Friday
Dec012017

Recent Uber and Lyft Healthcare Transportation Collaborations

By Clive Riddle, December 1, 2017 

Yesterday (November 30th) Cigna-HealthSpring reported on its collaboration with Lyft for medical transportation of Medicare Advantage members. They stated that "more than 14,500 transports have occurred through this collaboration. Since its introduction in May, 92 percent of Cigna-HealthSpring customers using Lyft have made it their preferred transportation option, according to customer surveys. On average, participants are waiting less than eight minutes for Lyft to take them to or from their appointments." They explain that "the service is for ambulatory customers in non-emergencies only and is only available to Cigna-HealthSpring customers whose benefit plan includes supplemental non-emergent medical transportation coverage through Access2Care at no additional cost. Participants need to contact Access2Care to establish Lyft as their designated transportation provider." 

I decided to check out what other developments have occurred during the past month regarding Uber, Lyft and medical transportation collaborations. 

The AHA during November published a nice 27-page report in their Social Determinants of Health Series on Transportation and the Role of Hospitals. In their chart summarizing transportation strategies, they state that “When transportation is unavailable, health care systems may need to provide transportation directly to patients and staff,” and their recommendations include that hospitals “partner with ride-sharing companies like Uber or Lyft.” 

A November1st Catholic Health World article Ministry systems tackle transportation barriers for vulnerable patients, that included these four examples of Uber and Lyft healthcare transportation collaborations: 

  • “St. Vincent Charity Medical Center in Cleveland launched a program in the spring to provide free transportation via the ride-sharing company Uber to patients undergoing addiction treatment in the hospital's Rosary Hall Intensive Outpatient Program.....Between June and September, 30 new clients logged 507 Uber rides, and 29 clients achieved 100 percent participation in the group and individual counseling sessions. In the 30 days before launch, Rosary Hall had 76 percent client participation in group sessions and 62 percent client participation in individual counseling sessions. “
  • “Trinity Health of New England has pinpointed pickup and drop-off locations exclusively for Uber riders to and from its five hospital campuses in Connecticut and Massachusetts that can be selected on the Uber smartphone app so the driver knows exactly where to deliver or meet a patient. Uber rides also can be scheduled through each hospital's website....Trinity also uses Uber to transport select patients from its Mandell Center for Multiple Sclerosis in Hartford, Conn., for services at nearby Saint Francis Hospital and Medical Center.”
  • “St. Louis-based Ascension was the first health care system to form a partnership with Lyft. Since February, Ascension has put agreements in place in 21 of its markets, and Lyft has provided more than 8,000 rides.....Ascension staff members use Lyft's concierge platform to schedule the rides.”
  • “Broomfield, Colo.-based SCL Health announced last month that it is collaborating with Lyft to make nonemergency on-demand or scheduled transport available to its vulnerable patients living in the front range of the Rockies near Denver.”  

The Advisory Board Care Transformation Center Blog featured this post on November 28th5 ways MedStar's nurse-inspired partnership with Uber has paid off, starting off by telling us “Since 2016, Uber has announced partnerships with MedStar Health, Hackensack University Medical Center, and Boston Children's Hospital. Lyft has announced partnerships with transportation service organizations National Medtrans Network and Logisticare, as well as BCBSA. Why have these organization, among others, turned away from more traditional van or cab service? We learned a bit more about MedStar's arrangement with Uber to try and figure it out.” They cite these key benefits of the Medstar/Uber partnership: Patient Transportation Service is now faster; Service is more reliable; Service is less expensive; Clinic staff workflow is more manageable; and Analytics on MedStar transportation support offer new opportunities. 

But there are concerns patients are beginning to use Uber and Lyft in emergent situations. The CBS affiliate in Cincinnati reported on November 9th on The "Uberlance" trend: People turn to Uber to offset high hospital transportation costs.  They tell us that “the new trend is forcing Uber drivers to act as first responders. The drivers asked to not have their identities revealed, but they still wanted to tell their stories of what is now being referred to as ‘Uberlance.’ ‘I said to him ‘why didn't you call an ambulance?’ His hand was bleeding. He goes ‘because you're quicker and you're cheaper,’ said ‘Johnny’, an Uber driver. ‘I've had people get in my car, they're dizzy, they don't feel well, their chest hurts,’ said ‘Brian’, an Uber driver. Drivers say passengers opt for Uber over an ambulance for speed and cost.” 

Despite these concerns of patients taking matters in their own hands and using Uber or Lyft to avoid dispatching an ambulance, some EMS, healthcare and health plan organizations are proactively pursuing such arrangements for urgent care visits to avoid use of ambulances in non-emergencies.  The San Diego Union Tribune on November 5th ran the story San Diego exploring new emergency response model amid ambulance crisis, stating that EMS officials there were seeking “an alternative model where non-emergency patients could take a taxi or Uber to a clinic or urgent care facility and get reimbursed by private insurers, Medicare or Medi-Cal.” The article cites that “Anthem Health Insurance recently announced it will start covering such alternative modes of transportation in 2018.”

Friday
Dec012017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Congress Isn’t Really Done With Health Care — Just Look At What’s In The Tax Bills

Having failed to repeal and replace the Affordable Care Act, Congress is now working on a tax overhaul. But it turns out the tax bills in the House and Senate also aim to reshape health care.

Kaiser Health News

Friday, December 1, 2017

CMS makes it official: Two mandatory bundled-pay models canceled

The CMS has finalized its decision to toss two mandatory bundled-payment models and cut down the number of providers required to participate in a third.

Modern Healthcare

Thursday, November 30, 2017

CVS Nears Deal to Acquire Health Insurer Aetna

CVS Health Corp. is nearing an agreement to acquire health insurer Aetna Inc. for more than $65 billion, according to a person familiar with the negotiations, in a deal that could reshape the pharmacy and health insurance industries.

Bloomberg

Thursday, November 30, 2017

Marketplace Confusion Opens Door To Questions About Skinny Plans

Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage.

Kaiser Health News

Monday, November 27, 2017

As Health Care Changes, Insurers, Hospitals and Drugstores Team Up

They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio.

NY Times

Sunday, November 26, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Nov172017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Medicaid Expansion Takes A Bite Out Of Medical Debt

As the Trump administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.

Kaiser Health News

Friday, November 17, 2017

Medicare Seeks Comment On Ways To Cut Costs Of Part D Drugs

Noting that the true price of a drug is often hidden from consumers, Medicare officials requested comments late Thursday on how to use discounts and rebates to help decrease what enrollees pay for prescriptions.

Kaiser Health News

Thursday, November 16, 2017

Remembering Health Care Economist Uwe Reinhardt

Reinhardt, who died on Monday, helped shape the debate about health care by advocating for individual mandates and universal health care. Originally broadcast in 2009.

NPR

Thursday, November 16, 2017

Sign-ups hit 1.5 million in first two weeks of ACA open enrollment

HealthCare.gov sign-ups continue to outpace last year's, with nearly 1.5 million people selecting plans during the first two weeks of open enrollment.

Modern Healthcare

Wednesday, November 15, 2017

Bill Gates says big data can help solve the Alzheimer's puzzle

Through his foundation, Bill Gates has focused on reducing global poverty, finding cures for infectious diseases, and promoting education and sustainable energy. Now Gates is getting into an area that's new for him: Alzheimer's disease.

Monday, November 13, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Wednesday
Nov152017

Patients Are a Design Problem

Patients Are a Design Problem
 

by Kim Bellard, November 15, 2017

 

When I say "patients are a design problem," I don't mean that the people who happen to be patients are a design problem.  They may well be, but that's an issue you'll have to take up with Darwin or your favorite deity (or, all-too-soon, perhaps a CRISPR editor...). 

No, I mean that making people into patients is a design problem.  And it's a big one.

 

Consider the following:

1.  Physician Respect: We treat physicians as something special. That white coat is no longer needed and may, in fact, 
be counterproductive, but serves to remind of us the deference the health care system believes physicians are due. 

2.  Patient experience: It's hard to get appointments.  The appointment time is often just a vague indicator of when we'll actually see our doctor.  We may have services done to us that we don't really understand and which not uncommonly are unpleasant, to say the least.   We may be asked to fast unnecessarily for hours before blood work or procedures.  We often are unsure about what is going to happen next, or when. It is not a patient-centered system.

3.  Medicalization:  We talk about the health care system, but we really mean the medical care system.  We almost never include, or pay for, the other things that impact our health, like diet, exercise, and environment. 

4.  Better, Soon: We've seen remarkable strides in what medical care can achieve.  We have become a nation of pill-poppers.  When something is wrong with us, we expect to be able to get it fixed, and we expect that to happen quickly. 

5.  Confusion reigns: Nothing about health care seems easy.  It's hard to pick a physician, or a health plan.  The terminology makes no pretense at being understandable to anyone not a health care professional.  The bills are practically indecipherable.  If you need multiple doctors, tests, or procedures -- which you almost certainly will -- you'll have to navigate the maze around getting them.  No one, lay or

professional, claims to understand the "system."

6.  Responsibility: We've delegated responsibility for our health to our health care professionals, especially our doctors.  It is more established than ever that regular exercise, moderate eating, and a balanced life would do more to improve our health than any regime of medical treatments.  Yet we continue to expect that the results of our increasingly poor habits will be "fixed." 

 

These are why we are "patients."  These are why we are expected to be patient.

We will always need physicians (although 
not always human ones!), and many other health care professionals.  That's a good thing.  They have knowledge and skills that can help us.  They deserve our respect. 

But we should design our health care system around us, not them. 

Make the "system" simpler.  Focus it around our health, not our care.  Expect us to have responsibility for our own health -- but ensure we have the tools we need to manage it.  Spend money to prevent health issues, not address them once they've happened.

If patients are a design problem, then maybe people can come up with a design solution.

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

 
Thursday
Nov092017

The State of Medicaid in the States

The State of Medicaid in the States
 

by Clive Riddle, November 8, 2017

 

Mark Farrah Associates has just released their Mid-Year 2017 Medicaid Market and Enrollment Trends report which cites national Medicaid coverage was “74.3 million as of June 2017. This represents approximately 17.5 million more covered lives, a 31% increase, when compared to the population of Medicaid recipients prior to Affordable Care Act (ACA) implementation.”

 

They fix Medicaid managed care enrollment nationally at 48.6 million, and tell us “total year-over-year managed Medicaid grew by only 187,000 members, a substantial difference from the 3.6 million increase between 2Q15 and 2Q16. Most of the top five managed care companies– Centene, Anthem, UnitedHealth, Molina and Wellcare – did however, experience enrollment increases. Among the leaders, Centene commanded 12% of the Medicaid market share as of second quarter 2016, enrolling approximately 6 million members. Anthem and UnitedHealth increased year-over-year membership with both attaining 11% market share. Molina and WellCare rounded out the top five Medicaid managed care leaders accounting for 7 and 5 percent market share, respectively. These top five Medicaid companies control 45% of the overall Medicaid Managed Care market.”

 

Meanwhile, CMS Administrator Seema Verma this week gave a major speech discussing “her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability.”

 

CMS reports that Verma emphasized “her commitment to ‘turn the page in the Medicaid program’ by giving states more freedom to design innovative programs that achieve positive results for the people they serve and pledged to remove impediments that get in the way of states achieving this goal. She announced several new policies and initiatives that break down the barriers that prevent state innovation and improvement of Medicaid beneficiary health outcomes.”

 

CMS touts that they have published new public website content that reflects “CMS’s willingness to work with state officials requesting flexibility to continue to provide high quality services to their Medicaid beneficiaries, support upward mobility and independence, and advance innovative delivery system and payment models.” Veema emphasized their “commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty.”  In shorthand, this means that states have a path to impose work requirements on applicable Medicaid beneficiaries and deny continued coverage for those that do not comply. 

 

Other changes CMS shares include:

·         Allowing states to request approval for certain 1115 demonstrations for up to 10 years;

·         Providing for states to more easily pursue “fast track” federal review

·         Reducing certain state 1115 reporting requirements;

·         Expediting SPA and 1915 waiver efforts through a streamlined process and by participating in a new “within 15-day” initial review call with CMS officials.

·         Developing “Scorecards that will provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes.”

 

Meanwhile, the question of the day is what to make of the Maine election results this week approving Medicaid expansion, with their Governor subsequently stating he will block implementation.