Entries in Announcement (141)

Friday
Oct272017

Fighting Healthcare fraud and over-prescriptions with predictive analytics

By Claire Thayer, October 31, 2017

Earlier this summer, the U.S. Department of Justice announced the largest ever health care fraud enforcement action, involving over 412 individuals across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Adoption of prescription drug monitoring programs is one way to hold health care providers accountable for overprescribing practices. Use of sophisticated claims analytic tools can help detect suspicious practice patterns as well. A health plan in the Midwest recently uncovered the case of an overprescribing neurologist using peer-to-peer analysis for comparison of practice patterns.

This recent edition of the MCOL Infographic, co-sponsored by LexisNexis, provides highlights from this case study:

 

Tuesday
Dec132016

The State of Provider Directory Accuracy

By Claire Thayer, December 13, 2016

Despite a federal mandate for all plans in the health insurance marketplace be required to have current and accurate provider directories, many health plan enrollees are finding that when it comes time to call a provider for their specialty visit or find a new primary care physician willing to take new patients, the information in the directory is often out of date or missing vital information.

We’ve posted a couple of infographics on this topic, one on the Accuracy of Health Provider Directories which outlined data points that CMS requires health plans to monitor and maintain on a monthly basis and the State of Provider Directory Accuracy Across the U.S. which outlined provider penalties that could be incurred for inaccuracies.

Last week, The New York Times published an in-depth article, Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors, highlighting from the consumer perspective just how frustrating the experience can be when you’re the patient shopping for health coverage and trying to find a physician willing to accept new patients.

While health plans participating in the health insurance marketplaces were to be subjected to penalties for directory inaccuracies starting in 2016, research by the New York Times found that while many directories are still incomplete, inaccurate or missing information, so far no plans have been fined or kicked off the enrollment sites for having poor doctor directories, said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which would enforce the rules. A Health and Human Services Department survey of Medicare plans for those 65 and older that was released in October found errors in nearly half of the listings in doctor directories .

Last week, the MCOL Infographoid, co-sponsored by LexisNexis Health Care, offered a deeper look at the provider directory requirements on a state by state basis in the State of Provider Directory Accuracy, 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.

Thursday
Nov102016

Changing the conversation from wellness to total wellbeing

By Claire Thayer, November 10, 2016

This week, Robin Bouvier from Aon’s Health Transformation Team, spoke in a HealthcareWebSummit webinar, co-sponsored by WebMD Health Services, on More than Meets the ROI: The Value of Investing in a Healthy Workforce.   Today’s forward thinking companies are moving towards a culture of health and changing the conversation about employee wellness from a ‘benefit’ to instead looking at health as a business imperative that’s integrated across all aspects of the organization.

Robin shares some perspective on general health of the workforce and somewhat surprisingly, the younger generations are not necessarily healthier:

 

Baby Boomers (1946-1964)

Generation X (1965 -1978)

Millennials (1979-1996)

Tobacco Use

18%

21.1%

26.5%

Obesity

33.3%

32.8%

30.9%

Depression

16%

16%

20%

Debt

$29,317

$30,039

$23,332

 

Robin tells us that wellness is evolving to an all encompassing, total wellbeing approach: “Wellbeing means having the appropriate resources, opportunities and commitment needed to achieve optimal function, health and performance for the individual and the organization.” Total wellbeing interconnects:

  • Emotional – attitudes and everyday living

  • Physical – energy to complete daily living tasks

  • Financial – confidently manage everyday and future finances

  • Social – connections to others

Robin cited recent study findings of the impact of total wellbeing:

  • 81% less like to seek out new employer in next year

  • 41% less work missed because of poor health

  • 69% of consumers say wellbeing programs health them get or stay healthy

  • 22% more profitable as organizations

  • 10% higher customer ratings

  • ½ point higher performance rating by supervisor

From the new Aon Hewitt 2016 Financial Mindset Study, Robin identifies employee needs by financial stage as:

  • Security: 30%

  • Foundation: 25%

  • Growth: 36%

  • Freedom: 9%

Tuesday
Oct112016

It’s Complicated – Navigating Health Care Integrated Delivery Networks

By Claire Thayer, October 7, 2016

Integrated delivery networks (IDNs) are vast and complex. In the U.S. alone, there are more the 626 IDNs operating at 44,000 sites, employing over 412,000 health care providers.  Some IDNs are groups of hospitals, some are regional, some have facilities scattered throughout the country and even internationally – think Kaiser Permanente and the Mayo Clinic – both long standing traditional IDNs. More and more health systems are taking on risk management for their patient populations and in doing so, are looking for ways to collaborate with health plans and providers and related entities to align efficiencies in overall patient care management.  In the not to distant future, expect to see most provider organizations involved at some level with an IDN. 

Navigating IDNs and understanding the scope of their reach is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, 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.

Thursday
Sep292016

What Health Plans Should Know About Marketing Costs

By Claire Thayer, September 29, 2016

Getting your message in front of the right audience sounds easy enough, but can be quite complicated for health plans during open enrollment season as well as throughout the year for member outreach.  A recent study of administrative expenses for Blue Cross Blue Shield finds that the 26.5% of total PMPM expenses is attributed directly to sales and marketing activities.  Being judicious and figuring out best practices for member engagement, when to contact members, identifying the healthcare CEO of the household, what language members speak at home, etc. requires marketing tools with intelligence capabilities to optimize campaign initiatives.

Helping health plans to keep their marketing costs down is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, 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.