Entries in Riddle, Clive (271)

Friday
Apr072017

Health Plans and the Opiod Abuse Crisis

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By Clive Riddle, April 7, 2017

 

The Associated Press reports that Dr. Scott Gottlieb, “the doctor nominated to head the powerful Food and Drug Administration told senators Wednesday that his first priority would be tackling the opioid crisis.” 

 

What are health plans doing about Opiod Abuse? Last June, the California Health Care Foundation released  a report taking the issue on: Changing Course: The Role of Health Plans in Curbing the Opioid Epidemic, along with companion California health plan case studies and an infographic. Nationally, last fall AHIP weighed in, discussing how health plans are Fighting Opioid Abuse With Solutions That Work.

 

So what are some current developments on the health plan Opioid Abuse front?

 

Cigna has just announced that Use of Prescribed Opioids Down Nearly 12 Percent Over 12 Months Among Cigna Customers. Cigna reports that “58 medical groups participating in Cigna Collaborative Care, representing nearly 62,000 doctors, have signed Cigna's pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition.”

 

Cigna states that their program works with participating doctors to: (1) Analyze integrated claims data across pharmacy and medical benefits to detect opioid use patterns that suggest possible misuse by individuals, and then notifying their health care providers; (2) Alert doctors when their opioid prescribing patterns are not consistent with CDC guidelines; and (3) Establish a database of opioid quality improvement initiatives for doctors.

 

Cigna also reports that “effective July 1, most new prescriptions for a long-acting opioid that are not being used as part of treatment for cancer or sickle cell disease, or for hospice care, will be subject to prior authorization, and most new prescriptions for a short-acting opioid will be subject to quantity limits.”

 

Last week the Wisconsin Association of Health Plans announced their member plans have jointly committed to combating opioid abuse and addiction in Wisconsin and effective April 1, Wisconsin's community-based health plans are collaborating on new initiatives.  The Association members agreed to: (1) support the Association’s Statement of Principles for addressing opioid abuse  that “form the basis for sharing information, best practices and evidence-based strategies”; (2) Track morphine equivalent dose and first-time user trends for their individual and employer group members,, generating comparative data to enrich provider education and management of prescription drug formularies and coverage policies; (3) Work with provider partners to support strategies to reduce and control the level of opioid prescribing; (4) Share methodologies, best practices and evidence-based strategies to improve the quality of pain management and opioid prescribing; and (5) Ensure that every member suffering from opioid abuse has access to medically-appropriate treatment options.

 

Two weeks ago BlueCross BlueShield of Western New York released episode four of their Point of Health Audiocast, “Addressing the Opioid Epidemic from a Health Plan Perspective,” aimed at increasing awareness of the issue and engaging stakeholders.

 

FamilyCare Health, a health plan serving Oregon Medicaid and Medicare members, “kicks off its 4-part Opioid Training series for providers on Thursday, April 27, 2017 with ‘Buprenorphine: What we know and what we don’t. Prescribing safely for pain management and opioid dependence.’ “

 

And last week, Prime Therapeutics, the Blue Cross Blue Shield Association PBM, released two studies, highlighting strategies for addressing opioid epidemic.  The first study “analyzed concurrent use of opioids with benzodiazepines”, citing “previous research has shown concurrent use of these two types of drugs can increase the risk of overdose and death,” and “found more than one in six opioid users without cancer – or nine per 1,000 commercially insured members – used these two drugs concurrently for 30 days or more in 2015.” Their second study “found pharmacists based in a PBM or health plan, who do outreach to prescribers, can reduce emergency room visits and controlled substance drug costs among persistent users of controlled substances.” Following the outreach conducted with the study intervention group, “controlled substances drug costs per member for the intervention group dropped from $5,802 to $5,148, while controlled substance drug costs increased for the control group from $3,511 to $3,627 per member. Emergency department visits were 6.4 percent lower in the intervention group, compared with the control group.”

 
Friday
Mar242017

What Hashtag to Use When Firing Off a Post on Healthcare Reform?

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By Clive Riddle, March 24, 2017

 

You want more people to read everything you have to say about whichever side of the wall you’re on in the great repeal and replace debate. Or you just want to know what trendy term to search on so you can read what everyone else is saying on the subject. What hashtag to use…what hashtag to use?

 

We compiled a list of the hashtags surrounding the debate and had them analyzed using keyhole.co, which tracks twitter usage during the past 36 hours or so. As of noon Eastern time today, here’s what we found for twenty one selected hashtags that had surfaced the most during our research, presented in alphabetical order:

 

·         #aca 705 posts | 2,191,075 reach

·         #ahca 405 posts | 18,106,544 reach

·         #BecauseOfMedicaid 500 posts | 302,037 reach

·         #coveragematters 272 posts | 448,981 reach

·         #fullrepeal 50 posts | 1,400,049 reach

·         #healthcarebill 94 posts | 4,154,646 reach

·         #healthcarereform 595 posts | 4,472,503 reach

·         #IfILoseCoverage 391 posts | 1,232,293 reach

·         #killthebill 729 posts | 2,153,734 reach

·         #MakeAmericaSickAgain 703 posts | 935,553 reach

·         #NoRepealWithoutReplace 31 posts | 28,318 reach

·         #obamacare 85 posts | 43,583,728 reach

·         #passthebill 704 posts | 48,210,419 reach

·         #ProtectOurCare 707 posts | 2,217,826

·         #readthebill 589 posts | 1,871,228 reach

·         #RepealAndReplace 706 posts | 44,990,188 reach

·         #ryancare 706 posts | 2,365,314 reach

·         #saveaca 705 posts | 2,234,518 reach

·         #SaveMedicaid 43 posts | 124,503 reach

·         #SaveTheACA 711 posts | 2,061,039 reach

·         #trumpcare 736 posts | 1,741,593 reach

 

The number of posts vs reach reflects the number of tweeters vs the number of tweetees. One tweet from @realDonaldTrump of course goes a long ways in reach.

 

The top ten hashtags in order of posts during this period were: #trumpcare, #killthebill, #savetheaca, #protectourcare, #repealandreplace, #ryancare, #aca, #saveaca, #passthebill, #makeamericasickagain. These were the only hashtags with 700+ posts, with a range of 703-736, so all are being used with similar frequency, and usage of other  hashtags in this genre really drop off after these top ten.

 

With regard to reach, #passthebill, #repealandreplace, and #obamacare were the top three, each exceeding 40 million. #ahca was fourth with 18+ million. #Healthcarereform and #healthcarebill were next, each with 4+ million and it drops off from there.

 

A number of the hashtags (#killthebill, #passthebill) will fall out of use once the #ahca legislative debate is over, while other monikers will likely have legs for some time to come.

 

So pick your hashtag and start posting or browsing.

 
Friday
Mar172017

Taking a Peek at the Irish Healthcare System on Saint Paddy’s Day

Clive Riddle, March 17, 2017

 

In observance of St. Patrick’s Day – that day on which we are all Irish – let’s take a quick peek at the Irish healthcare system. Ireland’s Health Service Executive provides all of Ireland's public health services in hospitals and communities across the country. Here’s what their website has to say about their public services:

 

“Who can access health services in Ireland? Ireland has a comprehensive, government funded public healthcare system. A person living in Ireland for at least one year is considered by the HSE to be 'ordinarily resident' and is entitled to either full eligibility (Category 1) or limited eligibility (Category 2) for health services. People who have not been resident in Ireland for at least one year must satisfy the HSE that it is their intention to remain for a minimum of one year in order to be eligible for health services. Dependants of such individuals must also contact the HSE to confirm their eligibility.” The website informs us that over 30% of people in Ireland are Category 1.

 

A recent article in Irish Times: Ireland worst of 36 countries for ease of access to healthcare – details recently released negative findings from the annual Euro Health Consumer Index report. The report states “the fact that Ireland has the highest percentage of population purchasing duplicate healthcare insurance – over 40 per cent, down from 52 per cent three years ago – also presents a problem. Should this be regarded as an extreme case of dissatisfaction with the public system, or simply as a technical solution for progressive taxation?”

 

The article cites these negative findings from the report:

  -  Irish patients spend longer waiting for emergency treatment in hospital than any others in Europe

  -  Ease of access to the Irish healthcare system is the worst of the 36 countries surveyed, with longer waiting times for minor operations and CT scans

  - Overall, the Irish system ranks 21st [out of 36] in the 2016 Euro Health Consumer Index, the same as in the previous year.

  - The Irish health service is also fifth-worst – on a composite “bang for your buck” measure included in the report.

 

MCOL’s Global Member website includes an archive of International Healthcare Factoids. Here’s some recent selected Irish healthcare factoids from the archive:

 

Healthcare Spending in Ireland

* Health accounted for 9.91% of Irish gross domestic product (GDP) in 2014.

* Government spending on health has increased by at least €1 billion since 2014.

* Total health spending came to more than €19 billion in 2014.

* €13.3 billion was spent by the Government on health in 2014.

* Household out-of-pocket spending was almost €3 billion in 2014.

* Ireland spent €4,147 per person on health in 2014, the sixth highest total in Europe.

Source: Irish health spending among highest in Europe

 

 

Cancer in Ireland

* 38,000 people are diagnosed with cancer each year in Ireland.

* In Ireland, 8,700 people die of cancer annually.

* 1 in 3 Irish men, and 1 in 4 women, will be diagnosed with cancer at some point.

* The chances of Irish women getting cancer is 16% above the EU average.

* The incidence of cancer among Irish men is 10% higher than the EU average.

* 6 out of 10 people will now survive at least five years after diagnosis.

Source: Risk of Irish men and women developing cancer levels off

 

Hospital Wait Times in Ireland

* More than 530,000 people are on public hospital waiting lists in Ireland.

* 435,000 patients were waiting for an outpatient appointment at the end of August.

* More than 74,000 of these outpatients have been waiting for an appointment for over a year.

* 43,000 have been waiting longer than the 15-month "maximum" waiting time set by the government.

* The hospital with the longest waiting list is University Hospital Galway, at 33,000.

* 78,500 people are waiting for inpatient or day case procedures.

Source: Record 530,000-plus patients on hospital waiting lists

 

Prevalence of Undiagnosed Type 2 Diabetes in Ireland

* An estimated 24,000 to 40,000 people in Ireland have undiagnosed type 2 diabetes.

* The risk of having undiagnosed type 2 diabetes increased by 89% for every 5kg/m2 increase in weight.

* Men were nearly 3X more likely to have abnormal blood sugar and undiagnosed diabetes than women.

* 17% of participants in a 30,000-person study had abnormal initial fasting blood sugar levels.

* Pre-diabetes was confirmed in 10% of study participants.

Source: Up to 40,000 people have undiagnosed type 2 diabetes, charity says

 

Under-Age-Six Physician Visitation Rates, Ireland

* Research carried out by the Department of Health last year shows that fee-paying children under the age of six have an annual GP visitation rate of 2.7

* Medical/GP visit cardholders under the age of six have a visitation rate of 3.1

*  GP numbers in Ireland have been increasing since 2010. At December 31 2013, there were 2,840 GPs in Ireland compared to 2,731 at the end of 2012, 2,562 at the end of 2011 and 2,270 at the end of 2010.

Source: Under-six visitation data revealed

 

Private Health Insurance in Ireland

* 2.123 million people – or 46.3% cent of the population – held private health insurance in September 2012. This represents a drop of 16,000 since March and a decrease of 61,000, or 4%, since June 2011.

* The number of people holding private health insurance peaked in 2008 at 2.3 million, but has been in decline since.

*  Aviva increased its share of the health insurance market last year. In 2011 Aviva grew its market share in Ireland to 17.7%, up from 13.7% the previous year.

* Over the same period VHI Healthcare’s market share fell from 61.6% to 57.3%.

*  Quinn Healthcare's – renamed Laya Healthcare earlier this year – share of the market remained steady at just under 21%.

Source:  Private health insurance numbers fall another 61,000

Friday
Mar102017

Your Seven Step Homework Guide for Studying the American Health Care Act

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 By Clive Riddle, March 10, 2017

 

1.       Don’t sweat all the granular details yet. Who knows for certain where the political process will take this proposed Act from here?
 

2.       Watch for the CBO “score” on the Act, which will soon peg estimated cost and volume numbers to what’s being proposed. The CBO score will likely shape discussions from that point forward. The portal for CBO healthcare analysis is www.cbo.gov/topics/health-care.  Here’s two articles about the upcoming CBO score:  Obamacare replacement is hard to score, budget experts say (Washington Examiner) and Nonpartisan Scorekeeper in Hot Seat for GOP’s Obamacare Repeal (Bloomberg).
 

3.       Keep some original sources handy – including a summary from the House’s Energy and Commerce Committee and the s Ways and Means Committee. Also, here’s Paul Ryan’s press release announcing the Act. 
 

4.       Looking for a nice, quick summary of key provisions of the Act? Check out the Association of Health Care Journalists article by Unpacking some key provisions of GOP’s health care bill by Joanne Kenan. Kaiser Health News also has a succinct listing of five key points in comparison to the ACA - Five Ways the GOP Health Bill Would Reverse Course From the ACA by Julie Rovner.
 

5.       Looking for thoughtful analysis of the Act? Check out the Timothy Jost – the oft quoted in national press expert on such matters – in his Health Affairs Blog: Examining The House Republican ACA Repeal And Replace Legislation.
 

6.        Understand some key opposition points from public interest groups: AARP isn’t happy about the increased premium load older individuals would bear in the market, or about Medicare changes. The AMA and AHA don’t like the ultimate reductions in Medicaid and other coverages. Families USA says the only the Healthy and Wealthy will benefit from the bill and also take major issue with the per-capita caps in Medicaid.
 

7.       Getting too tired to read any further? Here’s six selected videos from major organizations discussing the Act.

Friday
Mar032017

2017 Employer Health Care Strategies and Trends

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By Clive Riddle, March 3, 2017

 

DirectPath and CEB have just released their 2017 Medical Plan Trends and Observations Report, “which analyzed more than 975 employee benefit health plans, highlights the top ten trends in employers’ 2017 health care strategies across three categories – plan design, cost savings mechanisms and care options.”

 

The 11-page report tells us that “employers are incorporating solutions like health savings accounts (HSAs), wellness incentives, price transparency tools and alternative care options to reduce costs.”

 

The ten trends they discuss include:

1.     Annual Deductibles Leveling Out

2.     Marginal Change in Prevalence of HDHPs

3.     HSAs Continue to Remain Popular

4.     Specialty Medication to Become More Expensive

5.     Contribution Surcharge Amounts Vary

6.     Wellness Incentives Continue to Increase in Prevalence and Amounts

7.     Plan Comparison Tools Lead to More Savings

8.     Alternative Care Options Remain Affordable

9.     Barriers to Employee Use of Telemedicine

10.  Focus on Higher Quality Health Care

 

Major findings from their surveys cited in the report include:

·         51 percent of employers offer a price transparency tool to help employees choose the service or product best for them, and 18 percent plan to add such tools in the next three years

·         In a review of price comparison requests, these services resulted in an average employee savings of $173 per procedure and average employer savings of $409 per procedure.

·         While the percentage of organizations with spousal employee contribution surcharges remained static (26 percent in 2017, as compared to 27 percent in 2016), average total surcharge amounts increased dramatically to $152 per month, a more than 40 percent increase from 2016.

·         More than a third of organizations offer telemedicine, but over 55 percent of employees in these companies are not aware of telemedicine availability, and nearly 60 percent of employees who have telemedicine programs do not feel they are easy to access, according to a separate survey recently conducted by CEB.

·         The average cost of specialty drugs that treat rare and complex conditions increased by more than 30 percent for employers surveyed.

·         67 percent of employers surveyed offer HSAs, compared to 15% offering Health Reimbursement Arrangements (HRAs). Employer contributions to HSAs increased almost 10 percent.

·         58 percent of 2017 employer plans offer some type of wellness incentives, up from 50 percent in 2016.

 

While we’re on the subject of wellness incentives, Humana just released their 2017 Humana Wellness Trends Report, a 20-page document that discusses five trends:

1.     The “connected experience 2.0” revolutionizing wellness strategies: “…As wellness programs begin to integrate these devices and employers gain access to the data, employers will gain insight into what’s driving organizational health costs and how to resolve them.”

2.     Older workforce leads to health, caregiving burdens: “…The U.S. workforce is getting older and retiring later due to the stress of financial burdens, caring for older loved ones and increasing health care costs.”

3.     Financial stress affects productivity: “….Americans identify money as their top stressor, which can reduce employee productivity and contribute to absenteeism, presenteeism and poor health. Research states 37 percent of full-time employees deal with financial issues while working.

4.     Poor sleep leading to errors, low morale: “…Among workers age 30 and older, 74 percent say lack of sleep affects their work performance.”

5.     Workers benefit from mindfulness techniques: “…Research has found a mindful approach may help ease the “effects of stress, anxiety and other negative emotions.”

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