Entries in Surveys & Reports (68)


State Health Care Prison Spending by the Numbers

by Clive Riddle, July 10, 2014

The State Health Care Spending Project, an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, has been monitoring and analyzing prison healthcare costs for some time, and Pew has just released a new 32-page report: State Prison Health Care Spending: An Examination.

This is on the heels of their report Managing Prison Health Care Spending first released last October, which covered the period of 2001 – 2008, and found that spending sharply increased in most states during that time period. The new report analyzes spending from 2007 – 2011 and found “state spending on prisoner health care increased from fiscal years 2007 to 2011, but it is trending downward from its peak in 2009.”

The new report concludes: “Correctional health care spending poses a fiscal challenge to state lawmakers, though evidence indicates that spending peaked at the end of the last decade. The situation posed by these expenses may be particularly acute in states where older inmates represent a relatively large proportion of the prison population. Corrections officials will be better positioned to manage their systems effectively with access to rigorous, disaggregated spending and health outcomes data that can be used to identify cost drivers and to evaluate the value and impact of cost-containment initiatives.”

Here’s a compilation of various analysis and findings from the new report, by the numbers:

4 key variable characteristics that affect delivery of health care and increase costs include: (A) Prison population trend; (B)  Older inmates, greater expense; (C) Prevalence of disease and mental illness. And (D) Location and inmate transportation.

4 strategies being used to manage costs are: (A) use of telehealth technologies; (B) outsourcing of prison health care, (C) enrollment of prisoners in Medicaid, and (D) appropriately paroling older and/or ill inmates.

37% of health care spending was on general medical care (20% was on hospitalizations; 14% on pharmaceuticals; 14% on mental health; 5% on substance abuse)

39 States saw per-inmate health care spending rise from fiscal 2007-2011, with a median growth of 10%.

41 States experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%.

34 States saw their total correctional health care spending peak before fiscal 2011

40 Of 42 states surveyed experienced a rise in the share of older inmates from fiscal 2007-2011

204% increase in the number of state and federal prisoners age 55 and older

from 1999–2012

$441 million - The amount of California’s decrease in spending from fiscal 2009 to 2011 accounting for most of the national decline of half a billion dollars during that time

$7.7 billion total prison health care spending in fiscal 2011

$8.2 billion total prison health care spending in fiscal 2009


athenahealth Annual PayerView Report Ranks Human Top Plan Again For Providersa

by Clive Riddle, June 6, 2014

athenahealth recently released their 2014 PayerView Report, which ranks “commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers.” For the second year in a row, athenahealth found Humana the top performing plan out of 148 plans analyzed.

Here are their rankings for local and national Commercial plans:

  1. Humana
  2. HealthPartners
  3. BCBS of MA
  4. Cigna
  5. Group Health Cooperative
  6. Capital Blue Cross - PA
  7. Care First BCBS - DC
  8. Unicare
  9. BCBS of NC
  10. Neighborhood Health Plan

Four major insights were provided by athenahealth regarding the report:

(1) “ Medicaid's Lackluster Performance Continues - For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as Days in Accounts Receivable (DAR), Denial Rates, and Electronic Remittance Advice (ERA) transparency. “

(2)  “Providers' Burden to Collect on Claims Varies Widely - PayerView data indicates that provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. ..PayerView results reveal that Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection. “

(3) ”Blue Cross Blue Shield Plans Pay Providers the Fastest - As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer Days in Accounts Receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers.”

(4) “Commercial Payers Offer the Most Efficient Enrollments - While Medicaid enrollment proves particularly burdensome, national commercial payers' enrollment proves simplest. “

athenahealth notes that rankings from their report “are derived from athenahealth's athenaNet® database, which to date includes more than 52,000 providers across 50 states. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.”



RWJF Examines Current and Future Coverage Eligibility For the Uninsured – It’s a State by State Issue

By Clive Riddle, May 30, 2014

The Robert Wood Johnson Foundation, in conjunction with the Urban Institute, has just issued a nine-page Issue Brief: Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.

The Urban Institute authors, Matthew Buettgens, Genevieve M. Kenney, and Hannah Recht found that:

  • This year, under the ACA, 56% of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP or subsidized private coverage through the new marketplaces.
  • In states that expanded Medicaid eligibility under the ACA, 68% of the uninsured became eligible for assistance, compared with 44% in states that have not expanded Medicaid.
  • If states that have not expanded Medicaid eligibility were to do so, 71% of their uninsured would be eligible for assistance.
  • Among states expanding Medicaid, the ACA is projected to reduce the number of uninsured people by 56%, compared with a 34% reduction among states not expanding Medicaid.
  • If the states that have not expanded eligibility were to do so, the number of uninsured in those states would decrease by 59% 

The authors note that the “Medicaid expansion states with the lowest share of uninsured eligible for assistance tend to be those in which Medicaid eligibility for adults had already been expanded above minimum required levels before the ACA.”

Given the state decisions are the determining factor, what is the range of eligible uninsureds in the non-Medicaid expansion states, and where is the low end based? Look South. The Authors state that “with the exception of Wisconsin, the share of the uninsured in nonexpanding states eligible for assistance ranges from 40 percent in Texas to 58 percent in Alaska and Maine. The states with the lowest shares eligible for assistance (Texas, Mississippi, Louisiana, and Georgia) have particularly large shares of residents below 100 percent of FPL. [What’s up with Wisconsin? The authors note that Wisconsin changed its Medicaid Waiver in 2014 and “therefore, Wisconsin resembles a Medicaid expansion state.”]

The top five states (all expansion states) by percentage eligible for any assistance, along with the projected percentage decrease in uninsured under the ACA:

1. West Virginia – 83% Eligible / 76% decrease in uninsureds

2. Kentucky – 82% Eligible / 63% decrease in uninsureds

3. Michigan – 81% Eligible /64% decrease in uninsureds

4. Ohio – 81% Eligible / 65% decrease in uninsureds

5. North Dakota – 80% Eligible / 64% decrease in uninsureds

Conversely, here’s the bottom five states (all non expansion states):

50. Texas – 40% Eligible / 31% decrease in uninsureds

49. Mississippi – 42% Eligible / 31% decrease in uninsureds

48. Louisiana -– 42% Eligible / 32% decrease in uninsureds

47. Georgia – 42% Eligible / 30% decrease in uninsureds

46. Alabama -– 43% Eligible / 28% decrease in uninsureds


Practice Profitability Index: Physicians Bearish on the Year Ahead

By Clive Riddle, May 9, 2014

CareCloud, in partnership with QuantiaMD, has just released their second annual Practice Profitability Index report. The ten-page 2014 report, “intended to serve as an annual barometer for the operational wellbeing of U.S. medical groups in the year ahead,” finds that “U.S. physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014,” as they illustrate with survey results in this portion of an infographic provided in conjunction with the report.

Of course, as the healthcare landscape evolves and trends for integration continues to gradually gather steam, those remaining in private practice may view themselves in an increasingly embattled or even endangered species. Albert Santalo, CareCloud Chairman and CEO  tells us, “physicians are experiencing increasing strain on their practice operations as a result of healthcare reform and government mandates. This strain, in turn, affects patients – including the millions of new ones entering the system as a result of the Affordable Care Act.  Nearly half of physicians say they cannot take on these patients, foreshadowing an access to care issue. Meanwhile, despite the hype about emerging reimbursement models, physicians are most likely to seek improvements through programs that help them engage with their sickest and most vulnerable patients.”

The Practice Profitability Index involves gathering insights via an interactive online questionnaire and related discussion groups. This year, 5,064 physicians participated during March, 2014. Here’s highlights of findings presented in the report: 

  • Physicians with a negative outlook increased from 36% to 39% during the past year
  • Physician optimists declined from 22% to 19%.
  • The detailed breakdown of responses for profitability trending was 5% very positive; 14% somewhat positive; 30% about the same; 29% somewhat negative; 10% very negative; and 12% not sure.
  • Their top financial concerns are: declining reimbursements (60%); rising costs (50%); requirements from the Affordable Care Act (49%); and the transition to ICD-10 (43%).
  • The percentage of doctors spending more than one day a week on paperwork rose sharply between 2013 and 2014, from 58% to 70%.
  • 23% spend more than 40% of their time on administration, up from 15% last year.
  • 40% of physicians indicated patient engagement programs hold the greatest promise for improving their practice performance in 2014.
  • Other responses for improving performance including new alliances with other providers (21%), ACO participation (11%) and mobile technologies (11%)
  • The survey was taken before the minimum one-year delay to the ICD-10 code transition, originally scheduled for October 2014, but at that time 44% did not know whether they would be ready. Another 25% were certain they would not be prepared and faced high transition and upgrade costs.
  • Of the 48% of respondents that own their practice, 24% of these physicians are considering selling the practice, up from 21% in 2013. 53% are not looking to sell at all, down from 50% in 20

Humana Study Measures Claims Costs and Absence Rate by level of Wellness Program Engagement

By Clive Riddle, May 2, 2014

Humana has released findings from their HumanaVitality Health Claims and Productivity Impact Study of Humana employees. HumanaVitality is a joint venture between Humana Inc. and Discovery Holdings, Ltd. That serves 3.5+ million members and “is a data-driven wellness and rewards program that motivates members to make healthier life choices.”

Humana touts that “the two-year study found improved health, as shown through lower health care costs and fewer unscheduled absences, among employees who actively participated in the HumanaVitality program.”

Here’s their specific findings:

  • Unengaged members in both years averaged $53 more per month spent on health care claims than members who were engaged in HumanaVitality both years.
  • The largest impact on health care costs was on members with lifestyle-related chronic conditions like high blood pressure or diabetes. Engaged members with these conditions had 60 percent lower health claims costs than unengaged members with these conditions.
  • Another way of stating this: Unengaged members with lifestyle-related chronic conditions had 101% higher claims costs than the total population, while engaged members with these chronic conditions had 41% higher claims costs than the total population
  • Unscheduled absences were 56.3 percent higher among unengaged members in both years than engaged members
  • Members who were unengaged the first year but engaged the second year had 29% higher unscheduled absence and an average of $28 per month in claims costs than members who engaged both years

Humana shared this about the study methodology: “This study was performed on a cohort of Humana associates that were on a Humana employee medical health plan for a full 12 months in at least two consecutive plan years over the study period. The study was conducted by Humana actuaries for the following time period: Baseline Year (July 2010 – June 2011), Year 1 of the HumanaVitality program (July 2011 – June 2012) and Year 2 of the HumanaVitality program (July 2012 – June 2013). Only Humana employees were included in the study; individuals with high cost claims (>= $ 150,000 in the Baseline Year, Year 1 or Year 2) were removed from the sample. The final sample size was 13,046 members in the Year 1 analysis and 16,296 members in the Year 2 analysis.”