Entries in Consumers (59)

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

Wednesday
May102017

An Interview With Kaiser’s Robert Pearl, MD on Mistreated Patients and the American Health Care System

By Clive Riddle

By Clive Riddle, May 10, 2017

 

Doctor Robert Pearl, certainly a prominent figure in American healthcare today, agreed to sit down and expand upon his thoughts on the American health care system in 2017 and its impact upon patients. His new book, Mistreated - Why We Think We're Getting Good Health Care and Why We're Usually Wrong has just been released this month by Public Affairs, and we hoped he would elaborate on some of the questions that come to mind from issues raised in Mistreated, and in his public speaking appearances.

 

Robert Pearl, MD, is executive director and CEO of The Permanente Medical Group, responsible for the health care of 3.8 million Kaiser Permanente members, and he is the president and CEO of the Mid-Atlantic Permanente Medical Group. He is on faculty at Stanford and has taught at Duke, UC Berkeley, and Harvard. His column on Forbes.com addresses the business and culture of health care, and he has been featured in national media including Time, ABC News, USA Today, and NPR.

 

So here’s what Doctor Pearl shared with us in response to our half dozen questions:

 

Q. You have been an influential healthcare stakeholder and thought leader for some time. American healthcare has been problematic for even longer. What confluence of events influenced you to write this book at this juncture?

 

Doctor Pearl: The American health care system is walking towards a cliff, and if nothing is done to change course, we will step over the edge and crash to the ground below. We spend almost 50% more than any other country in the world and our outcomes are in the lower half of industrialized nations. Hundreds of thousands of people die each year from failures in prevention and medical error, including my dad. Our system most closely resembles a 19th century cottage industry. It is fragmented, with doctors scattered across the community and hospitals in every town, piece meal, what we call fee-for-service and using information technology from the last century. The cost is rising faster than our ability to pay. The government is spending 40% of tax revenues on health care today, and with 10,000 people becoming eligible for Medicare every day, that will rise rapidly in the future. And businesses are implementing high deductible insurance products, with patients increasingly unable to pay the out of pocket expense. In other words, the "patient" is becoming critical. I wrote Mistreated for two reasons. The first was my career long desire to make American health care better. And the second to prevent other people from losing their parent prematurely. For both reasons, all profits from the book will be given to charity to provide care to patients unable to access it today.

 

Q. You have written about how healthcare organizations should be less, and not more, regulated in some respects - for example reducing regulation in order to facilitate workflows that would allow hospital patients to get more uninterrupted sleep during the night. You also have written that a single payer system is not the answer for American healthcare. What legislative changes do you advocate in your book?

 

Doctor Pearl: I believe that change can best happen through transparent and fair competition. Making it possible for insurance companies, ACOs and large, multi-specialty medical groups to offer products that patients can understand, compare and choose among would be valuable. I have confidence in the wisdom of people and businesses to make the best selection, once they have broad choice and sufficient information.

 

I also believe that the government needs to address the egregious pricing by many drug companies. The patent laws were written for the greater good of all. They were designed to encourage R&D and focus drug companies on solving the most important clinical problems that exist. They never were designed to allow manufacturers to buy the rights to long standing, inexpensive drugs and raise their prices 500% - 5000 %.

 

Q. You cite three technologies as being key to transforming American health care: Video and digital photography; Data analytics; and EHR. These are not exotic items. So what are some primary factors in 2017 that are still holding us back from deploying these three items at optimal levels?

 

Doctor Pearl: There are three reasons I believe these technologies are not more broadly used. The first is that to use them effectively requires an integrated delivery system that is prepaid with effective physician leadership. Without all three pillars, the information in the EHR will be incomplete, the data analytics difficult to apply, and applications like video economically problematic.  The second reason is physician inertia. According to the Rand Corporation, it takes 17 years for a great idea to become common practice. Finally, when it comes to video and digital, the problem with these technologies is that they are inexpensive. As such, there is no manufacturer or device company that wants to invest the dollars needed to encourage and train physicians to embrace these patient conveniences. And without this level of support change is slow to happen.

 

Q. Speaking of exotic technologies, you are not necessarily the biggest fan of focusing on all things new and shiny, and have cited the challenges in overcoming behavioral biases in that direction. What are some significant examples of technologies that have at this point benefited from undeserved demand from consumers or providers?

 

Doctor Pearl: As you note, as a nation we are attracted to the new and the hyped. A variety of expensive medications fit this description. Often they have minimal improvements over what was previously available, or extend life by a few weeks for most patients.  Another example is Artificial Intelligence. It sounds great, but most of the systems are really just fancy computers with physician developed algorithms, not real self-learning applications. Similarly, expensive fitness trackers are minimally better than the free application on your smart phone. And medical wearable devices can transmit hundreds of heart rhythm tracings, but doctors don't want them cluttering up their EHRs, and rarely do they add value for someone without a known cardiac arrhythmia.

 

Q. You are a strong advocate for clinical integration. What in 2017 are the biggest impediments in urban markets that lack adequate clinical integration? And how do we bring greater clinical integration to rural America?

 

Doctor Pearl: In urban areas, the limitations are the associated changes that need to happen. For integration to add value, you need to create a structure with the right number of physicians from each specialty. Often there are too many or too few in a typical community. For the new structure to add major value, reimbursement needs to change, rewarding prevention and avoidance of medical error as highly as intervention. And altering how doctors are paid is always contentious. The computer systems need to connect, and that is difficult to accomplish today. Finally, physician leadership is essential, and that requires investments in training and a willingness of all to relinquish autonomy.

 

In some ways the rural areas could be easier. In this case I believe the structure can be virtual, with specialists in more urban areas linked to primary care in the rural location. We are already using this type of approach in our on-site clinics located in large businesses. Here specialists whose offices may be in a hospital miles away can consult on a employee needing specialty expertise without having to ask the patient to drive to the physicians' location and miss a day of work. Over half of the time, this solves the patient's problem.

 

Q. In what ways do you hope consumers will change their actions or thought processes as a result of reading your book? And in what ways do you hope other healthcare stakeholders will be influenced?

 

Doctor Pearl: I wrote Mistreated for the patient in all of us. My father was a professional with well trained doctors, and yet, he experienced a medical error from the lack of a comprehensive electronic health record and inability of his doctors to communicate effectively.  The first step to transforming American health care is to help people see what they are missing and why. Having done so, I would hope they would begin to make different choices in the health plan and delivery system they select. Information can be difficult to obtain, but increasingly it is available. Choose a five star program in Medicare or on the health care exchanges. Check to see if there is reported data on outcomes for various procedures like heart surgery, and go to the programs with the best results. Ask physicians before you have a procedure how many of these they did last year, and choose ones with the highest volume. And when you are in a hospital or doctor's office, and anyone fails to wash their hands before examining you, speak up.

 

Specific to the medical profession, my hope is that change will happen soon, rather than waiting for the predictible crisis. The current system isn't working for clinicians any more than patients. The fragmentation that exists today leads to isolation. Fee-for-service makes doctors feel like they are having to run faster and faster, and convince patients they need things done that often add little value. The lack of technology and medical information leads to errors. And the lack of leadership reduces coordination of care and produces growing frustrations in the practice of medicine.  Change always is difficult and scary, but it can happen. And when it does, I believe both patients and physicians will benefit immensely.

 

The current system is broken. I am optimistic that when large numbers of people from diverse backgrounds come together to talk about their experiences and recommendations, that we can improve health care delivery in the future. That is my hope in writing the book. The path I describe is the one I believe best for the nation, but I look forward to learning from others. If Mistreated stimulates discussion, debate and improvement, and as a result tens of thousands of lives are saved each year, then my father's death will have served a purpose.

 
Thursday
Apr272017

Clicks-and-Mortar: Health Care's Future

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By Kim Bellard, April 27, 2017

 

The woes of the retail industry are well known, and are usually blamed on the impact of the Internet.  Credit Suisse projects that 8,600 brick-and-mortar stores will close in 2017, which would beat the record set in 2008, at the height of the last recession.   And then there's health care, where the retail business is booming.

 

In a recent Wall Street Journal article, Christopher Mims set forth Three Hard Lessons the Internet is Teaching Traditional Stores.  The lessons are:

1.             Data is King

2.             Personalization + Automation = Profits

3.             Legacy Tech Won't Cut It

 

It's easy to see how all those also apply to health care.

 

But health care is different, right?  Patients want to see their physician.  That physical touch, that personal interaction, is a key part of the process.  It's not something that can be replicated over a computer screen.  

 

Yeah, well, the retail industry has been through all that.  Retail once primarily meant local mom-and-pop stores.  They knew their customers and made choices on their behalf.  But it was all very personal.

 

Still, though, when Amazon came along, booksellers were adamant: no one wants to buy books sight unseen!  When that truism was proven false, other sectors of retail had their turn in the Internet spotlight, and the last twenty years of results haven't been pretty for them.  

 

It turns out that the personal touch isn't quite as important as retailers liked to think.

 

So why hasn't health care been more disrupted by the Internet?  Well, for one thing, when you buy a book online, your state doesn't require that you buy it from a bookstore that is licensed by its not-so-friendly licensing board, as is true with seeing doctors over the internet.  

Strike one for disruption.

For another thing, we (usually) trust our doctors.  Then again, we used to trust recommendations from bookstore staff too.  That is, when they had time for us, if they seemed knowledgeable, and if they were making recommendations that fit us rather than just their own preferences.

Think the same thing won't happen when AI 
gets better at diagnoses? 


Let's go back to Mr. Mims three lessons and see how they apply to health care:

·         Data is King: Health care collects a lot of data, and will get even more with all the new sensors.  The big tech companies know their customers very well and tailor interactions accordingly; health care must as well.

·         Personalization + Automation = Profits:, We're stuck in waiting rooms, filling out forms we've already filled out elsewhere. That is not a personal experience that can survive in the 21st century.  It has to be smoother, faster, and friction-less.  

·         Legacy Tech Won't Cut It: EHRs that no one likes.  Claims systems that take weeks to process a claim.  Billing processes that produce bills no one can understand.   The list could go on almost indefinitely.  All too often, health care's tech is not ready for prime time.  

 

The question is, are health care's leaders learning these lessons?

 

The future of retail appears to be in "clicks-and-mortar" (or "bricks-and-clicks").  

 

Health care can act like B Dalton or Borders, assuming until it is too late that their consumers will visit them in person, because they always had.  Or it can act now to jump to the data-driven "clicks-and-mortar" approach that other retail businesses are moving to.  

 

Health care organizations which get that right will be the one to survive.  


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

 
Wednesday
Feb222017

The Good, the Bad, and the Ugly in Health Care

By Kim Bellard, February 22, 2017

 

I hate being a patient.

 

My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family.  The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient.

I offer what I consider the Good, the Bad, and the Ugly of the experience.

The Good:  The People
The various people involved in my care, from the most highly trained physician to the person who delivered meals, were great. I loved my nurses.  I liked my doctors a lot.  The aides, the lab techs, the imaging tech, the transportation specialists -- all of them doing jobs that I wouldn't be able to do -- were each friendly and helpful, taking pride in what they did and how it helped my care. 

The Bad: The Processes
On the other hand, on the lists of criticisms about our health care system, many of its rules and processes truly do deserve a place.  They're like part of an arcane game no one really understands. 

I'll offer three examples:

 

  • ·         Check-in
  • ·         NPO
  • ·         Discharge

 

The Ugly: The Technology

Oh, health care technology.  It is equally capable of delighting as it is of frustrating.  It is truly remarkable that the doctor could go up my arm to perform a procedure in my chest, just as the detail an MRI provides is simply astonishing.  

 

Let's start with the perennial whipping boy, EHRs.  On many occasions, EHRs did not mean that people did not still often have to drag in other electronic equipment or even paper in order for them to do their job.

 

MRIs are a wonderful technology, but as I was laying in that claustrophobic tube getting imaged, I kept thinking: what the heck are all those clanging noises?  

 

I was on various forms of monitoring devices, the smallest of which was the size of a 1980's cell phone and still required countless wires attached to numerous leads.  I kept wondering, hmm, have these people heard of Bluetooth?  Do they know about wearables?

 

My favorite example of ugly technology, though, came when I had to fill out a form, so that it could be faxed to the appropriate department.  

 

No health care system is perfect.  Every system has its own version of the Good, the Bad, and the Ugly. Our system can do better.  Let's give all those great people working in health care a better chance to help us.


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

Friday
Nov042016

The Somewhat Confident but Confused Open Enrollment Consumer

By Clive Riddle, November 4, 2016

This November, many consumers across the country are voting on more than a President, Congressmen and a hot mess of ballot propositions. They are also voting on their health insurance coverage for 2017. And many consumers may be more befuddled about choosing their health plan than their choices at the ballot box.

PolicyGenius has just released their Health Insurance Literacy Survey that “reveals 2017 open enrollment shoppers are overconfident in health insurance knowledge and under prepared to select a new plan.” Here’s an excpert from the infographic PolicyGenius provided on their findings:

Here’s additional PolicyGenius findings from the survey:

  • There was 22% gap between women’s self-rated confidence in their knowledge of insurance terms and their actual comprehension, compared with a 29% gap for men.
  • Millennials had a 29% gap between their confidence and comprehension.
  • 72% of those with non-employer-provided health insurance policies plan to shop on the open marketplace for coverage this year.
  • Most insured Americans are satisfied with their current plan, at 70% of total respondents
  • People who used their health insurance 2-3 times in the past year are 12% more likely to be satisfied with their plan than those who used it just once
  • Millennials are most likely to be satisfied with their health insurance plan, at 77%.
  • There is no variation in plan satisfaction between those who have individual insurance versus employer-provided insurance.
  • More than half of respondents aren’t very confident in their ability to choose the best health insurance plan for their needs.
  • Only one-third of women overall are “very confident” in their ability to choose the best health insurance plan for their needs.
  • The two groups that showed the highest confidence in their ability to choose the best plan were men at 58% and millennials at 43%.
  • The survey found higher confidence levels in men over women (12% difference) and younger vs older respondents (millennials were most confident at 43%, 10% more than ages 45-55) in their ability to choose the best plan.

Sticking with the confusion theme, Walgreens has just released results of a survey of 1,000 Medicare Part D beneficiaries in advance of the Medicare open enrollment. Here’s what they found:

  • 34% aren’t taking time to review their prescription drug plan prior to renewing it
  • 19% don’t have a good understanding of their plan
  • 22% look at just one component, checking, for example, to see if their own medications are covered, yet not looking at any other important considerations
  • 21% falsely believes that all pharmacies charge the same copay
  • 33% don’t know they can switch pharmacies outside of the enrollment period, at any time of year.
  • 30% said copay costs are the most important factor, followed by pharmacy location (18%) and the opportunity for one-stop shopping (18 percent).