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Entries in Surveys & Reports (156)

Friday
Aug092019

The Latest on Physician Burnout

By Clive Riddle, August 9, 2019

InCrowd has just released their 16-page 2019 Physician Burnout Survey report - a follow-up to their 2016 burnout research, asking their participating physicians how they’re coping with job-related stress. They found “sixty-eight percent of US-based physicians surveyed reported experiencing burnout at some level,” and that “primary care physicians (PCPs) report higher burnout rates than specialists, with 79% of PCPs personally experiencing burnout compared with 57% of specialists. And, more than a third of InCrowd physicians surveyed said they would not recommend their profession to a young family member.”

The report also shares findings that: 

  • Burnout is highest among younger physicians, with those in their 30s and 40s reporting highest rates of burnout (74%), and burnout rates dropping thereafter.
  • Hospital employees report slightly worse metrics for addressing burnout (20% effective) compared to those who work across private practices (27% effective).
  • Those who report that their facilities effectively address burnout credit workplace initiatives that improve workflow (46%), provide schedule flexibility (45%), and support wellness (41%).
  • When asked what actions their facilities could take to alleviate the issue of physician burnout, over half of respondents report that increased support staffing (66%), mandatory vacation time or half-days (57%), and reduced patient volume (56%) are likely to help. 

InCrowd notes their findings are “higher than the 43-54% range found in MedScape’s 2019 national report yet lower than the 80% of The Physicians Foundation/Merritt Hawkins biennial survey of September 2018. With PCPs, however, InCrowd found nearly 80% burnout levels—dramatically higher than the 43.9% cited in an American Academy of Family Physicians (AAFP) study of March 2019, which itself reflected a decline from 54.4% in 2014.”

Last month, Spok, Inc. released a paper: "Clinician Burnout in Healthcare: A Report for Healthcare Leaders" providing survey results from over 470 clinical staff at U.S. hospitals and health systems. in which clinician perception of burnout was measured. 92% of clinicians said burnout is “a public health crisis that demands urgent action.” 

When asked "what prevents clinicians from seeking help for potential symptoms of burnout, the No. 1 obstacle cited by respondents (65%) was that their organization lacks institutional attention and resources. When asked how often their organization leaders discuss burnout, 47% said rarely or never."  When asked "whether increased or ineffective technology contributes to the risk of clinician burnout, the vast majority (90% of all respondents) strongly or moderately agreed. And 89% of respondents said burdensome or increased workload (not related to direct patient care) is the biggest factor that contributes to this risk."

The Spok survey also found:

  • 70% experience symptoms of burnout "considerably” or “a great deal.
  • 95% believe improving EHR usability will be at least somewhat helpful
  • 30% of respondents said their organizations are improving EHR usability
  • Nurses use an average of 4.1 technology systems daily 
  • Physicians use an average of 3.9 systems daily and clinical leaders 3.5
  • 20% reported mental health treatment or support is available
  • 13% have a chief wellness officer or equivalent
  • 11% reported not experiencing risk factors including work-related stress, lost satisfaction, or a loss of efficacy in their own work

The Spok survey certainly lays much of the problem at the lap of HER. The InCrowd survey asked for suggestions on how to reduce burnout and “more than half (51%) of those providing additional recommendations suggest improving processes related to administrative burden: 23% suggest employing scribes, 23% advocate for reduced documentation, and 5% propose scheduling more time for charting.” 

Friday
Aug022019

Two Papers on the Health Plan Medicare Opportunity

By Clive Riddle, August 2, 2019 

Oracle has released an Executive Insight paper on the Opportunity Ahead for Agile and Efficient Medicare Advantage Plans,  cautioning that “While the opportunity is great, MA plans are not automatically a wise or profitable business decision for all health insurers. There is growing competition as new players enter the market, and cost and margin pressures continue unabated. To make the most of this opportunity, MA plans must look to accelerate innovation while optimizing costs across their enterprises— from marketing and enrollment to plan configuration, claims processing, compliance, and renewal.”

They report on three development plans should consider now:

  1. It is “Time to flex strength with expanded flex benefits. In 2019, MA plans were cleared to offer new flex benefits, designed to move plans toward expanded population health capabilities.”
  2. “MA plans look to differentiate on other fronts and deliver high levels of service—without placing profitability and stability in peril.”
  3. Payers are eager to bring new urgency and focus to improving claims accuracy and delivering innovative provider payment models.

HealthEdge has just released results of its Voice of the Market Survey, a study of 201 health insurance executives directly involved in Medicare lines of business. 92% responded that they are trying to grow their Medicare Advantage book of business faster than their traditional Medicare Supplement business.

 

Here’s some key findings from their survey:

  • 53.2% said the value-based model of Medicare Advantage significantly factors into a desire to grow the business, while 42.8% said it moderately factor in.
  • Expanding to new service areas ranked first in level of importance as the steps being taken to attract new Medicare and Medicare Advantage members, followed by (2) Appealing to tech-savvy digital consumers; (3) Providing incentives for healthy behaviors; (4) Addressing social determinants of health; and (5) Marketing/advertising to prospective members
  • Applicable steps above get re-ordered somewhat when ranking importance to retain current Medicare and Medicare Advantage members: (1) Appealing to tech-savvy digital consumers; (2) Addressing social determinants of health; (3) Providing cost transparency; (and 4) Providing incentives for healthy behaviors; (5) Providing education services to members about their benefits
  • There is not consensus on what is the biggest challenge to acquiring new members in the Medicare or Medicare Advantage (MA) line of business.  29.4% said it was funding/executing marketing outreach to  attract new members; 23.8% said competitors who  dominate the market; 22.4% said offering the variety of  plans necessary to satisfy members; and  19.9% answered differentiating  between MA and  traditional Medicare.
  • When asked “what is the biggest external challenge your organization faces in the Medicare and Medicare Advantage line of business.” Competitors seem top of mind, with 34.3% responding “competition”; and another 29.9% stating “members unwilling to switch plans from a competitor. Other responses were 19.9% replying “regulations” and 15.9% saying “member demands.”

 

Friday
Jul192019

Overconfident Healthcare Organizations? Could Be According to Healthcare Cybersecurity Survey 

By Clive Riddle, July 19, 2019

LexisNexis Risk Solutions in collaboration with Information Security Media Group has released results from their recent survey of hospitals, medical groups and payers, in their new 18-page report The State of Patient Identity Management, which found 50% are confident they have the necessary controls in place to prevent unauthorized access to patient information, 58% believe their portal cybersecurity is above average (and only 6% feel they are below average), yet 35% don’t deploy multifactor authentication.

To digress, some insight into those results can be gained from reading last week’s mcolblog post by Kim Bellard on Our Dinning-Kruger Healthcare System, which discusses the Dunning Kruger effect involving “the cognitive bias that leads people to overestimate their knowledge or expertise,” illustrated in the world of NPR’s Lake Wobegon – where “all the children are above average.” 

88% of the organizations surveyed had patient/member portals, and 93% use username and password as the patient portal authentication method. 65% deploy multifactor authentication, with 39% using a knowledge-based Q&A for verification, 38% using email verification, and 13% deploy device identification. 65% report that their individual state budgets for patient identity management will not increase in 2019.

Here’s the top three cybersecurity takeaways of the report according to LexisNexis:

  1. Traditional authentication methods are insufficient: As a result of many healthcare data breaches, hackers have access to legitimate credentials; users are also easily phished. Therefore, traditional username and password verification are considered an entry point, not a barrier, and alone cannot be relied upon to provide a confident level of security.
  2. Multifactor authentication should be considered a baseline best practice: HCOs should rely on a variety of controls, ranging from knowledge-based questions and verified one-time passwords to device analytics and biometrics to authenticate users based on the riskiness of the transaction. The more risky the access request is, the more stringent the authentication technique should be.
  3. The balance between optimizing the user experience and protecting the data must be achieved in an effective cybersecurity strategy: HCOs need to make it easy for patients and partners to access records while ensuring adequate data protection. To do this, an HCO's cybersecurity strategy should layer low to no-friction identity checks up front, making it easier for the right users to get through and layer more friction-producing identity checks on the back end that only users noted as suspicious would complete.
Friday
Jun212019

Ten Takeaways From PwC’s Medical Cost Trend Behind The Numbers 2020

By Clive Riddle, June 21, 2019 

PwC's Health Research Institute has just released their 14th annual report on medical cost trends: Medical cost trend: Behind the numbers 2020, which projects the 2020 trend to be a six percent cost increase. As PwC's HRI describes their 47-page report, they project "the growth of private medical costs in the coming year and identifies the leading trend drivers.... based on the best available information through June 2019. HRI conducted 55 interviews from February through June 2019 with health industry executives, health benefits experts and health plan actuaries whose companies cover more than 95 million employer sponsored large group members about their estimates for 2020 and the factors driving those trends. Also included are findings from PwC’s 2019 Health and Well-being Touchstone Survey of more than 550 employers from 37 industries as well as PwC HRI’s national consumer survey of 2,500 US adults."

Here’s Ten Takeaways from their 2020 report: 

  1. Small Uptick: The Medical Cost trend, still rounding to double digits in 2007 (11.9%) and 2008 (9.9%), trended downwards subsequently, to round to six percent since 2016 (6.2%), but have ticked up since the low-water mark of 5.5% in 2017 (and 5.7% in 2018-2019.)
  2. Price, Not Utilization: “Prices have been a larger component of employer benefit costs than utilization since 2004; utilization has hovered around zero percent growth since 2006. Utilization by individuals with employer-based insurance decreased by 0.2 percent from 2013 to 2017 while prices rose 17 percent during that time.”
  3. Impact of High Deductibles: “Average deductibles for employer-sponsored plans tripled between 2008 and 2018. This increase likely has led to a low utilization trend because employees are delaying or forgoing care due to their deductible.”
  4. Stall in HDHP Growth: “The shift to HDHPs by employers seems to have stalled. With 84 percent of employers offering an HDHP option in 2019 and a tight labor market, employers may not be as quick to push HDHPs in 2020.
  5. Acceleration in Retail Rx Spending: “Starting in 2020, retail prescription drug spending growth for private health insurance will begin to increase, hitting between 3 percent and 6 percent annually through 2027.24 The growth in spending can be attributed to the waning impact of generics on the market and the introduction of new drugs.”
  6. Specialty Drug Million Dollar Drugs Pipeline: The portion of total retail drug spending on specialty drugs continues to grow. “We are at an inflection point with drugs in the pipeline. We thought hep C was expensive at nearly $100,000 per treatment. Many drugs in the pipeline are life-altering and come with a price tag of $1 million to $2 million per treatment.”
  7. Growth in Chronic Disease Spending: "Spending by employers on individuals with chronic diseases is nearly quadruple [3.5x] that of healthy individuals while spending on individuals with complex chronic diseases is eight times higher" [8.2x].
  8. Growth in Onsite Clinics: “38 percent of large employers offered an onsite health clinic in 2019, up from the 27 percent that offered a clinic in 2014. An additional 13 percent said they were considering adding one.”
  9. Telehealth Potential: “49 percent of consumers with employer coverage said they are willing to use telehealth in place of an in-person visit.”
  10. Underutilized Wellness and Prevention programs: “For decades, employers have invested in health and wellness and prevention, yet participation remains low.....The small population of employees who participate in their employers’ health and wellness programs generally believe the programs have had a positive impact on their health.”

 

Thursday
Jun132019

Analyzing Blue Cross Blue Shield Plan Administrative Costs

By Clive Riddle, June 13, 2019

Sherlock Company in the June issue of their Plan Management Navigator examines administrative cost trends for Blue Cross Blue Shield Plans, analyzing year end 2018 vs 2017 data.  They found that costs “increased by 5.5% per member, up from an increase of 5.1% for 2017. Reweighting to eliminate the effects of product mix differences between the years, per member costs increased by 6.7% as compared with 5.9% in 2017. ASO/ASC increased as commercial insured membership declined. Medicare Advantage continued to grow rapidly.”

 Their key findings included:

  • Most clusters of expenses grew at rates less than last year.
  • Uniquely, Account and Membership Administration’s growth rate increased.
  • Growth in Information Systems was the single most important reason for administrative expense increase in 2018.
  • The shift in favor of products and market segments that are lower cost to administer muted the real growth.

 

Sherlock’s benchmarking study “analyzes in-depth surveys of 14 Blue Licensees serving 37 million members. Surveyed Plans comprise 52% of the members of Blue Cross Blue Shield Plans not served by publicly-traded companies.” 

Why does this benchmarking matter? Because the non-publicly traded BCBS plans provide a meaningful universe to benchmark, and plan administrative expenses are highly scrutinized, and certainly more controllable than medical expenses. As Doug Sherlock states, “in the current environment, optimizing administrative expenses is a high priority for health plan managers. Plans have completed their adaptation to the Affordable Care Act and the bulge in Exchange and Medicaid members. Plus, administrative expense visibility has been heightened by the rhetoric of presidential candidates.”

Here’s some key specific data from their report:

 

  • For the universe as a whole, the median total costs were $38.51 per member per month, higher than last year’s $34.99. 
  • By functional area, median pmpm costs were: Sales & Marketing $9.21; Medical & Provider Management $5.03; Account and Membership Administration $16.10 and Corporate Services $5.92
  • Median pmpm costs by product categories included: Commercial insured $49.84; Commercial ASO $28.32; Medicare Advantage $112.08; and Medicaid $46.08.
  • The median administrative expense ratio was 9.0% compared with 8.9% last year.
  • The median administrative expense ratio by product categories included: Commercial insured 10.8%; Commercial ASO 7.1%; Medicare Advantage 12.5%; and Medicaid 9.3%.
  • Staffing ratios increased by 6.8%, especially in Information Systems. 
  • Approximately 19 FTEs serve every 10,000 members in the commercial products. 
  • Compensation, including all benefits except OPEB, increased at a median rate of 3.8%. 
  • The median proportions of FTEs that were outsourced was 11.0%.
  • After the effect of the Miscellaneous Business Taxes, total administrative expense PMPM increased by 17.9% compared with a decline of 2.3% in the prior year