Predictable savings when health plan members are engaged in preventative care

By Claire Thayer, February 12, 2015

There are many approaches to patient care intervention, in terms of managing chronic disease. Several years ago an important study, that is still widely referenced, finds that some of the most successful patient care intervention approaches include those that are customized for each individual patient, allow for intensive time commitment in terms of time multi-disciplinary teams spent face-to-face with patient, and use of technology that is highly interactive with patients.  These approaches to engaging patients in preventative care, along with the payoff in financial savings and health outcomes is the focus of MCOL's infoGraphoid this week:

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


Analysis of Managed Care Organization CEO Turnover Rates

By Clive Riddle, February 6, 2015

MCOL has just conducted an analysis of managed care organization CEO turnover during the past ten years, and found the turnover rates to be surprisingly high, given the importance of management stability and continuity for most organizations. One-fourth of managed care organization CEOs turned over during the past year,  one-third turned over during the past two years, one-half turned over during the past three years, two-thirds during the past five years and only one in seven remain from ten years ago.

That doesn’t mean that all turnover is attributed to firings or resignations.  More than half of the organizations analyzed are part of chain or system in which upward mobility within the organization is often the cause.

The analysis is based upon data from MCOL’s HealthQuest Publishers National Managed Care Leadership Directory, which lists health plans, provider networks, administrative organizations, PBMs, and specialty benefit organizations involved with managed care. The 2015 Directory was recently released. HealthQuest Publishershas released the annual directory since 1994. MCOL acquired HealthQuest Publishers in 2000.

Managed Care Organization CEO Turnover Percentage Compared to 2015 Incumbent

While 926 organizations are listed in the 2015 directory, only organizations also listed in applicable prior years were included in the analysis. Organizations are added or dropped in the directory over time based upon mergers & acquisitions, closures, consolidations and expansions.

The turnover rate percentage for each year, compared to the 2015 incumbent, for the MCOs that were also listed in each applicable year are indicated below. The number of applicable MCOs that are still listed in 2015 of course drops over time due to the factors listed above.


CEO Turnover

Applicable MCOs



















While the cause of turnover was not measured in the analysis, and upward mobility or other transfers within the same organization is undoubtedly a significant factor, disruption at the CEO level presents significant challenges for managed care organizations during this disruptive era of healthcare reform, regardless of the reasons for the change.


The Value of Maternity Management in Mitigating Legal Risk

By Claire Thayer, February 4, 2015

Almost 85% of women in the U.S. receive maternity services when giving birth. According to a report presented by Childbirth Connection, "Maternity Care and Liability: Pressing Problems, Substantive Solutions," childbirth is the nation's leading reason for hospitalization and most expensive hospital condition. It is also estimated that 19 of 3,000 hospital births result in an adverse outcome. The importance of maternity management in mitigating legal risk is the focus of MCOL's infoGraphoid this week:

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.


Ranking the Seahawk’s Seattle vs. the Patriot’s Boston in the Health Care Bowl

By Clive Riddle, January 30, 2015

Given that the contest between the Seattle Seahawks  vs. the New England Patriots in Super Bowl XLIX is a product of listing and ranking NFL teams (by wins and losses), perhaps some irrelevant insights into the outcome of that contest can be gleaned by comparing how the two cities rank in various healthcare lists.

Of course the immediate challenge is to assign a city to the Patriots. Foxboro- the site of their stadium? The entire New England region and all metro areas within? We’ll deflate their claim to a multi-state region, and go with just Boston.

Looking to healthsprocket, the site for healthcare lists, we find these eight lists posted during the past year, which include mention of Seattle or Boston.  The result is basically a tie, based on mentions – unless you deflate the Patriot’s claim to Springfield and Worcester, in which case Seattle might prevail in a sqeaker.

There is a list claiming overall healthcare rankings – that puts Boston at #2 with Seattle whiffing:

Ranking Of The Best Healthcare Cities In The U.S. (Source: iVantage Health Analytics)

  1. Washington, DC
  2. Boston
  3. Minneapolis
  4. Portland, OR
  5. Chicago
  6. Charlotte
  7. Philadelphia
  8. Atlanta
  9. New York
  10. St. Louis

On the other hand, Boston makes the Most Expense Healthcare Cities list (#9), unlike Seattle:

10 Most Expensive Cities for Healthcare (Source: Castlight Health)

  1. Sacramento, CA
  2. San Francisco, CA
  3. Dallas, TX
  4. St. Louis, MO
  5. Kansas City, MO
  6. Charlotte, NC
  7. Denver, CO
  8. Miami, FL
  9. Boston, MA
  10. Portland, OR

Seattle makes this list of lowest cost bronze plans (at #18) in 2014 public exchanges, unlike Boston

2014 Lowest Cost Bronze Plan After Subsidies by Largest City in Each State For A Single 25 Year Old (Source: Kaiser Family Foundation)

  1. Los Angeles, CA - $140
  2. Denver, CO - $142
  3. Hartford, CT - $117
  4. Washington, DC - $124
  5. Indianapolis, IN - $157
  6. Baltimore, MD - $115
  7. Portland, ME - $146
  8. Billings, MT - $152
  9. Omaha, NE - $135
  10. Albuquerque, NM - $122
  11. New York City, NY - $111
  12. Cleveland, OH - $136
  13. Portland, OR - $130
  14. Providence, RI - $127
  15. Sioux Falls, SD - $173
  16. 16.Richmond, VA - $127
  17. 17.Burlington, VT - $116
  18. 18.Seattle, WA - $138

Seattle is also the place to be if you don’t like waiting for your doctor – ranked at #1, with Boston not mentioned

Top 10 Cities With The Shortest Average Wait Times To See The Doctor (Source: Vitals)

  1. Seattle, WA- 16 minutes, 15 seconds
  2. Milwaukee, WI- 16 minutes, 17 seconds
  3. Denver, CO- 16 minutes, 25 seconds
  4. Minneapolis, MN- 16 minutes, 42 seconds
  5. Portland, OR- 17 minutes, 05 seconds
  6. Omaha, NE- 17 minutes, 23 seconds
  7. Charlotte, NC- 17 minutes, 26 seconds
  8. Austin, TX- 17 minutes, 32 seconds
  9. San Diego, CA- 17 minutes, 43 seconds
  10. Raleigh, NC- 17 minutes, 48 seconds

Boston Children’s comes in #1 in this list of best Children’s hospitals, while Seattle is ignored:

Deborah Kotz: The Honor Roll of Best Children's Hospitals 2014-15 (Source: The Boston Globe)

  1. Boston Children’s Hospital/ Children’s Hospital of Philadelphia (tied)
  2. Cincinnati Children’s Hospital Medical Center
  3. Texas Children’s Hospital, Houston
  4. Children’s Hospital Los Angeles
  5. Children’s Hospital Colorado, Aurora
  6. Nationwide Children’s Hospital, Columbus, Ohio
  7. Ann and Robert H. Lurie Children’s Hospital of Chicago
  8. Children’s Hospital of Pittsburgh of UPMC
  9. Johns Hopkins Children’s Center, Baltimore

If you use the Patriot’s inflated claim to the larger region, Springfield and and Worcester come in at #1, and #14 respectively  for best heart surgery hospitals, while Seattle has a hospital ranking #13, in the list:

Top 15 hospitals in U.S. for heart surgery (Source: Castlight Health)

  1. Baystate Medical Center, Springfield, Mass.
  2. Borgess Medical Center, Kalamazoo, Mich.
  3. Cleveland Clinic, Cleveland
  4. The Heart Hospital Baylor Plano, Plano, Texas
  5. Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.
  6. Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.
  7. Mother Frances Hospital-Tyler, Tyler, Texas
  8. St. Joseph Mercy Hospital, Ypsilanti, Mich.
  9. St. Joseph's Hospital Health Center, Syracuse, N.Y.
  10. St. Vincent Heart Center of Indiana, Indianapolis
  11. Sequoia Hospital, Redwood City, Calif.
  12. Spectrum Health - Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.
  13. Swedish Medical Center-Cherry Hill Campus, Seattle
  14. UMass Memorial Medical Center, Worcester, Mass.
  15. Valley Hospital, Ridgewood, N.J.

Using an access benchmark, Boston ranks #5 while Seattle doesn’t make this list:

Top 10 Cities With The Highest Per-Capita Ratio Of Both Hospitals And Primary Care Physicians Per Resident (source: Vitals)

  1. Cleveland
  2. Minneapolis
  3. Milwaukee
  4. Kansas City
  5. Boston
  6. Omaha
  7. Denver (tie)
  8. Miami (tie)
  9. Atlanta
  10. Nashville

And finally, perhaps in a bit of a stretch, Seattle placing an Executive in the this Most Influential list, while Boston is ignored:

Modern Healthcare: 10 Most Influential Physician Executives And Leaders (source: Modern Healthcare)

  1. Richard Gilfillan- President and CEO, CHE Trinity Health, Livonia, Michigan
  2. John Noseworthy- President and CEO, Mayo Clinic, Rochester, Minnesota
  3. Gary Kaplan- Chairman and CEO, Virginia Mason Health System, Seattle, Washington
  4. Margaret Hamburg- Commissioner, Food and Drug Administration, Washington
  5. Ardis Dee Hoven- President, American Medical Association, Chicago, Illinois
  6. Patrick Conway- Deputy Administrator for Innovation and Quality, CMO, CMS, Baltimore, Maryland
  7. John Kitzhaber- Governor of Oregon
  8. Glen Steele Jr.- President and CEO, Geisinger Health System, Danville, Pennsylvania
  9. Jonathan Perlin- President, Clinical Services CMO, HCA, Nashville Chairman-elect, American Hospital Association, Nashville, Tennessee
  10. Toby Cosgrove- CEO, Cleveland Clinic, Cleveland, Ohio

Population Health Management - Integration of Medical and Pharmacy Benefits 

By Claire Thayer, January 22, 2015

A new Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics LLC (Prime) study examined yearly medical costs of 1.8 million members of Blue Cross® and Blue Shield® (BCBS) independent companies, whose pharmacy benefit services were divided between “carve-in” and “carve-out” benefit options.  This study finds that members integrating the pharmacy benefits experienced:

  • 9% fewer hospitalizations
  • 4% fewer emergency room visits
  • 11% lower medical costs

HealthPartners, in their Pharmacy Integration Study, estimated that integrating medical and pharmacy benefits can save a group with 9,000 continuously enrolled members more than $1 million per year.  These and other data points are featured in MCOL’s infoGraphoid this week:

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.

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