Monday
May232016

How are health plans meeting behavioral health needs of members?

By Claire Thayer, May 23, 2016

There’s been a lot of awareness about mental health lately, especially during the month of May – officially recognized as Mental Health Month, via Mental Health America .  In the spirit of this awareness, AHIP recently released a new 28-page issue brief on behavioral health benefits and mental health coverage from collective case studies of 11 member health plans. This new issue brief, Ensuring Access to Quality Behavioral Health Care: Health Plan Examples, identifies innovative approaches to these key areas:

  • Awareness and Education
  • Identification and Outreach
  • Timely access to care
  • Quality measurement
  • Evidence-based clinical criteria
  • Care Coordination and integration
  • Programs targeting opioid use

Health Plans profiled in the report include:

  • Anthem
  • Beacon Health Options
  • Blue Shield of California
  • CareFirst
  • Cigna
  • Health Care Service Corporation
  • Health Partners
  • Highmark
  • Humana
  • Kaiser Permanente
  • Wellcare

To read this complete Issue Brief: Ensuring Access to Quality Behavioral Health Care: Health Plan Examples

Thursday
May192016

Patients Happy With PCPs But Not Always Following Their Advice Due to Costs

By Clive Riddle, May 19, 2016

The Physicians Foundation has just released a 74-page report with results from their Physicians Foundation Patient Survey conducted by Harris Poll. The report findings state that “95 percent of patients surveyed are satisfied or very satisfied with their PCP’s ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Moreover, 93 percent were satisfied or very satisfied with how well their PCP listened to them during their most recent exam, with 92 percent noting high levels of satisfaction relative to how well their doctor knew their medical history.”

But the report notes that “patients who saw a primary care physician for their most recent routine exam are not fully adhering to treatment plans, avoiding routine check-ups or opting not to take prescription medication due to rising healthcare costs.”

They cite that “ sixty-two percent of U.S. adults are concerned with being able to pay for medical treatment if they get sick or injured. Almost half (48 percent) are not confident they could afford care should they become seriously ill. In addition, more than a quarter of U.S. adults (28 percent) have skipped a medical test, treatment or follow-up or avoided a visit to the doctor for a medical problem in the past 12 months because of costs. Twenty-seven percent of patients have avoided filling a prescription in the past 12 months, noting costs as a primary factor.”

Who do patients feel are driving these costs? The report says that “59 percent of patients surveyed say it’s the cost of prescription drugs. One-third (33 percent) of patients cited fraud as another contributor factor, followed by social conditions and poverty (28 percent), government mandates (26 percent) and an aging population (25 percent).”

Rip Hollister, MD, a Physicians Foundation board member tells us “patients recognize that there is an array of stakeholders and external influences that affect treatment options and, in effect, clinical autonomy. Historically, treatment plans have been developed between the doctor and patient. Yet, patients understand that there are now many other parties ‘in the room,’ so to speak, which complicates and challenges the manner in which physicians practice medicine.”

In this regard, the report cites how much patients felt each of the following stakeholder groups, as a whole, impacts treatment options available to them:

  • Health insurance companies (83 percent)
  • Physicians (79 percent)
  • Pharmaceutical companies (68 percent)
  • Federal legislature (60 percent)
  • State legislatures (54 percent)
Tuesday
May102016

Walgreens raising awareness on mental health with online screening tools and telehealth services

By Claire Thayer, May 10, 2016

Walgreens and Mental Health America have forged an ambitious initiative to screen 3 million people for mental issue, by the end of 2017. Walgreens is well positioned to step up to expand mental health services and treatment options and has announced it will offer access to 1,000 therapists and psychiatrists via MDLive’s subsidiary, Breakthrough.

Walgreens new dedicated mental health “answer center” is designed to help connect people to Mental Health American’s Online Screening Program— free, scientifically-based online screenings for a number of conditions including depression, anxiety, bipolar disorder, PTSD and others.

The National Alliance on Mental Illness reports that getting access to services for treatment of mental health illness continues to be a concern:

  • Approximately 60 percent of adults, and almost 50% of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
  • African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.
  • One-half of all chronic mental illness begins by the age of 14; three-quarters by age 24.
  • Despite effective treatment, there are long delays−sometimes decades−between the first appearance of symptoms and when people get help.

Further reading:

Friday
May062016

Hot Healthcare M&A Market Starting to Cool

By Clive Riddle, May 6, 2016

Irving Levin Associates reports that healthcare merger & acquisition activity, which has been relatively overheated, is starting to cool a little. Lisa E. Phillips, editor of Irving Levin’s Health Care M&A News tells us “the slowdown in deal volume in the first quarter of 2016 might simply be fatigue setting in after a record-setting year in 2015. Also, some buyers are still figuring out where the best opportunities are, as the shift to value-based reimbursements gains momentum.”

Health Care M&A News states that “health care merger and acquisition activity began to slow down in the first quarter of 2016. Compared with the fourth quarter of 2015, deal volume decreased 7%, to 351 transactions. Deal volume was also down 7% compared with the same quarter the year before. Combined spending in the first quarter reached $79.5 billion, an increase of 87% compared with the $42.5 billion spent in the previous quarter.”

Here’s a snapshot the publication provided of the quarter’s activity:

How big was 2015?  Bigger than 2014, which was also a huge year.  Irving Levin’s Lisa Phillips says “health care mergers and acquisitions posted record-breaking totals in 2015. The services side contributed 62% of 2015’s combined total of 1,503 deals, which is even higher than 2014, when services deals accounted for 58% of the deal total.” A separate Irving Levin publication, the Health Care Services Acquisition Report, cites that “deal volume for the health care services sectors rose 22%, to 936 transactions versus 765 in 2014. The dollar value of those deals grew 183%, to $175 billion, compared with $62 billion in 2014. Merger and acquisition activity in the following services sectors—Behavioral Health Care, Hospitals, Laboratories, MRI & Dialysis, Managed Care, Physician Medical Groups, Rehabilitation and Other Services—posted gains over their 2014 totals. The exception was the Home Health & Hospice sector, which declined 33% in year-over-year deal volume.”

In the hospital sector, for 2015, they report that “activity remained strong in 2015, up 3% to 102 transactions, compared with 99 transactions in 2014. An average of 2.6 hospitals were involved in each transaction, compared with an average of 1.8 in 2014 and 3.3 in 2013.” Philips noted that “several deals resulted from the mega-mergers of 2013,” and that “we’re seeing more sales resulting from bankruptcies, especially in states that have not expanded Medicaid coverage.”

Friday
Apr292016

Getting on the Blockchain Bandwagon

By Kim Bellard, April 28, 2016

Face it: health care IT infrastructure is a mess.  After spending tens of billions of dollars to "incent" providers to move to EHRs, they're using them but are not very happy with them. We now have millions of electronic records that are still way too siloed, and all too often incomplete.

Enter blockchain.

To the extent most people think of blockchain at all, it is in relation to one of its most prominent users, Bitcoin.  Bitcoin, which has its passionate advocates and equally passionate skeptics, is not synonymous with blockchain.  Blockchain is the technology that allows Bitcoin to operate, but they are no more one and the same than Salesforce.com and Oracle are.

In layman's terms -- and, trust me, when it comes to this I definitely am a layman -- blockchain is a set of distributed records, or databases, that are shared by multiple parties and which can only be updated by a majority of those parties.  There is no central authority, no central database.  It reminds me of the Internet's distributed networks, which help assure its robustness. 

Equally important, in blockchain once a record is stored (or "transcribed"), it can't be tampered with.  For better or for worse, Bitcoin has demonstrated that blockchain does, in fact, assure anonymity, privacy and security. 

Blockchain is starting to become more visible even outside of Bitcoin.  Businesses are being told they need a "blockchain czar.  Wall Street is starting to embrace it.  Britain looking into using it for manage the distribution of public money
 
Some people think it is the greatest thing since sliced bread -- or, in modern terms, since the Internet.  IBM's Jerry Cuomo says: "Blockchain has the potential to become the technological foundation for all electronic transactions conducted over the Internet."

If they are even remotely right, blockchain is something that we better be paying attention to, and what industry needs its advantages more than health care?

We're already beginning to see blockchain show up more in health care.  For example, Gem just announced Gem Health, As they say: "We need a modern infrastructure that unlocks new channels for services to connect, while balancing the need for strong data privacy and security.  Blockchain technology is that infrastructure."

Philips is onboard, with the Philips Blockchain Lab joining the Gem Health network.

It's not going to be easy.  Health care has had a hard time agreeing to things like ICD-10 or HL7, much less interoperability standards.  In CIO, Peter B. Nichol points out the need for foundational protocols, such as the Linux Foundation's Hyperledger project is working on  If we thought getting providers to use EHRs was hard, picture trying to get the health care industry onto a entirely new technology platform like blockchain. 

True to form, the "HIT standards mandarins" are already showing resistance to blockchain.

However, Mr. Nichol also enumerates a number of companies already jumping on the blockchain bandwagon for healthcare uses, including not just Gem but also TierionFactomHealthNautica, and Guardtime.  It is something that any organization involved in health care can ignore only at their own risk.

Look, I'm no technology seer.  I don't know if blockchain is going to totally revamp how we store and update data, as its proponents claim.  What I do know is that, when it comes to health care, our current approaches are not getting us to the interoperability that we need, or are doing so only at glacial speeds, and that they allow our electronic data to be increasingly vulnerable.   

If not blockchain, what?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting