Entries in Trends & Strategies (104)

Wednesday
Apr252018

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview
 

Last week, Erin Benson, Director Marketing Planning and Rich Morino, Director, Strategic Solutions, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on opportunities for health plans to leverage social determinants of health data to attain quality goals while managing cost and enhancing member experience.  If you missed this engaging webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Erin and Rich on five key takeaways from the webinar:

 

1. What are some of the ways that member health is impacted on a daily basis by social, economic and environmental factors?

 

Erin Benson and Rich Morino: The environment in which a person lives impacts their likelihood to develop health conditions as well as their likelihood to effectively manage those conditions. Care recommendations need to be a good fit for a member’s environment, not just their medical condition. If recommendations won’t work within the person’s physical environment, aren’t affordable or conveniently located, and are provided in a way that is hard for the member to understand, they won’t be effective at improving health. Studies support this fact. For example, 75-90% of primary care visits are the result of stress-related factors (JAOA Evaluating the Impact of Stress on Systemic Disease: The MOST Protocol in Primary Care). Money, work and family responsibilities – all reflective of social determinants of health -- are cited as the top three causes of stress (APA 2015).

 

2. We've heard reference to aggregating data at the zip code level for use in personalizing care for members. However, this is one of your top five myths about socio determinants of health. Can you tell us more?

 

Erin Benson and Rich Morino: While aggregate data can be useful in certain capacities, it isn’t recommended as a best practice for personalizing care. Within a single zip code, it is not unusual to see variance in income levels, crime rates and other factors impacting an individual’s neighborhood and built environment, so we recommend looking at an individual’s neighborhood from the perspective of their specific address. Focusing on zip code alone also ignores the influences of education, economic stability and social and community context so we recommend incorporating these other social determinants of health into decision-making in order to view the member holistically and create a more comprehensive plan of care outreach.  

 

3. Can you briefly explain why previous generations of SDOH have failed to improve health outcomes?

 

Erin Benson and Rich Morino: There are two primary reasons why previous generations of SDOH have failed to improve health outcomes, data and workflow.   In order to get sufficient value, the data needs to address all 5 categories of SDOH to properly draw useful insights.  The data should also be at the member level, and address who the member’s family and close associations.  Without that information, we cannot tell if someone is socially isolated or living with caregivers, for instance.

 

The second reason why previous generations of SDOH have failed is how they are deployed in the workflow.  An example would be a plan simply adding them to an existing claims-based model to achieve an increase in lift.  The lift is nice, but no changes in process are filtering down to the Care Management team interacting with the members.   In this scenario, a lot of value was ignored.

 

A better method would be if the plan also built models identifying members with barriers to improved health outcomes.  If you now apply this to your chronic or at-risk population you can determine not just who is sick and in need of help, but how to most likely achieve success in an intervention program.  Care Managers would immediately know the challenges to success, and what type of intervention program the member should be in enrolled in from the start.

 

4. One of the SDOH models to uncover health barriers referenced during your webinar was social isolation. Can you provide more context for us here?

 

Erin Benson and Rich Morino: Studies have shown that social isolation can increase risk of heart disease by 29% and stroke by 32% (New York Times How Social Isolation Is Killing Us). By understanding factors about an individual such as who else is living in the household with them, their predicted marital status, and how close their nearest relatives and associates live to them, healthcare organizations can identify who may be socially isolated. This allows care providers to ask the right questions to determine if that person needs access to social support systems such as support groups or community resources to improve their health outcomes.

 

5. What are some ways social determinants can help health plans enhance predictions and improve care management?

 

Erin Benson and Rich Morino: The most common way of utilizing SDOH data so far has been to incorporate it into existing claims-based predictive models to improve predictive accuracy or to use it to create new predictive models. The second use is for care management purposes and this is where social determinants of health can be truly transformational. We recommend as a best practice to use social determinants of health insights to also build models that identify health barriers. The combination of models allows healthcare organizations to better stratify the risk of their members and then better tailor care to their medical and social needs.

 
Wednesday
Apr182018

No Signatures Required!

No Signatures Required!
 

By Kim Bellard, April 18, 2018

 

If you live in the U.S., you've probably had the experience of paying for a meal using a credit card.  The server takes your card, disappears to somewhere in the back, does something with it that you can't see, and returns with your card, along with two paper receipts, one of which you need to sign.

As of last week, the major credit card companies are no longer requiring that signature.  As a Mastercard person told CNET, "It is the right time to eliminate an antiquated practice."  

No kidding.  Healthcare should be eliminating its antiquated practices too.

Ending the requirement was 
announced last year, went away last week, but its actual demise will happen more slowly, as individual merchants can still require it.  Of course, the signature is only part of the antiquated process.  They're probably not looking up your card number on a monthly list of stolen cards any longer, nor using a manual imprinter to charge your card, but both using the physical card and taking it from you are steps that there are 21st century alternatives to. 

Still, I'd be willing to bet that the credit card companies and merchants bring their processes fully into the 21st century before healthcare does.


Let's go through some of these:

·         Healthcare still relies heavily on faxes. Supposedly it is because of security, "HIPAA," etc., but this reliance is a lot like requiring signatures for credit cards. 

·         In an era of ubiquitous smartphones, healthcare is still making heavy use of pagers, especially within hospitals

·         I can use an AMT pretty much anywhere in the world, and can not only access my bank account to obtain balance or transfer funds, but even to get cash on the spot.  In healthcare, I can't even go to a new doctor or healthcare facility without having to start from ground zero in terms of information about me (unless they are part of a health system I've already used).  

·         Patient portals have proliferated, with more options to do tasks online, but how many times do you visit a health care professional without having to fill out or sign yet another form? 

·         We can make online reservations for, say, restaurants, airlines, or hotels.  When it comes to making healthcare appointments, though, we're almost always forced to go through a tedious phone tree and end up negotiating with a human scheduler.   In 2018?

·         Manufacturers have overwhelmingly turned to just-in-time processes.  Meanwhile, in healthcare, an appointment time is usually at best an approximation; we expect to be seen late.  If you are in a facility expecting a test or procedure, it's even worse.  These aren't even 1960's levels of precision.

·         Telemedicine is widely available, but usually it won't be with your doctor and the doctor you end up getting won't have your medical history.  Shouldn't virtual visits usually be the first step?  

·         With healthcare there, no institution has access to even most of our medical history, which remains highly scattered, siloed, and sometimes even still paper-based.  How 1980's!  

·         We continue to urge people to get annual preventive exams, even though the value of them for most adults is highly dubious.  We still make people get unpleasant procedures like digital rectal exams, or tests of questionable value like PSAs or even mammograms.  

 

In many ways, we do have "space age" healthcare, but that space age is too often more like 1960's NASA than 21st century SpaceX. 

 

We can do better.  Much of healthcare has one foot firmly planted in the 21st century, and its vision looking forward.  But too much of it still has the other foot dragging in the 20th century. It is past time to not only identify but also to act upon antiquated practices in healthcare.
 

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

 
Friday
Feb232018

The State of the Uninsured and Health Insurance Coverage

The State of the Uninsured and Health Insurance Coverage
 

by Clive Riddle, February 23, 2018

 

The National Center for Health Statistics has just released updated health insurance coverage estimates from selected states using 2017 National Health Interview Survey data.  Here are seven things to know about their findings for the first 9 months of 2017:

 

1.     28.9 million (9.0%) persons of all ages were uninsured, not significantly different from 2016, but 19.7 million fewer persons than in 2010.

2.     12.7% of adults aged 18–64, were uninsured, 19.5% had public coverage, and 69.3% had private health insurance coverage.

3.     4.4%  of adults aged 18–64 (8.6 million) covered by private health insurance plans obtained their coverage through the federal or state-based exchanges.

4.     Adults aged 25–34 were almost twice as likely as adults aged 45–64 to lack health insurance coverage (17.3% compared with 9.2%)

5.     4.9%  of children aged 0–17 years, were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage.

6.     The percentage uninsured decreased significantly for all age groups from 2013 through the first 9 months of 2017, ranging from –6.2 percentage points for ages 45–64 to –10.7 percentage points for ages 18–24.

7.     43.2% of persons under age 65 with private health insurance were enrolled in a high-deductible health plan (HDHP) compared to 39.4% in 2016

 

However, as a warning sign that 2018 may see slippage in these insurance coverage, the Minnesota Department of Health just issued an ominous press release, indicating that “last year Minnesota saw one of its largest, one-time increases in the rate of people without health insurance since 2001. The uninsured rate rose from 4.3 percent in 2015 to 6.3 percent, leaving approximately 349,000 Minnesotans without coverage.”
 
Friday
Feb162018

It's About Time

It's About Time
 

By Kim Bellard, February 16, 2018

 

Chances are, the sun isn't directly overhead for you when it is for me.  That's why for most of human existence time was a local matter.

Nowadays, we have time zones that span the globe, and we have clocks so accurate that satellites have to 
take into account relativistic time-dilation effects. Technology made the change possible, and necessary. 

Health care should learn from this.

 

It used to be that local time was good enough.  The village clock served your purposes.  It was the railroads that made this impractical.  People wanted to know when trains would arrive, and when they'd leave.  More importantly, if they weren't coordinated, trains traveling in different directions might -- and did -- run into each other.

We treat health care much like we used to treat time. That is, it is largely local.  How it is practiced in one community may not be how it is practiced in the next community, or even the next hospital or physician practice within a community. . 

The care you get will depend on, of course, what is wrong with you, but also on 
which physician you see.  Very few dispute that there is significant variation in care, or that it is probably bigger than it should be.  But there's not much evidence that it is getting any less. 

We accept these variations because, well, that's how it has always been.  We accept them because we think our personal situation is unique.  We accept them because we trust our local experts.   

We accept them for all the same reasons we used to accept that time should be local. Technology has made it both necessary and possible that we move away from this attitude.

It is necessary because the scope of the problem is clear.  As Propublica put it in a 
recent expose of unnecessary procedures: "Wasted spending isn’t hard to find once researchers — and reporters — look for it." 

 

Almost twenty years ago the Institute of Medicine estimated as many as 98,000 hospital deaths annually due to medical errors.   More recently, medical errors have been estimated to be the third leading cause of death in the U.S. 

Yes, moving away from "local" health care is necessary.

The good news is that it is possible.  We have the technology to consult with physicians who don't happen to be local, such as through telemedicine.  It is possible to get the "best" doctor for our needs, not just the closest. We have artificial intelligence that can analyze all that data plus all those medical studies that no human can possibly keep up with.  It is possible to come up with the "right" recommendations for us.   

We have to stop thinking of health care as local.  The information it is based on is not.  The people who are best able to apply that information to our situation may not be.

If I get a driver's license, I don't have to get another one when I drive to another state.  If I get on a plane, the pilot doesn't have to have a pilot's license from each state he/she lands in, or flies over.  But if I want to use a doctor who is in a different state (or country), that doctor needs a license from my state.    

We've always justified such licensing by states wanting to ensure the safety of their citizens, but drivers and pilots can put those citizens at risk too.  It's not really about risk; it's 
more about controlling competition

There is irrefutable evidence that local health care is rarely what is going to be best.  It might not be bad care, but most likely it's only going to be average. 

Maybe we're willing to settle for that.  I'm not.

Time for a change.

 

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

 
Thursday
Feb012018

AmazonBerkshireJP Healthcare: Think About Kaiser

AmazonBerkshireJP Healthcare: Think About Kaiser
 

By Clive Riddle, February 1, 2018

 

After Amazon, Berkshire Hathaway and JPMorgan Chase issued their press release this week regarding their employer based healthcare partnership, healthcare stock portfolios went into a tailspin and a lot of smart people have had something to say about what this venture might become. But where there is consensus is that what we do know is what we don’t know, as right know the venture is a dot to dot healthcare coloring book where no lines have been connected yet and we haven’t even been issued our crayons.

 

The press release, while void of details, espouses technology solutions. Learned speculation surrounds their replacing PBMs, going whole hog into self-insurance, promoting telemedicine and much more.

The New York Times quotes Segal Group’s Ed Kaplan: “Those are three big players, and I think if they get into health care insurance or the health care coverage space they are going to make a big impact.”

 

Paul Demko in Politico writes that Amazon's new health care business could shake up industry after others have failed. But while citing some optimism, he also reports that ““ ‘We’ve seen these deals before,’ said Sam Glick, a partner in the health and life sciences division at Oliver Wyman. He cited Walmart and Intel as two companies that have sought to provide health care for employees while cutting out the insurance middleman. ‘It’s not news that jumbo employers are frustrated with escalating costs and lousy experiences in the health care system.’ “

 

A great tweet from Yale Health Economist Zach Cooper tells us "I do hope Amazon, JP Morgan, & Berkshire succeed. Health care is wildly inefficient However, it’s a bit like Mayo Clinic, Cleveland Clinic, and Partners Health coming out and saying they don’t like their computers so they’re going to form a new IT company."

 

An Axios post by Sam Baker cautions “A new health care behemoth? Not so fast.” He reminds us “We don't know what they're even trying to do” and that “other big companies have tried something similar.”

 

While like Sam Glick, we can point to less than stellar results from a number of other corporate forays into this arena, if we peek further back into time, we can also point to Kaiser, whom Sam Baker mentions in his post.

 

Let’s take the wayback machine to 80 years ago: In 1933, Sidney Garfield MD establishes prepaid plan to fund care for his Contractors General Hospital and clinic providing care to workers on the Los Angeles Aqueduct. In 1938 Henry J Kaiser recruits Dr. Garfield to establish prepaid clinic and hospital care for his Grand Coulee Dam project in Washington. In 1942, at the request of Henry Kaiser, Dr. Garfield expands program to Kaiser-managed shipyards and Kaiser’s steel mill. In 1945, Permanente Health Plans opens to the public in California, in addition to serving Kaiser employees.

 

Kaiser and their clinically integrated health care is often cited now as an example of a better system than much of the rest of American healthcare. Perhaps Amazon et al should take a long look at the Kaiser experience, and consider directly providing some levels of care enhanced by technology, instead of just relying on technology alone.