Henry Loubet on Three Immediate Trends Impacting 2016 Healthcare

By Clive Riddle, January 15, 2016

What’s in store for 2016? Henry Loubet, Chief Strategy Officer for Keenan, tells us “The business of health care has experienced both evolution and revolution through the decades. Innovation and transformation are driving dramatic developments in the health care industry at a rapid pace these days. While the major insurers' merger and acquisition activity will draw plenty of speculation about the health care landscape, I believe there are other, more immediate trends that will influence policy and financial decisions in 2016.”

Henry Loubet

Here’s three trends Henry points to for 2016:

The 2016 Election could potentially hold transformative Affordable Care Act impacts, with a new President and approximately 470 seats in the House and Senate to be decided. We don't know who will ultimately occupy those offices or whether the partisan balance will spell the possibility of the ACA being modified or repealed. Even with a strong Republican shift, there are significant barriers to repealing a law that now provides health insurance to millions of Americans. Some elements that would be easier for Congress to change about the ACA include risk corridors reimbursement, Cadillac Tax modification or deferral, or provisions affecting Medical Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).

Disruptive start ups will continue to alter how health care is delivered as more members of the Millennial generation become health care consumers and entrepreneurial purchasers. Companies like Oscar, Zenefits, and Omada Health all appeal to those who are most comfortable functioning in a connected environment. These organizations have realized growing valuations as they've acquired market share at unprecedented rates. Their approach to care access should make telemedicine more mainstream, promote adoption of wearable devices for wellness and condition management, and expand utilization of "minute clinics" and other alternative treatment venues.

Not frequently discussed, but a growing area for health care is the application of non-occupational medical, pharmacy, and wellness/condition management principles to workers' compensation. Inflationary increases in occupational medical have prompted steps toward implementing drug formularies, preferred provider networks, and wellness/population health management as risk management strategies to reduce paid claims as well as the incidence and severity of workers' compensation claims. Though maybe not in 2016, we will be monitoring whether the line between occupational and non-occupational medical becomes less distinct or eventually eliminated.

Henry’s comments originally appeared in in MCOL’s December-January 2016 issue of ThoughtLeaders


“Fateful Eight” Trends to Watch in 2016

by Clive Riddle, January 8, 2016

With apologies to Quentin Tarantino, here are a “Fateful Eight” collection of trends to watch in the business of healthcare for 2016, in no particular order:

1. Prescription drug slice of the cost pie

While the overall healthcare cost trend has been relatively fit and trim for more than a decade, prescription drug costs are consuming a growing portion of the healthcare cost pie, and threaten to send the entire cost structure back to more obese levels.  Watch for a continued shift in priorities and resources towards managing this sector. A December MCOL e-poll on managing prescription costs, co-sponsored by Keenan, found that 41% of respondents felt the prospects for managing prescription costs going forward will be somewhat difficult and challenging, and 56% felt the prospects will be very difficult and challenging. 71% would place a higher priority on dedicating new or additional resources in managing prescription costs, compared to dedicating resources to managing other components of health care costs, and another 16.5% would place the highest priority in this regard.

2. Aftermath of health plan consolidations

There really can’t be the same level of mega health plan mergers in 2016 to follow up on the 2015 Aetna-Humana; Anthem-Cigna; and Centene-HealthNet deals, because we’re running out of separate mega health plans to merge with each other. But 2016 is a key year regarding health plan mergers none the less, as regulatory review of these deals gathers steam, individual health plan markets shake out, and the merged mega plans unveil a more detailed vision of health plan life post-merger.

3. Onward march of health system m&a

But merger and acquisition activity will still flourish in 2016, on the health system side, particularly as systems continue paths towards integration as they acquire and manage more and more medical group practices.

4. Private sector embrace of two ACA concepts

For all the political pushback the ACA continues to experience, its noteworthy that two ACA concepts have morphed over into the healthcare private sector with gusto.  Private health insurance exchanges and commercial accountable care arrangements have both evolved from the ACA primordial stew to become significant private sector initiatives that will play in increasing role in 2016.

5. Pay for Value Initiatives

But as significant as the rise in public and private accountable care arrangements have been, the biggest action in the provider reimbursement and care delivery arena is cast in the wider net of pay for value. While encompassing a range of type of initiatives, all things pay for value will be what to watch for in payer-provider relationships in 2016.

6. Healthcare Political Theatre

It’s a presidential election year. ACA opponents will continue pushing back on all possible fronts. While public opinion polls show the country is still quite divided on the ACA, polls also show it is slipping some in relationship to priority of other national issues.  But this won’t stop healthcare from being a featured actor in political theatre for 2016, casting ripples of uncertainty for the prognosis of the healthcare environment post-2016.

7. Quiet but big adoption progress for all things mHealth

Perhaps all the big things that can be said for the moment about mHealth have been said. While 2016 might not be the year that big new, new shiny things will be touted to change the face of healthcare forever, a more quiet revolution will take place in 2016 as more and more consumers continue to adopt various apps and technologies that are out there already, just waiting to gain traction.

8. The ever growing burden of consumer cost sharing

The ever upward spiral in the burden of consumer cost sharing is not news. Perhaps though, this growing burden might relate to the parable about the frog in the frying pan, who just sits there if the temperature is just increased one degree at a time. While things aren’t boiling over yet, the pace of marketplace and regulatory reactions to this issue should pick up in 2016.


Oh, And It Is Also An EHR

By Kim Bellard, December 18, 2015

You wouldn't -- I hope -- still drive your car while trying to read a paper map.  Hopefully you're not holding up your phone to follow directions on its screen either.  Chances are if you need directions while you are driving, you'll be listening to them via Bluetooth.  Or maybe you're just riding in a self-driving car.

But when it comes to your doctor examining you, he's usually pretty much trying to do so while fumbling with a map, namely, your health record.  And we don't like it.

study in JAMA Internal Medicine found that patients were much more likely to rate their care as excellent when their physician didn't spend much time looking at their EHR while with them; 83% rated it as excellent, versus only 48% for patients whose doctors spent more time looking at their device's screen.  The study's authors speculate that patients may feel slighted when their doctor looks too much at the screen, or that the doctors may actually be missing important visual cues.

Indeed, a 2014 study found that physicians using EHRs during exams spent about a third of the time during patient exams looking at their screen instead of at the patient. 

As one physician told the WSJ, "I have a love-hate relationship with the computer, with the hate maybe being stronger than the love." 

The problem is that we forget that the record is not the point.  Figuring out what is wrong with a patient and what to do about it is the point.

Let's picture a different approach, one that doesn't start with paper records as its premise.  Let's start with the premise that we're trying to help the physician improve patient care by giving him/her the information they need at point of care, when they need it, but without getting in the way of the physician/patient interaction.

Let's talk virtual reality.

Picture the physician walking into the office not holding a clipboard or a computer or even a tablet.  Instead, the physician might be wearing something that looks like Google Glass or OrCam. There might be an earbud.  And there will be the health version of Siri, Cortana or OK Google, AI assistants that can pull up information based on oral requests or self-generated algorithms, transcribe oral inputs, and present information either orally or visually. 

When the physician looks at the patient, he/she sees a summary of key information -- such as diabetic, pacemaker, recent knee surgery -- overlaid on the corresponding portion of the patient's body.  Any significant changes in blood pressure, weight, and other vitals are highlighted.  The physician can call up more information by making an oral request to the AI or by using a hand gesture over a particular body part.  List of meds?  Date of that last surgery?  Immunization record?  No problem.

The physician can indicate, via voice command or hand gesture, what should be recorded.  It shouldn't take too long before an AI can recognize on its own what needs to be captured; the advances in AI learning capabilities -- like now recognizing handwriting -- are coming so quickly that this is surely feasible.

Building better EHRs is certainly possible.  Improving how physicians use them, especially when with patients, is also possible.  But it's a little like trying to make a map you can fold better while driving.  It misses the point. 

We need a whole different technology that subsumes what EHRs do while getting to the real goal: helping deliver better care to patients.

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


Accuracy of Health Provider Directories

By Claire Thayer, December 17, 2015

Health plans participating in the federal exchange program (think Obamacare) and Medicare will be required in 2016 to monitor and maintain online directories.  CMS online directory requirements stipulate that health plans are to communicate with their contracted providers for updates on their ability to accept new patients, changes to street address or phone number, along with any of changes affecting availability to patients.

Penalties will be assessed for inaccuracies discovered in the online provider directory – and the assessment may be steep --up to $25,000 a day, per beneficiary for Medicare Advantage plans, and up to $100 per day for those covered under the federal exchange program.

A recent study into the availability of providers in the Medicaid Managed Care program found that 43% were not participating in the Medicaid managed care plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed.

These and other issues on maintaining accurate information in provider directories 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.


List of Chronic Diseases for Young Adults – Add Mental Health!

By Claire Thayer, December 13, 2015

When we think about chronic conditions, we typically think about chronic diseases such as cancer, heart disease, diabetes, etc. But rarely is mental health thought of as a chronic condition. According to data in the 2014 National Survey on Drug Use and Health (NSDUH), 11.9 percent of young adults aged 18 to 25 received mental health services in the past year

It’s interesting to note that 42.3 percent of young adults who received mental health services in the past year are receiving prescription medication as their only mental health service.

A recent Health Affairs blog, The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults, identified 5 primary barriers in obtaining needed mental health treatment:

  • Stigma
  • Inadequate screening by primary care providers
  • Trouble finding treatment
  • Failure to implement evidence-based therapies
  • Slow implementation of research findings

Additional information:

The CBHSQ Report, Substance Abuse and Mental Health Services Administration (SAMHSA). December 8, 2015.

The Forgotten Chronic Disease: Mental Health Among Teens And Young Adults. Health Affairs Blog. October 1, 2015.

Mental Health Myths and Facts. U.S. Department of Health & Human Services.

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