Will COVID-19 Create a Tipping Point For TeleHealth and Mobile Apps?

by Clive Riddle, March 6, 2020

mHealthIntelligence reminds us that the emergency spending now passed by Congress "will waive Medicare’s geographical restrictions on telehealth during a public health emergency, enabling providers to use telehealth in urban and rural areas as well as in the patient’s home" and "also loosens restrictions on the use of a telephone to deliver care, as long as that phone has audio-visual capabilities."

The Wall Street Journal notes that "doctor groups, hospitals and health insurers are increasingly steering people with mild or no symptoms toward initial visits conducted by phone, interactive video or secure messaging. They are also starting to use the technology to care remotely for people with suspected or confirmed cases of Covid-19, the respiratory disease caused by the virus."

CNBC reports, from a market perspective, that “Coronavirus could be a boon for telemedicine, as health industry hopes to keep ‘worried well’ out of the hospital” and that “the coronvirus outbreak could provide a bright spot for one sector of the health industry that has struggled to gain widespread acceptance: Telemedicine. Health insurer Anthem, for instance, is staffing up more doctors for its  service, LiveHealth Online, in case there are more cases in the United States. Telemedicine start-ups are also bracing for a rush of customers.”

But StatNews tell us that "Telehealth can help fight the novel coronavirus, but U.S. challenges could limit its potential," noting that "there are obstacles to telehealth in the U.S., since its health care system is not well-suited to widely adopt digital health tools. The biggest challenges stem from factors that don’t exist in China, like our vast array of private, state, and federal payers with varying reimbursement policies and state-based medical licensing."

These U.S. obstacles also impact adoption rates for mobile apps – which are evident not just with the urgent issue of COVID-19, but with the increased prevalence of chronic disease. Avalere has just released a report “Chronic Disease Mobile Health Apps Need Better Value Propositions and Evidence” that tells us this “increased prevalence of chronic disease in the US are incentivizing stakeholders to develop new solutions to tackle these issues. Many have turned to digital health innovations like mobile health applications to facilitate care prevention and management for chronic disease, but significant gaps remain in their ability to be used in real-world practice.”

The crux of the problem? Avelere says “mobile health apps are difficult to sell directly to patients, introducing additional complexity for how to fund the provision and maintenance of these technologies. With relatively few patients willing to pay for digital tools, health care organizations – providers (health systems or primary care practices) and payers (self-insured employers or health insurers) – often assume the costs. To date, little evidence demonstrates improved health outcomes or lowered costs that can justify the cost of development and adoption. However, some promising examples demonstrate clinical efficacy and cost savings in digital chronic disease management solutions”

Avalere advises that “to drive broader use and adoption of digital solutions in chronic disease, app developers need a strong value proposition that can demonstrate improved outcomes and cost efficiency to organizations that can both pay for apps and incentivize providers and physicians to use them.”

Perhaps COVID-19 might be an impetus with value proposition that could stimulate greater overall adoption that would benefit chronic disease initiatives as well.

Ten Things to Know from HCCI's Health Care Cost and Utilization Report

by Clive Riddle, February 21, 2020

The Health Care Cost Institute has released its annual Health Care Cost and Utilization Report, now addressing 2018 data. The report "analyzes 2.5 billion medical claims to inform the public about trends affecting approximately 160 million U.S. individuals with employer-sponsored insurance." 

Here's ten takeaways from the 29-page report:

1. Health care spending grew 4.4% in 2018, slightly above growth in 2017 of 4.2%, and the third consecutive year of growth above 4.0%.
2. Total annual spending per person increased by 18.4%, from $4,978 to $5,892, between 2014 and 2018.
3. Between 2014 and 2018, average prices rose by 15%. Growth in average prices was 2.6% between 2017 and 2018, the slowest rate over the period.
4. Higher prices accounted for 74% of total spending increases above inflation over the 5-year period - an average of $453 per person.
5. Increased utilization of medical services accounted for 21% of spending growth after inflation - an average of $130 per person. Utilization of medical services rose by 3.1% between 2014 and 2018. Most of that increase, 1.8%, occurred between 2017 and 2018.
6. Professional Services averaged $1,985 per person, consuming 33.7% of spending. Outpatient Services averaged $1,662 per person, or 28.2% of spending. Inpatient Services averaged $1,128 per person, accounting for 19.1% of spending. Prescription Drugs averaged $1,118 per person, with 19.0% of spending.
7. Of the four major categories, outpatient visits and procedures saw the highest 2018 spending increase (5.5%), followed by prescription drugs (4.7%), professional services (4.5%) and inpatient services (2.2%)
8. Demographic shifts in the employer-insured population accounted for 4% of post-inflation spending growth over the 5-year period - an average of $27 per person.
9. People with job-based insurance saw their out-of-pocket costs rise by an average of 14.5%, or $114, between 2014 and 2018. The average out-of-pocket spending increased to $907 per person.
10. On average, Americans with employer-sponsored insurance spent $155 out-of-pocket on prescription drugs in 2018. Generic drugs accounted for 88% of all prescriptions. The average out-of-pocket price for generic drugs was less than 1/5 the average for brand-name drugs

SDoH, Chronic Care, Reinsurance, Pools and Doughnuts

By Clive Riddle, February 13, 2020

I gave a presentation recently to a healthcare group on the state of the business of healthcare in 2020, and in the ensuing reactor panel discussion, the topic of return on health plan investment in longer range initiatives such as in SDoH or applicable chronic care management programs came up.

For Medicare programs, plans can have the motivation to invest in programs that may take years to generate material improved outcomes and resource savings for individual patients – as they potentially can keep these patients enrolled for the duration. But with Medicaid and commercial programs, there is ongoing turnover – employees change jobs and individual Medicaid eligibility is subject to change.

Thus a plan that invests in long range programs for their covered Medicaid and commercial populations, may not retain specific individual members long enough to reap the improved outcomes and savings for those specific individuals. An SDoH investment might get a specific member on a better footing to improve their health, but then the member loses eligibility with that plan for a variety of reasons – loss of Medicaid eligibility, loss of a plan’s Medicaid contract, change of employer, change of plan during open enrollment, etc. Programs to improve certain chronic conditions or effect lifestyle or behavioral changes have the same challenge.

Many plans are investing in SDoH at least partly through a philanthropic perspective – typically providing funding through their plan’s affiliated foundation to designated Community Based Organizations that may serve some of the plan’s members, but also serve other segments of the population as well. Here’s some headlines during the past month in this regard:

• Anthem Blue Cross and Blue Shield Activates $3.6 Million Across Ohio in 2019
• CareFirst Contributed $43 Million To Health Initiatives in 2019
• Kaiser Permanente pledges $5.1M in 2020 to reduce homelessness
• Blue Shield of California Promise Health Plan Awarded $1.1 Million

But what if there was pooled funding mechanism for SDoH and eligible long-range chronic care management programs for pre-Medicare populations, Plans could refer members into applicable programs, and uninsured patients could participate as well. Plans could have allocated contribution requirements, along with other sectors providing funding.

Think of it as reinsurance pooling on the other end of the spectrum. In fact, a case can be made for advancement of pooling on both ends of the spectrum. Patients meeting catastrophic case criteria would transfer to coverage by kind of catastrophic “Medicare for All” plan. Plans would provide funding for the pooled plan, along with public funding, and uninsured could qualify as well if they met the criteria.

Between the pooled SDOH/Chronic Care programs, and pooled Catastrophic program, would be the doughnut hole filled by our quilt of current health care coverage.

Reinsurance pooling, while not as for along as a catastrophic Medicare for All program, does exist. Much of such efforts focus on the state ACA individual coverage markets. The Center on Budget and Policy Priorities published this paper last April covering the topic:  Reinsurance Basics: Considerations as States Look to Reduce Private Market Premiums. And for example, last August, CMS “approved Montana’s plan to create a reinsurance pool that aims to help lower individual health insurance premium costs.”

Pooled funding for SDoH programs is also not a new idea.  Back in 2016, the Public Health Institute published this paper: When Tackling the Social Determinants of Health, Pooling Funding Streams Is the Wise Course, stating “It seems like a logical approach to tackling tough social problems: coordinate across agencies, pool funds, and take aim at the issues from all angles. In practice, that rarely happens, but not for want of trying.”

You’ll also find the topic addressed in this February 2015 paper from the Center for Health Care Strategies: State Payment and Financing Models to Promote Health and Social Service Integration, and in this Institute for Medicaid Innovation January 2019 paper:  Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care.

In fact, while a December Health Affairs Blog piece Health Conundrum: How State Budgets Can Find The Balance Between Social Versus Medical Services  by Shannon Brownlee, Vikas Saini, and Benjamin F. Miller is skeptical that SDoH investment can lower spending – “there are several reasons to doubt this argument, if only because rising prices for medical services are driving national health care expenditures more than rising medical need” – they do go on to advocate pooled funding.

They authors state “in our report, we recommend that the California state government, and by implication all state governments, serve as a catalyst for multiple co-ventures of this type. States can convene all stakeholders, including health care institutions, health plans or payers, social service providers, community development financing institutions, and public health officials. They can also commission research, create the infrastructure for pooled funds for investing in community conditions, and draft new community benefit regulations for hospitals that would bring nonprofit health care providers to the table with funds to offer.”

So – food for thought - about programs that think about food as part of the solution, and doughnut holes between pools.

The Visits, They Are A-Changing

By Clive Riddle, February 7, 2020

Many facets of daily American life woven into the fabric of the Greatest Generation and Boomers have been gradually unraveling -  Attending church regularly, Belonging to service clubs, and Golfing for example. Is having a primary care doctor another?

The February issue of the Annals of Internal Medicine features the research article: Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008–2016.  The authors pose the issue, that despite well documented value to primary care visits and relationships, "there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline." They conclude: "commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care."

 

Their study of 142 million primary care visits among 94 million member-years found that PCP visits declined 24.2%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1% to 46.4%. Yet visit rates to specialists remained stable and visits to urgent care, retail clinics, and telehealth increased by 46.9%. They also found that the decline was largest among the youngest adults (−27.6%), healthier patients - those without chronic conditions (−26.4%), and lowest-income area residents (−31.4%).

Prior studies prompted the authors to examine this trend. Some previous indicators include:

• The Kaiser Family Foundation Health Tracking Poll in July 2018 found that 26% of all adults don’t have a primary care doctor – and that rate grows much higher for younger age groups: 45% without a PCP for age 18029; 28% for age 30-49; 18% for age 50-64 and 12% for age 65+.

• A study published in the November/December 2019 issue of the Annals of Family Medicine: National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015, found that PCP visits per capita declined 20% during this time period, while visit duration increased 2.4 minutes per visit, and visits addresses 0.3 more diagnoses and 0.82 more medications per visit. The authors offered the hypothesis that “the decline in primary care visit rates may be explained in part by PCPs offering more comprehensive in-person visits and using more non–face-to-face care.”  But perhaps this could also be explained by an aging case mix (fewer younger people seeking visits) that require more visit intensity.

• A study published in the EBRI March 2018 Issue Brief Consumer Engagement in Health Care Among Millennials, Baby Boomers, and Generation X Findings from the 2017 Consumer Engagement in Health Care Survey, reported that "Eighty-five percent of Baby Boomers have a PCP, compared with 78 percent among Gen Xers and 67 percent among Millennials."

Further studies and time will tell how much of this generational shift away from PCP visits is due to alternative points of care,  vs. cost issues, vs. changes in perception of the value of primary care, or perhaps – just maybe – PCPs are doing too good a job with younger generations in communicating electronically via patient portals and other means, and participating in plans with nurse call line options and web based care information that renders the lowest level of primary care physician visits unnecessary.

The Yellow Brick Road to Savings $13B In Further Automated Healthcare Administrative Transactions

By Clive Riddle, January 24, 2020

CAQH has released their seventh annual report  - the 2019 CAQH Index - which measures "the progress made by the healthcare industry in reducing the costs and burden associated with administrative transactions through automation. Their 49-page report found that "of the $350 billion dollars widely cited as the cost of administrative complexity in the US healthcare system, $40.6 billion is spent on eight administrative transactions. Of that, the industry can save $13.3 billion, or 33 percent of existing annual spend, by transitioning to fully electronic processes." 

Regarding the $13.3 billion in potential savings through automation, the report tells us “$9.9 billion can be saved by the medical plans and providers, while $3.4 billion can be saved by the dental industry. In both industries, the greatest savings exist for providers as compared to plans.”

The Index report “analyzes levels of automation, spending and savings opportunities for eight administrative transactions related to verifying patient insurance coverage and cost sharing, obtaining authorization for care, submitting claims and supplemental information and sending and receiving payments.”

What are these eight transaction categories, and what were their corresponding rates of full electronic transaction processing in 2019 vs. 2015?

1. Eligibility and Benefit Verification:  84% 2019 | 71% 2015
2. Prior Authorization  13% 2019 | 10% 2015
3. Claim Submission  96% 2019 | 94% 2015
4. Attachments  20% 2019 | NA 2015
5. Coordination of Benefits  86% 2019 | 49% 2015
6. Claim Status Inquiry  70% 2019 | 57% 2015
7. Claim Payment  70% 2019 | 61% 2015
8. Remittance Advice  50% 2019 | 51% 2015

Of these eight transaction categories  - the term “Attachments” might be a little generic and require further definition. CAQH defines Attachments as "the exchange of patient-specific medical information or supplemental documentation needed to support administrative transactions and clinical decisions." They go on to say "serving as a bridge between clinical and administrative data, attachments are also critical to the success of value-based payment models" and that the majority of attachments are exchanges through mail and fax as opposed to electronically.

The largest remaining estimated savings opportunities from further automation are with:

• Eligibility and Benefit Verification:  $4.24 Billion
• Claim Status Inquiry: $2.16 Billion
• Remittance Advice: $1.85 Billion

CAQH’s call to action for the industry to achieve these savings centers around:

• Focusing efforts to reduce provider burden
• Accelerating standards and operating rule development to support harmonization of administrative and clinical data exchange
• Needing vendor adoption of all standards and operating rules; and
• Expanding research related to the administrative workflow

The CMS Innovation Center: Innovative Savings Projections?

Avalere has released a report: CMMI’s Financial Impact on Medicare Spending Challenging to Project, which concludes “CMMI’s impact on Medicare spending has not reached earlier projections by the Congressional Budget Office (CBO), demonstrating the difficulty in projecting savings from untested and future unknown alternative payment models.”

Before we delve into the details of Avalere’s findings, let’s take a step back and peek into what goes on these days at The Center for Medicare & Medicaid Innovation (CMMI), which they now like to refer to as the CMS Innovation Center.

The CMS Innovation Center tells us they develop new payment and service delivery models brought about by the Affordable Care Act and other legislation, overseeing a number of specific demonstrations to be conducted by CMS; and implement the Quality Payment Program brought about by MACRA. The demonstrations and QPP were developed with an underlying assumption of savings to be accrues, and Avalere is now finding the savings have missed their targets.

The CMMI site provides tables itemizing the Alternative Payment Models in the Quality Payment Program, which list 50 specific Alternative Payment Models (APMs), plus Other Payer Advanced APMs including 7 Medicaid Other Payer Advanced APMs; 59 Medicare Health Plan Payment Arrangements; and 2 CMS Multi-Payer Payment Arrangements.

The CMMI Site indicates 90 specific demonstration models, which fall under seven categories:

1. Accountable Care
2. Episode-based Payment Initiatives
3. Primary Care Transformation
4. Initiatives Focused on the Medicaid and CHIP Population
5. Initiatives Focused on the Medicare-Medicaid Enrollees (dual eligible)
6. Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
7. Initiatives to Speed the Adoption of Best Practices

Given this scope, Avalere tells us that "CBO’s 2010 projection was $1.3 billion in net federal government savings from CMMI over the 2010-2019 budget window. In 2015, CBO began projecting more substantial savings from CMMI: $27 billion in net federal government savings over the 2016-2025 budget window; and then in 2016, $34 billion in net federal government savings over the 2017–2026 budget window."

Avalere however “estimates net Medicare savings of $18.0 billion from CMMI for the 2017-2026 budget window, lower than the $34 billion projected by the CBO in 2016. Net Medicare savings reflects expected reduced Medicare program expenditures net of CMMI outlays.” They break down their projection as follows:

1. The continuation and expansion of already-existing CMMI demonstrations generate $4.4 billion in gross Medicare savings between 2017 and 2026. 
2. Proposed demonstrations generate $21.4 billion in gross Medicare savings for 2017–2026. 
3. CMMI will launch new, not yet proposed demonstrations that generate $3.3 billion in gross Medicare savings for 2017–2026.

Of course, the aftermath of a Presidential election year could bring about any number of scenarios that could spin CBO or Avalere projections sideways.

The Facts of Managed Care

By Clive Riddle, January 10, 2020

The MCOL Managed Care Fact Sheets have just been updated, an ongoing online feature provided since the 1990s. Here’s some highlights:

Overall national managed care penetration is now 75.4%. Here’s a breakdown by payor segment, based on 2019 data: 

Sources: (see Note 1)

Here is the total national managed care enrollment by coverage type, based on 2018 data:

Health Maintenance Organization (HMO):  94.8 million

Preferred Provider Organization (PPO):    165.8 million

Point of Service (POS):                                 4.8 million

High Deductible Health Plan (HDHP):        15.6 million

Total*                                                          81.0 million

* The above total enrollment exceeds the total actual national managed care population due to double counting of A) spouses and dependents who have dual coverage; and B) HDHP plans that are also classified as PPO, HMO or POS

Sources: (see Note 2)

And here is major national health plans enrollment as of September 30, 2019:

United Health Group:  49.4 million

Anthem:                       41.0 million

CVS Health (Aetna):    22.8 million

Humana:                      16.6 million

CIGNA HealthCare:     17.1 million

HCSC:                         16.0 million

Centene*:                    15.3 million

Kaiser Permanente:    12.2 million

Wellcare*:                     6.4 million

Molina:                          3.3 million

*Centene/Wellcare Enrollment is reported separately, prior to public reporting of combined membership from merger

Source: Compiled by MCOL from company financial reports

The Managed Care Fact Sheets also include:

• National HMO Enrollment Graph
• Medical Cost Components
• Premium Rate Increase Trends Graph
• 2020 Premium Rate Increase Estimates

Notes

1: National Managed Care Penetration sources:

• MCMS Fast Facts: www.cms.gov/fastfacts/
• Kaiser Family Foundation State Health Facts Total Medicaid MCO Enrollment http://kff.org/other/state-indicator/total-medicaid-mco-enrollment/
• People Enrolled in Medicare and Medicaid, Fact Sheet March 2019, CMS Medicare-Medicaid Coordination Office  https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf    
• Tricare Prime Beneficiaries: https://www.tricare.mil/About/Facts
• Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey,  2018, Division of Health Interview Statistics, National Center for Health Statistics   https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf   
• U.S. Census Bureau Quick Facts, United States  https://www.census.gov/quickfacts/fact/table/US/PST045216

2. National Managed Care Enrollment sources:

• 2018 PayerDigest Series, Sanofi Managed Care Digest Series www.managedcaredigest.com
• Health Coverage State-to-State, 2019  www.ahip.org/wp-content/uploads/StateDataBook_2019-FINAL.pdf

What's Predicted in Healthcare for the Dawn of a New Decade

by Clive Riddle, January 3, 2019

As we enter 2020, what are prognosticators sensing the start of the new decade will bring forth in the healthcare arena? Here's nine recent HealthSprocket lists that peek into year ahead:

Deloitte offers these ten overall Healthcare and Life Sciences Predictions 2020:

1. Health consumers in 2020: Informed and demanding patients are now partners in their own healthcare
2. Health care delivery systems in 2020: The era of digitized medicine - new business models drive new ideas
3. Wearables and mHealth applications in 2020: Measuring quality of life not just clinical indicators
4. Big Data in 2020: Health data is pervasive- requiring new tools and provider models
5. Regulation in 2020: Regulations reflect the convergence of technology and science
6. Research and Development in 2020: The networked laboratory - partnerships and big data amidst new scrutiny
7. The pharmaceutical commercial model in 2020: Local is important but with a shift from volume to value
8. The pharmaceutical enterprise configuration - the back office in 2020: Single, global, and responsible for insight enablement
9. New business models in emerging markets in 2020: Still emerging, but full of creativity for the world
10. Impact of behaviors on corporate reputation in 2020: A new dawn of trust

Becker's Hospital Review summarized these S&P 7 healthcare trends to watch in 2020 with a financial marketplace perspective: 

1. Changes in healthcare may speed up
2. Industry disruption will continue
3. Rating deterioration will continue
4. Mergers among payers and other players will pressure pricing
5. M&A activity in the healthcare industry will remain elevated
6. Opioid litigation settlements will accelerate
7. Medical device makers will see a stable 2020

On the life sciences front, Syneos Health offers these Pharma Trends for 2020: 

1. The Many Points of Care - shifting away from where clinic exists to wherever patient goes
2. Better, By Design - big shifts in clinical research user experience
3. The Trust Deficit - initiatives to win trust back from people
4. Patient Value - patient-centricity
5. Digital Amplification and Innovation - digital experiences taking another big step forward
6. The Value Evaluation - to show initial population-relevant data and defend value against constant change
7. Answering to Real World - get ahead of both regulatory requirements and payer expectations
8. Connected Communications - personal communications that understand where people are in their individual journeys
9. Rapidly Changing Life Experience - Our world is changing and aging faster than ever before
10. New Strategic Blueprint - resetting focus on core assets, building ROI models around the yield of data investments

And Managed Healthcare Executive adds the pharmaceutical benefit perspective with Eight Trends Expected to Shape Managed Care Pharmacy in 2020:

1. Continued shift to value-based care
2. Increased integration of medical and pharmacy benefits
3. Drug prices will continue challenging patients, payers, and providers
4. Medication systems will gain connectivity
5. Precision medicine will mature
6. Ongoing emphasis on social determinants of health (SDoH)
7. Pharmacists emerge as primary care providers.
8. Consumers will become more cautious about prescribed medications

With respect to life sciences and healthcare, the Cleveland Clinic published their annual Top 10 Medical Innovations for 2020:

1. Dual-Acting Osteoporosis Drug
2. Expanded Use of Minimally Invasive Mitral Valve Surgery
3. Inaugural Medication for Transthyretin Amyloid Cardiomyopathy
4. Therapy for Mitigation of Peanut Allergies
5. Closed-Loop Spinal Cord Stimulation
6. Biologics in Orthopaedic Repair
7. Antibiotic Envelope for Cardiac Implantable Device Infection Prevention
8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients
9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer
10. Drugs for Heart Failure with Preserved Ejection Fraction

Turning to technological oriented trends, Health Data Management lists these 8 Healthcare trends that will rock medical care in the 2020s:

1. Artificial intelligence
2. Digital health tools
3. Imaging technology
4. Data sharing and interoperability
5. Patient communication and engagement
6. Payer evolution
7. Precision medicine
8. Virtual or remote care

In the same vein, Forbes published 9 technology trends that will transform medicine and healthcare in 2020:

1. AI and Machine Learning
2. Robotics
3. Computer and Machine Vision
4. Wearable Tech
5. Genomics
6. 3D Printing
7. Extended Reality (Virtual, Augmented and Mixed Reality)
8. Digital Twins
9. 5G

How does all this shape health policy? The Hill tells us there will be Five health care fights to watch in 2020:

1. Drug pricing
2. Surprise billing
3. ObamaCare
4. Medicare for All
5. Vaping

And finally, here's a summary of Seven Quick Takes on Healthcare Trends Shaping 2020 previously posted in mcolblog:

1. Election Year Policy Angst
2. Expanding Impact of Medicaid Expansion
3. One More Year for SDoH Before ROI Naysayers
4. Viral Value Based Payment
5. Health Technolytics - Healthcare Analytics + Technology
6. Morphing Point of Care and Coverage
7. Behind the Veil of Pricing Transparency and the CMS Final Rule

Happy New Year and New Decade!

Corrective Lens Needed for 2020 Healthcare Vision

By Clive Riddle, December 19, 2019

How did two decades of the new Millennium already fall into the rear view mirror? Weren’t we just bracing healthcare organizations for all the fallout that was supposed to emanate from Y2K?

It’s a shame we don’t have corrective lens that can adjust for hindsight, as we attempt to seek 20/20 vision into 2020 and beyond. None the less, here’s seven quick takes on trends that should shape our new year:

1. Election Year Policy Angst - Its not just Democrat vs Trump policy proposals – it’s also what fallout is coming from the forever legal saga surrounding the ACA, congressional proposals, state proposals and ballot initiatives, and lobbying clout. A lot is at stake and a lot is uncertain.
2. Expanding Impact of Medicaid Expansion - While Medicaid Expansion policy falls under the above discussion, the impact of Medicaid Expansion is a category unto itself: the coverage disparities between states; the resulting funding disparities for hospitals; the health improvement metrics where expansion is firmly in place; the transformation of dominant product mix for health plans and much more.
3. One More Year for SDoH Before.. - Speaking of impact of Medicaid Expansion, growth of Social Determinant of Health initiatives were totally fueled from that source. Good vibes are abundant from the embrace of SDoH by plans and providers, which will continue to reach a crescendo. Then a year from now, as always happens with shiny new trends, naysayers and boo birds will start to emerge questioning the ROI.
4. Viral Value Based Payment - No end seems to be in sight for value based payment models and arrangements. They will continue to spread and mutate into new forms.
5. Health Technolytics - The rapid evolution of healthcare technology platforms, devices and analytics will continue to make healthcare organization analytic capabilities more powerful and impactful. Will the humans in the organization be able to keep pace?
6. Morphing Point of Care and Coverage - the lines drawn for where people get their care continue to blur with telehealth, retail sites, mergers of cross-industry forces, e-commerce and other disruptors. Where is this all headed? One thing is certain – disruption will abide.
7. Behind the Veil of Pricing Transparency - CMS hospital pricing transparency regulations will have more of an operational impact in 2020 – and what new pricing transparency initiatives lie ahead for other healthcare stakeholders? (see Election Year Policy Angst)

Is there a trend or issue for 2020 that could potentially have a significant impact for healthcare stakeholders that might be flying under some organizations’ radar? That’s the question posed in the current issue of MCOL ThoughtLeaders.  Some of the above takes are reflected in the ThoughtLeader panel’s responses. Here’s some key snippets they shared:

Patrick Horine, CEO, DNV GL Healthcare says “the push for more transparency of healthcare providers has reached an all-time high. The demands for transparency of pricing, coverage, costs, performance quality raises many challenging questions and concerns as to what should be shared.”

Hank Osowski, Managing Partner, Strategic Health Group tells us “there exists a curtain of uncertainty that is masking what could potentially be one of the most impactful and disruptive periods in the industry’s history. This uncertainty is driven by two dynamics which will help to determine our future: a ruling on the constitutionality of the Affordable Care Act (“ACA”) and the likely turmoil to be created by the elections of 2020. The healthcare industry may not be prepared for the disruption. “

Mark Lutes, Chairman, EpsteinBeckerGreen notes that “an important emerging trend is attention to serious illness management (“SIM”) in the subacute settings—ideally the home. The trend is embryonic yet terribly important — both from quality and cost perspectives. There are significant opportunities to improve patient satisfaction and to optimize the application of resources by focusing on the development of appropriate care models.”

Neal Hogan, Director, BDC Advisors, shared that “value based payment (which looks a lot more like the traditional fee-for-service model than risk) seems to be a signpost on the road to population health---if that is where our system is truly heading. We need to start matching the reality to the rhetoric so we can be clear about how to win in an era of consumerism and transparency.”

William DeMarco, Founder and President, Pendulum HealthCare Development Corporation, comments: “the issues that are under the radar for many organizations who see only one or two options, are the vast variety of CMS models which are emerging and reemerging in different forms that are altering reimbursement as well as delivery of care.”

And Lindsay Resnick, Executive Vice President, Wunderman Thompson Health, summarizes that we should “expect the healthcare community to step-up efforts in cross-industry collaboration. While we’ll continue to see vertical and horizontal M&A reshape the landscape, collaborative partnerships will thrive.”

Tracking the Evolution of Top Health Trends and Issues During the Trump Era

By Clive Riddle, December 13, 2019

Every December, the PwC Health Research Institute - like many other organizations – releases their compiled list of the top health issues from their perspective, for the coming year. This year their headline question posed from their list is “will digital start to show an ROI?” PwC hasn’t been married to the Dave Letterman Top Ten format – this and last year they identified six key issues, two years ago it was a dozen, three years ago they did pick ten.

 Here’s a summary of their top six issues for 2020 from their 53-page report:

1. A looming tsunami of high prices – “facing a tsunami of high-priced gene and cell therapies and ever-rising provider prices in 2020” stakeholders will pursue “creative ways to finance care, spread risk and ensure that their money is paying for value.”
2. Regulation trumps policy – “the outcome of the 2020 election is unlikely to bring about profound” change but the election will determine the fate of Trump policies on Medicaid, ACA, pricing transparency and trade.
3. Consumers inch closer to DIY healthcare – Consumers will “finally reap benefits from the enormous investments in data collection, storage and analysis that have been made by the US health industry.”
4. US health organizations are seeking opportunities overseas and through innovation. Beware of the tax risks.
5. A whole new you: Deals as makeovers – with “strategic deals not to just grow larger but instead to expand into new identities with platforms anchored in value, innovation, customer experience and population health.”
6. Equity and inclusion, not just diversity, as a business imperative – “health companies will align diversity, equity and inclusion initiatives with business goals and identify blind spots.”

So, using the PwC annual list as a yardstick, how has a view of the top healthcare issues for coming year evolved during the Trump years? Using previous Healthsprocket lists that summarized the PwC issues, here’s how they viewed the coming year for 2019, 2018 and 2017:

PwC: 6 top health industry issues of 2019

1. Digital therapeutics and connected care reshape the life sciences industry
2. The Affordable Care Act in 2019: Still Alive
3. Your company’s new, upskilled health worker of the future is you
4. Tax reform has only just begun for healthcare companies
5. Creating the Southwest Airlines of healthcare
6. Private equity: Healthcare’s new growth accelerator

PwC: Top 12 health industry issues of 2018

1. The healthcare industry tackles the opioid crisis
2. Social determinants come to the forefront
3. Price transparency moves to the statehouse
4. Natural disasters create devastation that lasts long after the event passes
5. Medicare Advantage swells in 2018
6. Health reform isn't over, it's just more complicated
7. Securing the internet of things
8. Patient experience as a priority and not just a portal
9. Meet your new coworker, artificial intelligence
10. Healthcare's endangered middlemen: PBMs, wholesalers
11. Real-world evidence a growing challenge for pharma
12. Tax reform moves forward

PwC - Top 10 health issues for 2017

1. Under a new administration, the fate of the ACA remains unclear
2. Pharma’s new strategic partner? Patients
3. Easing the training wheels off value-based payment
4. Insert your card here for healthcare
5. Paging Dr. Drone: It’s time to prepare for emerging technologies
6. The battle against infectious diseases sparks invention
7. Rx cauliflower: Nutrition moves to population health
8. Putting the brakes – gently - on drug prices
9. A year of new partnerships and collaborations
10. Preparing medical students for work in a value-based world

Fifteen Things to Know from the 2019 America’s Health Rankings Report

By Clive Riddle, December 6, 2019

Vermont is number one in health, Mississippi is in last place, and New York gets most improved. Smoking is down, obesity is up, along with diabetes, drug death, and suicides. Fortunately the supply of mental health providers is increasing as well. These indicators and countless more come courtesy of the 2019 America’s Health Rankings Annual Report.

 

The United Health Foundation, affiliated with UnitedHealth Group, has released their 118-page 2019 America’s Health Rankings Annual Report, marking their 30th annual study that "has grown from ranking states across 16 measures of health to 35 measures in 2019." This year’s report was developed in partnership with the American Public Health Association.

The Foundation share these key findings from their report:

1. In the past year, improvements have been made in lowering the rates of smoking (decreasing 6%), children in poverty (decreasing 2%), and increasing the supply of mental health providers (increasing 5%).
2. In the past two years, infant mortality has declined, resulting in 1,200 fewer deaths (decreasing 2%).
3. Obesity prevalence among Americans is now at 30.9%, up 11% since 2012.
4. Diabetes is now at 10.9% of the U.S. population, up 4% in the past year.
5. The rate of drug deaths increased 37% from 14.0 to 19.2 deaths per 100,000 – equating to more than 53,000 additional deaths over a three-year period.
6. The suicide rate increased 4% nationally in the past year, and is up in a total of 30 states.
7. Smoking among adults has decreased 45% since 1990. Today, 16.1% of adults report that they smoke.
8. Infant mortality has decreased 43% since 1990, with declines in all 50 states.
9. Obesity has increased 166% over the past 30 years, from 11.6% to 30.9%.
10. Diabetes has reached the highest prevalence since 1996, increasing 148% among adults.
11. The national suicide rate has increased 17% since 2012.
12. Drug deaths have increased 104% since 2007.
13. Vermont topped the list of healthiest states in 2019, followed by Massachusetts (No. 2), Hawaii (No. 3), Connecticut (No. 4) and Utah (No. 5).
14. Mississippi ranks No. 50 this year, followed by Louisiana (No. 49), Arkansas (No. 48), Alabama (No. 47) and Oklahoma (No. 46).
15. New York has made the most progress since the Annual Report was first released in 1990, improving 29 ranks from No. 40 to No. 11.

A Current Snapshot of Medicare Advantage, PDP Medicare Employer Group Enrollment

by Clive Riddle, November 22, 2019

As of November, Medicare Advantage now serves 22,584,367 enrollees. Another 709,746 are enrolled in related plans (Dual, Cost and PACE), for a total of 23,294,113 Medicare enrollees in managed plans. 88.3% of these total managed enrollees have Prescription Drug Plan coverage. Another 25,626,600 Medicare enrollees not in managed plans have PDP coverage.

14.1% of Medicare Advantage enrollees are in Special Needs Plans. 20.1% of Medicare Advantage enrollees are in Employer Plans. 18.5% of Medicare PDP only enrollees are in Employer Plans. Below is the CMS November 2019 enrollment contract summary report: 

Speaking of Employer plans, Mark Farrah Associates has just released a brief: Trends in Employer Group Medicare Advantage Enrollment. For the employer group segment, they identified the top five MA payers by group enrollment (Oct. 2019 data) to be:

• UnitedHealth: 1,387,052
• CVS/Aetna: 913,490
• Kaiser: 550,331
• Humana: 510,956
• BCBS Michigan: 378,890

These top five payers comprise 83.7% of total Employer Group MA enrollment, and “all 5 of the leading group MA health plans achieved double-digit growth in membership since December 2016.” Enrollment is also concentrated by state, with the top ten states (20% of the states) comprising 63.9% of Employer Group MA enrollment, with California on top with 622,404 enrollees followed by Michigan with 405,415.

Overall, they note that “employer group MA enrollment has increased by almost 321,000, a 7.7% increase, since December 2018. Moreover, group market enrollment has increased by approximately 1.3 million members since December 2016.”

Affordability and Coverage of Prescription Drugs for Seniors: A Gallup Poll and a KFF Study

by Clive Riddle, November 15, 2019

West Health and Gallup have just released results from a new survey on healthcare costs that found 13.4% of U.S. adults had “a friend or family member [who] passed away after not receiving treatment for their condition due to their inability to pay for it.” That percentage decreases with age: 16.9% under age 45, 12.4% between age 45 and 64 and 6.6% age 65%+  knew someone passing away.

That might seem counter-intuitive, given the greater frailty of seniors, but greater income levels compared to those under age 45, combined with stable coverage (Medicare) factor in. By income the percentages were 18.5% under $40k annually, 11.1% between $40k to $100k, and 9.1% over $100k.

Prescription drugs pricing was a particular focus in the survey, and “89% of U.S. adults report that drug prices are either ‘much higher’ or ‘somewhat higher’ than what consumers should be paying for them.” The survey found “28% of women vs. 18% of men have been unable to pay for prescription drugs;’ and that “medication insecurity skyrockets to 42% among those with annual household incomes of under $40,000.”

Today’s seniors have something the previous generation did not –the availability of  Medicare prescription drug coverage to help insulate from drug costs, and Kaiser Family Foundation has just released a new study: Medicare Part D: A First Look at Prescription Drug Plans in 2020.

Here’s eight things to know from KFF’s study:

1. The average Medicare beneficiary will have a choice of 28 PDPs in 2020, a 29% increase from 2017
2. A total of 948 PDPs will be offered in 2020, an increase of 202 PDPs since 2017.
3. Among the 20 PDPs available nationwide, average premiums will range sixfold from a low of $13 per month for Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts Medicare Choice.
4. Two-thirds of Part D enrollees without low-income subsidies will have premium increases in 2020 if they stay in their same plan, and one-third will have premium decreases.
5. The estimated national average monthly PDP premium for 2020 is projected to increase by 7% to $42.05
6. In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and specialty drugs, and cost sharing other than the standard 25% coinsurance, similar to 2019.
7. 86% of PDPs will charge a deductible, with most PDPs charging the standard deductible of $435 in 2020.
8. Among all PDPs, median cost sharing is $0 for preferred generics and just $3 for generics, but $42 for preferred brands and 38% coinsurance for non-preferred drugs plus 25% for specialty drugs

Telling Tooth to Power: J.D. Power 2019 Dental Plan Satisfaction Report

by Clive Riddle, November 8, 2019

J.D. Power has just released its 2019 Dental Plan Satisfaction Report, which found that “customer satisfaction with dental plans increased in 2019, driven by year-over-year increases in coverage and communication experience,” with an overall satisfaction score in 2019 of 772 (on a 1,000-point scale) increasing from 768 in 2018.

The study found that DentaQuest (810 score) ranks highest, Blue Cross Dental/Blue Shield Dental (806 score) ranked second and HumanaDental (780 score) ranked third. The study noted “while most dental care providers included in the study typically provide insurance coverage through the customers’ employer, DentaQuest largely provides government plans.” Their report is based on survey responses from 1,400+ dental plan members.

The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey found that “among firms offering health benefits in 2019, 59% of small firms and 92% of large firms offer a dental insurance program to their workers separate from any plan included in their plan,” and that “sixty­three percent of firms offering a dental program to their workers make a contribution toward the cost of the coverage.”

The recently released 2020 Segal Health Plan Cost Trend Survey found that dental PPO plans were projected at 3.8% premium increases, dental maintenance organization plans at 3.5% increases, dental reference priced plans at 3.0% and dental FFS/indemnity plans at 4.1% increases. The report notes that dental benefits have "remained relatively unchanged for decades."

Here are the detailed results from the J.D. Power Dental Plan Satisfaction Report:

Measuring Telehealth Satisfaction: J.D. Power Study Finds Early Adopters Love It

by Clive Riddle, November 1, 2019

Telehealth use has progressed to the point where J.D. Power now has added the category to items included in their consumer satisfaction studies. The J.D. Power 2019 Telehealth Satisfaction Study finds that while “nationwide consumer adoption of telehealth services has been stubbornly low, with just 10% of healthcare consumers having used such services,” among those early adopters who are using telehealth, customer satisfaction with the experience ranks among the highest of any consumer category studied by J.D. Power.”

Greg Truex, Managing Director, Health Intelligence at J.D. Power offers this perspective: “Early attempts at trying to convince consumers to bank via their phone failed, and initiatives were abruptly canceled. Now, with mobile banking apps having grown to become the third-most-used application among consumers, we expect telehealth to follow a similar path. Telehealth offers an alternative avenue to receive quality care that is cost efficient and accessible. Once providers and payers refine the formula for awareness and adoption, telehealth will change the landscape of how affordable and quality care is delivered.”

J.D. Power found “the overall customer satisfaction score for telehealth services is 851 (on a 1,000-point scale), and is 900 or higher among 46% of telehealth users.,” and that “these customer satisfaction scores are among the highest of all healthcare, insurance and financial services industry studies conducted by J.D. Power. Only direct banking customer satisfaction ranks higher, with an average score of 855.”

Among direct-to-consumer brands, Teladoc ranked highest with a score of 870. Followed by Doctor on Demand (867) and MDLIVE (847). Among payers of health plan-provided telehealth services, Humana ranks highest with a score of 864, followed by Kaiser (863) and Cigna (862).

 

Additional J.D. Power study findings included:

• 65% of telehealth users used the service because they received a positive recommendation from others, including friend, family or colleague (22%); health plan (21%); primary care doctor (20%); employer (18%); or health plan, hospital, or another provider (15%).
• Among consumers who have not used telehealth, 29% indicate that telehealth is not available to them and 37% say they do not know if it is offered by their health provider or health system.
• Self-reported availability is lowest in rural areas (25%).
• 84% of telehealth users were able to completely resolve their medical concern(s) during their visit 
• 73% of users did not experience any issues or problems during their service.
• 49% of users say there were no barriers that made using telehealth difficult.
• 87% of users describe the enrollment process as somewhat/very easy.
• Users averaged 44 minutes for their entire experience, including: 17 minutes to complete the enrollment process, 9 minutes to wait for a physician or nurse practitioner and 18 minutes for the actual consultation. 

Thirteen Things to Know About the State of Vaping Use and Healthcare

By Clive Riddle, October 22, 2019

The CDC recently released numbers on vaping prevalence and health issues, which has been compiled along with their Electronic Cigarette Infographic Fact Sheet, to yield these thirteen things to know:

1. As of October 8, 2019, 1,299 confirmed and probable lung injury cases associated with use of e-cigarette, or vaping, products were reported nationally
2. As of that date, 26 deaths have been confirmed in 21 states
3. The median age of patients who have died is 49 years, ranging from 17 to 75 years old.
4. 76% of users reported using THC-containing products, with or without nicotine-containing products;
5. 32% of users reported exclusive use of THC-containing products;
6. 58% of users reported using nicotine-containing products, with or without THC-containing products
7. 13% of users reported exclusive use of nicotine-containing products.
8. 70% of users are male.
9. 80% of users are under 35 years old.
10. 15% of users are under 18 years old
11. 21% of users are 18 to 20 years old.
12. As of 2015, among all adult users 11.4% had never been regular cigarette smokers, but for age 18-24 40.0% had never been regular cigarette smokers
13. In 2018, 4.9% of middle school and 20.8% of high school students had used e-cigarettes in the past    30 days, compared to a 2017 study citing 2.8% of all adults

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.”

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.

Taking the Healthcare Time Machine to 2040 – Two Separate Peeks into the Future

by Clive Riddle, October 4, 2019

Several days ago, I – like numerous others – received a mysterious email from Robert Pearl, MD informing us that “It’s 2040 and the U.S. health system is the best in the world.” He asks, “How did it happen?” and informs us “that question is more difficult to answer than what happened.”

The mystery quickly solved itself, as his new article in Forbes was released that same day: “It’s 2040: How Did American Healthcare Become The Best In The World?” Doctor Pearl quickly explains his thought experiment posed in his email and in the opening of his article: “As far-fetched as this outcome may seem, the purpose of the question is to consider what, specifically, could spark major change in U.S. healthcare. Below are 12 possibilities, each based on the comments and credentials of recent Fixing Healthcare [his podcast] guests.”

So remember – his list derived from his podcast guests isn’t the specific fixes, but rather what movements caused the fixes to happen:

1. Global Disruption
2.  Twenty-first Century Tech
3. The Power Of Moments
4. Bright Spots
5. Transparency: "was it because doctors and hospitals were required to disclose their pricing and quality outcome data"?
6. Healthcare Voting: after "Americans exercised their rights at the polls and demanded change from elected officials?"
7. Consumerized Care: after "doctors, hospitals and health plans put patients first, resulting in a more consumer-centric and affordable form of healthcare"?
8. Battling Burnout
9. Modern Heroes: "was American healthcare saved by a new batch of medical visionaries?"

10.  Social Determinants: "did public health advances in U.S. society lead to better outcomes and greater life expectancy"?

11.  Patient Power: "did patients band together online and use their collective voice to inspire major healthcare changes?"

12.  Internet Reliability: "did sweeping internet regulations help people avail themselves of reliable information and the best medical care possible?"

Now that we’ve considered what might drive healthcare change into 2040, let’s peek into another examination of 2040 done earlier this year by the Deloitte – entitled: Forces of change – The future of health, and opens like this: “The future of health will likely be driven by digital transformation enabled by radically interoperable data and open, secure platforms. Health is likely to revolve around sustaining well-being rather than responding to illness. Twenty years from now, cancer and diabetes could join polio as defeated diseases. We expect prevention and early diagnoses will be central to the future of health.”

We are told that “By 2040 (and perhaps beginning significantly before), streams of health data—together with data from a variety of other relevant sources—will merge to create a multifaceted and highly personalized picture of every consumer’s well-being;” and that “consumers—armed with this highly detailed personal information about their own health—will likely demand that their health information be portable.”

Deloitte says they “anticipate that by 2040 successful companies will identify and compete in one or more of the[se] new business archetypes:

Data and Platforms:

• ·         Data conveners (data collectors, data connectors, and data securers)
• ·         Science and insights engines (developers, analytics gurus, insight discoverers)
• ·         Data and platform infrastructure builders (core platform developers, platform managers and operators)

Well-being and care delivery

• ·         Health products developer (application developers, inventors/innovators, manufacturers)
• ·         Consumer-centric health/virtual home and community (virtual health providers and enablers, and wellness coaches)
• ·         Specialty care operators (world-class health centers, event-specific facilities)
• ·         Localized health hubs

Care enablement

• ·         Connectors and intermediaries (enterprise tool developers, supply chain designers and coordinators, delivery service providers)
• ·         Individualized financiers (N of 1 insurers, catastrophic care insurers, government safety net payers)
• ·         Regulators (market leaders and innovators, government regulators and policy makers)

So what should we do armed with this glimpse into 2040? Deloitte advises "as stakeholders prepare for the future of health, they should consider the following actions:"

• ·         Build new businesses
• ·         Forge partnerships; and
• ·         Appeal to the newly empowered health consumer

As for me, my primary objective will be to still be alive to see what happens.

Healthcare Consumers on Technology and Decision Making: A Dozen Things To Know from a UnitedHealthcare Survey

by Clive Riddle, September 27, 2019

As healthcare consumers are about to embark into a decade, a new survey tells us they are turning even more to technology for health information, decision-making and purchasing. UnitedHealthcare has released results from their fourth-annual Consumer Sentiment Survey, which “examines Americans’ attitudes and opinions about multiple areas of health care, including open enrollment preparedness, technology and transparency trends and health literacy.” United tells us the study focuses on three areas: 1) Open Enrollment Preparedness; 2) Technology & Transparency Trends; and 3) Health Literacy & Consumer Preferences.

 

Here’s a dozen takeaways from the survey:

1. A new-high 37% have used the internet or mobile apps to comparison shop for care (14% in 2012), including 50% of Millennials
2. 46% cited a health care professional, such as a doctor or nurse, as the first source of information about specific health symptoms or ailments, and 20% first use the internet or a mobile app
3. 39% who shopped online changed the facility or care provider (or both) as a result
4. 64% “never” know the Rx costs before leaving the doctor’s office; 21%  “sometimes” know and 11% always know the price.
5. 45% said they would be interested in their physician using AI in care decisions (including 55% of Millennials); and 28% were uninterested
6. For those interested in AI support for physicians, 46% were motivated by the potential for a more accurate diagnosis; 31% cited the potential to reduce human error; and 15% hoped for faster treatment decisions
7. 39% would likely use telemedicine in the future to access care (up 2 from 2016)
8. 75% of those with benefits say they are prepared for the fall’s open enrollment season (down 2 points from last year) including 84% of Gen-Xers and 78% of Baby Boomers, but just 69% of Millennials and 44% of Gen-Z.
9. 36% devote less than one hour to open enrollment; 27% spent between one and three hours; and 23% said more than three hours.
10. 55% check if their doctors are in-network for the health plan they intend to select
11. 59% successfully defined plan premium, 53% defined the meaning of deductible, while 335 could define out-of-pocket maximum and 21% define co-insurance
12. 66% preferred speaking directly with a customer service representative to resolve health plan issues; and 10% preferred a self-service option through an app or online.