Entries in Riddle, Clive (302)

Friday
Feb232018

The State of the Uninsured and Health Insurance Coverage

The State of the Uninsured and Health Insurance Coverage
 

by Clive Riddle, February 23, 2018

 

The National Center for Health Statistics has just released updated health insurance coverage estimates from selected states using 2017 National Health Interview Survey data.  Here are seven things to know about their findings for the first 9 months of 2017:

 

1.     28.9 million (9.0%) persons of all ages were uninsured, not significantly different from 2016, but 19.7 million fewer persons than in 2010.

2.     12.7% of adults aged 18–64, were uninsured, 19.5% had public coverage, and 69.3% had private health insurance coverage.

3.     4.4%  of adults aged 18–64 (8.6 million) covered by private health insurance plans obtained their coverage through the federal or state-based exchanges.

4.     Adults aged 25–34 were almost twice as likely as adults aged 45–64 to lack health insurance coverage (17.3% compared with 9.2%)

5.     4.9%  of children aged 0–17 years, were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage.

6.     The percentage uninsured decreased significantly for all age groups from 2013 through the first 9 months of 2017, ranging from –6.2 percentage points for ages 45–64 to –10.7 percentage points for ages 18–24.

7.     43.2% of persons under age 65 with private health insurance were enrolled in a high-deductible health plan (HDHP) compared to 39.4% in 2016

 

However, as a warning sign that 2018 may see slippage in these insurance coverage, the Minnesota Department of Health just issued an ominous press release, indicating that “last year Minnesota saw one of its largest, one-time increases in the rate of people without health insurance since 2001. The uninsured rate rose from 4.3 percent in 2015 to 6.3 percent, leaving approximately 349,000 Minnesotans without coverage.”
 
Friday
Feb092018

Employees Feel Their Own Health Plan is Better Than Most Others

Employees Feel Their Own Health Plan is Better Than Most Others
 

By Clive Riddle, February 9, 2018

Surveys have consistently shown over the years that the public generally ranks Congress low in esteem, but their personal Congressman is held in higher regard. Health Plans, like Congress, have been a favorite target as well, but similarly – people tend to like their personal coverage more than how they view health plans overall.

AHIP has just released a 42-page report of findings from their national survey “The Value of Employer Provided Coverage” that not only reinforces this phenomenon – in which respondents rank their own plan higher than their overall view how health care is covered, but also makes the case that consumers place employer provided coverage in higher regard than the nation’s health coverage system as a whole. On top of that, there is perhaps less angst about the nation’s health insurance system overall than one might have thought.

63% were satisfied with the nation's current health insurance system, and 31% were dissatisfied. 71% were satisfied with their own health plan, and 19% were dissatisfied. 60% felt their personal cost was reasonable and 29% felt the cost was unreasonable, while 66% felt the cost was unreasonable for Americans as a whole. 52% described their deductible as reasonable, while 36% said it was unreasonable. However, for those dissatisfied with their plans, 82% cited costs as the main reason.

72% say they are adequately informed about health insurance benefits under their plan, yet only 20% understand that employers average paying above 75% of the total costs.

In other findings from the survey:

·         71% remain concerned the cost of health care will continue to rise

·         56% prioritize comprehensive benefits while 41% prioritize affordability of plans.

·         46%said health insurance was a deciding factor in choosing their current job

·         56% support keeping employer provided coverage tax free, and 13% oppose

·         58% prefer increased market competition while 42% support increased government involvement to address costs

·         Prescription drug coverage (51%), preventive care (47%), and emergency care (47%) rank among the benefits that matter most.

 
Thursday
Feb012018

AmazonBerkshireJP Healthcare: Think About Kaiser

AmazonBerkshireJP Healthcare: Think About Kaiser
 

By Clive Riddle, February 1, 2018

 

After Amazon, Berkshire Hathaway and JPMorgan Chase issued their press release this week regarding their employer based healthcare partnership, healthcare stock portfolios went into a tailspin and a lot of smart people have had something to say about what this venture might become. But where there is consensus is that what we do know is what we don’t know, as right know the venture is a dot to dot healthcare coloring book where no lines have been connected yet and we haven’t even been issued our crayons.

 

The press release, while void of details, espouses technology solutions. Learned speculation surrounds their replacing PBMs, going whole hog into self-insurance, promoting telemedicine and much more.

The New York Times quotes Segal Group’s Ed Kaplan: “Those are three big players, and I think if they get into health care insurance or the health care coverage space they are going to make a big impact.”

 

Paul Demko in Politico writes that Amazon's new health care business could shake up industry after others have failed. But while citing some optimism, he also reports that ““ ‘We’ve seen these deals before,’ said Sam Glick, a partner in the health and life sciences division at Oliver Wyman. He cited Walmart and Intel as two companies that have sought to provide health care for employees while cutting out the insurance middleman. ‘It’s not news that jumbo employers are frustrated with escalating costs and lousy experiences in the health care system.’ “

 

A great tweet from Yale Health Economist Zach Cooper tells us "I do hope Amazon, JP Morgan, & Berkshire succeed. Health care is wildly inefficient However, it’s a bit like Mayo Clinic, Cleveland Clinic, and Partners Health coming out and saying they don’t like their computers so they’re going to form a new IT company."

 

An Axios post by Sam Baker cautions “A new health care behemoth? Not so fast.” He reminds us “We don't know what they're even trying to do” and that “other big companies have tried something similar.”

 

While like Sam Glick, we can point to less than stellar results from a number of other corporate forays into this arena, if we peek further back into time, we can also point to Kaiser, whom Sam Baker mentions in his post.

 

Let’s take the wayback machine to 80 years ago: In 1933, Sidney Garfield MD establishes prepaid plan to fund care for his Contractors General Hospital and clinic providing care to workers on the Los Angeles Aqueduct. In 1938 Henry J Kaiser recruits Dr. Garfield to establish prepaid clinic and hospital care for his Grand Coulee Dam project in Washington. In 1942, at the request of Henry Kaiser, Dr. Garfield expands program to Kaiser-managed shipyards and Kaiser’s steel mill. In 1945, Permanente Health Plans opens to the public in California, in addition to serving Kaiser employees.

 

Kaiser and their clinically integrated health care is often cited now as an example of a better system than much of the rest of American healthcare. Perhaps Amazon et al should take a long look at the Kaiser experience, and consider directly providing some levels of care enhanced by technology, instead of just relying on technology alone.

 
Friday
Jan192018

2018 CMS Medicare Shared Savings Program: 43 Previous ACOs out, 124 New ACOs In

By Clive Riddle, January 19, 2018

CMS recently published 2018 Medicare Shared Savings Program information.  After comparing the listing of 561 2018 MSSP participants to the 480 2017 participants, we found 43 2017 ACOs have exited the program for 2018, and there are 124 new ACOs for 2018.  Caravan Health has sponsored 15 new ACOs, and Community Health Systems is sponsoring 14 of the new ACOs.

Here’s the list for the 43 ACOs exiting the program:

  1. Accountable Care Coalition of Mount Kisco (CT, NY)
  2. Accountable Care Coalition of Western Georgia (AL, GA)
  3. ACO of East Hawaii (HI)
  4. Advanced Premier Physicians ACO (CA)
  5. APCN-ACO (CA)
  6. ApolloMed Accountable Care Organization (CA, FL, HI)
  7. Arkansas High Performance Network ACO of FQHC (AR, KY)
  8. Arkansas HIgh Performance Network ACO (AR)
  9. Bay Area Medical Associates ACO (CA)
  10. Bluegrass Clinical Partners (FL, KY, TN)
  11. Care Covenant (TX)
  12. Catholic Medical Partners-Accountable Care IPA (NY)
  13. CHRISTUS Louisiana ACO (LA)
  14. CHWN ACO (IL)
  15. Collaborative Health ACO (MA)
  16. Community Health Accountable Care (NH, NY, VT)
  17. Connected Care (MI)
  18. Cornerstone Health Enablement Strategic Solutions (NC)
  19. Health Leaders Medicare ACO Network (LA)
  20. Indiana Care Organization (IN)
  21. Kansas Primary Care Alliance (KS, MO)
  22. KCMPA-ACO (KS, MO)
  23. Mary Washington Health Alliance. (VA)
  24. Mercy ACO (AR, MO)
  25. MHT-ACO (GA, MI, OK, SC, TX)
  26. Midwest Quality Care Alliance (KS, MO)
  27. NEQCA Accountable Care, (MA)
  28. North Jersey ACO (NJ, NY)
  29. OneCare Vermont Accountable Care Organization (NH, VT)
  30. Oregon ACO (OR, WA)
  31. Palm Accountable Care Organization (FL)
  32. Physicians Accountable Care Solutions (CA, CO, CT, IL, NY, OH, PA, UT, WV)
  33. Physicians Collaborative Trust ACO (FL)
  34. Primaria ACO (IN)
  35. Primary Care Alliance (FL)
  36. Revere Health (AZ, UT)
  37. Shannon Clinic (TX)
  38. South Shore Physician-Hospital Organization (MA)
  39. SPACO (FL)
  40. Torrance Memorial Integrated Physicians (CA)
  41. UW Health ACO, (WI)
  42. VirtuaCare (NJ)
  43. Western Maryland Physician Network (MD, PA, VA, WV)

And here’s the list of the 124 new ACOs joining the program for 2018:

  1. Accountable Care Coalition of Alabama (AL)
  2. Account. Care Coal. of Community Health Centers (AR, DC, FL, IL, KY, MD, MI, RI)
  3. Accountable Care Coalition of New Jersey (NJ)
  4. Accountable Care of Nevada (NV)
  5. Accountable Care Organization of Aurora (IL, MI, WI)
  6. ACO West Virginia (PA, WV)
  7. Acorn Network (IL, IN, MI)
  8. Adventist Health Accountable Care (CA)
  9. Adventist Health System ACO (FL)
  10. Alabama Physician Network (AL)
  11. Aledade Accountable Care 22 (OH, PA)
  12. Aledade Accountable Care 25 (NJ)
  13. Aledade Accountable Care 35 (LA, MS, TN)
  14. Aledade Accountable Care 37 (MD, TN, VA, WV)
  15. Baptist Health/UAMS Accountable Care Alliance (AR, TX)
  16. Baptist Physician Partners ACO (FL, GA)
  17. Bethesda Health Quality Alliance (FL)
  18. Boulder Valley Care Network (CO)
  19. Bridges Health Partners ACO (PA)
  20. Caravan Health ACO 11 (AL, GA, IL, KY, NM, NV, TX)
  21. Caravan Health ACO 12 (MN, WI)
  22. Caravan Health ACO 13 (MA, NY, VT)
  23. Caravan Health ACO 14 (ID, MN)
  24. Caravan Health ACO 15 (IA, MN, NE, SD)
  25. Caravan Health ACO 16 (AL, TN)
  26. Caravan Health ACO 17 (OR)
  27. Caravan Health ACO 31 (OK)
  28. Caravan Health ACO 32 (OK)
  29. Caravan Health ACO 33 (OK)
  30. Caravan Health ACO 34 (OK)
  31. Carolinas HealthCare System ACO (NC, SC)
  32. Cascadia Care Network (WA)
  33. Centrus Health of Kansas City (KS, MO)
  34. CHSPSC ACO 1 (AL, FL, LA, MS)
  35. CHSPSC ACO 10 (FL)
  36. CHSPSC ACO 12 (GA, NC, SC, VA)
  37. CHSPSC ACO 13 (PA)
  38. CHSPSC ACO 14 (TN, WV)
  39. CHSPSC ACO 15 (KY, TN)
  40. CHSPSC ACO 16 (OK)
  41. CHSPSC ACO 17 (FL)
  42. CHSPSC ACO 2 (IN)
  43. CHSPSC ACO 21 (AL, FL)
  44. CHSPSC ACO 6 (TX)
  45. CHSPSC ACO 7 (AR, LA, MO, OK)
  46. CHSPSC ACO 8 (AK, AZ, NM, NV)
  47. CHSPSC ACO 9 (IN)
  48. Coastal One Health Partners (CA)
  49. ColigoCare (NJ, NY)
  50. Community Health Center Network Of Idaho (ID, OR, WA)
  51. Community Healthcare Partners ACO, (IL, IN)
  52. Connected Care of East Tennessee (AL, GA, TN)
  53. Connected Care of Middle Tennessee (TN)
  54. Connected Care of Mississippi (MS)
  55. Connected Care of West Tennessee (MS, TN)
  56. CPSI ACO 2 (CA, CO, GU, ID, ND, OR, SD, WA)
  57. CPSI ACO 3 (GA, MS, NC)
  58. CPSI ACO 7 (IA, IL, NE, WI, WV)
  59. CPSI ACO 8 (AR, LA, MO, TX)
  60. Crestwood Regional Healthcare Alliance (AL)
  61. CVACC (VA)
  62. DMH Health Network (IL)
  63. DOCACO GULF COAST (FL, SC)
  64. Einstein Care Partners (PA)
  65. Family Choice ACO (CA)
  66. Foothill Accountable Care Medical Group, (CA)
  67. Genesis Physicians Group (TX)
  68. Health Alliance ACO (DC, MD, VA)
  69. Healthcare Quality Partners (NJ, PA)
  70. HealthChoice (AR, MS, TN)
  71. Heritage Valley Healthcare Network ACO (OH, PA, WV)
  72. Holy Name Medical Center ACO (NJ)
  73. HP2 (GA)
  74. Independent Physicians Accountable Care (CA, CT, FL, SC, TX, VA)
  75. Inspire Health Partners (IN)
  76. Intermountain Accountable Care (NV, UT)
  77. Keep Well ACO (IL, KS, MO)
  78. KENNEDY HEALTH ALLIANCE (NJ)
  79. Kootenai Accountable Care (ID, WA)
  80. McFarland Clinic, PC (IA)
  81. McLeod Healthcare Network (NC, SC)
  82. MHC Accountable Care Organization (KY, OH, WV)
  83. MHN ACO (IA, IL, NE, SD)
  84. MSHP ACO (NY)
  85. MultiCare Connected Care (WA)
  86. NCH ACO (FL)
  87. NorthShore Physician Assoc. Value Based Care (IL)
  88. OhioHealth Venture (OH)
  89. Orange Accountable Care Organization (FL, MD, NJ, NM, PA, TX)
  90. Pacific Private Practice Network, Inc (CA, TX)
  91. PathfinderHealth (AZ)
  92. Physician Partners of Western PA (PA)
  93. Physician Performance Network of Arizona (AZ)
  94. Primary Comprehensive Care ACO (IL, NC)
  95. PRIMARY PARTNERS (FL)
  96. PRIME ACCOUNTABLE CARE WEST (AZ, CA, IL, NV)
  97. Privia Quality Network Gulf Coast II (TX)
  98. QHI ACO (CA, CT, IL)
  99. Renaissance Physicians Accountable Care (TX)
  100. Riverside Health Source (VA)
  101. Rush Health ACO (IL)
  102. Saint Francis Hospital Medicare ACO (AR, IL, MI, MS, TN)
  103. Select Physicians Associates (AL, FL)
  104. SIGNATURE NETWORK (VA)
  105. Space Coast Independent Practice Association (FL)
  106. St. Dominic Medical Associates (MS)
  107. St. Luke's ACO (IL, MO)
  108. St. Luke's Medicare ACO (NJ, PA)
  109. St. Tammany Hospital ACO (LA)
  110. Steward National Care Network, (FL, MA, NJ, OH, PA)
  111. The Iowa Clinic, P.C. (IA)
  112. The Ohio State Health ACO (OH)
  113. Treasure Coast Integrated Healthcare (FL)
  114. UC Davis Health ACO (CA)
  115. UC Irvine Health Accountable Care Organization (CA)
  116. UC San Diego Health Accountable Care Network (CA)
  117. UCSF Health ACO (CA)
  118. UMC Accountable Care (NM, TX)
  119. United Physicians ACO (MI)
  120. University Health ACO (TN)
  121. UPQC (NV, UT)
  122. Valley Medical Group-Renton (WA)
  123. VillageMD Chicago ACO (GA, IL, IN, KY, TN)
  124. White River Health System Clinically Int. Network (AR)
Friday
Jan122018

Accenture’s Advice to Pharma: It’s The Evidence, Stupid.

Accenture’s Advice to Pharma: It’s The Evidence, Stupid.
 

By Clive Riddle, January 12, 2018

 

Remember when Bill Clinton’s first presidential campaign mantra was “it’s the economy, stupid”?  Accenture advises the pharmaceutical industry to substitute evidence for economy in that equation and focus more on evidence-based solutions than products or brand.

 

Accenture has just released 16-page report: Product Launch: The Patient Has Spoken in which they conclude “brands are not major influencing factors when patients consider new pharmaceutical products. More than two-thirds (69 percent) of patients surveyed said the product’s benefits – i.e., treatment outcomes – are more important than the brand itself, with less than one-third (31 percent) citing a strong affinity to brands in a healthcare setting.”

 

Accenture tells us that for the report, they commissioned a survey of 8,000 patients in France, Germany, the U.K. and the U.S across eight therapeutic areas – immunology, cardiology, pulmonology, neurology, oncology, rheumatology, endocrinology and eye disease. Respondents represented three main age demographics: baby boomers, Gen Xers and millennials.

 

Accenture shared the following findings:

 

When patients were asked which factors influence their healthcare product and treatment decisions:

·         66% cited the doctor/physician relationship

·         55% indicated the ability to maintain their current lifestyle

·         53% said ease of access to the care they’ll need

·         But just 31% listed brand loyalty or popularity, and this ranked twelfth out of 14 influencing factors

 

The report notes that patient perspectives include:

·         38 % said they feel very knowledgeable about new or existing products coming to market for their condition

·         25 % reported having either very limited or no knowledge of new products that might be suitable for them

·         48 % believe that their doctors discuss the full range of product options with them

·         44 % feel that they have significant input into their treatment selection

·         63 % said they want to be involved in such decisions

·         47% said they’ve thought about switching their treatment at some point

·         62%of those who think about switching end up doing so

 

So if it isn’t product and brand, what does drive patient treatment choice decisions? Accenture says “despite survey results showing that many patients look online for information about new treatments, physicians remain the primary influencer of their treatment choices. In fact, the reason patients cited most often for switching treatments was a recommendation from their physician (cited by 81 percent of patients who switched treatments), followed by proven benefits compared to current treatment (79 percent) and fewer side-effects than their current treatment (78 percent).”

 

Regarding demographics, the survey “findings also identified differences in attitude and behavior by age group, with younger patients more likely than older ones to understand which treatments are available—and switch treatments when they believe there’s something better. For instance, while physician recommendation was the most-cited reason across all age groups for switching treatment, Millennials are almost twice as likely as Baby Boomers to be influenced by people posting alternative treatment options on social media.”

 

Of course what the report doesn’t focus on regarding treatment decisions is the role of insurance coverage, cost-sharing and formularies. But Accenture’s message in this value based era should still resonate. Accenture’s Jim Cleffi, a co-author of the report, tells us “given the significant budgets pharmaceutical companies devote to driving brand equity in the marketplace, our report findings should be a strong signal to the industry that launch strategies need to change. Patients in our study made it clear that outcomes matter most which means that pharma companies should focus their launch strategies and communications more on patient value and impact versus the brand—and do so in a much more precise and personalized way. Reallocating parts of launch budgets to programs that resonate the most with different patient segments would not only better meet patients’ needs and deliver better outcomes, but likely provide the companies with better ROI.”

 

Accenture provides pharma two recommendations in the report:

1)    Bring an outcome – not just a product – to market. Patients value outcomes over brands, so instead of launching just products, pharmaceutical companies should start launching evidence-based solutions, or products with services as a secondary offering. This will require collaborative data-sharing – between patients, providers and payers – along with advanced analytics to generate robust insights and delivery via digital channels. This mindset should begin at the clinical trial-stage so it informs new launch strategies and full commercialization.

2)    Make it personal and precise. One size no longer fits all; pharmaceutical companies need to understand patient sub-segments and develop value-driven launch strategies tailored to each segment. Harnessing advanced analytics and other new technologies that leverage the proliferation of health data will help enable companies to modify launch strategies that make new treatments more relevant to patients while also driving better-informed resource and investment allocations.

 
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