Entries in Surveys & Reports (92)


Provider Collaboration – Bundled Payments Top Survey Results for Impact on Medicaid Transformation

by Clive Riddle, December 11, 2015

MCOL has just released results from its second annual Medicaid Transformation e-poll of stakeholders interested in Medicaid transformation. Last year, when respondents were asked to a rank of topics for their impact on Medicaid Transformation, with 1 being the top rank, Provider Collaboration/Engagement and Risk Sharing virtually tied with State Medicaid Funding and ACA participation for the top spot (based on weighted average rank). This year, there was some separation between the two, with Provider Collaboration taking the top spot. Breaking down these results by category of respondents, providers definitively gave collaboration the top ranking, while purchasers and vendors/others results were more mixed.

When asked which type of provider collaboration would have the most impact, last year’s results were mixed, but this year bundled payments and other new payment models emerged as the clear top choice. Interestingly, perceived Medicaid ACO impact reduced this year from last, with providers seeing ACOs having less impact than purchasers or vendors/others.

Below are table of the results broken out by respondent category, along with 2015 and 2014 totals:


Taking an early Post ICD10 Transition Pulse from Five Surveys

by Clive Riddle, December 3, 2015

As time ticks by after the October 1st ICD10 transition, early survey results are coming in regarding the impact and implications for providers. Let’s take a look at these initial findings:

KPMG has just released results from a survey of 298 attendees of a Nov 9th ICD10 webcast for providers, which found:

  • 28 percent saying the transition has been smooth
  • 51 percent found “a few technical issues, but overall successful.”
  • 11 percent described the transition as a “failure to operate in an ICD-10 environment.”

 Survey respondents listed challenges they see with ICD-10 as:

  1. rejected medical claims
  2. clinical documentation and physician education
  3. reduced revenue from coding delays
  4. information technology fixes

The survey found 42 percent of respondents said all of these challenges are part of ICD-10. 11 percent of claimants said they did not expect those challenges to arise.

46 percent of respondents said they were thinking of pursuing initiatives in clinical documentation improvement, revenue cycle optimization, and electronic health record and IT system optimization. 25 percent were pursuing none of those options.

Last month, Healthcare Informatics reported on a survey from Himagine Solutions that found “Large hospitals have reported a 30 to 45 percent productivity reduction on the inpatient side and a 20 to 40 percent productivity reduction on the outpatient side since implementation the ICD-10 codes.”

Also last month, the vendor Kareo announced that 99 percent of client claims submitted in the first month of the ICD-10 coding transition were successful, and 87 percent of clients have already been paid for at least one submitted claim. 11 days was the average time to payment for ICD-10 claims. Kareo also surveyed its customer base directly to gauge its experience with the transition. Based on customer responses, 57 percent of respondents considered the ICD-10 transition “easy” or “very easy.” Just three percent of respondents considered the transition “difficult,” or “very difficult.” The remaining 40 percent considered the event “moderate.”

Executive Insight reported that “in early October, Navicure, a claims management and patient payment solutions provider, only processed 50% of the medical claims processing it would've in pre-ICD-10 months, which could have been a result of providers' caution along with a mix of ICD-9 claims from the previous month. Towards the end of October, however, data showed that claims gradually increased to 90% of the pre-transition volume. Rejections, too, are staying in a manageable range rather than spiking like many healthcare experts anticipated.”

Finally, Information Management reported on a SERMO survey in which “physicians were asked if the new requirement to use ICD-10 has taken away time from patients. Two-thirds of responding doctors said yes. The poll of 1,249 physicians was conducted from November 20 to 30. Although doctors strongly indicated that the code switchover has detracted from patient care, that percentage is down significantly from a SERMO poll last month that asked members if ICD-10 was taking their time away from patient care. At that time, 86 percent said it had negatively impacted patient care while only 14 percent said it had not.”


The Prescription Drug Locomotive and the U.S Big Slice of the Global Rx Pie

by Clive Riddle, November 20, 2015

With prescription drug spending now having taken over the locomotive of the healthcare cost train, it behooves stakeholders to better get to know what lies on the tracks ahead. The IMS Institute for Healthcare Informatics has just released the 47-page report: Global Medicines Use in 2020:  Outlook and Implications in which they examine the global use of medicines and spending levels in 2020, including small and large molecules, brands and generics, those dispensed in retail pharmaceutics as well as those used in hospital or clinic settings.

IMS tells us the report “found that total global spend for pharmaceuticals will increase by $349 billion on a constant-dollar basis, compared with $182 billion during the past five years. Spending is measured at the ex-manufacturer level before adjusting for rebates, discounts, taxes and other adjustments that affect net sales received by manufacturers. The impact of these factors is estimated to reduce growth by $90 billion, or approximately 25 percent of the growth forecast through 2020.”

The report also tells as that “developed markets will contribute 63% of the spending, led by the U.S.  Original brands will represent 52% of spending and 85% of global spending will be for medicines to treat non-communicable diseases.” 

A pie chart exhibit in the report is telling in how large the U.S. slice of the medicine spending pie is projected for 2020 – 41% of global spending, with the next closest slice being the entire European Union at 13%.

Report findings on spending impacting U.S. costs include:

  • Brand spending in developed markets will rise by $298 billion as new products are launched and as price increases are applied in the U.S., most of which will be offset by off-invoice discounts and rebates. 
  • Patent expiries are expected to result in $178 billion in reduced spending on branded products, including $41 billion in savings on biologics as biosimilars become more widely adopted. 
  • Many of the newest treatments are specialty medicines used to address chronic, rare or genetic diseases and yielding significant clinical value. By 2020, global spending on these medicines is expected to reach 28 percent of the total.
  • More than 90 percent of U.S. medicines will be dispensed as generics by 2020. Generic medicines will continue to provide the vast majority of the prescription drug usage in the U.S., rising from 88 percent to 91-92 percent of all prescriptions dispensed by 2020. 
  • Spending on medicines in the U.S. will reach $560-590 billion, a 34 percent increase in spending over 2015 on an invoice price basis. 
  • While invoice price growth – which does not reflect discounts and rebates received by payers – is expected to continue at historic levels during the next five years, net price trends for protected brands will remain constrained by payers and competition, resulting in 5-7 percent annual price increases. 

Some international findings include:

  • Global medicine use in 2020 will reach 4.5 trillion doses, up 24 percent from 2015.
  • Most of the global increase in use of medicines over the next five years will take place in pharmerging markets, with India, China, Brazil and Indonesia representing nearly half of that growth.
  • Generics, non-original branded and over the counter (OTC) products will account for 88 percent of total medicine use in pharmerging markets by 2020, and provide the greatest contribution to increased access to medicines in those countries. 
  • Newer specialty medicines, which typically have low adoption rates in pharmerging countries lacking the necessary healthcare infrastructure, will represent less than one percent of the total volume in those markets.
  • Global spending will grow by 29-32 percent through 2020, compared with an increase of 35 percent in the prior five years. 
  • Spending levels will be driven by branded drugs primarily in developed markets, along with the greater use of generics in pharmerging markets—offset by the impact of patent expiries. 

A Definitive Study and Reference Resource on Healthcare Cost and Utilization

By Clive Riddle, October 30, 2015

The Health Care Cost Institute (HCCI) has just released its free 26-page 2014 Health Care Cost and Utilization Report, and 92-page Appendix, which provide a definitive examination of detailed U.S. health care cost and utilization component line items and demographics. Their study – as with other major cost studies released this year – put a lot of focus on increases in prescription drug prices.

They found the costs increased 3.4 percent in 2014, with overall utilization decreasing somewhat, while prices for all categories of services rose.  Average spending per person was $4,967, up $163, including out-of-pocket spending of $810 that grew 2.2%.

With prescription costs standing out, they note that “despite a nearly 16 percent decrease in use of brand prescriptions, spending on these prescriptions jumped by $45 per capita in 2014—an increase four times larger than in 2013. Much of this increase was due to use of high-priced Hepatitis C drugs Olysio, Sovaldi, and Harvoni, which became available starting in late 2013.”

Here’s some other key findings:

  • “In 2014, the largest decline in use (-2.7%) was for acute admissions, which fell by 1 admission per 1,000 individuals. The smallest decline in use (-0.9%) was for outpatient visits, which fell by 3 visits per 1,000 individuals.”
  • “The smallest average price increase was for professional services (3.1%), an increase of $3 per service. The largest average price increase was for acute inpatient admissions (4.6%), an increase of $831 per admission.”
  • “Spending out of pocket on acute inpatient admissions (–$1) and on brand (–$9) and generic (–$4) prescriptions decreased by $14 per capita in 2014 compared to the previous year, while spending out of pocket on outpatient ($16) and professional ($15) services increased by a total of $31 per capita in 2014.”
  • “Every year between 2010 and 2014, out-of-pocket spending was higher by women than by men. This difference grew every year, reaching $237 in 2014.”
  • “The difference in spending between the oldest and youngest age groups studied increased every year studied: from $6,281 in 2010 to $6,806 in 2014. In 2014, spending was $2,660 for children ages 0-18 and $9,466 for pre-Medicare adults, ages 55-64.”

Consumers and Physicians and Technology in 2015

by Clive Riddle, October 9, 2015
The Deloitte Center for Health Solutions has just released a survey report, Health Care Consumer Engagement: No One-Size-Fits-All Approach, which they say shows 'that Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles in acting like consumers instead of passive patients."
Overall, how "techy" are American healthcare consumers? They found "22% used technology to access, store and transmit health records in the last year, up from 13% in 2013. Use was higher for those with major chronic conditions: 32% compared to 19% in 2013."
Deloitte’s findings are that consumer engagement is increasing three ways:
  1. "More consumers today prefer to partner with doctors instead of relying passively on them to make treatment decisions"
  2. "Consumers’ trust in the reliability of information sources is rising"
  3. Consumers are increasingly relying Relying on technology
Here's some of the numbers behind their report, regarding the oercentage of survey consumer respondents: 
  • 28% have used technology to measure fitness and health goals, up from 17% in 2013 (45% of Millennials this year)
  • 23% have used technology to monitor a health issue, versus 15% in 2013
  • 40% of the surveyed technology users have shared their fitness or monitoring information with their doctor
  • 39% with major chronic conditions use tech-based monitoring (22% in 2013)
  • 63% of the surveyed technology users say their use of fitness or monitoring technologies has led to a significant behavior change
  • 13% who take prescription drugs receive electronic alerts or reminders
  • 48% prefer to partner with doctors rather than have them make decisions for them, up from 40% in 2008
  • 34% strongly believe doctors should encourage patients to raise questions
  • 58% feel that doctors should explain treatment costs to them before decisions are made
  • 16% who received care report asking their doctor to consider treatment options other than the one initially recommended.
  • 52% report searching online for health or care-related information; 
  • 16% who needed care went online for cost information, up from 11% in 2013 (27% of Millennials this year)
  • 71% of all those surveyed said they have not gone online for cost information but are "very" or "somewhat" likely to use a pricing tool in the future
  • 25% used a scorecard to compare the performance of doctors, hospitals and/or health plans, up from 19% in 2013 (49% of millennials this year)
What do these numbers mean? Harry Greenspun, M.D.Director of the Deloitte Center for Health Solutions, tells us "not all consumers are alike in how they engage the system, and a large segment still remains disengaged. Companies likely won't take a one-size-fits-all approach in their marketing and operations, but a tailored strategy that considers the unique characteristics of the segments they are most interested in."
Greg Scott, Principal, Vice Chairman and national sector leader for Deloitte's health plans practice, adds "the specter of a more customer-driven industry is causing many health companies to transform into retail-focused organizations, impacting everything from strategy and scale to operations and human capital. For the enterprise, this is about more than a cool app – this is about making the end-to-end changes needed to better identify and engage a more empowered purchaser."
So at the other end of the stethescope, how do doctors feel about using technology in their practices? Geneia just released survey results on this topic - not addressing physician interaction with consumers as discussed above, but rather how physicians relate to EMR, data and analytics.
Heather Lavoie, Geneia's President & Chief Operating Officer, tells us that "seemingly, there is an inverse relationship between health IT spending and physician job satisfaction,..physician sentiment towards technology is surprisingly nuanced. Doctors are indicating that data and analytics tools have the potential to reduce time spent on recordkeeping, one of their primary frustrations, while also contributing to it."
24% of physicians said that EMR impact on practices was positive, 19% negative, 53% a little of both, and 5% said they do not use EMRs. 69% of physicians felt data and analytics tools positively impacted their ability to efficiently assess patient history and needs, 63% said they help them get value and improved outcomes from chart documentation, and nearly 60% felt they helped identify and triage the highest need patients and created greater efficiencies in office workflow.
But Geneia shares that "on the other hand, more than 60% of physicians say that data and analytics tools have negatively impacted recordkeeping time. In fact, when asked to identify the number one way data and analytics could improve their job, the most popular answer was to reduce the time spent on recordkeeping (41%) followed by more time with every patient (22%), better access to patients' complete medical profile and history (20%), and more time with the patients who require enhanced care (14%)."