Tuesday
May312016

Blue Shield of California Releases Executive Pay Report

By Claire Thayer, May 31, 2016

This week, Blue Shield of California released its first report on executive pay, thanks in part to a state audit that raised questions on the amount of executive pay and large cash reserves, along with mounting public pressure to be more transparent on executive compensation.  It pays to meet incentive plan goals - the CEO’s compensation jumped 40% in less than two years in doing so. 

The report includes components of the executive compensation program –including base salary and incentives tied to short and long term goals. Compensation paid to their top ten executives is listed, details on the CEO's individual pay package, along with comparison of how their exec pay ranks compared to their peers (Centene, Aetna, United, Anthem, Humana and Kaiser).

For further reading:

Blue Shield of California 2015 Executive Compensation Summary [May 2016]

Blue Shield ‘Lifts The Veil’ On Executive Pay [Kaiser Health News, May 26, 2016]

Blue Shield reveals executive compensation [BenefitsPro, May 27, 2016]

Friday
May272016

Practicing in an Age of Uncertainty

By Kim Bellard, May 27, 2016

If you've ever had a hard time trying to decide what's best for your health, perhaps you can take comfort in the fact that physicians often aren't so sure either. 

Or perhaps not.

new study in Annals of Surgery, and nicely reported on by Julia Belluz inVox, focused on surgical uncertainty.  The researchers sent four detailed clinical vignettes to a national sample of surgeons, seeking to get their assessment on the risks/benefits of operative and non-operative treatment, as well as their recommendations. You'd like to think there was good consensus on what to do, but that was not the case.

In one of the vignettes, involving a 68 year-old patient with a small bowel blockage, there was fairly universal agreement -- 85% -- that surgery was the best option.  In the other three vignettes, though, the surgeons were fairly evenly split about whether to operate or not, even on something as common as appendicitis. 

So, there may be a "right" answer but you might as well flip a coin in terms of getting it, or there may just not be a right answer.  Both options are troubling.

The authors believe that surgeons are less likely to want to operate as their perception of surgical risk increased and the benefits of non-operative treatment increased, and more likely to want to operate as their perception of surgical benefit increased and non-operative risk increased.  The problem is that surgeons vary dramatically -- literally from 0 to 100% -- on their perceptions of those risks.

Most surgeons based their estimates of risks/benefits on their experience, their training, and -- if you're lucky -- on whatever literature might be available, but it is doubtful that we can usually expect an objective, quantifiable assessment. 

The American College of Surgeons has developed a "surgical risk calculator" to help surgeons better gauge these risks, using data from a large dataset of patients.  However, an earlier related study from the same team of researchers found that it doesn't make much difference.  The calculator did narrow the variability of surgeons' assessment of risk, but: "Interestingly, it did not alter their reported likelihood of recommending an operation."

Oh, well.

It is not just surgeons who aren't always sure of the right course of action, of course.  A study in the American Journal of Managed Care found that 62% of physicians reported that they found the "uncertainty involved in providing patient care disconcerting."  The discomfort with uncertainty did not vary appreciably between type of specialty.

Then there is the example of PSA tests.  In 2008 the US Preventive Services Task Force recommended routine PSA tests not be given to men over 75, and in 2012 broadened that recommendation to all ages.  Yet data suggest that the group least likely to need the tests -- men over 75 -- had the smallest declines in rates of testing.  Almost 40% of this age group are still getting the test, which is not far from the previous rates. 

As one researcher told The New York Times,   "That’s just insanity...bad medicine, poor use of health care resources and poor decision-making.”

There's all too much of that in our health care system.

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

Monday
May232016

How are health plans meeting behavioral health needs of members?

By Claire Thayer, May 23, 2016

There’s been a lot of awareness about mental health lately, especially during the month of May – officially recognized as Mental Health Month, via Mental Health America .  In the spirit of this awareness, AHIP recently released a new 28-page issue brief on behavioral health benefits and mental health coverage from collective case studies of 11 member health plans. This new issue brief, Ensuring Access to Quality Behavioral Health Care: Health Plan Examples, identifies innovative approaches to these key areas:

  • Awareness and Education
  • Identification and Outreach
  • Timely access to care
  • Quality measurement
  • Evidence-based clinical criteria
  • Care Coordination and integration
  • Programs targeting opioid use

Health Plans profiled in the report include:

  • Anthem
  • Beacon Health Options
  • Blue Shield of California
  • CareFirst
  • Cigna
  • Health Care Service Corporation
  • Health Partners
  • Highmark
  • Humana
  • Kaiser Permanente
  • Wellcare

To read this complete Issue Brief: Ensuring Access to Quality Behavioral Health Care: Health Plan Examples

Thursday
May192016

Patients Happy With PCPs But Not Always Following Their Advice Due to Costs

By Clive Riddle, May 19, 2016

The Physicians Foundation has just released a 74-page report with results from their Physicians Foundation Patient Survey conducted by Harris Poll. The report findings state that “95 percent of patients surveyed are satisfied or very satisfied with their PCP’s ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Moreover, 93 percent were satisfied or very satisfied with how well their PCP listened to them during their most recent exam, with 92 percent noting high levels of satisfaction relative to how well their doctor knew their medical history.”

But the report notes that “patients who saw a primary care physician for their most recent routine exam are not fully adhering to treatment plans, avoiding routine check-ups or opting not to take prescription medication due to rising healthcare costs.”

They cite that “ sixty-two percent of U.S. adults are concerned with being able to pay for medical treatment if they get sick or injured. Almost half (48 percent) are not confident they could afford care should they become seriously ill. In addition, more than a quarter of U.S. adults (28 percent) have skipped a medical test, treatment or follow-up or avoided a visit to the doctor for a medical problem in the past 12 months because of costs. Twenty-seven percent of patients have avoided filling a prescription in the past 12 months, noting costs as a primary factor.”

Who do patients feel are driving these costs? The report says that “59 percent of patients surveyed say it’s the cost of prescription drugs. One-third (33 percent) of patients cited fraud as another contributor factor, followed by social conditions and poverty (28 percent), government mandates (26 percent) and an aging population (25 percent).”

Rip Hollister, MD, a Physicians Foundation board member tells us “patients recognize that there is an array of stakeholders and external influences that affect treatment options and, in effect, clinical autonomy. Historically, treatment plans have been developed between the doctor and patient. Yet, patients understand that there are now many other parties ‘in the room,’ so to speak, which complicates and challenges the manner in which physicians practice medicine.”

In this regard, the report cites how much patients felt each of the following stakeholder groups, as a whole, impacts treatment options available to them:

  • Health insurance companies (83 percent)
  • Physicians (79 percent)
  • Pharmaceutical companies (68 percent)
  • Federal legislature (60 percent)
  • State legislatures (54 percent)
Tuesday
May102016

Walgreens raising awareness on mental health with online screening tools and telehealth services

By Claire Thayer, May 10, 2016

Walgreens and Mental Health America have forged an ambitious initiative to screen 3 million people for mental issue, by the end of 2017. Walgreens is well positioned to step up to expand mental health services and treatment options and has announced it will offer access to 1,000 therapists and psychiatrists via MDLive’s subsidiary, Breakthrough.

Walgreens new dedicated mental health “answer center” is designed to help connect people to Mental Health American’s Online Screening Program— free, scientifically-based online screenings for a number of conditions including depression, anxiety, bipolar disorder, PTSD and others.

The National Alliance on Mental Illness reports that getting access to services for treatment of mental health illness continues to be a concern:

  • Approximately 60 percent of adults, and almost 50% of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
  • African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.
  • One-half of all chronic mental illness begins by the age of 14; three-quarters by age 24.
  • Despite effective treatment, there are long delays−sometimes decades−between the first appearance of symptoms and when people get help.

Further reading:

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