Ten Things to Know From the NBGH Employer Survey 

By Clive Riddle, August 16, 2019

The National Business Group on Health has released their annual study - The 2020 Large Employers' Health Care Strategy and Plan Design Survey, which found “employers project the total cost of health benefits will rise 5% in 2020, taking cost management initiatives into account. That increase is identical to 2019’s projected increase - but actual costs are coming in lower. Large employers reported the actual increase in 2018 was 3.6%.”

For comparison, PwC's Health Research Institute in their June report: Medical cost trend: Behind the numbers 2020, projected which projects the 2020 trend to be a six percent cost increase.  In late July Milliman released their 2019 Milliman Medical Index, a 12-page report and their 15th annual analysis that "measures healthcare costs for individuals and families receiving coverage from an employer-sponsored preferred provider plan (PPO). For 2019, they found overall healthcare costs for a hypothetical family of four have reached $28,386, an increase of 3.8% from the year prior.

Here’s ten things to know from this year’s NBGH study:

  1. Total cost of health care per employee including premiums and OOP is estimated to be $14,642 for 2019 and $15,375 in 2020.
  2. The employers will cover contribution is about 70% of costs while employees will bear about 30%, 
  3. 44% of employers ranked musculoskeletal issues as the top condition impacting their costs. 85% ranked it among the top three conditions.
  4. The top two listed large employer initiatives for 2020 were: (1) Implement more virtual care solutions - 51%; (2) More focused strategy on high-cost claims - 39%
  5. 31% of employers plan to implement an ACO or high performance network in select markets in 2020
  6. 49% of employers plan to pursue an advanced primary care strategy in 2020, and another 26% are considering one by 2022.
  7. 34% of employers will deliver advanced primary care through an onsite or near-site health center 
  8. 85% of employers rate high-cost drugs as the number one or two most concerning pharmacy issues.
  9. 20% of employers will have a point of sale prescription rebate program in 2020, but 67% favor a model based on net price of medications with no rebate as an alternative.
  10. The number of employers offering full replacement consumer-directed health plans will shrink to 25% in 2020, down from 30% this year and 39% in 2018.



The Latest on Physician Burnout

By Clive Riddle, August 9, 2019

InCrowd has just released their 16-page 2019 Physician Burnout Survey report - a follow-up to their 2016 burnout research, asking their participating physicians how they’re coping with job-related stress. They found “sixty-eight percent of US-based physicians surveyed reported experiencing burnout at some level,” and that “primary care physicians (PCPs) report higher burnout rates than specialists, with 79% of PCPs personally experiencing burnout compared with 57% of specialists. And, more than a third of InCrowd physicians surveyed said they would not recommend their profession to a young family member.”

The report also shares findings that: 

  • Burnout is highest among younger physicians, with those in their 30s and 40s reporting highest rates of burnout (74%), and burnout rates dropping thereafter.
  • Hospital employees report slightly worse metrics for addressing burnout (20% effective) compared to those who work across private practices (27% effective).
  • Those who report that their facilities effectively address burnout credit workplace initiatives that improve workflow (46%), provide schedule flexibility (45%), and support wellness (41%).
  • When asked what actions their facilities could take to alleviate the issue of physician burnout, over half of respondents report that increased support staffing (66%), mandatory vacation time or half-days (57%), and reduced patient volume (56%) are likely to help. 

InCrowd notes their findings are “higher than the 43-54% range found in MedScape’s 2019 national report yet lower than the 80% of The Physicians Foundation/Merritt Hawkins biennial survey of September 2018. With PCPs, however, InCrowd found nearly 80% burnout levels—dramatically higher than the 43.9% cited in an American Academy of Family Physicians (AAFP) study of March 2019, which itself reflected a decline from 54.4% in 2014.”

Last month, Spok, Inc. released a paper: "Clinician Burnout in Healthcare: A Report for Healthcare Leaders" providing survey results from over 470 clinical staff at U.S. hospitals and health systems. in which clinician perception of burnout was measured. 92% of clinicians said burnout is “a public health crisis that demands urgent action.” 

When asked "what prevents clinicians from seeking help for potential symptoms of burnout, the No. 1 obstacle cited by respondents (65%) was that their organization lacks institutional attention and resources. When asked how often their organization leaders discuss burnout, 47% said rarely or never."  When asked "whether increased or ineffective technology contributes to the risk of clinician burnout, the vast majority (90% of all respondents) strongly or moderately agreed. And 89% of respondents said burdensome or increased workload (not related to direct patient care) is the biggest factor that contributes to this risk."

The Spok survey also found:

  • 70% experience symptoms of burnout "considerably” or “a great deal.
  • 95% believe improving EHR usability will be at least somewhat helpful
  • 30% of respondents said their organizations are improving EHR usability
  • Nurses use an average of 4.1 technology systems daily 
  • Physicians use an average of 3.9 systems daily and clinical leaders 3.5
  • 20% reported mental health treatment or support is available
  • 13% have a chief wellness officer or equivalent
  • 11% reported not experiencing risk factors including work-related stress, lost satisfaction, or a loss of efficacy in their own work

The Spok survey certainly lays much of the problem at the lap of HER. The InCrowd survey asked for suggestions on how to reduce burnout and “more than half (51%) of those providing additional recommendations suggest improving processes related to administrative burden: 23% suggest employing scribes, 23% advocate for reduced documentation, and 5% propose scheduling more time for charting.” 


Two Papers on the Health Plan Medicare Opportunity

By Clive Riddle, August 2, 2019 

Oracle has released an Executive Insight paper on the Opportunity Ahead for Agile and Efficient Medicare Advantage Plans,  cautioning that “While the opportunity is great, MA plans are not automatically a wise or profitable business decision for all health insurers. There is growing competition as new players enter the market, and cost and margin pressures continue unabated. To make the most of this opportunity, MA plans must look to accelerate innovation while optimizing costs across their enterprises— from marketing and enrollment to plan configuration, claims processing, compliance, and renewal.”

They report on three development plans should consider now:

  1. It is “Time to flex strength with expanded flex benefits. In 2019, MA plans were cleared to offer new flex benefits, designed to move plans toward expanded population health capabilities.”
  2. “MA plans look to differentiate on other fronts and deliver high levels of service—without placing profitability and stability in peril.”
  3. Payers are eager to bring new urgency and focus to improving claims accuracy and delivering innovative provider payment models.

HealthEdge has just released results of its Voice of the Market Survey, a study of 201 health insurance executives directly involved in Medicare lines of business. 92% responded that they are trying to grow their Medicare Advantage book of business faster than their traditional Medicare Supplement business.


Here’s some key findings from their survey:

  • 53.2% said the value-based model of Medicare Advantage significantly factors into a desire to grow the business, while 42.8% said it moderately factor in.
  • Expanding to new service areas ranked first in level of importance as the steps being taken to attract new Medicare and Medicare Advantage members, followed by (2) Appealing to tech-savvy digital consumers; (3) Providing incentives for healthy behaviors; (4) Addressing social determinants of health; and (5) Marketing/advertising to prospective members
  • Applicable steps above get re-ordered somewhat when ranking importance to retain current Medicare and Medicare Advantage members: (1) Appealing to tech-savvy digital consumers; (2) Addressing social determinants of health; (3) Providing cost transparency; (and 4) Providing incentives for healthy behaviors; (5) Providing education services to members about their benefits
  • There is not consensus on what is the biggest challenge to acquiring new members in the Medicare or Medicare Advantage (MA) line of business.  29.4% said it was funding/executing marketing outreach to  attract new members; 23.8% said competitors who  dominate the market; 22.4% said offering the variety of  plans necessary to satisfy members; and  19.9% answered differentiating  between MA and  traditional Medicare.
  • When asked “what is the biggest external challenge your organization faces in the Medicare and Medicare Advantage line of business.” Competitors seem top of mind, with 34.3% responding “competition”; and another 29.9% stating “members unwilling to switch plans from a competitor. Other responses were 19.9% replying “regulations” and 15.9% saying “member demands.”



Four Questions for Erin Benson and Courtney Timmons with LexisNexis Health Care: Post-Webinar Interview

By Claire Thayer

Erin Benson, Director Market Planning and Courtney Timmons, Market Planning Specialist, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.  If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed Erin and Courtney on four key takeaways:  

1. What are some of the key ways health plan members are using their member portals? 

Erin Benson and Courtney Timmons: Health plan members are increasingly using their member portals as a tool to View and get answers to coverage questions

  •  Track claims and account activity
  •  Locate providers and services
  •  Find health advice
  •  Manage their member profile
  •  Pay bills

2. With the rise of digital healthcare, there's also a rise in online fraud. Tell us more about how this impacts healthcare firms?

Erin Benson and Courtney Timmons: 

As the ways in which members access their data becomes more sophisticated, so too do the ways in which hackers are finding ways to commit fraud:

  • More than 1 in 10 new account openings are fraudulent with 60% of those accounts being created using a mobile device
  • Call center fraud is up 113%
  • A record 1 Billion BOT attacks were seen in Q1 of 2018
  • There has been a 202% growth in login attacks since 2016
  • And 88% of all ransomware attacks were against healthcare organizations in 2017 –healthcare organizations are known on the black market to pay      

When fraudsters are successful it compromises patients’ trust in the healthcare organization, increases costs if they have to remediate a breach, and potentially leads to member safety risks if any of the patient’s health data is altered and care givers then act on bad information. Not to mention members will go somewhere else if they don’t trust that you can take care of their data.

3. You've mentioned that identity is the key to solving the challenge of balancing member engagement and data security. How do these interact together?

Erin Benson and Courtney Timmons: The healthcare organization should determine when and how to communicate with the member, ensuring updated contact information is maintained to best engage them. The member’s information should be protected from fraudster access. A foundational step is for healthcare organizations to aggregate the many data points about each member into one location linked together by a unique, persistent member-level identifier to create the one golden record about the individual.

Identity management and proofing, in tandem with new technological innovation, allows organizations to:

  •  Perform intuitive linking of data points to the accurate identity
  •  Leverage cross-industry analytics that allow organizations to determine if an identity enrolling in   your plan actually exists and if all of the identity information is accurate and belongs together, and 
  •  Monitor transaction activity across a diverse array of industries from financial, retail, insurance and   government, using machine learning to build analytics, provide fraud intelligence and track   fraudulent behaviors and schemes.

In order to protect their data, you have to know who to grant access to and be able to verify their identities. Knowing your members will allow you to validate that the right users get access to their information, while keeping fraudsters out, and providing insight into who is accessing your site, mobile application and/or portal no matter where in the medical journey a member… or fraudster… is trying to gain access. 

4. Identity verification is complex. What are a few key considerations in selecting identity verification layers? 

Erin Benson and Courtney Timmons:  Various types of authentication methods should be used to cover different types of security vulnerabilities.  It is important to implement solutions that serve different purposes, targeting different types of fraud.

Some questions to ask as you develop your strategy are:

  • Do we have a way of preventing fraud such as BOT attacks or ransomware by scanning devices trying to gain access to our portal?
  • Can we confirm that the user requesting access to the data is the owner of that identity?
  • Does the input identity exist and do all of those data elements belong together?

We recommend putting the no to low friction solutions up front in the process and introducing solutions with increasing levels of friction later in the process so only suspicious identities are facing additional scrutiny before logging in or completing a high risk transaction. 


Overconfident Healthcare Organizations? Could Be According to Healthcare Cybersecurity Survey 

By Clive Riddle, July 19, 2019

LexisNexis Risk Solutions in collaboration with Information Security Media Group has released results from their recent survey of hospitals, medical groups and payers, in their new 18-page report The State of Patient Identity Management, which found 50% are confident they have the necessary controls in place to prevent unauthorized access to patient information, 58% believe their portal cybersecurity is above average (and only 6% feel they are below average), yet 35% don’t deploy multifactor authentication.

To digress, some insight into those results can be gained from reading last week’s mcolblog post by Kim Bellard on Our Dinning-Kruger Healthcare System, which discusses the Dunning Kruger effect involving “the cognitive bias that leads people to overestimate their knowledge or expertise,” illustrated in the world of NPR’s Lake Wobegon – where “all the children are above average.” 

88% of the organizations surveyed had patient/member portals, and 93% use username and password as the patient portal authentication method. 65% deploy multifactor authentication, with 39% using a knowledge-based Q&A for verification, 38% using email verification, and 13% deploy device identification. 65% report that their individual state budgets for patient identity management will not increase in 2019.

Here’s the top three cybersecurity takeaways of the report according to LexisNexis:

  1. Traditional authentication methods are insufficient: As a result of many healthcare data breaches, hackers have access to legitimate credentials; users are also easily phished. Therefore, traditional username and password verification are considered an entry point, not a barrier, and alone cannot be relied upon to provide a confident level of security.
  2. Multifactor authentication should be considered a baseline best practice: HCOs should rely on a variety of controls, ranging from knowledge-based questions and verified one-time passwords to device analytics and biometrics to authenticate users based on the riskiness of the transaction. The more risky the access request is, the more stringent the authentication technique should be.
  3. The balance between optimizing the user experience and protecting the data must be achieved in an effective cybersecurity strategy: HCOs need to make it easy for patients and partners to access records while ensuring adequate data protection. To do this, an HCO's cybersecurity strategy should layer low to no-friction identity checks up front, making it easier for the right users to get through and layer more friction-producing identity checks on the back end that only users noted as suspicious would complete.