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Entries in Consumers (72)

Friday
May102019

Consumer Insights and Kaiser Initiative on SDOH

By Clive Riddle, May 10, 2019

McKinsey has just published various insights from their 2019 Consumer Social Determinants of Health Survey, which found that compared to those whose social need is met, respondents (2,010 surveyed with government program coverage or uninsured and below 250% of federal poverty level) that:

  • Reported food insecurity were 2.4 times more likely to report multiple ER visits, and 2,0 times more likely to be hospitalized
  • Reported unmet transportation needs were 2.6 times more likely to report multiple ER visits, and 2,2 times more likely to be hospitalized
  • Reported unmet community safety needs were 3.2 times more likely to report multiple ER visits

Encouraging news from the survey for health plan advocates of SDOH was that 85% of respondents reporting unmet social needs said they would use a social program offered by their health insurer. Regardless of their social needs, respondents were interested in these types of health plan SDOH programs as follows: 

  • 50% were interested in grocery store discounts for healthy foods
  • 48% were interested in free memberships at local gyms
  • 45% were interested in a wellness dollar account used towards wellness services of their choice
  • 41% were interested in total reimbursement of home improvement purchases to address health issues
  • 40% were interested in after-hours drop-in clinics at lower or no cost 

Speaking of health plans, Kaiser Permanente has just announced their new Thrive Local initiative, a “a social care coordination platform” with “a network of public agencies and community-based organizations that will support” Kaiser “members to meet their social needs.”

 

Kaiser says that “starting this summer, closed-loop and bidirectional communication will provide confidence that referral, follow-up and ongoing patient/family engagement happen. Improved cross-sector collaboration and communication will also reduce the unintentional trauma and stigma that our patients and families may experience. Beyond Kaiser Permanente members and patients, community-based organizations will also benefit through improved decision support, automation, and relevance of the referrals they receive from their health system. This connectivity and interoperability between health care and social organizations and agencies will redefine the meaning of ‘provider network’ in this new world as the network of providers of health, health care, and social needs to address total health of our communities.”

 

Kaiser Permanente is partnering with Unite Us to launch the program, as tells us that Thrive Local within three years “will be available to all of Kaiser Permanente’s 12.3 million members and the 68 million people in the communities Kaiser Permanente serves.


 

 

 

Friday
Feb152019

Speaking Tooth to Power: J.D. Power Releases Dental Plan Satisfaction Report

By Clive Riddle, February 15, 2019 

J.D. Power has released their annual Dental Plan Satisfaction Report for 2018, which finds that “overall dental plan customer satisfaction has improved by 5 points (on a 1,000-point scale) to 775 from 2017.”  

J.D. Power reports that “DentaQuest (805) ranks highest, performing particularly well in the customer service, communication, and cost factors. HumanaDental (784) ranks second and myCignaDental (782) ranks third.” 

And just who is DentaQuest, who has now been ranked first for the third year in a row? They tout that they “manage dental and vision benefits for more than 27 million Americans and provide direct care to patients through our network of more than 85 oral health centers in five states,” and that they provide “dental solutions for Medicaid and CHIP, Medicare Advantage, small and large businesses and individuals throughout the U.S.” 

Steve Pollock, president and chief executive officer of DentaQuest.  Pollock says the company’s continued investment in technology and person-centered care solutions as reasons for the high customer satisfaction. “While it is incredibly gratifying to see the high satisfaction among our members, we know that true success means ensuring everyone has access to quality oral health care,” Pollock said. “Our Preventistry™ platform, which is a prevention-based approach that defines oral health as more than visits to the dentist, will ultimately improve oral health for all.”

Friday
Dec072018

Premium and Deductible Cost Sharing: A Dozen Key Findings from the Commonwealth Fund

by Clive Riddle, December 7, 2018 

CMS has just touted the National Health Expenditure growth of 3.9% for 2017 is at historic low levels, with the Office of the Actuary stating “prior to the coverage expansions and temporary high growth in prescription drug spending during that same period, health spending was growing at historically low rates. In 2017, health care spending growth returned to these lower rates and the health spending share of GDP stabilized for the first time since 2013.” 

Meanwhile, The Commonwealth Fund paints a different picture from another perspective, and has just released a 21-page DataBrief: The Cost of Employer Insurance Is a Growing Burden for Middle Income Families, with lead author Sara Collins commenting “The cost of employer health insurance premiums and deductibles continues to outpace growth in workers’ wages. This is concerning, because it may put both coverage and health care out of reach for people who need it most — people with low incomes and those with health problems. Policies that would reduce health care burdens on employees include fixing the Affordable Care Act’s family coverage glitch, requiring employers to exclude some services from the deductible, and increasing the required minimum value of employer plans.” 

The Commonwealth Fund tells us their study uses “the latest data from the federal Medical Expenditure Panel Survey–Insurance Component (MEPS–IC) to examine trends in employer premiums at the state level to see how much workers and their families are paying for their employer coverage in terms of premium contributions and deductibles. We examine the size of these costs relative to income for those at the midrange of income distribution.” 

Here’s a dozen key findings: 

  1. Average employee premium contributions for single and family plans amounted to nearly 7 percent of U.S. median income in 2017, up from 5 percent in 2008. 
  2. In 11 states (Arizona, Delaware, Florida, Georgia, Louisiana, Mississippi, Nevada, New Mexico, North Carolina, Oklahoma, Texas), premium contributions were 8 percent of median income or more, with a high of 10.2 percent in Louisiana.
  3. Premium and deductible costs amounted to nearly 12 percent of median income in 2017. Added together, the total cost of premiums to workers and potential spending on deductibles for both single and family policies climbed to $7,240 a year in 2017. 
  4. This combined cost ranged from a low of $4,664 in Hawaii to a high of more than $8,000 in eight states (Alaska, Arizona, Delaware, New Hampshire, North Carolina, South Dakota, Texas, Virginia). 
  5. In two states, Mississippi and Louisiana, these combined costs rose to 15 percent or more of median income.
  6. Premiums for employer health plans rose sharply in nearly every state in 2017. After climbing modestly between 2011 and 2016, overall premiums for employer health plans (employer and employee share) grew more sharply in 2017, by 4.4 percent for single plans and 5.5 percent for family plans. 
  7. Annual single person premiums rose above $7,000 in eight states (Alaska, Connecticut, Delaware, Massachusetts, New Jersey, New York, Rhode Island, Wyoming) and family premiums were $20,000 or higher in seven states (Alaska, Connecticut, Massachusetts, New Jersey, New York, West Virginia, Wyoming) and the District of Columbia. 
  8. Average premiums for families increased overall in 44 states and the District of Columbia.
  9. As employer premiums have risen, so have workers’ contributions. Between 2016 and 2017, employee premium contributions rose by 6.8 percent to $1,415 for single-person plans and by 5.3 percent to $5,218 for family plans.
  10. Contributions for single plans increased in 32 states, ranging from a low of $675 in Hawaii to a high of $1,747 in Massachusetts. 
  11. Contributions for family plans rose in 35 states and the District of Columbia, with the lowest increase in Michigan ($3,646) and the highest in Delaware ($6,533).
  12. The average deductible for single policies rose to $1,808 in 2017, a 6.6 percent increase. Average deductibles rose in 35 states and the District of Columbia, ranging from a low of $863 in Hawaii to a high of about $2,300 in Maine and New Hampshire.

 

Friday
Oct262018

Two Reports on Cost Driven Deferred Medical Care

By Clive Riddle

Two reports were published this week on deferred medical care driven by cost considerations, based on survey findings. Earnin’s report: Waiting to Feel Better: Survey Reveals Cost Delays Timely Care is based on two surveys – a commissioned online Harris Poll among over 2,000 U.S. adults and an Earnin poll of their users, “many of which live paycheck to paycheck.” AccessOne’s report: AccessOne Patient Finance Survey- Analysis on how healthcare costs impact is based on a survey conducted by ORC International of 693 people with at least $35,000 in annual household income, weighted by age, sex, geographic region, race and education.

Earnin tells that 54% of Americans “have delayed medical care for themselves in the past 12 months because they could not afford it, “ with the top three most delayed types of care being dental/orthodontic work (55%), eye care (43%), and annual exams (30%.) Earnin reports that “23 percen) have put off getting medical care for more than one year because they could not afford it. Among those whose household is living paycheck to paycheck or not making enough to get by, the rate of this extremely delayed care averages 36 percent. Nearly half of Americans (49 percent) say their health tends to take a back seat to other financial obligations.”

 

AccessOne reports that “Twenty-seven percent of households with children are likely to delay care because they can’t afford to pay for it.” Focusing on the dollar amounts involved and financing issues, they tell us that
  • 21% of families who had trouble paying their medical bill reported that their accounts had been sent to collections.
  • More than half of respondents were concerned about their ability to pay a medical bill of less than $1,000; with 35 percent being concerned about paying a bill that totals less than $500 – 20 times less than the average healthcare balance of a person in the U.S.
  • Only 21 percent of respondents said their healthcare providers have spoken to them about available patient financing options in the past two years.
  • Fifty-five percent of those surveyed said they prefer to discuss healthcare costs and financing options before care of service is delivered.
  • Fifty-four percent of those surveyed said they would use a no-interest financing option for a balance of $1,000 or less, and 57 percent said availability of a no-interest finance option is important or very important in evaluating a provider.
So if the AccessOne report implications bear out that improving financing options up front will reduce deferred medical care, the question is, will our younger generations that have had to assume much greater overall burden of college debt, also assume a growing burden of medical debt?

 

Wednesday
Jul252018

The Sounds of Silence

By Kim Bellard, July 25, 2018

Listen closely, healthcare organizations and professionals: those sounds you are not hearing are the voices of people not speaking up, including patients. And that’s a problem.

Let’s start with the elephant in the room: a new study found that even when physicians actually asked patients why they were there, on average they only listened to the patient’s explanation for eleven — that’s 11 — seconds before interrupting them.

Think about that, and then think back to a doctor’s visit you had about something that was worrying you: could you have explained it in eleven seconds?

Believe it or not, that’s not the worst of it. Only 36% of the time did patients even get a chance to explain why they were there. Even then, two-thirds of them were interrupted before they had finished.

Primary care doctors did better, allowing 49% of patients to explain their agenda for being there, versus only 20% for specialists. Hurray for the primary care physicians…

The researchers say there are many reasons why physicians aren’t listening better, including time constraints, burnout, and lack of communications training. But still…11 seconds? For the minority that even get the chance to talk?

As Bruce Y. Lee said in Forbes, “A doctor’s visit shouldn’t feel like a Shark Tank pitch.”

As bad as this is, it is not the only area where not feeling able to speak up is a problem in healthcare. For example, a study in BMJ Quality and Safety found that 50% to 70% of family members with a loved one in the ICU were hesitant to speak about common care situations with safety implications.

It’s not just patients who are silenced. One study found that 90% of nurses don’t speak up to a physician even when they know a patient’s safety is at risk. Another survey, of medical students in their final year of school, found that 42% had experienced harassment and 84% had experienced belittlement.

A couple of years ago ProPublicalooked at why physicians stay silent about other physicians they know commit medical errors, including ones who do so repeatedly. One physician, speaking about his hospital, told them:

There’s not a culture where people care about feedback. You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.

It’s about power: who has it, or at least who we think has it. We trust our doctors (although not as much as our nurses!). We assume that more experienced doctors have more knowledge than newer doctors, that doctors know more than nurses, and that healthcare professionals know more than we do. We’re at the bottom of the knowledge tree.

But that may not be true. Dave deBronkart — e-patient Dave — likes to cite Warner Slack’s great quote: “Patients are the most underused resource.”

But healthcare professionals must be willing to listen, and they must ensure that they ask. And we must take the initiative to speak up.

Our values are wrong if we allow reimbursement considerations to squeeze our time with physicians to the point we’re not talking and they’re not listening. Our values are wrong if we’re conditioned to think our opinions and concerns do not matter. Our values are wrong if everyone is not only empowered but also expected to speak up, especially when we see or experience something we think is a problem.

Anybody listening?

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