Study finds fewer office visits, prescriptions with CDHPs | Home Channel News

By Cyndy Nayer, July 1, 2013

There are more studies being translated for consumer sites and broader business reach.  Small and large businesses alike know that up to 20 cents of every revenue dollar goes toward health care.  Understanding what works, what appears to work, and what really isn’t hitting the mark is crucial for business success.

This article echoes the findings of studies from Employee Benefit Research Institute (EBRI),  Kaiser Family Foundation, and others.   When folks have to choose between paying out of pocket for appropriate care and paying the rent, the care falls behind.  Study after study have shown that, over the past 5 years, fewer prescriptions have been filled, more prescriptions have been subject to non-compliance (pill splitting, etc.), fewer follow up physician visits and tests/labs have been performed, all of which hinder outcomes.

AHIP recently published an infographic showing the increase in CDHP plans.  These increases appear to dovetail with the lower adherence to protocols that could prevent rescue treatments and avoidable inpatient days.  

The opportunity in value-based design is to follow the high-value protocol and treatments.  These can be place on special designs that encourage the appropriate behaviors.  Further, direct contracts with providers, urgent care centers, and pharmacist coaches can help to manage high-cost chronic care, even within account-based consumer-directed plans.

Let’s spread the word:  consumer-directed can work, but the insurance plan design and contractual arrangements for appropriate, outcomes-based quality providers, are essential.


Consumer More Generous This Year with Expressing Health Plan Satisfaction

By Clive Riddle, June 28, 2013

J.D. Power has just released their excellent annual Health Plan Study of Satisfaction.  I got a different major takeaway from the study than did the folk at J.D. Power, although I also agree with their conclusions. Their take is in the context of the impending health exchange environment: “With such alternative healthcare purchasing choices as public and private exchanges--or cutting coverage altogether--taking shape among employers, health plans risk losing group business unless they improve employer satisfaction.” 


The J.D. Power study “is based on responses from 5,857 employers, with quotas to assure an adequate distribution of small, medium and large companies. The study was fielded in April and May 2013. …The study, now in its fourth year, measures six key factors that affect employer satisfaction with health plans: employee plan service experience; account servicing; program offerings; benefit design; problem resolution; and cost. Health plans are ranked in two employer segments: fully insured employers (health plan assumes the risk of providing health coverage for insured events); and self-funded employers (employers bear the risk associated with offering health benefits).”


Richard Millard, J.D. Power’s senior director of the healthcare practice  tells us “health plans need to understand the importance of satisfaction in order to limit the erosion of their business from employer-sponsored coverage to alternative channels where employees have more choices. Those health plans that focus on closing the satisfaction gap across key performance factors are more likely to retain employer-sponsored group contracts."


J.D. Power notes that “nearly one-fifth (15%) of employers say they "definitely will not" or "probably will not" continue sponsoring coverage in five years. Among employers in both segments, there is a 90-point gap in overall satisfaction scores between employers that intend to offer coverage in the future and those that intend to discontinue coverage.”


They go on to point out that “in both the fully insured and self-funded segments, employer satisfaction with program offerings, such as preventive health programs, disease management or wellness initiatives, is a key area of differentiation between employers that intend to offer coverage in the future and those that intend to drop coverage.  In the program offerings factor, the gap in satisfaction scores between fully insured employers that intend to offer coverage in the future and those that intend to drop coverage is 104 points--705 among employers that intend to offer coverage, compared with 601 among those that intend to drop coverage. Among self-funded employers, the gap in satisfaction scores between those that intend to offer coverage in the future and those that intend to drop coverage is also 105 points--689 among employers that intend to offer coverage, compared with 584 among those that intend to drop coverage.”


All good point as 2014 hovers over health plans. But what I found interesting was that health plan satisfaction scores improved significantly almost across the board for plans, compared to their 2012 study. I compiled their 2012 results with the current results J.D Power made available:


Overall Customer Satisfaction Index Scores
(Based on a 1,000-point scale)

Fully Insured Employer Segment















Fully Insured Segment Average













Self-Funded Employer Segment




Self-Funded Segment Average













What is the cause of the rise in satisfaction? The 2011 overall rate full insured was 696, so the rate dropped in 2012, and rebounded even higher in 2013. What are the implications of this improvement in satisfaction as the health exchange landscape takes shape?

Here’s a graphic J.D. Power provided on fully insured satisfaction results:


Fine-Tuning your E-Mail Subject Line

By Claire Thayer, June 25, 2013

Managing our daily email volumes is a growing task and something tells me yours is too! A report published by The Radicati Group earlier this year estimates that in 2013, the typical corporate user sends and receives about 219 messages daily, up from 167 in 2009. This study confirms a McKinsey Global Institute report that  finds employees spend more than a quarter of their workday (28%) each week reading and answering e-mails. 

Well, if you’re in the advertising business or trying to market your message, it’s more important now than ever to start thinking about creative ways to fine-tune and tweak your email subject line so that your message gets read! Here are a few tips:

  • Keep it short. The less the better, many recommending 70 characters or less, and we’ve seen some recommend as few as 15 characters.
  • Tell the why. What’s in it for the reader? Give them a compelling reason to open the email.
  • Ask a question. This gets direct right away: “Would you like a free subscription to MCOL Basic?
  • Personalize. While the email may be distributed to hundreds or even possibly thousands of email addresses, make it personal, using “you” to draw attention.
  • Arouse curiosity. Peak the reader’s interest with something unusual, new, odd, unique, compelling.
  • Avoid ALL CAPS.  People feel like they're being yelled at when seeing ALL CAPS, who wants that?

We send out emails to close to 150,000 addresses for health care business professionals every month and have lots of ideas of ways to get your email open, just ask us!!

McKinsey Global Institute (MGI) report: The social economy: Unlocking value and productivity through social technologies

The Radicati Group report: Email Statistics Report, 2009 - 2013

Businessweek’s: The Art of the E-Mail Subject


Hiding in Plain Sight

by Kim Bellard, June 18, 2013

I saw two recent articles in The New York Times recently that I thought merited further discussion.  One attracted a fair amount of attention, the second not quite as much.  They deal with the high prices in the U.S. health system and the trend towards provider consolidation, respectively.  Both problems are well known, yet they describe continue to get worse, not better.  

The first article – The $2.7 Trillion Medical Bill: How Colonoscopies Explain Why the U.S. Leads the World in Health Expenditures – focuses on the wacky world of charges and overuse of expensive procedures, especially as they relate to colonoscopies.  It will come as no surprise to anyone who has been paying attention, but their analysis indicated that charges for the procedure varied dramatically between providers, and were much higher than in other countries.  The U.S. also does them more commonly than many other countries, preferring the expensive surgical approach to other screening options.  

The boom in the number of colonoscopies has been great for gastroenterologists, anesthesiologists, and surgical centers; for patients, perhaps not so much.  The article’s discussion of how many gastroenterologists have invested in surgical centers to reap more of the profits from the procedure is disturbing, and they are far from the only specialty to have discovered this financial gimmick.  It’s part of what drives our health care bill.  

The article notes that insured patients typically shrug off the inflated charges, since their insurance has negotiated rates that are far lower, but, of course, uninsured patients get stuck with the full bill, kind of like having to pay those absurd prices on the back of hotel room doors.  Arbitrary and inconsistent as charges may seem, they’ve nonetheless helped lead to “allowed charges” that are still much higher than anywhere else in the world.  We all end up paying for the costs, of course, through higher insurance rates or as taxpayers.  

Meanwhile, the second article – Health Care’s Overlooked Cost Factor – centers on market consolidation, particularly through mergers of health systems.  It starts off with the FTC’s first successful antitrust case against a hospital merger since 1990 (!!), blocking the merger of two neighboring Chicago hospitals.  A victory of sorts, but the case was done post-merger and it is not at all clear that the ruling actually rolled back pricing with the payors to the levels they would have been sans merger.  

Earlier this year the FTC did move to block the acquisition of Idaho’s largest physician group by its largest hospital provider, so perhaps they’re starting to wake up to the problem.  With all the health system merger activity in the past 10-15 years, these isolated victories lead one to wonder why the FTC has been so asleep at the wheel. 

The article cites research by Gaynor and Town, done for the Robert Wood Johnson Foundation last year, which concluded that hospital consolidation generally raises prices, often dramatically, and that physician-hospital consolidation has not led to improved quality or reduced costs.  Their research is not the first to reach these conclusions, and of course the American Hospital Association has a different perspective.  Earlier this month they released a report that which indicated that only about 10% of hospitals have been involved in a merger in the past five years, that most mergers aren’t happening in concentrated markets, and don’t necessarily result in higher prices.  Uh-huh.  

AHIP was quick to rebut the recent study’s conclusions. 

These are well-known problems.  The insight on prices goes back at least ten years to Gerry Anderson’s Health Affairs famous article “It’s the Prices, Stupid.”  Steve Brill wrote a similar article in Time (“Why Medical Bills Are Killing Us”) earlier this year.  The state of California and the Commonwealth of Massachusetts have both publically been concerned about the consolidation issue, and there was the great quote from consultant Robert Murray: “Finally the evidence is catching up with the reality that we have a humongous monopoly problem in health care.”  Even I’ve previously written on both prices and market consolidation.  So, no, these shouldn’t catch anyone by surprise. 

Many experts cite greater transparency as an important way to attack prices, and there are numerous companies purporting to provide consumers transparency tools.  Indeed, a recent report from the Aite Group claims transparency itself will be a $3 billion industry by 2016 – up from $540 million in 2012.  Of course, someone – i.e., consumers – ultimately will pay for that increase.  Only in the American health care system does creating a business to provide information on prices lead to greater costs for the system, as to date the data is inconclusive at best that consumers will actually change their behavior based on transparency information.  And in a consolidated market they may find few options to price shop even if they want to. 

We need more competition, and we need it on the right things, like value.  I’m not sure any of the metrics we use now are going to get us there anytime soon.  Some claim that this is the era of “Big Data,” and its application in health care will provide revolutionary insights.  McKinsey & Company issued a report that says use of Big Data in health cae could save $450 billion a year.  Do a search on Big Data in health care and you’ll find a plethora of eager companies, from behemoths like IBM to upstarts that specialize in health care, like ExplorysGNS Healthcare, or Health Catalyst, to name a few.  Hidden in the morass of health care data, it appears, are gems. 

Much has been made of the recent scandal over the NSA pulling unimaginable reams of data from telephone and internet records, and using their Big Data capabilities to mine it – hopefully only to detect terrorists.  Meanwhile, when I read articles like the one Bloomberg News recently reported about how one Chicago hospital has literally been cutting patients’ throats – e.g., performing tracheotomies -- unnecessarily to increase revenues, I kind of wish we did have some Big Brother looking at the data better.  

In a series of articles over two years ago the Wall Street Journal showed (see here or here) the kinds of fraud can be detected through proper analysis of the Medicare claims data – and it makes one wonder why CMS hasn’t done the same.  Perhaps now that the Wall Street Journal has forced CMS to release Medicare claims data on individual doctors someone else can detect this kind of abuse on an ongoing basis.  That data is still not freely available, but at least the door is open wider.  

Some say pricing can be addressed via greater transparency, others want more bundled payments, and yet others like reference pricing, which essentially limits payor liability to a fee schedule.  I’m old enough to remember when health insurance often had set fee schedules, with charges above those scheduled amounts the patient’s problem, and I don’t recall people being too crazy about them.  On the other hand, costs were a lot lower, so maybe there is something there, just as we’re also going back to the old idea of big upfront deductibles.  

Personally I think the source problem is that we’ve allowed our pricing structures to become so complex, so piecemeal, and so jargon-filled that no consumer – and few professionals – can really be expected to understand them, much less shop based on them.  Step one has to be to greatly, greatly simplify how we price health care services. 

One of my pet peeves in health care are those financial responsibility forms providers try to get everyone to sign upfront.  They say, essentially: we don’t know exactly what we’ll do to you, or how much it will cost, and we may get some other people to do some other things to you too, and we don’t know what that will cost either, but whatever is done to you and however much it costs, you are obligated to pay.  I’m no contract lawyer, but that sure doesn’t seem like an enforceable contact to me, given the vast asymmetries.  I’d sure love to see the ACLU or Public Citizen or maybe even AHIP take this on in court.  Pricing would get a whole lot more rational if there had to be more upfront disclosure and agreement. 

As for the market consolidation, if health systems are going to create monopolies or virtual monopolies, they may need to be treated more like public utilities, facing rate and spending review.  I’d hate for that to happen, and much prefer that we reimagine the role of these capital-intensive structures.  Why do these big buildings with all those beds and all that equipment still make sense in the 21st century?  Can they be reinvented with something that allows more competition?  I offered one conceptual approach some time ago, but would welcome other proposals to address the issue. 

There is a lot of “reform” happening in health care these days, but if they just end up incorporating these two structural problems I doubt we’re going to actually see much real improvement to our health care system.


Infographic: Chronic Care is a Team Sport

By Cyndy Nayer, June 13, 2013

Chronic care is a long-term management strategy, and it requires a focus on outcomes, especially in reimbursement for the team of providers that manage the complex conditions. Diabetes, hypertension and high cholesterol get a lot of attention, but there are more, such as depression, cancer, arthritis. While the ACA will attempt to manage the escalation of premiums, it requires a team effort to manage chronic care. Lifestyle, treatment adherence, and regular primary care visits are a must. Value-based designs will work to get better engagement from the beneficiaries, but the plan sponsors, especially the employers, must pay close attention through regular data reporting, coordinated care, and communication across all of the team members, including the patient and his/her family. Chronic care is a team effort, and to be a member of the winning team, coaches and players must be headed for the same goals!

For more blog posts by Cyndy Nayer, visit