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Friday
Oct182019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Google nabs ex-Obama official DeSalvo for new chief health role

Google has hired ex-Obama administration official Karen DeSalvo as its first chief health officer, further solidifying its investment in the $3.5 trillion industry by rounding out its healthcare team.

Healthcare Dive

Friday, October 18, 2019

Whistleblower Alleges Medicare Fraud At Iconic Seattle-Based Health Plan

Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Kaiser Health News

Friday, October 18, 2019

Surprise Settlement In Sutter Health Antitrust Case

Sutter Health has reached a tentative settlement agreement in a closely watched antitrust case brought by self-funded employers, and later joined by the California Attorney General’s Office.

Kaiser Health News

Thursday, October 17, 2019

Medicare, Medicaid hospital payment cuts to hit $252.6B, industry study finds

Reductions in federal payments to hospitals will total $252.6 billion from 2010 through 2029, reflecting the cumulative impact of a series of legislative and regulatory actions, according to a new study from Dobson DaVanzo & Associates, a health economics and policy consulting firm.

Healthcare Dive

Wednesday, October 16, 2019

New study: Full-scale 'Medicare for All' costs $32 trillion over 10 years

The study from the Urban Institute and the Commonwealth Fund found $32.01 trillion in new federal revenue would be needed to pay for the plan, highlighting the immense cost of a proposal at the center of the health care debate raging in the presidential race.

The Hill

Wednesday, October 16, 2019

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Wednesday
Oct162019

Getting More Precise About Precision Medicine

By Clive Riddle, October 16, 2019

 

The October Care Intervention Edition of Care Analytics News profiled Dr. Jen Buhay, Precision Medicine Clinical Program Manager for The US Oncology Network. The term “Precision Medicine” can sound straight-forward, yet for those not directly involved in this arena, there is not always a clear understanding of its current scope.

 

So the first question asked of Doctor Buhay was simply “What is Precision Medicine?” she replied: “In the simplest terms, Precision Medicine is the “right test for the right patient at the right time.” But the practice of Precision Medicine is not so simple. A physician must choose from an array of complicated tests that are appropriate for a diagnosis and the creation of a treatment plan for their patient in a timely manner. That’s a lot of separate data and time points to manage for one patient, so how do we connect these individual patients together with their own personalized sets of tests and outcomes to improve population health?”

 

It can also help to take a glimpse of the background of someone in the field. Jen leads biomarker testing, education, and operational efforts at The US Oncology Network, “to support personalized patient care for oncology. Previously, she led precision medicine initiatives in a community hospital setting and worked as a laboratory scientist for commercial and academic molecular diagnostic laboratories. Dr. Buhay holds a PhD in Integrative Biology (molecular genetics and computational biology) from Brigham Young University, an MS in Biology from Eastern Kentucky University, and a BS in Animal Behavior from Juniata College. She is board-certified as a Molecular Biologist through the American Society for Clinical Pathology.”


Dr Buhay cites breast cancer as an area where Precision Medicine can really help, and “has resulted in the development and evolution of standard biomarker testing guidelines, risk assessment and screening protocols, and treatment plans that are now widely recognized and used. This clinical application of Precision Medicine has resulted in the avoidance of unnecessary and ineffective testing and treatment, rapid identification of targeted treatments with good responses in similar populations, and the proactive screening of families at high risk for breast cancers.”

 

Regarding future potential, Jen says “the big picture comes together in Precision Medicine when clinical outcomes are linked to the biomarker testing choices, disease screening methods, and targeted treatment plans for large groups of patients as part of clinical trials and translational research. With the analysis of “big data” comes new and updated biomarker testing recommendations, patient care models, disease screening protocols, and treatment guidelines by professional medical societies. These guidelines reflect the most recent technological advances in laboratory science from the bench to the bedside, and this information is continually evolving with new studies leading to better survival rates, increased detection, and improved treatments for future patients. Precision Medicine efforts will continue to expand across many diseases as more physicians learn the lessons of how breast cancer incorporated biomarker testing, disease screening, and targeted therapies into standard practices and guidelines for the betterment of individuals, families, and populations.”

Friday
Oct112019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Sutter, Kaiser among hospitals hit by Northern California blackouts

The blackouts created by the Pacific Gas & Electric (PG&E) utility in Northern California have led to numerous hospitals relying on their backup generators for power.

Healthcare Dive

Friday, October 11, 2019

Amazon Textract now HIPAA-eligible as tech giant expands AI portfolio

Amazon Textract, a machine learning service that automatically extracts selected text and data from scanned documents, is now HIPAA-eligible, Amazon Web Services announced in a blog post Thursday.

Healthcare Dive

Friday, October 11, 2019

How HHS wants to update anti-kickback rules to support value-based care

HHS on Wednesday issued long-anticipated proposed rules to update anti-kickback and physician-referral regulations so they do not interfere with physicians' ability to participate in value-based payment arrangements.

The Advisory Board

Thursday, October 10, 2019

VCU Health Will Halt Patient Lawsuits, Boost Aid In Wake Of KHN Investigation

VCU Health, the major Richmond medical system that includes the state’s largest teaching hospital, said it will no longer file lawsuits against its patients, ending a practice that has affected tens of thousands of people over the years.

Kaiser Health News

Wednesday, October 9, 2019

Waste gobbles up 25% of US healthcare spending, JAMA study finds

The estimated cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion, or about 25% of the total healthcare spending, according to a report in JAMA issued Monday.

Healthcare Dive

Monday, October 7, 2019

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 

Friday
Oct112019

High Deductible Plans, Absentee Employer Contributions and the Burden of Employee Cost Sharing

By Clive Riddle, October 11, 2019

Much is being said about the increasing burden of employee health insurance cost sharing, which continues to far outpace employee wage increases and other cost of living indexes. The prevalence of high deductible plans is often cited as a significant factor adding to this burden. Perhaps not enough is being said about the prevalence of employers that do not make any or adequate account contributions for such high deductible plans, and the role of these absentee employers in adding to the employee burden.

The current issue of MCOL's ThoughtLeaders asks "What are the stakeholder implications going forward arising from employee health plan cost sharing increasing at twice the rate of wages during the past decade?”

Lindsay Resnick, EVP at Wunderman Thompson Health opens his response by telling us the implications "can be summed-up on one word: OOPS…Out Of Pocket Spending. As corporate stakeholders – providers, payers, pharma and employers – joust in a ‘Game of Thrones’ battle over payment schemes, network configurations, price manipulation, and bureaucratic machinations, what about the ultimate stakeholder, America’s healthcare customer. For them, healthcare has become an amalgam of medical, financial and lifestyle transactions where they’re searching for value and grappling with mind-numbing personal decisions."

Natasha Elsner, Research Manager, Deloitte Center for Health Solutions comments that "high-deductible plans—that have become a common benefit option—are blunt instruments: they can discourage utilization of both low-value and high-value services, and such plans can be particularly challenging for people with ongoing health care needs, as well as those with low and even moderate incomes."

Dudley E. Morris, Senior Advisor, BDC Advisors notes that "compared to the press attention paid to Medicare-For-All, the escalating cost of large employer health plan insurance for working families is something of an elephant in the room in terms of the current political discourse."

A couple of weeks ago Kaiser Family Foundation released its 2019 Employer Health Benefits Survey,  Their comprehensive report found that “"despite the nation’s strong economy and low unemployment, what employers and workers pay toward premiums continues to rise more quickly than workers’ wages and inflation over time. Since 2009, average family premiums have increased 54% and workers’ contribution have increased 71%, several times more quickly than wages (26%) and inflation (20%)."

Section Eight of their 238-page report covers “High-Deductible Health Plans with Savings Option.” They found that 28% of firms offering health benefits offer a HDHP with a HRA (Health Reimbursement Account) or Health Savings Account (HSA). 30% of covered workers are enrolled in an account based HDHP (20% in 20140; with 7% in HRAs and 23% in HSAs. The average general deductibles for HDHP/HRAs was $2,583 for single, and $5,335 for family, and the average firm contribution being $1,713 for singles (67% of the deductible) and $3,255 for family (61% of the deductible.) The HRA employer contribution could certainly be worse (although it should be noted HRAs are not portable after the employee leaves the company.)

The problem is that for HSAs, the contribution is worse, and that’s where most of the enrollees are. The average general deductibles for HDHP/HSAs was $2,476 for single, and $4,673 for family, and the average firm contribution being $572 for singles (23% of the deductible) and $1,062 for family (23% of the deductible.)  It isn’t that all employers are miserly -  the KFF report notes that “there is considerable variation in the amount that employers contribute to savings accounts.”

But the bigger problem beyond employer contributions averaging under one fourth of the deductible requirement, is that 55%pf employers offering qualified HDHP/HSA plans do not make any contribution. Many of these employers are small businesses, meaning the percentage of total employees receiving a contribution is better, but still – 25% of total single employees receive no contribution and 26% of families receive no contribution.

Looking at the contributions on a total dollar basis for all HSAs, the Devinir Midyear HSA Market Statistics & Trends report found that 31% of 2019 HSA contributions come from employers (52% from current employees, 13% from individuals, and 3% from IRA rollovers and Other.)

The problem caused by Absentee Employers and Miserly Employers when it comes to account contributions, is that the true promise and potential of consumer choice and engagement in health care decision making is severely compromised when the consumer doesn’t have the financial resources to make and engage in the options available. It is one thing for a consumer to make selections taking cost into consideration when they have an account that can fund an adequate portion of the cost involved – and their decisions involve allocating those funds and retaining any savings for future healthcare needs. If is quite another to make those decisions when they are burdened by deductibles that have skyrocketed over the past decade without the backing of adequate employer account contributions and don’t have the personal resources to cover that gap.

Friday
Oct042019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Why Hospitals Are Getting Into The Housing Business

One patient at Denver Health, the city’s largest safety net hospital, occupied a bed for more than four years — a hospital record of 1,558 days. Another admitted for a hard-to-treat bacterial infection needed eight weeks of at-home IV antibiotics, but had no home.

Kaiser Health News

Friday, October 4, 2019

Humana's chief strategy officer: Insurance giant is shifting to be a healthcare company

Insurance giant Humana operates a mail-order pharmacy, has more than 230 owned or alliance primary care clinics and a large home health care provider, Kindred at Home. And the payer continues to build out capabilities to address members' social determinants of health.

Fierce Healthcare

Thursday, October 3, 2019

Trump signs executive order bolstering MA in pushback on 'Medicare for All'

President Donald Trump signed an executive order in Florida on Thursday he said would bolster the Medicare program as numerous Democratic presidential candidates seek to expand the program beyond seniors, a move Trump said would jeopardize the entire program.

Healthcare Dive

Thursday, October 3, 2019

US vaping illnesses top 1,000; death count is up to 18

The number of vaping-related illnesses has surpassed 1,000, and there’s no sign the outbreak is fading, U.S. health officials said Thursday.

The Associated Press

Thursday, October 3, 2019

Walmart To Give Workers Financial Incentives To Use Higher-Quality Doctors

Worried its employees aren’t getting good enough care from doctors in their insurance networks, Walmart next year will test pointing workers in northwestern Arkansas, central Florida and the Dallas-Fort Worth area toward physicians it has found provide better service.

Kaiser Health News

Thursday, October 3, 2019

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.