Monday
Jun052017

In your member enrollment process leaving you exposed? 

By Claire Thayer, June 2, 2017

In September last year, the Government Accounting Office released a new study on findings from its undercover enrollment eligibility testing of federal and selected state marketplaces. As part of the study, GAO submitted 15 fake applications for subsidized coverage through the federal Marketplace in Virginia and West Virginia and through the state marketplace in California. GAO’s applications tested verifications related to (1) applicants’ making required income-tax filings, and (2) applicants’ identity or citizenship/immigration status. Through this extensive under cover testing process, GAO found that eligibility determination and enrollment processes continue to remain vulnerable to fraud.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, highlights some of findings presented in the GAO report: 


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.

Friday
Jun022017

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:

 

The Fate of 16.8 Million Medicaid Enrollees Rests On 20 GOP Senators From 14 States

The Senate is on the verge of debating legislation to repeal and “replace” the Affordable Care Act, and Medicaid is on the chopping block. Huffington Post, June 2, 2017

 

Trump Rule Could Deny Birth Control Coverage to Hundreds of Thousands of Women

The Trump administration has drafted a sweeping revision of the government’s contraception coverage mandate that could deny birth control benefits to hundreds of thousands of women who now receive them at no cost under the Affordable Care Act. The New York Times, June 1, 2017

 

Ohio Sues 5 Major Drug Companies For 'Fueling Opioid Epidemic'

The state of Ohio has sued five major drug manufacturers for their role in the opioid epidemic. In the lawsuit filed Wednesday, state Attorney General Mike DeWine alleges these five companies "helped unleash a health care crisis that has had far-reaching financial, social, and deadly consequences in the State of Ohio." NPR, May 31, 2017

 

How plan for California gov't health care might be funded

A pending state Senate bill would provide government-funded universal health care for California's 39 million residents. The bill faces a Friday deadline for passage out of the Senate if it is to be considered by the state Assembly. ABC News, May 31, 2017

 

Drug Rebates Reward Industry Players — And Often Hurt Patients

Medicare and its beneficiaries aren’t the winners in the behind-the-scenes rebate game played by drugmakers, health insurers and pharmacy benefit managers, according to a paper published Tuesday in JAMA Internal Medicine. Kaiser Health News, May 30, 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
Jun022017

Nine Things to Know About J.D. Powers 2017 Member Health Plan Study Results

By Clive Riddle, June 2, 2017

 

J.D. Powers has just released their 2017 Member Health Plan Study Results. J.D. Powers tells us this 11th annual study “measures satisfaction among members of 168 health plans in 22 regions throughout the United States by examining six key factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service. The study also touches on several other key aspects of the experience including plan enrollment and member engagement.” The study is based on responses from 33,624 commercial health plan members and was fielded in January-March 2017.

 

The study assigns scores to each plan based on the above criteria based upon a possible 1,000 point scale. Here are nine things to know about their findings:

 1.     J.D. Powers found that “Integrated delivery systems dominate rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—outperform traditional health plans on every factor measured in the study.”

 2.       Even though narrow networks have often been presented negatively in the media, the study found otherwise: “Regardless of product choice, members who were presented with lower-cost narrow network options were significantly more satisfied with their health plan versus those who were not offered such an option or did not know whether it was offered. However, just 33% of respondents say they were offered a narrow network option.”

 3.       J.D. Powers found that “the effect of payer-provider alliances is mixed: Aetna, Cigna, Anthem, and many other providers have begun to offer commercial products in collaboration with specific providers in the past few years.”

 4.       Satisfaction is highest among health plan members in the five regions: Maryland (723); East South Central (722); California (716); Michigan (716); and Ohio (714).

 5.       Satisfaction is lowest among members in the Colorado (676) and Northeast (682) regions.

 6.       The highest score achieved by any major plan was 794 (Kaiser in Maryland.)

 7.       Kaiser by far had the most regional top scores for major health plans with six: (California, Colorado, Maryland, Northwest, South Atlantic, Virginia)

 8.       The lowest score achieved by any major plan was a tie between Coventry (Aetna) in the Heartland region, and Blue Cross Blue Shield Montana in the Mountain region, both with 653. Given the regional average in the Mountain region (706) was higher than in the Heartland (693), the tiebreaker for Bottom performer would go to BCBS Montana.

 9.       UnitedHealthcare and subsidiaries by far had the most bottom regional bottom scores for major health plans with thirteen:  (Colorado, Delaware/WV/DC, East South Central, Florida, Maryland, Michigan, New Jersey, New York, Northwest, Ohio, Pennsylvania, Southwest, Virginia)

 

Here are the top and bottom performers of major health plans for each of J.D. Powers 22 defined regions with their respective scores, along with the average score for the region:

 

California

Top: Kaiser 780

Average: 716

Bottom: Aetna 683

 

Colorado

Top: Kaiser 725

Average: 676

Bottom: United 661

 

Delaware/WV/DC

Top: Highmark 712

Average: 691

Bottom: United 666

 

East South Central (AL, KY, LA, MS, TN)

Top: BCBS Tennessee 735

Average: 722

Bottom: United 684

 

Florida

Top: AvMed 733

Average: 702

Bottom: United 694

 

Heartland (AR, IA, KS, MO, NE, OK)

Top: Wellmark BCBS Iowa 723

Average: 693

Bottom: Coventry (Aetna) 653

 

Illinois-Indiana

Top: Health Alliance Medical Plans 723

Average: 708

Bottom: Coventry (Aetna) 666

 

Maryland

Top: Kaiser 794

Average: 723

Bottom: United 693

 

Massachusetts

Top: BCBSMass 707

Average: 703

Bottom: Cigna 664

 

Michigan

Top: Health Alliance Plan of Michigan 750

Average: 716

Bottom: United 672

 

Minnesota-Wisconsin

Top: Unity Health Plans 737

Average: 695

Bottom: Cigna 679

 

Mountain (ID, MT, UT, WY)

Top: SelectHealth 727

Average: 706

Bottom: BCBS Montana 653

 

New Jersey

Top: Horizon BCBS 712

Average: 705

Bottom: United 693

 

New York

Top: Capital District Physicians Health Plan 755

Average: 702

Bottom: Oxford (United) 658

 

Northeast (CT, ME, NH, RI, VT)

Top: BCBS Vermont 725

Average: 682

Bottom: Harvard Pilgrim 666

 

Northwest (OR, WA)

Top: Kaiser 751

Average: 697

Bottom: United 644

 

Ohio

Top: Medical Mutual of Ohio 720

Average: 714

Bottom: United 695

 

Pennsylvania

Top: UPMC 739

Average: 702

Bottom: United 672

 

South Atlantic (GA, NC, SC)

Top: Kaiser 791

Average: 707

Bottom: Aetna 696

 

Southwest (AZ, NV, NM)

Top: BCBS AZ 704

Average: 693

Bottom: Health Plan of NV (United) 661

 

Texas

Top: NA

Average: 710

Bottom: Aetna 686

 

Virginia

Top: Kaiser 769

Average: 702

Bottom: United 699

Friday
May262017

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:

Top News From the Past Week as reported from key news services, and compiled by MCOL

 

Patient, Doctor Groups Say New CBO Score Reveals Health Care Bill's Flaws

Health care groups that represent doctors and patients are warning members of Congress that the House Republicans' plan to overhaul the Affordable Care Act would hurt people who need insurance most. NPR. Thursday, May 25, 2017

 

Senate to Start Drafting Health Care Bill Despite Policy Debates

Senate staffers will start to draft legislation that would repeal and replace significant parts of the Affordable Care Act next week, GOP senators said Thursday, despite the many differences among members of the caucus over policy. Morning Consult. Thursday, May 25, 2017

 

10 key points from the CBO report on Obamacare repeal

Here are some key facts and figures from the new CBO report on the American Health Care Act, the House-passed bill to repeal and replace Obamacare. CBO stressed the uncertainty of its estimates, given that it's hard to know which states would take up the chance to opt out of certain key parts of Obamacare. Politico Wednesday, May 24, 2017

 

Tab For Single-Payer Proposal In California Could Run $400 Billion

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. Kaiser Health News Tuesday, May 23, 2017.

 

Trump budget: $800 billion in Medicaid cuts

Donald Trump's budget that is expected to be unveiled on Tuesday will include $800 billion in cuts to Medicaid -- a move that underscores the President's resolve to significantly downsize the federal program even as Republican lawmakers are clashing over the issue in Congress. CNN Monday, May 22, 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.

Wednesday
May242017

Rise of the Drones

By Kim Bellard, May 24, 2017

For those of us of a certain age, we expected to be living in a Jetsons-type world, complete with flying cars.  That hasn't happened, but it is starting to appear as though the skies may, indeed, soon be full of flying vehicles.  It's just that they may not have people in them. 

Welcome to the brave new world of drones.

Many people may have viewed drones as a toy akin to radio-controlled airplanes. We're beyond that now.  Last summer PwC asked "Are commercial drones ready for take-off?"  They thought so, estimating the total available market for drone-enabled services at $127b

This is not going to all be about getting your books, or your socks, or even your new HD television faster.  It is going to impact many industries -- including health care.

And that impact has already started to happen.

Zipline International, for example, is already delivering medical supplies by drone in Rwanda.  They deliver directly to isolated clinics despite any intervening "challenging terrain and gaps in infrastructure."  They plan to limit themselves to medical supplies, but not only in developing countries; they see rural areas in the U.S. as potential opportunities as well.  Last fall they raised $25 million in Series B funding.  

Drones are also being considered for medical supply delivery in Guyana, Haiti, and the Philippines.   

And drone delivery is already being tested in more urban areas.  The Verge reported that Swiss Post, its national postal service, is working with two hospitals in Lugano to ferry lab samples between them. 

Similarly, Johns Hopkins has been testing drone transport of blood supplies, concluding that it is "an effective, safe, and timely way to get blood products to remote accident or natural catastrophe sites, or other time-sensitive destinations."

Airbus is developing the A-180 drone specifically to deliver medical supplies, especially for emergencies.  Its cargo capsule is "capable of transporting everything from medicine and antivenin to supplemental blood and even organs." A company called Otherlab is going a different direction.  Wired reports that their drone will deliver its package -- then decompose, making it ideal for deliveries to humanitarian crises (or to battle sites, since Darpa helped fund them).  

Lest we focus too narrowly on the concept of drones delivering medical supplies, argodesign has proposed a flying ambulance, which could be operated as a drone or by a pilot.  If you've ever seen ambulances stuck in traffic and felt sorry for the patients relying on them, such ambulances could be the solution -- arriving faster and to locations regular ambulances could not reach.  

But for real impact, let's go back to Amazon.  CNBC's Christina Farr broke the news last week that Amazon was considering getting into the pharmacy business. Put rapid delivery -- especially with drones -- together with lower and more transparent prices, and it is no wonder that the stocks of CVS and Walgreens took a hit when the news broke about Amazon's new interest.

Health care has been all-too-much a story of waiting.  That's quickly changing, with telemedicine, WebMD, retail clinics, and -- soon -- 3D printing and health care robots.  We can add health care drones to the list, allowing 30-minutes-or-less kinds of promises that we haven't even begun to tease out yet.

Bring on the drones!

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