Telemedicine and Virtual Visits preferred by close to one-third of consumers

By Claire Thayer, March 17, 2016

Telehealth, quite simply refers to the use of electronic technology to deliver health care and health information between patients and their providers. Use of mobile devices and smartphones for vitual visits and remote patient monitoring alone goes a long ways in terms of enhancing patient engagement. The American Telemedicine Association reports that up to 15 million people used telehealth services in 2015, a 50 percent increase from 2013. 

A new Accenture survey finds that nearly one-third (29 percent) of consumers said they prefer virtual doctor appointments to face-to-face doctor appointments,  compared with just under one-quarter (23 percent) in the 2014 survey.

The survey further finds that both physicians and consumers alike believe that virtual visits provide benefits for patients, such as:

  • lower costs:  58% of consumers vs. 62% of doctors
  • convenience:  52% of consumers  vs. 80% of doctors
  • timely access to care: 42% of consumers vs. 49% of doctors

For providers, plans and health systems evaluating incorporation of telemedicine into overall care delivery systems, ECG Management Consultants offers a few key questions to take into consideration:

  • What operational and care delivery challenges is your organization looking to solve?
  • How far do your patients live from sites of care?
  • What are the demographics and health needs of your organization’s patient population?
  • Which services will your contracted health plans reimburse for?
  • What is your organization’s capacity and ability to build telemedicine services internally?
  • Which companies are the right partners to support your telemedicine services?
  • What is the level of technology adoption in your organization, and what are the technology habits of your patient population?

HIMSS: Only 3% of Providers Believe Their Organization is Highly-Prepared for Transition to Value-Based Payment Model

By Claire Thayer, March 14, 2016

The clock is ticking! There’s a lot of incentive for hospitals and physicians to transition to value-based care.  With the onset of the Affordable Care Act, HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. Last week it was announced that  more than 30 percent of Medicare payments are now made through alternative payment models tied to quality outcomes.

The 2016 HIMSS Cost Accounting Survey finds that while the transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces,  a mere 3% of respondents believe their organization is highly prepared to make the transition from fee-for-service to a value-based payment system.

The Top 3 Needs in transitioning to a value-based payment system, identified in the HIMSS Survey:

  • Tools to track and evaluate quality of care
  • Better communication between disparate providers
  • Consistent definition of quality by specific type of disease

Retail Clinics: Trying to Reconcile Cost Per Visit, Utilization, Access and Convenience

By Clive Riddle, March 10, 2016

The March issue of Health Affairs features a paper presenting study findings on retail clinic:  Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending. The title would seem to say it all regarding their findings. The study involved retail clinic use by 3 million Aetna members, from 2010 to 2012 for 11 low-acuity conditions. 

Here’s what the authors had to say in part in their abstract: “We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.”

Kaiser Health News, in covering the story, notes that “The study doesn’t contradict earlier research that found retail clinics provide care that costs 30 to 40 percent less than similar care provided at a physician’s office and that the treatment for routine illnesses was of similar quality. But it suggests those savings are more than offset by increased use of medical services.”

But for some who embrace this perspective, but also are critics of increased consumer cost-sharing including high deductible plans that can limit access, is this perhaps a bit contradictory from a policy standpoint? If you are concerned the increased access and use of such services drives up costs, should you be concerned about cost savings measures that decrease potential access and use?

Interestingly, a Policy Brief in last month’s Health Affairs  on High Deductible Health Plans features the lead-in: “As high-deductible health plans become increasingly prevalent in both group and individual markets, it remains to be seen how they will affect health care access and outcomes.”

Is it a paradox that high-deductible health plan consumers are target audiences for retail care clinics?

Last month, NPR, Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health released the 42-page study: Patients’ Perspectives on Health Care in the United States which addressed retail clinic and urgent care use among many things. 92% of survey respondents rated retail clinic costs as reasonable, and 74% rated urgent care costs as reasonable, compared to 77% rating their personal doctor visit costs as reasonable and 58% rating emergency room costs as reasonable.

Granted, the study published in Health Affairs didn’t dispute the lower cost per visit – they just conclude that the retail supply creates demand and thus drives up costs. But what about access, and what happens to overall costs when access isn’t adequate? Isn’t that the critique of high deductible plans – that high out of pocket costs become a barrier to access?

The argument put forth in Health Affairs is your out of pocket costs might be higher per visit, but ultimately lower overall, by always sticking with your personal doctor because you will see them less.

And see them less you very well may. Another aspect of access addressed in the NPR study: 22% said they could not see their regular doctor at some point in the past two years when they needed health care, with the number one reason the doctor did not have any available appointment times (followed by care was needed at night or on the weekend.)


Truven Examines Scope and Drivers in Bundled Commercial Spend for Lower Joint Replacement 

By Clive Riddle, March 4, 2016

Truven Health Analytics has just released a twelve page research brief:  Bundled Pricing for Total Joint Replacements in the Commercially Insured Population: Cost Variation Insights by Bundled Care Components, which follows up on their recently released eight page brief on this same topic: Geographic Variation and Cost-Driver Insights.

Truven “found that the primary drivers of cost variation for major lower joint replacement are tied to hospital cost and length of stay. For facility costs, the study attributes up to $1,944 per additional day in total cost variation. That variation is independent of professional costs. The study builds on previous research that found more than $10,000 in commercial bundled spend variation for the same surgeries based on geography.”

Truven shares these key findings:

  • The increase in facility cost only (removing professional cost) for each additional day a patient is hospitalized after the procedure varies from $313 per day in the East North Central region to $1,944 per day in the Pacific region, a difference of more than $1,600.
  • On average, the cost to treat a patient at a rehab facility was $10,600 per patient, versus $5,300 per patient at a skilled nursing facility, and $1,300 using home health services. And, the cost for rehab facilities varied widely by region, with the cost per patient in the Pacific totaling close to $22,500 compared with roughly $7,000 per patient in New England.
  • The cost per bundle for readmissions varied from $538 in the East South Central to $918 in the West South Central division. This lower cost in the East South Central resulted from both a low rate of readmission (3.3 percent) and a low cost per discharge ($16,340).

In their most recent brief, Truven notes that “in our previous research, we estimated the marginal impact of one extra day in the hospital after a TJR to be about $880 per day across all geographic divisions.  To further analyze that finding, we used a mixed effects regression model, with fixed average professional costs, to quantify the increase in facility cost only for each additional day a patient remains hospitalized after the procedure…. The average impact varied from $313 or 1 percent of the base price per additional day in the anchor facility after initial day of hospitalization in the East North Central division, to $1,944 or 6.2 percent of the base price in the Pacific. That’s a difference of more than $1,600.”

Bob Kelley, senior research fellow, advanced analytics, at Truven Health Analytics tells us “as providers and payers begin to consider bundled payment programs for these procedures, it is increasingly important to understand the cost implications of each additional inpatient day, as well as post-acute care and readmissions. Once claims-based, actual patterns are recognized and understood, guidelines and standard best practices can be put in place to guide discharge planning and post-acute care based on patient risk for readmission and other factors contributing to a successful recovery.”


Use of Predictive Analytics in Health Care

By Claire Thayer, March 3, 2016

Healthcare payers and providers are increasingly looking for innovative strategies to leverage big data and use of predictive analytics across the organization to manage population health risks, identify claims trends, improve clinical outcomes, reduce costs, etc.  Management of all the data and integration of the systems built up over time is complex at best  - 72% of CIOs surveyed reported using more than 10 platforms or interfaces to extract data, while still relying on traditional sources: Clinical Data from EHRs (95%); Pre-adjudicated administrative, billing and financial data (91%), and post-adjudicated claims data (69%).   Given this, it’s not surprising that many payer organizations are now seriously looking to outsource their IT and analytics related projects - 93% of health plans responding to recent Black Book survey plan to do so by Q1 2017. 

These and issues pertaining to predictive analytics in health care was the focus of a recent MCOL infographoid, highlighted below:

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.