Thursday
Mar022017

How Health Plans Impact Revenue Performance and Improve Quality Outcomes

By Claire Thayer, March 2, 2017

The Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA) are now used by over 90% of health plans to measure quality performance.  HEDIS consists of 81 measures across 5 domains of care and address a broad range of important health issues, including:     

  • ·         Asthma Medication Use
  • ·         Persistence of Beta-Blocker Treatment after a Heart Attack
  • ·         Controlling High Blood Pressure
  • ·         Comprehensive Diabetes Care
  • ·         Breast Cancer Screening
  • ·         Antidepressant Medication Management
  • ·         Childhood and Adolescent Immunization Status
  • ·         Childhood and Adult Weight/BMI Assessment

Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service.  Each year, NCQA publishes The State of Health Care Quality Report to raise awareness on key quality issues and drive improvement in the delivery of evidence-based medicine. This report documents performance trends over time, tracks variation in care and recommends quality improvements.  Additionally, HEDIS data is also incorporated into many health plan ‘report cards’ and increasingly used by consumers and purchasers to track and compare health plan performance.

This week, a special edition of the MCOL Infographic, co-sponsored by DST Health Solutions, focused on strategic trends and key elements of performance improvement for health plans: 

 

 

 

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.

Wednesday
Feb222017

The Good, the Bad, and the Ugly in Health Care

By Kim Bellard, February 22, 2017

 

I hate being a patient.

 

My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family.  The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient.

I offer what I consider the Good, the Bad, and the Ugly of the experience.

The Good:  The People
The various people involved in my care, from the most highly trained physician to the person who delivered meals, were great. I loved my nurses.  I liked my doctors a lot.  The aides, the lab techs, the imaging tech, the transportation specialists -- all of them doing jobs that I wouldn't be able to do -- were each friendly and helpful, taking pride in what they did and how it helped my care. 

The Bad: The Processes
On the other hand, on the lists of criticisms about our health care system, many of its rules and processes truly do deserve a place.  They're like part of an arcane game no one really understands. 

I'll offer three examples:

 

  • ·         Check-in
  • ·         NPO
  • ·         Discharge

 

The Ugly: The Technology

Oh, health care technology.  It is equally capable of delighting as it is of frustrating.  It is truly remarkable that the doctor could go up my arm to perform a procedure in my chest, just as the detail an MRI provides is simply astonishing.  

 

Let's start with the perennial whipping boy, EHRs.  On many occasions, EHRs did not mean that people did not still often have to drag in other electronic equipment or even paper in order for them to do their job.

 

MRIs are a wonderful technology, but as I was laying in that claustrophobic tube getting imaged, I kept thinking: what the heck are all those clanging noises?  

 

I was on various forms of monitoring devices, the smallest of which was the size of a 1980's cell phone and still required countless wires attached to numerous leads.  I kept wondering, hmm, have these people heard of Bluetooth?  Do they know about wearables?

 

My favorite example of ugly technology, though, came when I had to fill out a form, so that it could be faxed to the appropriate department.  

 

No health care system is perfect.  Every system has its own version of the Good, the Bad, and the Ugly. Our system can do better.  Let's give all those great people working in health care a better chance to help us.


This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Friday
Feb172017

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 nominee breezes through confirmation hearing

The Hill reports: President Trump's pick to lead the Center for Medicaid and Medicare Services (CMS) cruised through her confirmation hearing Thursday, though Democrats showed frustration at her refusal to offer specifics.

The Hill

Thursday, February 16, 2017

 

The IRS Has Just Made Obamacare’s Individual Mandate Optional

The Fiscal Times reports: When President Trump signed an executive order shortly after taking office designed to weaken the Affordable Care Act, some questioned whether the instructions to federal agencies to look for ways to ease the law’s burden on businesses and individuals would have any real bite.

The Fiscal Times

Wednesday, February 15, 2017

 

Amid Obamacare uncertainty, insurance giant Humana plans to leave marketplaces in 2018

Los Angeles Times reports: Humana Inc., one of the nation’s largest health insurers, will stop selling Obamacare health plans next year, the company announced Tuesday. The move threatens to rattle jittery insurance markets and further complicate Republicans’ push to repeal and replace the Affordable Care Act.

LA Times

Tuesday, February 14, 2017

 

Aetna, Humana end $34 billion merger agreement

CNBC reports: Aetna and rival Humana are terminating their merger, after their $34 billion deal was blocked by a federal court on antitrust grounds. Aetna will pay Humana a $1 billion break-up fee, in accordance with the agreement.

CNBC

Tuesday, February 14, 2017

 

Drugmaker Marathon ‘Pausing’ Delivery Of $89,000-A-Year Muscular Dystrophy Drug

Kaiser Health News reports: In a surprise move Monday, Marathon Pharmaceuticals told patient advocates that it would “pause” the launch of its drug Emflaza because of pricing concerns expressed by patients and advocacy groups.

Kaiser Health News

Monday, February 13, 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.

 

Friday
Feb172017

The Scourge of Healthcare Ransomware to Loom Larger in 2017

By Clive Riddle, February 17, 2017

 

CynergisTek has just released Redspin’s annual cybersecurity Breach Report:  2016: Protected Health Information (PHI). Their 21-page seventh annual report “provides in-depth analysis of the causes of PHI breaches reported to the Department of Health and Human Services and the overall state of cybersecurity in healthcare.”

 

 

 

The report cites that in 2016 there were:

  • ·         325 large breaches of PHI, compromising 16,612,985 individual patient records
  • ·         3,620,000 breached patient records in the year’s single largest incident
  • ·         40 percent of large breach incidents involved unauthorized access/disclosure
  • ·         over a dozen providers reported in media as having been victims of ransomware attacks with PHI breaches

 

The report lists the largest 2016 hacking attack on providers as affecting Banner Health with 3.62 million patient records breached, followed by 21st Century Oncology with 2.2 million records breached. Of large breaches, they state 78% involved providers, 16% health plans and 6% healthcare vendors.

 

The report makes particular note of “the scourge of Ransomware” and cite that in 2016 there was $1 billion overall in ransomware payments worldwide impacting all types of businesses and consumers The report cautions this will get worse in 2017, as “late last year, disturbing reports surfaced regarding the rise of ‘ransomware as a service’ (RaaS) – a business model in which malware authors enlist ‘distributors’ to launch the initial attacks (likely weaponized phishing emails) and then share in any profits. The potential accomplices do not need much technical expertise or capital to get started. Some ransomware kits cost as little as $100 dollars.”

 

Becker's Health IT & CIO Review featured an article: Get ready for hospital ransomware attacks 2.0 also cautions about a growing ransomware threat this year, stating "here are three tactics we've seen in the wild that are likely to become more widespread in 2017. Beyond encryption: 3 ways criminals are making their attacks more disruptive," and they go on to list and describe:

1) Developing ransomware strains that spread like a virus

2) Creating new versions of ransomware that disable the victim systems

3) Turning ransomware attacks into data breach events

 

The Department of Health and Human Services has weighed in, offering an eight page FACT SHEET: Ransomware and HIPAA, in which they cite “a recent U.S. Government interagency report indicates that, on average, there have been 4,000 daily ransomware attacks since early 2016 (a 300% increase over the 1,000 daily ransomware attacks reported in 2015).

 

The healthcare ransomware threat certainly isn't focused just on the U.S., and is a global issue. New research based on a Freedom of Information (FOI) request has revealed that 34% of NHS trusts in the UK have suffered a ransomware attack in the last 18 months.

Friday
Feb102017

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:

Tom Price Is Confirmed as Health Secretary

The New York Times reports: The Senate early Friday approved the nomination of Representative Tom Price to be secretary of health and human services, putting him in charge of President Trump’s efforts to dismantle the Affordable Care Act.

The New York Times

Friday, February 10, 2017

Obama’s Drug Czar: The Opioid Crisis Must Continue To Be A Federal Priority

Kaiser Health News reports: The GOP is working to repeal and replace the 2010 health law, known for insuring more than 20 million people. And the change could affect another health concern: the nation’s opioid abuse problem.

Kaiser Health News

Thursday, February 9, 2017

Judge, Citing Harm To Customers, Blocks $48 Billion Anthem-Cigna Merger

The New York Times reports: The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds. Judge Jackson wrote in her order that she found the Justice Department’s arguments against the deal persuasive, and that putting Anthem and Cigna together would harm customers.

NY Times

Thursday, February 9, 2017

How Would Republican Plans for Medicaid Block Grants Actually Work?

The New York Times reports: There are only so many ways to cut Medicaid spending. You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.

NY Times

Monday, February 6, 2017

Trump Says Health Law Replacement May Not Be Ready Until Next Year

The New York Times reports: President Trump said in an interview that aired on Sunday that a replacement health care law was not likely to be ready until either the end of this year or in 2018, a major shift from promises by both him and Republican leaders to repeal and replace the law as soon as possible.

NY Times

Sunday, February 5, 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.