Entries in Surveys & Reports (87)


The Patient Experience of the Very Elderly

by Clive Riddle, October 2, 2015

Press Ganey has just published a seven page white paper Patient Experience in the Very Elderly: An Emerging Strategic Focus, that in their words, “examines the clinical and strategic benefits for health care organizations creating targeted care strategies for the ‘Very Elderly’ population” which they  define as patients 80 years of age and older.

Thomas H. Lee, MD, Press Ganey’s Chief Medical Officer and a co-author of the paper tells us “most patients in this Very Elderly population claim a ‘poor’ or ‘fair’ health status and tend to have greater and more complex needs. The data suggest their needs are not being met reliably. Organizations that embrace a more focused, compassionate, connected care model have the potential to reduce suffering for this very vulnerable population and mitigate the impact of age and health status on patient experience ratings.”

Press Ganey points out that while only 3.5% of the U.S. population is over 80 years of age - this demographic is a dominant presence in hospitals, emergency departments and outpatient practices, representing “27% of medical service and 12% of surgical service admissions, and their lengths of stays are longer.” Press Ganey’s analysis examined HCAHPS data by service line and age group for 1.5 million patients.

Press Ganey uses HCAHPS patient service ratings as an argument that the medical needs of the Very Elderly are not being adequately met. They note that “the percentage of patients giving top ratings [to providers] steadily increases as patients get older—but then declines for patients above 80 years old. When data “change directions,” the reason is usually two different forces are at work. The most likely explanation for the data in Figure 1 is that the elderly patients have greater needs, and that, in the Very Elderly, failure to meet these needs overcomes the tendency of older patients to give higher ratings to their providers.”

Service ratings of providers that were a 9 or 10 (out of ten) increased by each age group (medical services from 58.6% for age 18-34to 71,2% for ages 65-79; and surgical services from 65.2% for ages 18-34 to 78.2% for ages 65-79; which fell to 69.2% for age 80+ medical services and 75.9% for age 80+ surgical services.)

Press Ganey also points out that “patients in poorer health give lower ratings to their hospitals than do those in better health, regardless of age,” and the HCAHPS data clearly shows a deterioration in reported health status by age. 83% of patients reporting excellent health rating medical service providers 9+ out of ten, compared to 61% reporting poor health. 86% of patients reporting excellent health rating surgical service providers 9+ out of ten, compared to 65% reporting poor health. Press Ganey provides graphs demonstrating that “older patients are more likely to describe their health as fair or poor, and few Very Elderly patients report being in very good or excellent health.”

Press Ganey emphasizes to providers that “taken together, these data demonstrate both an opportunity and a threat. The threat is the risk of losing the patient segments that account for a large proportion of the care delivered by most organizations—the sick elderly. Furthermore, hospital payments might be compromised by lower patient experience scores that result from having more sick Very Elderly patients.” Press Ganey concludes that “this group wants more thorough, communicative care that meets their needs for information, coordination, responsiveness and general hygiene;” and that “providers have the potential to reduce suffering for this very vulnerable population, improve patient experience and market share through focused efforts and team-based care.”

Royal Philips has also just published new study results relating to the elderly’s healthcare experience, with their analysis “demonstrating an insightful correlation between chronic conditions and falls risk. Their researchers” retrospectively analyzed the records of 145,000 seniors equipped with a standard Philips Lifeline medical alert service or a medical alert service with AutoAlert (automatic fall detection) between January 2012 and June 2014.”

Their findings, and national data they highlight in their report include:

  • Seniors with chronic conditions fell and required emergency transport up to 54 percent more often, compared to their peers with no chronic conditions. (they note that one in three seniors fall each year and that 80 percent of the senior population has at least one chronic condition and 68 percent has two or more.)
  • Seniors with physical conditions not typically tied to frailty, including COPD and diabetes, also were shown to fall more often.
  • Among Philips users, seniors who self-reported suffering from three chronic conditions had 15 percent more falls that required hospital transport, and those with five or more conditions had 40 percent more falls than those with no chronic conditions.
  • Within the study population, 72 percent reported having one or more chronic conditions, with 20 percent reporting five or more.
  • The data shows that seniors fell more often and needed hospital transport when reporting the following: Cognitive impairment by 54 percent; COPD by 42 percent; Diabetes by 30 percent; and Heart condition by 29 percent.

Pharmaceutical Industry in Transition

By Clive Riddle, August 7, 2015

KPMG has just conducted a survey of pharmaceutical and medical device companies, finding “their biggest commercial challenges coming from payers, surpassing hurdles posed by regulators, declining access to healthcare providers, and the move toward specialty drugs.”

Based on these findings, KPMG’s Bill Shew, Alison Little and Peter Gilmore have released a twelve-page report:  Change in pharma? Not optional; 10 Integrated imperatives for pharmaceutical commercial transformation.  Page two contains just these 35 words, in large font – which sums up the situation for pharma: “The pharmaceutical industry is caught between a blockbuster-driven past and a future  comprising precision medicine, curative therapies, and payment for outcomes. The years of consistent  double-digit growth and unconstrained pricing power are fading into memory.”

Author Alison Little tells us "life sciences companies face increasingly high demands from payers to prove the value of their products in terms of improved patient outcomes and lower costs. This requires not only clinical and analytical rigor, but increased focus on account management and strategy. This is a significant part of the commercial model for the pharma, biotech and medical device sectors, which need to evolve to compete in the future.  These are dramatic changes in bringing drugs to market and are far removed from the blockbuster model of marketing drugs with large direct-to-consumer advertising budgets and extensive physician detailing. Newer brand name drugs are treating much more complex medical conditions and have more stringent handling and administration requirements than those a decade ago. Pharmaceutical and biotechnology companies need to consider 'beyond the pill' services to help with patient engagement and helping them adhere to treatment."

Their report cites challenges for the industry including a paltry one percent annual growth rate for top 25 life sciences companies in 2014, down from double digits five years ago; and that seventy percent of recent brand launches underperformed analyst forecasts.

Without further adieu, here’s The ten “Imperatives for Commercial Transformation” they elaborate on, in their report:

  1. Use commercial tactics, not clinical data, to differentiate new products
  2. Elevate pricing and contracting within the organization
  3. Take a more holistic approach to stakeholder mapping and prioritization
  4. Base sales models on a collaborative approach to improving outcomes
  5. Play a larger role in the industry transformation from “volume to value”
  6. Support providers in improving quality and patient satisfaction
  7. Leverage data and analytics to enhance commercial strategies
  8. Allocate commercial resources optimally across markets and brands
  9. Evolve performance metrics and incentives to reflect new realities
  10. Drive the transformation agenda throughout the enterprise\

The author’s sum up where the industry needs go from here:  “Pharmaceutical companies need to transform their commercial models so that they can continue to thrive. In our evolving healthcare ecosystem, power centers are shifting, quantifiable outcomes are expected, and companies must demonstrate value for every healthcare dollar spent. We are approaching a tipping point when pharmaceutical companies, no matter the size or therapeutic focus, will no longer be able to view commercial transformation as an aspiration. Instead, they will need to recognize that it is a critical imperative.”


PwC and Milliman Examination of Medical Cost Trends

by Clive Riddle, June 10, 2015

PwC projects a medical cost trend for 2016 of 6.5%, netting down to 4.5% after benefit design changes. Milliman tells us that the 2015 actual trend was 6.3%, up from 5.4% in 2014.

PwC’s Health Research Institute this week released their tenth annual Behind the Numbers report, which includes a “projection for the coming year’s medical cost trend based on analysis of medical costs in the large employer insurance market. In compiling data for 2016, HRI interviewed industry executives, health policy experts and health plan actuaries whose companies cover more than 100 million employer based members.

Milliman released their fifteenth annual Milliman Medical Index report two weeks ago, which is “an actuarial analysis of the projected total cost of healthcare for a hypothetical family of four covered by an employer-sponsored preferred provider organization (PPO) plan. Unlike many other healthcare cost reports, the MMI measures the total cost of healthcare benefits, not just the employer’s share of the costs, and not just premiums. The MMI only includes healthcare costs. It does not include health plan administrative expenses or profit loads.”

With respect to 2015, Milliman found “the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $24,671”, up from $23,215 in 2014. The 2015 family costs works out to $2,055 on a monthly basis.

Milliman emphasizes the importance of the role the Rx costs play in the mix. They note “prescription drug costs spiked significantly, growing by 13.6% from 2014 to 2015. Growth over the previous five years averaged 6.8%. The 2015 spike resulted from the introduction of new specialty drugs as well as price increases in both brand and generic name drugs, increases in use of compound medicines, and other causes. Since the MMI’s inception in 2001, prescription drugs have increased by 9.4% on average, exceeding the 7.7% average trend for all other services. Prescription drug costs now comprise 15.9% of total healthcare spending for our family of four, up from 13.2% in 2001.”

Milliman also highlights the role of cost-sharing, citing that the “total employee cost (payroll deductions plus out-of-pocket expenses) increased by approximately 43% from 2010 to 2015, while employer costs increased by 32%. Of the $24,671 in total healthcare costs for this typical family, $10,473 is paid by the family, $6,408 through payroll deductions, and $4,065 in out-of-pocket expenses incurred at point of care.”

PwC also keys on these two issues for 2016 as well, with drugs as an inflator, and cost-sharing as a deflator of the medical trend.  PwC spotlighted two inflators of the 2016 medical trend: (1) New specialty drugs entering the market in 2015 and 2016 will continue to push health spending growth upward; and (2) Major cyber-security breaches are forcing health companies to step up investments to guard personal health data, adding to the overall cost of delivering care.

PwC notes three factors that serve to "deflate" the 2016 medical cost trend: (1) The Affordable Care Act’s looming “Cadillac tax” on high-priced plans which is accelerating cost-shifting from employers to employees to reduce costs; (2) Greater adoption of “virtual care” technology that can be more efficient and convenient than traditional medical care; and (3) New health advisers helping to steer consumers to more efficient healthcare.

PwC also comments on the longer range medical trend perspective, citing four key cost growth factors H observed over the past decade:

  • The healthcare-spending trajectory has leveled off but is not declining;
  • Cost sharing slows consumer use of health services;
  • Curtailing inpatient care lowers costs; and
  • The ACA has had minimal direct effect on employer health costs.

Positive Trends in the Land of Retail and Workplace Clinics

By Clive Riddle, May 29, 2015

Last month, the Robert Wood Johnson Foundation commissioned Manatt Health to issue an excellent 25 page report:  The Value Proposition of Retail Clinics, in which they remind us that “since first emerging on the health care landscape more than 15 years ago, retail clinics are now a common feature, with 10.5 million visits occurring annually at more than 1,800 retail clinics.

The report emphasizes the potential for current and future collaborations between retail clinic organizations and health care systems, noting “to date, more than 100 partnerships between retail clinics and health systems have been formed, linking care between retail sites and primary care medical homes, expanding after-hours care options and enabling health systems to provide patients with alternatives to emergency departments (EDs). In fact, one study estimated that up to 27 percent of ED visits could be handled appropriately at retail clinics and urgent care centers…”

With respect to the growth and scope of the retail clinic market, just this month CVS  Health’s MinuteClinic announced they  “will open more than 100 new clinics this year and anticipates surpassing 1,500 clinics by 2017,” and they have reached  the cumulative “25 Million Patient Visit Milestone.“

With respect to partnerships during the past month, California Healthline discussed: ”Kaiser-Target Partnership Sign of Times” and CVS Health announced clinical affiliations with Ochsner Health System in Louisiana and the University of Mississippi Medical Center, including their Center for Telehealth.

Meanwhile, on the workplace onsite clinic front, Towers Watson this week released their 2015 Employer-Sponsored Health Care Centers Survey report, which polled  137 U.S. employers in which 105 currently offer employer-sponsored health centers, and 15 are planning to offer by 2018, and represent 4.6 million employees.

Here’s some highlights of Towers Watson’s onsite clinic findings:

  • 38% of large U.S. employers with onsite health facilities plan to add new centers over the next two years,
  • 66% expect to expand or enhance the already broad services they offer by 2018
  • Wellness programs are already available at 86% of the centers
  • Lifestyle coaching to promote and reinforce behavior changes is currently offered at 63% of the centers
  • Half of employer-sponsored health centers now offer some type of pharmacy services, up from 38% in 2012
  • 35% offer telemedicine services, with another 12% planning to in the next two years.
  • 40% have two to five centers
  • 56% have had onsite health centers for over five years
  • 55% are open before 8:00 a.m.; 32% are open after 5:00 p.m., and 16% are open on weekends
  • 64% outsource managing staffing and services at the health centers
  • 23% run the centers themselves
  • 18% use local or regional provider groups or health systems
  • 75% employers with onsite health centers calculate their ROI, up from 47% in 2012

One free resource for those monitoring activities in this sector, the Workplace & Retail Clinic Bulletin, offering free twice monthly e-newsletters.


Patient Reported Outcomes

By Clive Riddle, May 15, 2015

The National Quality Forum defines Patient-Reported Outcomes (PROs) as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else." They elaborate that “in other words, PRO tools measure what patients are able to do and how they feel by asking questions. These tools enable assessment of patient–reported health status for physical, mental, and social well–being.”

The concept is obviously not new, but has certainly been overlooked at times. In an era with tremendous advances and emphasis in patient engagement, mobile health technologies, patient-centered care, we need to continue to see application of PROs receive the attention they deserve.

Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions, tells us "As our healthcare system moves toward a value-based care model, the role of the patient is becoming increasingly important. We need to reframe the way we think about care to include not only the cost and clinical effectiveness of the treatment, but also the burden of disease and therapy on the patient's perceived sense of well-being. Patient-reported outcomes (PRO) are key to this equation, particularly for patients being treated for high-cost, complex diseases such as cancer or rheumatoid arthritis (RA)."

Dr. Feinberg’s organization is presenting a series of new clinical studies demonstrating the potential role of PRO research in improving the quality and reduce the costs of treatment provided to patients with complex diseases, at the International Society of Pharmacoeconomic and Outcomes Research (ISPOR) annual meeting.

Here's an overview of some of the key findings they will be presenting:

  • One study used PRO to demonstrate that rheumatologists significantly underestimated the negative impact of RA disease burden and treatment on their patients' sense of well-being. Understanding this disparity in perceptions can help physicians make effective treatment decisions that lessen the burden on patients – and can sometimes also reduce the costs of their care.
  • Another study showed that PRO can be critical to identifying and managing medication access and adherence challenges for high-cost specialty drugs.
  • Of a total of 239 oncology and rheumatology patients who were contacted at the time of their initial prescription to provide patient reported outcomes, 28% were identified as having problems that either restricted access or adherence to the drug.
  • Armed with this information, interventions and support services were provided to address those challenges. With the support of these interventions, a medication possession ration exceeding 95% was achieved – enabling nearly all patients to initiate or continue treatment.
  • A third study  proved the feasibility of collecting PRO at the point of care. In the clinical study involving 3,185 RA patients, PRO data was captured during 90% of physician visits. The participating physicians were then able to utilize the data to inform real-time treatment decisions at the point of care.