Entries in Riddle, Clive (265)


Healthcare Bowl 2017: Atlanta vs New England

By Clive Riddle, February 3, 2017


The Atlanta Falcons and New England Patriots square off this Sunday in Houston during a Lady Gaga concert (the halftime show.) But another performance between this two cities is playing out on a daily basis – healthcare indicators. Let’s see how Atlanta vs. New England stack up in a healthcare bowl.


Instead of the venue for this comparison being NRG stadium in Houston, we find ourselves at The Big Cities Health Coalition, a “forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 54 million people they serve.” Their playing field is a Data Platform that features over 17,000 data points across 28 large cities.


Here’s the selected results from their data platform. Let’s score 7 points when one city’s indicator bests the US average and the other city is below the US average, and 3 points the better city when both or neither best the US average. Data is from 2013, and represents Fulton County for Atlanta and the Boston metropolitan area for New England.


  • ·         Uninsured Rate: Atlanta 16.9%; Boston 4.4%; US 14.5%. New England takes a 7-0 lead.


  • ·         Adult Obesity Rate: Atlanta 25.4%; Boston 21.7%; US 28.3%. New England extends their lead to 10-0.


  • ·         Heart Disease Mortality per 100,000:  Atlanta 157.3; Boston 133.6; US 169.8. New England goes up 13-0.


  • ·         Diabetes Mortality per 100,000: Atlanta 19.3; Boston 19.4; US 21.2. To close to call. The score at halftime remains New England 13, Atlanta 0.


  • ·         Asthma Annual ER visits per 10,000: Atlanta 49.8; Boston 125.8%; No US average provided. Atlanta now trails 13-3.


  • ·         Opioid related unintentional drug overdose mortality rate per 100,000: Atlanta: 9.4; Boston 16.8; US 4.2. Atlanta cuts further into the lead, now trailing 13-6


  • ·         Smoking: Atlanta 16.0%; Boston 18.4%; US 17.9%. Atlanta ties the score 13-13.


  • ·         All Cancer Mortality per 100,000: Atlanta 159.3; Boston 176.1; US 163.2. Atlanta wins 20-13.


There you have it – Atlanta wins the Healthcare Bowl 2017 by a score of 20-13.


2017 MSSP ACOs By The Numbers

by Clive Riddle


CMS has announced their 2017 new and renewing ACOs, so we took a somewhat deeper dive into what comprises this year’s MSSP ACO roster, along with who dropped out. For starters, though, here’s the 2017 totals including the other active ACO types (there are also 9 remaining ACOs in the non-active Pioneer model):

  •          MSSP - 480
  •          Next generation - 45
  •          Comprehensive ESRD (CEC) – 47
  •          Total: 572


52 MSSP ACOs participating in 2016 dropped out of the program for 2017. 8 of these started in 2012, 11 in 2013, 22 in 2014, 8 in 2015, 3 in 2016.


For the 480 MSSP ACOs participating in 2017, with respect their track:

  •          Track 1 – 438
  •          Track 2 – 6
  •          Track 3 – 36


17 of these ACOs remain in the non-active Advance Payment program. 45 of these ACOs are the AIM program, and 25 are in the SNF 3 day waiver program.


With respect to geography, when classifying the MSSP ACOs by the primary state they serve (many ACOs serve markets in more than one state), 16 states comprise over two-thirds (68%) of the total:

  •          FL 44 ACOs
  •          TX 44 ACOs
  •          NY 34 ACOs
  •          CA 25 ACOs
  •          MI 20 ACOs
  •          NJ 19 ACOs
  •          NC 18 ACOs
  •          IL 17 ACOs
  •          GA 15 ACOs
  •          IN 15 ACOs
  •          MD 14 ACOs
  •          OH 14 ACOs
  •          KY 13 ACOs
  •          VA 13 ACOs
  •          PA 12 ACOs
  •          MA 11 ACOs


With respect to their initial year joining the program, MSSPs break down as follows:

  •          2012: 49 ACOs (14%)
  •          2013: 63 ACOs (13%)
  •          2014: 79 ACOs (16%)
  •          2015: 77 ACOs (16%)
  •          2016: 97 ACOs (20%)
  •          2017: 99 ACOs (21%)

The Similarities Between Health Plans and Subscription Television

By Clive Riddle, January 13, 2017


One can even directly impact if people live or die.  The other merely informs and entertains. Still, as I recently turned on the television to discover my favorite local station currently wasn’t available because of a contract dispute with my satellite television service, it occurred to me that there are significant parallels between health plans and subscription channel services.


I must digress to say it isn’t that easy finding the correct, simple mainstream term to refer to all that is subscription cable television, satellite television, and streaming internet services. With devices now delivering an increasing load of channel viewing, should we even use the term “television“ when referring to subscription services?  Wikipedia provides the term Multichannel video programming distributor (MVPD), which doesn’t exactly roll of the tongue.


Both health plans and subscription channel services, by their very nature, are based upon the volume of subscribers they amass, the monthly subscription revenue they receive, and the network of providers they contract with (be they health care or channels.) Both are significantly regulated. Both are now dominated by mega companies that emerged from acquisitions. Both now try to distinct themselves by offering enhanced engagement through customer portals. Both are evolving and experiencing disruptive innovations and change. Both are experiencing their providers becoming integrated delivery systems (such as ESPN or HBO.)


And both are plagued by contract disputes with their provider networks.


Just this month, Hearst Television local channels were pulled from DirectTV over a contract dispute affecting markets across the country including Sacramento, Kansas City and Pittsburgh. DishTV experienced headlines including Dish loses more subscribers and says there’s no deal yet to bring back Fox, NFL, and Tribune Stations Blacked Out On Dish Network In 33 Markets.  Cable fare no better than satellite on this front. Comcast/Xfinity earlier this year had headline including As Opening Day looms, Comcast-YES flap leaves many Yankees fans shut out and Verizon headlines included Verizon Dumps The Weather Channel in Favor of Looking out the Window.


Does this sound familiar for health plan subscribers? Consider these recent headlines: Blue Cross to drop Texas Health Resources from its network in 2017 after contract dispute; Humana, Tenet Cut Ties over Contract Dispute; Blue Cross, Fairview network spat could affect 170k patients (Minnesota); or NMHS prepares to drop United as negotiations stall (Mississippi).


Is it any wonder that after much ado has been made for health plans investing in “narrow networks”, DISH TV has just introduced its “Skinny Bundle”?


The point is, it can be instructive for health stakeholders to consider the experiences and lessons learned in the subscription channel service arena, and vice-versa.


But one could argue that a significant dissimilarity between health plans and subscription channel services is that while the uninsured rate was cut in half during the past decade, the trend towards “cord cutting” for subscription channel services is growing, with 21.9% of households having been projected to be cable or satellite free by the end of 2016, while the overall U.S. uninsured rate has dipped below 9%. On the other hand, a material portion of these “cord cutters” have recently ventured into internet subscription services offered via Hulu and others that are still under the radar when cable and satellite subscriptions are counted, and for health plans – it remains to be seen what the percentage of uninsured will look like after “repeal and replace” occurs.


But still, it can be interesting to observe the portion of “cord cutters” cobbling together their own network of integrated providers, bypassing an overall subscription service: assembling their own customized collection of HBONow, ESPN, Netflix, Amazon and other channels. Is there a parallel to emerge for the inevitable increased number of post-repeal and replace uninsured?


Magnificent Seven Healthcare Business Trends for 2017

By Clive Riddle, January 3, 2017


Here’s seven trends, in no particular order, that we see weighing heavily on the business of healthcare during 2017. If they all come to pass, of course you should marvel at the wisdom and insight emanating from this blog. If they are well off the mark, well, here’s hoping for short memories and I’ll search for the delete button on this post.


1. Inaction on Several Fronts While Waiting For Other Shoe to Drop

The individual health insurance markets will be in a holding pattern pending the outcome of sorting through the weeds of the Repeal and Replace activities in Congress and the Trump administration. Ditto for Medicaid initiatives. CMS innovations could even end up in a holding pattern.


2. A new Trigger for Prescription Drug Pricing Backlash?

Furor over Mylan EpiPen pricing and other prescription drug cost stories have subsided a little, and it remains to be seen how and if the Trump administration and Congress weigh in on this. But if a new major prescription drug pricing story erupts, and the odds are sooner or later one will, it should trigger a new groundswell of support for some public response.


3. Year of the MACRA

MACRA was separate from the ACA and is somewhat insulated from ACA dismantling. While the framework for Medicare Quality Payment Program MIPS and APMs are already in place, 2017 will witness widespread activity as physicians follow through on positioning themselves.


4. Private Sector Embrace Also Keeps Value Based Care Momentum Strong

Even if ACA repeal goes so far as tearing asunder Medicare ACO initiatives and other public value based purchasing innovations, the private sector’s embrace of all things value based care will ensure an onward march in this direction.


5. Consumer Driven Care Gains New Momentum

The Trump Administration and new Congress policy agenda would seem to favor increased emphasis on all things consumer driven.


6. Aftermath of Health Plan Mega Mergers

The ACA was credited with helping set the stage for mega health plan mergers. It is difficult to imagine further mega merger activity in the current environment. Cigna and Anthem will surely unwind their deal.  Trump administration emphasis on deregulation might cause the DOJ to take the foot off the gas on their opposition to the Aetna-Humana deal, or at least be more prone to negotiation.


7. Impact of New Technology and Innovation

We may not know what the next New Big Thing is, but we should know that there will be one, and then another. And that one or more of these next new big things will have a major impact on the business of healthcare. 


Touring Lists of Top Healthcare Trends and Issues for 2017

By Clive Riddle, December 21, 2016


It’s that time of year when healthcare prognosticators point out predictions, priorities, and progressions for the coming year. Here is a tour of some of what is being said about healthcare in the new year, starting with overall trends and then examining some specific topics:


PwC’s Health Research Institute releases an annual list that many stakeholders look to. Here is their Top health industry issues of 2017, which they label as “a year of uncertainty and opportunity.” PwC devides these trends into three components, stating “many of 2017’s Top issues highlight how this shift toward value is occurring, and how traditional health organizations and new entrants are responding to it. There are three main tactics that organizations will use to address this shift to value – they will adapt, they will innovate and they will build new programs and approaches to their work.”

Adapt for value

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

Innovate for value

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

Build for value

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


Black Book’s year end C-suite polls produced a list of 9 Healthcare Tech Trends in The New Year of Uncertainty:
1.       Technology Budgets Stagnate, Purchases through Q2 largely will be based on current business need.
2.       Electronic Data Warehouses (EDW) move to the top of short term priorities.
3.       Renewed and upgraded Enterprise Resource Planning Systems (ERP) swings back into importance, now for Value Based Care Costing.
4.       Financially stable, regional IDNs are spending big dollars toward extended connectivity while the rest of the pack looks on.
5.       Providers keep watch and wait for Large Scale Healthcare Cyber Attacks before forming a Better Defense.
6.       Hype around the Cloud quiets down as it becomes the primary way to build enterprise architecture.
7.       Focus on Front End and Middle Office Business Office Functions & RCM Outsourcing intensifies.
8.       Skilled hospital tech staff recruitment is even more challenging.
9.       Interest in Precision Medicine initiatives continue but few have commitments to buy for first half of the New Year.


The Medical Futurist Newsletter shared these top technologies with the biggest promise for 2017:

1)      A new era in diabetes care

2)      Precision medicine in oncology

3)      Narrow artificial intelligence in US clinics

4)      Driverless trucks or cars will include health sensors

5)      New service in nutrigenomics

6)      SpaceX and NASA will realize they need a digital health masterplan to reach Mars

7)      The genome editing method CRISPR in clinical trials

8)      A big tech company will step into health

9)      An insurance company launches a wearable sensor package

10)   The surgical robot by Google and Johnson&Johnson will compete with daVinci

11)   Vocal biomarkers: the future of diagnostic medicine

12)   Pharma will start using massive AI in clinical trials and drug research

13)   A company will make the 3D printed cast a real choice


Also on the topic of technology, Becker's ASC Review features an article 5 healthcare technology trends taking center stage in 2017 summarizing a list of “San Mateo, Calif.-based PokitDok predicted technology trends that will impact the healthcare industry in 2017”:

1.       Healthcare will transition from theory to practice in the Blockchain world. The new year will see academic and theoretical discussions move forward into pilots and applications.
2.       Healthcare e-commerce will witness a boost in 2017, with more major health systems collaborating with technology companies for infrastructure with built-in cybersecurity and HIPAA compliance.
3.       Telehealth will no longer be on the outskirts, pushed into the mainstream with expanded reimbursement policies, usage and outreach programs.
4.       President-elect Donald Trump will likely not fulfill his promise to completely repeal the ACA, despite a Republican Party-dominant Congress and Tom Price, MD, (R-Ga.) leading the HHS.
5.       Auto-adjudication will drive providers to interact with EHRs, revenue cycle management and practice management vendors.


Shifting gears, the McKesson Pharmacy Optimization Team released Five Health System Pharmacy Trends to Watch in 2017:

1.       Continued Growth in Specialty Market
2.       Leveraging Pharmacy Analytics to Make Strategic Business Decisions
3.       Health System Pharmacy Seen as a Revenue and Margin Generator
4.       Centralizing Pharmacy Operations and Improving Clinical Services
5.       Future Directions for Reform and the Affordable Care Act (ACA)


Moving on to the employer healthcare world, MediaPlanet published these 6 Trends in Corporate Worksite Wellness for 2017, explaining that “here’s how corporations are using wellness programs (and this year’s lessons) to promote employee health in the coming year:”

1.       Place greater emphasis on sleep
2.       Continue to stay on top of wellness regulations
3.       Embrace new technologies
4.       Focus on total well-being, not just physical health
5.       Give back to the community
6.       Create a healthy work environment


And finally, also in the employer arena, Mercer shares this Top 10 Compliance Issues for 2017 Health Benefit Planning:

1.       Wellness Plans (podcast): More innovative designs make it critical to know the new rules that begin on January 1, 2017.
2.       Essential Health Benefits (podcast): Check those dollar limits and maximum out-of-pocket maximums against updated benchmark plans for 2017.
3.       Mental Health Parity (podcast): Make sure your benefits are aligned with current law and best practices.
4.       Employer Shared Responsibility: Affordability (podcast): Know the impact of opt-out cash and flex credits; 30-hour (podcast): Understand what payments must be converted to hours of service; ACA Reporting (podcast): Make sure it’s right – no more good faith standard and the old deadlines return for the 2016 reporting year.
5.       Preventive care: Modify benefit terms to reflect latest recommendations and guidance on preventive care.
6.       Summary of Benefits and Coverage (podcast): New model SBC must be used for open enrollments on and after April 1, 2017.
7.       FLSA overtime rules: It’s not just a compensation issue – don’t forget to consider the benefits implications.
8.       Expatriate group health plans: Position group health plans covering globally mobile employees to take advantage of ACA relief.
9.       HIPAA privacy, security, and electronic transactions: Revisit health plans’ privacy and security obligations.
10.   DOL fiduciary rule: Assess the impact on welfare plans with an investment component.