Tuesday
Dec132011

Benchmarking Employer Onsite Health and Fitness Centers

By Claire Thayer, December 13, 2011

MCOL’s Healthcare Web Summit announces the Benchmarking Employer Onsite Health and Fitness Centers, scheduled for Thursday, January 19th from 1:00 PM to 2:30PM Eastern. Regardless of size, every employer needs comparisons in their efforts to design, manage and expand the capabilities and performance of their worksite health and fitness centers. This session will provide attendees with the results of surveys intended to help employer-sponsors of such facilities benchmark against others.

More information: http://www.healthwebsummit.com/nawhc011912.html

Thursday
Dec082011

Employer Positions on Health Reform: Measuring a Moving Target

By Clive Riddle, December 8, 2011

A multitude of studies continue to measure and monitor employer reactions to health reform. The big question typically included in surveys has to do with the employers likelihood of continuing to provide group health coverage. Findings have not been altogether consistent, some studies like McKinsey’s estimate earlier estimated 30% of employers would drop coverage once Health Insurance Exchanges became available, while others estimate a far lower number.

Gfk Custom Research North America this week released findings from such a study (surveying 502 private sector companies) that seems to land in the middle ground, and thus might be a reasonable assessment of employer’s current state of mind. Here’s what Gfk found overall:

  • 56% of employers surveyed are likely to continue to offer employer-sponsored health insurance after health care reform is fully enacted
  • 12% of benefits decision-makers say they would be very or somewhat likely to drop coverage
  • 32% are unsure what they will do

But the important thing to emphasize when bandying about such numbers is the size of the employers surveyed. Gfk notes that “only four percent of decision-makers surveyed from those companies with 500 or more employees considering terminating coverage completely. In addition, decision-makers who say they are familiar with health care reform are less likely to foresee their dropping coverage (7 percent, versus 15 percent among those not familiar).”

In fact, given that HIXs (Health Insurance Exchanges) are being designed to target small businesses in addition to individuals, it is not a bad thing – and one should expect – that employers in that sector would be considering dropping their own group coverage in favor of the exchanges.

The survey also found that employers don’t believe reform will save anyone money:

  • 11% believe costs of health benefits will increase more slowly than if no reform had passed
  • 51% think costs will increase more rapidly because of reform.
  • 38% are not sure about the effect of health reform on future costs.
Friday
Dec022011

Ten Trends to Tend to in Two Thousand Twelve

By Clive Riddle, December 1, 2011

Alliteration abounds inside the MCOLBlog crystal ball. What trends and issues will significantly shape the business of health care in 2012? The MCOLBlog crystal ball knows all, sees all, and now tells all:

  1. Supreme Court Affordable Care Act decision and presidential election will either cause chaos, or be impetus to for those waiting on sidelines to get moving

    If the Supreme Court knocks down just the Insurance mandate, a mess will ensue. If the Supreme Court knocks down the entire Affordable Care Act, supreme chaos will ensue. How to handle all the midstream programs and initiatives, how to undo some things that perhaps can’t be undone? Confusion will reign for awhile in this event, as detailed guidance won’t be handed down the same day as the court’s decision. To whatever degree stakeholders perceive the outcome of the presidential election will change - or keep - the administration, Affordable Care Act implementation activities could grind to a halt or hasten the pace. Should the Supreme Court validate the Affordable Care Act, and should the current administration be re-elected, the stakeholders who have chosen to sit on the sidelines will be pushed to get more than their toe in the water of the deep end of the pool.

  2. Attempts to dodge the bullets of Automatic Medicare Payment Cuts will consume Providers lobbying resources

    So the SuperCommittee failed. HFMA cites that as result, and barring a subsequent agreement,  “Medicare provider payments would be reduced by up to 2 percent, while Medicaid would be spared. Hospitals would likely see an estimated $63 billion in Medicare cuts through 2021, while physician reimbursements would be reduced by $25 billion, according to forecasts by the Centers for Medicare & Medicaid Services.” Conventional wisdom is that some agreement will be reached in 2012 to avert a Medicare provider disaster, but this will be at the expense of consuming the waking hours and legal & regulatory budgets of hospital, physician and related providers and their industry associations.

  3. Significant resources will be allocated towards the holy grail of reducing preventable hospital readmissions

    Purchasers, whether they be Medicare, Medicaid or Commercial, are driving the readmissions train through hospitals in the form of value based payment arrangements, compliance requirements, and other structures. Hospitals are generally onboard, but the question remains where the train is headed. Can- and will - true improvements in quality and utilization be achieved; and how will this be accomplished? A lot of money and resources will be spent by hospitals, medical groups, vendors and purchasers in this pursuit. The jury is still out on the ROI – MCOL’s own October 2011 stakeholder e-poll asked “do you feel the current level of national attention and initiatives regarding hospital readmissions will ultimately result in significant reductions in avoidable readmissions?” 40% answered yes, 49% maybe and 11% no. The same e-poll indicated “Identification and Case Management of High At-Risk Patients” as the top choice as the single most important factor in reducing overall hospital readmission rates. The problem for 2012 is in identifying the high risk patients. A recent JAMA article by Devan Kansagara MD et.al. concluded that “most current readmission risk prediction models that were designed for either comparative or clinical purposes perform poorly.”

  4. Hospital Systems will ramp up physician integration initiatives

    Many hospital systems are already at various points down this path. 2012 will see them taking steps forward, not backward, and increased traffic from new travelers. Nearly three-fourths of physicians surveyed by PwC “are already in financial relationships with hospitals, and more than half said they want to move closer financially.”

  5. The shift to Value Based Provider Payments will be in full swing

    It isn’t just about ACO payment arrangements. Value based provider payments are to officially be named the flavor of the year at all employer, health plan, government and provider network restaurants in 2012.

  6. ACO progress will occur in Commercial  health plan initiatives

    ACO development slowed in 2011 until the Medicare Shared Savings Program Final Rule was issued, and offered somewhat more favorable conditions for at least some stakeholders, and now the brakes have been lifted from a number of provider Medicare ACO initiatives. But the timetable for these programs is longer, and the real hub of ACO activity in 2012 is in commercial health plan partnerships, which continue to spring up. An increased number of commercial ventures will appear in 2012, and results (good and bad) from early adopters will become more apparent.

  7. Accelerated demise of the small physician practice

    The list of woes for a small physician practice is long, growing, and facing a number of impending deadlines and other “shoes” to drop. Pick your poison: Meaningful Use compliance; ICD-10 conversion;  increased overhead costs in an economic downturn; the specter of Medicare and other program payment cuts (see above); increased difficulties in recruiting junior partners to a small practice; increased patient expectations for ehr, patient portal and other technological capabilities; increased purchaser compliance requirements; value based provider payment arrangements that require greater infrastructure to succeed; and purchaser initiatives and market forces to drive patient populations into more integrated networks.

  8. “Retailization” of health care will advance more than ever

    There are so many marketplace, health reform and other forces converging to fuel the” retailization” of  health care beyond its current orbit. Medicare, and increasingly – Medicaid, offer selection choices at the individual level. Public and numerous private health insurance exchange initiatives are in full swing (with private initiatives immune from any Supreme Court or election-day mood swings) that offer significant potential to drive a material portion of commercial health plan offerings into a full retail venue. Consumer driven plans still continue to grow, which nudge the health care consumer into more of a retail mode. Generic drugs (see below) are now often priced below health plan copayment levels, meaning consumer can shop on a retail basis for applicable generics regardless of health insurance restrictions. Employer and health plan continue to expand initiatives to further empower consumers, such as with wellness initiatives, or to offer new direct access choices such as on-site clinics. Furthermore, technology enhancements and expansion, via web portals, mobile pda apps, consumer ehr interfaces, and much more, continue to facilitate this retail environment.

  9. Implications of Consumers’ further embrace of generics will be far reaching

    What was innovative several years ago when Walmart introduced national flat copayment-0like retail pricing for their generics, is now mainstream with major pharmacies. Generics accounted for 78 percent of retail prescriptions in 2010, up from 63 percent in 2006. Health plan and employer initiatives to drive consumers further towards generics were taken up a number of notches by these pharmacies’ retail pricing programs. Beyond increased use of generics, there are a number of implications for 2012 and beyond. Pharmacies will continue to enhance and shift  their retail marketing efforts and channels for these package priced generics. Consumers are now increasingly purchasing their generic drugs outside of their health insurance because the price is below the cost sharing requirement (see above). This could ultimately drive even more health plan prescription benefit designs into deductibles (to pull these outside prescriptions back into the fold – as the consumer would need to meet the deductible requirement.) In the short term, the situation will cause an increasing vexing problem for providers and health plans trying to maintain a complete ehr for a patient, and prevent data loss for analytics staff trying to manage these patient populations


  10. Health Plan M&A Activities will continue to concentrate in government sector

    Many health plans are strategically trying to increase their member mix with program patients (vs commercial.) 2011 witnessed a number of such national health plan acquisitions of companies serving these populations: Cigna acquiring HealthspringAmeriGroup acquiring Health Plus (Medicaid); WellPoint acquiring CareMore; and UnitedHealthGroup acquiring XLHealth.  2012 should witness additional acquisitions, including more Medicaid in addition to Medicare. As Medicaid has a large presence of non-profit and publicly owned plans, such ventures may also be in the form of management contracts and other structures.
Thursday
Nov242011

Managing Patient Security and Privacy on a New Data-Sharing Playground

By Claire Thayer, November 24, 2011

MCOL’s HealthcareWeb Summit announces the Managing Patient Security and Privacy on a New Data-Sharing Playground, scheduled for Wednesday, January 25th at 1PM.  Join PwC's Sarah Haflett, as she presents findings and insights from 2011 HRI research encompassing a survey of more than 600 provider, health insurer, and pharmaceutical/life sciences professionals on the privacy and security implications of the explosion of new data sources and uses in the healthcare industry; and interviews of 25 chief privacy officers (CPOs), chief information security officers (CISOs), chief information officers (CIOs), and other executives of healthcare organizations. 

More information: http://www.healthwebsummit.com/data012512.htm

Tuesday
Nov222011

Transparent Cost Networks: A Consumer Driven Solution

By Claire Thayer, November 22, 2011

MCOL’s HealthcareWeb Summit announces the Transparent Cost Networks: A Consumer Driven Solution, scheduled for Thursday, February 9th at 1PM.  Milliman's Will Fox discusses the issues, implications and components of a transparent cost network, and the specific approach and steps involved in implementing the network.

More information: http://www.healthwebsummit.com/milliman020912.htm