the Numbers 2018 Report

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By Clive Riddle, June 16, 2017

 

PwC’s Health Research Institute has released Medical Cost Trend: Behind the Numbers 2018, their twelfth annual report projecting the growth of private sector medical costs in the coming year and identifying the leading trend drivers. The findings are largely based upon PwC’s annual Health & Well-being Touchstone Survey results, which draws from responses of 780 employers from 37 industries, and have also just been released.

 

Here’s a dozen takeaways from this year’s 32 page Behind the Numbers report, and 114 page Touchstone Survey report:

 

1.       PwC’s HRI projects a 6.5 percent growth rate for next year, a half percentage point increase from the estimated 2017 rate.
 

2.       This growth rates steadily decreased from 11.9% in 2007 to 6.5% in 2014, and has fluctuated slighly above or below that figure since then
 

3.       PwCs provides this definition of their projected medical cost trend: the “increase in per capita costs of medical services that affect commercial insurers and large, self-insured businesses. Insurance companies use the projection to calculate health plan premiums for the coming year.”
 

4.       PwC's HRI has identified three major inflators expected to impact medical cost trend in the coming year: (A) Rising general inflation impacts healthcare. As the U.S. economy heats up, a rise in general inflation during 2016 and 2017 will likely put upward pressure on wages, medical prices and overall cost trend in 2018; (B) Movement to high-deductible health plans is losing steam. The wave of growth in high-deductible health plans, employers' go-to strategy in recent years to curb health spending, may be plateauing; and  (C) Fewer branded drugs are coming off patent. Employers may have less opportunity to encourage employees to buy cost-saving generics in 2018.
 

5.       PwC's HRI has identified two major deflators expected to impact medical cost trend in the coming year: (A) Political and public scrutiny puts pressure on drug companies. Heightened political and public attention could encourage drug companies to moderate price increases; and (B) Employers are targeting the right people with the right treatments to minimize waste. They are doubling down on tactics such as prescription quantity limits and exploring new technologies such as artificial intelligence to match people with the best treatment.
 

6.       The report also cites these healthcare drivers affecting the 2018 cost trend:  Technology and treatment innovation: Provider and Plan Consolidation; Government regulation; and Evolving Payment models.
 

7.       The report allocated these proportions of costs by component for 2018: Pharmacy 18%; Inpatient 30%; Outpatient 19%; Physician 29%; Other 4%
 

8.       The Touchstone Survey cites that “Medical plan costs have continued to increase, but employers expect that the rate of increase will start to slow. Plan design changes contributed towards slightly lower-than-expected increases in 2016;” and that “the average increase in 2016 was 6.8% before plan design changes and 3.6% after plan design changes. In 2017, participants expect to see a 6.0% increase before plan design changes and a 3.2% increase after plan design changes.”
 

9.       The Touchstone Survey notes that “participants appear to be in a "wait and see" mode – rather than considering broader and more transformational changes, they continue to use traditional cost-shifting approaches to control health spend;” and that “57% of participants expect to continue to increase employee contributions in the next three years, while 38% (29% for Rx) plan to increase employee cost-sharing through plan design changes.”
 

10.   The Touchstone Survey finds that “participants are increasing contributions in the form of surcharges for spouse, domestic partner and dependent coverage. This may be contributing towards a decrease in enrolled family size and slowing the rise in net employer spend.”
 

11.   The Touchstone Survey also finds that “participants are utilizing High Deductible Health Plans (HDHPs) more and Preferred Provider Organizations (PPOs) less, although PPOs remain more popular among employees. PPOs are the highest-enrolled plan 44% of the time, compared to 46% in 2016 and 60% in 2009. HDHPs are the highest-enrolled plan 34% of the time, up from 32% in 2016 and 8% in 2009.”
 

12.   The Touchtone Survey found that employer interest in population health is strong but private exchange interest is waning. They report that “79% offer wellness programs compared to 76% in 2016, and 63% offer DM programs compared to 56% in 2016;” while  “8% of participants are considering moving their active employees to a private exchange; 2% have already done so. Interest seems to have dropped off as the discussions on public exchanges and ACA have increased. However, 36% of participants who offer retiree medical coverage are considering moving pre-65 retirees to a private or public exchange.”
 

 
Friday
Jun092017

Centura Health Shares Strategies for Reducing Readmissions in Bundled Payment Arrangements

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By Clive Riddle, June 9, 2017

 

Two experts from Centura Health, the Colorado based healthcare system shared their organization’s strategies in reducing readmissions in bundled payment arrangements for total hip and knee replacements, as part of a panel presentation in a HealthcareWebSummit event held this week on “Advanced Strategies in Appropriately Reducing Bundled Payment Arrangement Readmissions.”

 

Centura’s Kristen Daley, Group Director – Value Based Programs, and Brenda Lewis, RN, MBA-HCM, CCM, ACM Group Manager – Care Coordination started by providing context from the literature for total hip arthroplasty (THA)  and total knee arthroplasty (TKA):

·         5.6% of THA and 3.3% of TKA require Readmission within 30 days of discharge

·         Unplanned Readmissions Costs for Medicare Patients = $17.5 Billion/Year

·         THA costs: $17,103/Readmission

·         TKA costs : $13,008/Readmission

 

Daley and Lewis reminded us that elevated patient risk factors for these readmissions come from increased age; male gender; african american race; and medical co-morbidities including obesity,

chronic pulmonary disease, bleeding disorders, cancer history, and psychiatric illness.

 

They cited the leading complication for readmissions is infection: (12.1% of unplanned 30 day readmission) and the many other causes including: systemic: pulmonary, cardiac and circulatory; joint specific:  dislocation, fracture, malposition; hematoma, falls; failure to mobilize; increased pain and

social determinants. They noted 50% of these readmissions are unrelated to the patient’s index arthroplasty.

 

Here is Daley and Lewis’ summary of their readmissions reduction strategies:

·         Team Approach: All Providers and Caregivers Engaged, Communicating, and on the same page

·         Every Patient receives preoperative medical evaluation/optimization by Perioperative Hospitalists

·         Perioperative Hospitalists round post-op and collaborate on discharge with the Surgeon

·         Robust Care Coordination Program

·         Prepare Patients for Efficient Discharge

·         Front-Load Discharge Planning

·         Partner with Acute Case Management Team

·         Promote use of Preferred Partners

·         Extend Patient Management Post-Discharge

 

They have undertaken the following to prepare patients for the transition from hospital to home:

·         Begin Education Preoperatively and Re-emphasize throughout Hospitalization

·         Embed Care Coordinator into Joint Education Class

·         Utilize LACE Tool to Assist to Identify Risk of Readmission (The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge)

·         Provide Detailed Discharge Instructions

·         Educate patients on Wound Care, DVT Signs

·         Help patients with understanding Pain Management

·         Emphasize importance of Post-op Rapid Mobilization and Physical Therapy

 
Friday
Jun022017

Nine Things to Know About J.D. Powers 2017 Member Health Plan Study Results

By Clive Riddle, June 2, 2017

 

J.D. Powers has just released their 2017 Member Health Plan Study Results. J.D. Powers tells us this 11th annual study “measures satisfaction among members of 168 health plans in 22 regions throughout the United States by examining six key factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service. The study also touches on several other key aspects of the experience including plan enrollment and member engagement.” The study is based on responses from 33,624 commercial health plan members and was fielded in January-March 2017.

 

The study assigns scores to each plan based on the above criteria based upon a possible 1,000 point scale. Here are nine things to know about their findings:

 1.     J.D. Powers found that “Integrated delivery systems dominate rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—outperform traditional health plans on every factor measured in the study.”

 2.       Even though narrow networks have often been presented negatively in the media, the study found otherwise: “Regardless of product choice, members who were presented with lower-cost narrow network options were significantly more satisfied with their health plan versus those who were not offered such an option or did not know whether it was offered. However, just 33% of respondents say they were offered a narrow network option.”

 3.       J.D. Powers found that “the effect of payer-provider alliances is mixed: Aetna, Cigna, Anthem, and many other providers have begun to offer commercial products in collaboration with specific providers in the past few years.”

 4.       Satisfaction is highest among health plan members in the five regions: Maryland (723); East South Central (722); California (716); Michigan (716); and Ohio (714).

 5.       Satisfaction is lowest among members in the Colorado (676) and Northeast (682) regions.

 6.       The highest score achieved by any major plan was 794 (Kaiser in Maryland.)

 7.       Kaiser by far had the most regional top scores for major health plans with six: (California, Colorado, Maryland, Northwest, South Atlantic, Virginia)

 8.       The lowest score achieved by any major plan was a tie between Coventry (Aetna) in the Heartland region, and Blue Cross Blue Shield Montana in the Mountain region, both with 653. Given the regional average in the Mountain region (706) was higher than in the Heartland (693), the tiebreaker for Bottom performer would go to BCBS Montana.

 9.       UnitedHealthcare and subsidiaries by far had the most bottom regional bottom scores for major health plans with thirteen:  (Colorado, Delaware/WV/DC, East South Central, Florida, Maryland, Michigan, New Jersey, New York, Northwest, Ohio, Pennsylvania, Southwest, Virginia)

 

Here are the top and bottom performers of major health plans for each of J.D. Powers 22 defined regions with their respective scores, along with the average score for the region:

 

California

Top: Kaiser 780

Average: 716

Bottom: Aetna 683

 

Colorado

Top: Kaiser 725

Average: 676

Bottom: United 661

 

Delaware/WV/DC

Top: Highmark 712

Average: 691

Bottom: United 666

 

East South Central (AL, KY, LA, MS, TN)

Top: BCBS Tennessee 735

Average: 722

Bottom: United 684

 

Florida

Top: AvMed 733

Average: 702

Bottom: United 694

 

Heartland (AR, IA, KS, MO, NE, OK)

Top: Wellmark BCBS Iowa 723

Average: 693

Bottom: Coventry (Aetna) 653

 

Illinois-Indiana

Top: Health Alliance Medical Plans 723

Average: 708

Bottom: Coventry (Aetna) 666

 

Maryland

Top: Kaiser 794

Average: 723

Bottom: United 693

 

Massachusetts

Top: BCBSMass 707

Average: 703

Bottom: Cigna 664

 

Michigan

Top: Health Alliance Plan of Michigan 750

Average: 716

Bottom: United 672

 

Minnesota-Wisconsin

Top: Unity Health Plans 737

Average: 695

Bottom: Cigna 679

 

Mountain (ID, MT, UT, WY)

Top: SelectHealth 727

Average: 706

Bottom: BCBS Montana 653

 

New Jersey

Top: Horizon BCBS 712

Average: 705

Bottom: United 693

 

New York

Top: Capital District Physicians Health Plan 755

Average: 702

Bottom: Oxford (United) 658

 

Northeast (CT, ME, NH, RI, VT)

Top: BCBS Vermont 725

Average: 682

Bottom: Harvard Pilgrim 666

 

Northwest (OR, WA)

Top: Kaiser 751

Average: 697

Bottom: United 644

 

Ohio

Top: Medical Mutual of Ohio 720

Average: 714

Bottom: United 695

 

Pennsylvania

Top: UPMC 739

Average: 702

Bottom: United 672

 

South Atlantic (GA, NC, SC)

Top: Kaiser 791

Average: 707

Bottom: Aetna 696

 

Southwest (AZ, NV, NM)

Top: BCBS AZ 704

Average: 693

Bottom: Health Plan of NV (United) 661

 

Texas

Top: NA

Average: 710

Bottom: Aetna 686

 

Virginia

Top: Kaiser 769

Average: 702

Bottom: United 699