Monday
Jan072013

MCOL Blog | Key healthcare business trends to watch for 2013

By Claire Thayer, January 7, 2013

The 11th Annual Future Care Web Summit will be held on January 24th this year.  An expert faculty panel has been assembled to discuss a variety of pressing healthcare business trends to watch out for throughout the year. The live 90 minute webinar will feature thought leadership from PricewaterhouseCoopers on health reform and the 30 million newly insured, new Mercer research findings on employer health benefit trends, as well as Oliver Wyman research on ACOs. In addition, the Web Summit event includes three On-Demand presentations on the following topics: Accountable Care provider issues; private health insurance exchanges; and health cooperatives. Hope you can join us! http://www.healthwebsummit.com/futurecare.htm

Wednesday
Dec192012

TrendSoup: Ten Key Healthcare Business Trends for 2013

By Clive Riddle, December 19, 2012

There may not be a point to ranking the components in a collection of the top trends to impact the business of healthcare in 2013. It can be difficult to say what specific trend singularly will be the most important – beauty may be in the eye of the stakeholder. It would seem that top tier trends all converge and have some degree of effect on each other – kind of like the ingredients of a soup.

So here’s what this chef sees as the ingredient list – in no particular order – of the 2013 TrendSoup for the business of healthcare:

Exchanging Confusion with Public Health Insurance Exchanges

It is not too daring to predict a good deal of confusion will reign for all stakeholders involved with public health insurance exchanges during 2013, as everyone scrambles to prepare for HIX implementation in 2014. Guidance won’t be able to get produced fast enough; guidance won’t anticipate all the scenarios, and a monumental level of decisions and development must be delved into. It won’t be for the faint of heart.

Employer embrace of Defined Contribution Approach

Interest in private HIXs took off during 2012, and even though public HIXs were validated by SCOTUS and the November elections, it is clear that public and private exchanges can co-exist, and that mid-size and large employers are intrigued by utilizing private HIXs to facilitate a switch to defined contributions for health benefits, particularly for those still involved with retiree benefits.

Medicaid Matters: Implications for local Medicaid Plans

Size Matters. Therefore in healthcare, Medicaid Matters. Starting in 2014, the formerly uninsured will shift in sizeable numbers into the Medicaid system. Much attention has been given to the implications for national Medicaid plans – WellPoint acquired Amerigroup – all eyes are on the implications for Centene or Molina. But the real impact, and larger implications, may be spread over the blanket of local, publicly run Medicaid plans throughout the country. The question is – how will the Medicaid Surge transform the local plans?

Early Successes and Failures of Medicare ACOs

With any major new model of care delivery and payments, comes the buildup and the teardown.  So much has already been said about the hopes, dreams and aspirations for what ACOs can do for healthcare. In 2013, enough early experience will exist for Medicare ACOs, that the inevitable examples of big failures will emerge, with pundits and naysayers gleefully parading out their case studies, proclaiming that ACOs are a big bust. Similarly, there will be big successes that will emerge, with pundits and cheerleaders cheerfully parading them out as well.

Employer and Health Plan Embrace of Commercial Accountable Care Arrangements

The real ACO action around the country may be in how major national and regional health plans are investing in building and securing accountable care arrangements with provider organizations for commercial populations. Already a big deal in 2012 – the level of activity will continue to increase in 2013.

Integrated Healthcare Momentum

A greater  number of healthcare systems will either expand their integration efforts, or initiate such steps, with a particular emphasis on medical home development, accountable care arrangements, full system EHR, and some level of administrative capability to function as a payer, while not typically going so far as a licensed commercial health plan.

Hybridization of Employer Worksite Clinics

Onsite workplace clinics continue to gain in popularity among very large employers, to fulfill a number of objectives – reducing costs, improving access, reducing time off work for appointments, implementing a medical home, and many other strategies. But the concept appeals to a wide number of employers that can’t swing implementation due to their size, physical campus logistics, corporate capital constraints or a variety of other issues. 2013 will find development of more hybrid arrangements, such as shared sites between multiple employers or employer coalitions, TPA or health plan sponsored sites for large clients, mobile clinics rotating between sites and other arrangements.

The Convergence of EHR critical mass, readmissions and analytics

A much wider swath of the provider universe now orbits around EHR. Among other EHR implications, 2013 will find many more provider organizations mining their newfound trove of electronic data to conduct analytics, particularly for readmissions management strategies.

Medication Adherence Becomes a Bigger Target

Whether as part of wellness incentive programs, disease management programs, hospital readmissions management, or other care management initiatives; the realization will become even clearer in 2013 that medication adherence may the largest, lowest hanging fruit for stakeholders to focus on, with a wide range of approaches emerging to better address this long-standing issue.

Explosion of mHealth and Emergence of Breakthrough Apps

There’s an explosion of any kind of app, so it follows there’s an ongoing explosion of available healthcare apps. What will also shakeout in 2013 is that a handful of these mHealth apps will gain traction, go mainstream, and will be coming to an iPad near you, this New Year.

Tuesday
Dec182012

MCOL Blog | Latest Trends in the California Healthcare Market

 

By Claire Thayer, December 18, 2012

The Healthcare Crystal Ball: California in 2013

Join us on Wednesday this week as three leading experts discuss important trends in the California healthcare marketplace. This exciting event will touch upon all of the major hot topics, including: Health Insurance Exchanges, ACOs, Medical Homes, employer covered insurance, hospital and physician trends, ACA implementation, and more. We hope you'll join us to hear three of California’s most dynamic leaders in the healthcare industry: Steven T. Valentine, President of The Camden Group; Henry Loubet, Chief Strategy Officer for Keenan and Peter Boland, President at Boland Healthcare. Register at: http://www.healthwebsummit.com/pp121912.htm

Monday
Dec102012

AHIP’s Karen Ignagni Discusses Value-Based Payment Models

By Claire Thayer, December 10, 2012

Karen Ignagni, AHIP’s President and Chief Executive Officer, says that we need to move from paying clinicians and hospitals based on volume of services instead to a payment methodology based on the value of the services provided.  In this four-minute video, Ms. Ignagni discusses collaborative strategies that health plans and their provider partners are engaged in, in an effort to change the way payment is designed and delivered. 

To view the entire four-minute video on HealthShareTV: http://www.healthsharetv.com/content/karen-ignagni-president-and-ceo-ahip-discusses-value-based-payment-models

Monday
Dec102012

Members from Mars and Their Cars

By Laurie Gelb, December 10, 2012

You wake up one morning and decide gasoline costs are just too high. You want to begin filling your car's gas tank with water, which is, of course, much cheaper. You call your mechanic to find out if this is a good idea. He sadly tells you that it will not work. Chastened, you text your broker to invest in some alternative energy stocks.

What is unlikely about this scenario? Well, first and foremost, you have already internalized the fact that water will not run your car. You don't blame car manufacturers or your mechanic or even the oil producers for this. You don't call them biased and part of the IMF conspiracy. You recognize that what they all say (and consistently) is a fact and you proceed accordingly. In part, this is because you have abstracted at least of the chemical differences between gasoline and water, which will also help you recognize important safety hazards  like not throwing water on certain types of fires.

How much do your members and patients know about the vehicle they occupy 24/7-- their own body?  How much do you know about what they know? How many hopeful or destructive assumptions are they making, seeking information about, and/or simply acting on with no relevant evidence at all? Apart from transactional correspondence like enrollment and EOBs, the common thread within all your health communication can perhaps be described as attempts to drive behavior and choices that safeguard your customers' vehicles, if you will.

Unfortunately, health and disease management are often perceived in terms of being a cheerleader for fresh fruit snacks, when instead patients could most benefit from the calm, factual mechanic who leverages his customer's existing knowledge to improve understanding of the mechanisms that run your car. If you in a moment of extreme forgetfulness or frustration did ever call your mechanic and ask, "Why can't I use water in my gas tank?" he probably wouldn't begin his answer with, "For centuries, cars have been designed to utilize gasoline" or "Are you insane?" He'd probably say, "Carl, I realize it's tempting [empathy] but not only won't it work, it'll destroy your car's engine [clarifying stakes]. If you want to save money, have you thought about buying a car with better mileage or a hybrid? [positive alternatives] What are you driving now, that old Buick? [baselining]" And so on.

The bottom line: any mechanic or service provider...until we get to health care, education and a few other problem areas... that receives frequent customer calls and has a successful practice has likely learned how to communicate reasonably effectively while still driving repeat business and trust. And the auto/energy industries as a whole have largely succeeded in disseminating/reinforcing certain key bits of information on a pre-need basis. So the least sophisticated teenager knows not to pour water into a gasoline-powered engine, complete klutzes like me can put air in a tire or change a light bulb and life goes on.

Yet, with the stakes higher in medicine, people don't always dose analgesics correctly. Why? In part, we have failed to remain calm, neutral information providers in the face of human fear, anger, denial, confusion and vulnerability. Health care is no more the place for cheerleading or fear-mongering than the automotive world. Auto dealers do not post signs saying "Warning! Buying the wrong car could result in a fatal accident!"  even though technically it is true that car integrity/stability/maneuverability varies. Instead, they build a case across media channels, back it up with evidence and build its salience via brands. Which do you think is safer, a Volvo or a Lamborghini?

When a migraine or cerebrovascular event strikes, we want the patient to be responsible with OTC preps and seek care if/as needed. These are both pre-need education stories, but they only get internalized to the extent that they are believable. When they are dogmatic, on the order of "Are you insane?", contradictory, jargon-laden and/or confusing (sound familiar?), they cannot be internalized as early and often fail to drive outcomes.

So before you approve any more educational copy this week, you might ask your mechanic if it makes sense.