Friday
Sep292017

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

By Claire Thayer, September 29, 2017

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:

CMS adds open enrollment period, offers regulatory relief for payers and members in wake of hurricanes

CMS has announced special open enrollment periods for all Medicare enrollees and some federal health insurance exchange consumers in the wake of hurricanes Harvey, Irma and Maria, along with other disaster-related policies to help insurance companies in affected areas.

FierceHealthcare. Friday, September 29, 2017

Senators close to bipartisan deal on health exchanges: Schumer

Two U.S. senators from both parties are close to finalizing a bipartisan deal to shore up the health insurance exchanges created under Obamacare, the chamber’s top Democrat said on Thursday.

Reuters. Thursday, September 28, 2017

Price took military jets to Europe, Asia for over $500K

The White House approved the use of military aircraft for multi-national trips by Health and Human Services Secretary Tom Price to Africa and Europe this spring, and to Asia in the summer, at a cost of more than $500,000 to taxpayers.

Politico. Thursday, September 28, 2017

Health crisis in Puerto Rico: Few hospitals have power or fuel, but public health officials fear the worst is yet to come

Only 11 of Puerto Rico’s 69 hospitals have power or fuel, leaving the few hospitals that are open to handle a surge of injured patients and those who need care for chronic conditions.

Fierce Healthcare. Wednesday, September 27, 2017

Anthem Says No To Many Scans Done By Hospital-Owned Clinics

Tightening the screws on pricey imaging exams, health insurer Anthem will no longer allow many patients to get MRI or CT scans at hospital-owned outpatient facilities, requiring them to use independent imaging centers instead. NPR Wednesday, September 27, 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.

Thursday
Sep282017

Studies on Prescription Drugs and Social Media

By Clive Riddle, September 29, 2017

Given that prescription drugs are perhaps the most direct-to-consumer marketed U.S. healthcare service, and pharmacies perhaps the most retail oriented distribution of health care services, social media would seem to have the greatest influence on pharmaceuticals than other healthcare sectors. PrescribeWellness this week released results of its 2017 Pharmacy Social Media Survey, which "looked at how Americans choose their pharmacy, what pharmacy services they most value, and their interest in interacting with their neighborhood pharmacists online and through social media."

Here’s what the shared from their findings:

  • 37% look to Google when looking for a pharmacy, versus 34% relying on word of mouth
  • Another 18% look to Facebook to choose a pharmacy
  • 32% look for a pharmacy with a useful website
  • 78% would consider following their pharmacist on social media— and 48% already do
  • 42% percent wish their pharmacist were more active on social media.
  • 47% say their preferred social network for interacting with their pharmacist is Facebook
  • 15% prefer Twitter in this regard and 12% prefer Instagram (12 percent)
  • 34% are interested in their pharmacist’s website
  • 25% would be interested in a pharmacy email newsletter.
  • 54% would be more inclined to use a product that their pharmacist recommended on social media

Respondents say the top benefits of following their pharmacist on social media include:

  • Deals and promotions – 58 percent
  • New offerings or services – 39 percent
  • Healthcare news – 37 percent
  • Relevant news and tips about health and wellness – 37 percent
  • Seasonal vaccine reminders – 31 percent

62% use their pharmacy’s website, with 61% using the site for refill requests; 47% for online orders; 29% for medication reminders; 29% for a medication list; 20% for online appointments; and 19% to access messages from their pharmacists, 40% say their pharmacy has a mobile app, which they use to place refill requests (48%), receive refill reminders (38%) and place orders (38%).

Moving on from pharmacies to pharmaceutical companies, earlier this year, the Journal of Medical Internet Research published to paper: Direct-to-Consumer Promotion of Prescription Drugs on Mobile Devices: Content Analysis, which sought to “investigate how prescription drugs are being promoted to consumers using mobile technologies. We were particularly interested in the presentation of drug benefits and risks, with regard to presence, placement, and prominence.”

Of the mobile communications they examined, 41% were product claim communications, 22%) were reminder communications, and 37were help-seeking communications (includes information about the medical condition but not the drug name. 69% linked to branded drug websites indicating both benefits and risks, 25% linked to a landing page listing benefits but no visible risks, and 6% linked to a landing page listing risks but no visible benefits.

The Frontiers in Pharmacology journal last December published the article Perspectives for the Use of Social Media in e-Pharmamarketing which among other things concluded that "in November 2015, American Food and Drug Administration (FDA) has encouraged the use of social media to improve communication and information exchange in health promotion and public health (U.S. Food and Drug Administration Social Media Policy, 2015). Foreign studies show that one in four interactions with doctor, patient, and healthcare providers in the United States is a digital contact. Patient education through social media is therefore an opportunity for the pharmaceutical industry to gain confidence in the company and increase the awareness of consumer when choosing a product. In this way, customer acquires knowledge about health, diseases, and treatment. In various social media channels it is possible to find information on any drug. This information is available on: websites of a manufacturer, social network brand fanpages, portals for white staff specialists. According to a study, conducted by Comscore, patients who are familiar with drug brand website often followed the recommendations for its use (20% of patients). Internet advertising also influenced the use of a drug (13.5% of patients; ROI Media, 2016). E-pharmamarketing activities in social media and in the network tend to increase. It is estimated that in the year 2016 the US pharmaceutical companies allocate for this purpose 2.48 billion dollars.”

Wednesday
Sep272017

Provider Data Accuracy – Continued Challenges for Health Plans

By Claire Thayer, September 27, 2017

Inaccurate provider directories continue to pose challenges for health plans both in terms of removing barriers to patient care as well as the monumental task of keeping track of network providers and managing all data elements associated with a single provider record.  Not only is the data constantly changing, consider this: documenting this information takes time as a detailed record can track up to 380 distinct line items, including service locations, billing locations, payment locations, specialties, certifications, affiliations, office hours, and languages spoken.  Regulations have been enacted on both the federal and state level on required data elements and timeliness of maintenance requirements, with penalties for non-compliance and regulations that vary widely from state-to-state.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, focuses on increasing challenges for health plans with data reporting and maintenance of provider directories:

 

 

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
Sep222017

NCQA Releases 2017-2018 Health Plan Ratings

NCQA Releases 2017-2018 Health Plan Ratings
 

By Clive Riddle, September 22, 2017

 

The National Committee for Quality Assurance (NCQA) has just released its 2017-2018 Health Insurance Plan Ratings. NCQA reports that they evaluated 1,429 health plans and rated 1,062: 498 private (commercial), 386 Medicare and 178 Medicaid.

 

NCQA’s ratings are based on a scale of 1.0 to 5.0, and they state their system is similar to the CMS Star Rating approach for Medicare Advantage plans. NCQA tells us that “the overall rating is the weighted average of a plan’s HEDIS and CAHPS measure ratings, plus accreditation standards (if the plan is accredited by NCQA), rounded to the nearest half point. Accreditation standards are given 10 percent of the weight of the valid HEDIS and CAHPS measures that a plan submits. The overall rating is based on performance on dozens of measures of care and is calculated on a 0–5 (5 is highest) scale in half points. Performance includes three subcategories (also scored 0–5 in half points): Consumer Satisfaction, Prevention and Treatment.” If you really want to get into the weeds regarding their methodology, you can click here to review their 16-page methodology report.

 

NCQA share that the “Top Ten States with the Highest-Rated Health Plans (receiving a 4.5 or 5.0 out of 5 rating) for Three-Year Average:

1.     Massachusetts

2.     Rhode Island

3.     Maine

4.     New Hampshire

5.     Wisconsin

6.     Minnesota

7.     Hawaii

8.     New York

9.     Vermont

10.  Iowa

 

NCQA also tells us that “high and low performers Are rare: of the 1,062 rated plans, 103 (10%) received a top rating of 4.5 or 5.0 out of 5. Twenty-three (2%) earned the ratings of 1.0 to 2.0.

 

Digging into their website, we compiled this list of health plans with 5.0 overall ratings for Private, Medicaid or Medicare:

 

·         BCBS MA (Private)

·         Johns Hopkins US Family MD (Private)

·         Kaiser Northern California (Private)

·         Tufts MA, NH, RI (Private)

·         Jai Medical Systems MD (Medicaid)

·         Group Health Plan MN, WI (Medicare)

·         Gundersen Health Plan IA, WI (Medicare)

·         Kaiser Southern CA (Medicare)

·         Kaiser Northwest OR, WA (Medicare)

·         Kaiser Washington (Medicare)

·         Kaiser Hawaii (Medicare)

·         Medical Associates Health Plan WI (Medicare)

·         Medical Associates Health Plan IL, IA (Medicare)

 

On the flip side, here’s the plans we identified with ratings of 2.0 or less:

 

·         Cigna NM  (Private 2.0)

·         Cigna Utah (Private 2.0)

·         Connecticut General NM (Private 2.0)

·         Human Puerto Rico (Private 2.0)

·         Anthem BCBS Nevada (Private 2.0)

·         Triple S Salud PR (Private 1.5)

·         UnitedHealthcare of Texas (Private 1.5)

·         Tokio Marine Pacific Guam (Private 1.0)

·         Union Health Service IL (Private 1.5)

·         Aetna Better Health IL (Medicaid 2.0)

·         Family Health Network IL (Medicaid 2.0)

·         Health Plan of Nevada (Medicaid 2.0)

·         South Florida Community Care Network (Medicaid 2.0)

·         Aetna Better Health NJ (Medicaid 1.5)

·         Community Care Alliance IL (Medicaid 1.5)

·         Cook Children's Health Plan TX (Medicaid 1.5)

·         Affinity NY (Medicare 2.0)

·         Atrio (Medicare 2.0)

·         Community Care Alliance IL (Medicare 2.0)

·         Elderplan NY (Medicare 2.0)

·         Gateway KY, NC, OH (Medicare 2.0)

·         Group Health Inc. NY (Medicare 2.0)

·         Inland Empire CA (Medicare 2.0)

·         Meridian IL (Medicare 2.0)

·         United Healthcare of New York (Medicare 2.0)

·         Virginia Premier (Medicare 2.0)

·         VNS Choice NY (Medicare 2.0)

 

To be fair to the above plans rated 2.0 and less, there were 367 NCQA evaluated but did not rate due to only partial or no data available – and it is quite possible that a number of these would have received low ratings as well.

 
Friday
Sep222017

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:

 

Of Cassidy-Graham’s four co-sponsors, only one has the support of his governor

The latest Republican health-care bill gives significant power to the states. But several of the nation’s governors, including a handful of Republicans, aren't interested.

The Washington Post

Friday, September 22, 2017

CVS tightens restrictions on opioid prescriptions in bid to stanch epidemic

CVS Health announced Thursday that it was limiting the amount and strength of prescription opioid painkillers it provides to patients taking the drugs for the first time, a step intended to help curb opioid abuse.

Stat News

Thursday, September 21, 2017

Graham-Cassidy Health Bill Would Shift Funds from States That Expanded Medicaid

Senate Republicans' latest plan to overhaul the U.S. health care system ends with a massive shift of federal money from states that expanded Medicaid — and are largely dominated by Democrats — to those that refused to expand.

NPR

Thursday, September 21, 2017

Almost half of Americans favor single-payer healthcare system, poll finds

Congressional Republicans may be trying once again to repeal and replace the Affordable Care Act with a more market-based approach, but a new poll finds that almost half of Americans favor a plan more in line with the single-payer offering served up earlier this year by progressive Sen. Bernie Sanders.

Healthcare Finance News

Wednesday, September 20, 2017

Amazon in talks with PBMs over pharma supply chain

Amazon is reportedly communicating with pharmacy benefit managers about potential drug contracts, according to a Leerink Partners analysis cited by CNBC. Amazon has been hiring more healthcare leaders and expanding its drug and medical supply distribution in recent months, spurring rumors the online retailer is stepping into the pharmacy business.

Becker's Hospital Review

Wednesday, September 20, 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.

 
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