I’m back. After the takeover editions, I’m answering Jessica DaMassa about Atul Gawande as the CEO of the ABC new venture, the demise of Caresync, Ooda Health and its demand for a female VC, and whole bunch more blather! — Matthew Holt
matthew holt
Adjusting for Risk Adjustment
Risk adjustment in health insurance is at first glance, and second, among the driest and most arcane of subjects. And yet, like the fine print on a variable-rate mortgage, it can matter enormously. It may make the difference between a healthy market and a sick one.
The market for individual health insurance has had major challenges both before and after the Affordable Care Act’s (ACA’s) risk adjustment program came along. Given recent changes from Washington, like the removal of the individual mandate, the market now needs all the help it can get. Unfortunately, risk adjustment under the ACA has been an example of a well-meaning regulation that has had destructive impacts directly contrary to its intent. It has caused insurer collapses and market exits that reduced competition. It has also led to upstarts, small plans and unprofitable ones paying billions of dollars to larger, more established and profitable insurers.
Many of these transfers since the ACA rules took effect in 2014 have gone from locally-based non-profit health plans to multi-state for-profit organizations. The payments have hampered competition not just in the individual market, which has never worked very well in the U.S., but in the small group market, which arguably didn’t need “help” from risk adjustment in many states.
The sense of urgency to fix these problems may be dissipating now that the initial rush for market share under the ACA is over and plans have enough actuarial data to predict costs better. There has been an overall shift to profitability. But it would be a serious mistake to think that just because fewer plans are under water, the current approach to risk adjustment isn’t distorting markets and harming competition.
Defining Engagement in an Age of Patient Monitoring and Data Collection
SPONSORED POST
If you have an innovative solution that addresses Patient Engagement and Remote Monitoring, Bayer’s Dealmaker Challenge wants to hear from you! Apply here for a shot at collaborating with the Bayer G4A Digital Health Team and participating in Dealmaker Day, an exclusive matchmaking event, October 9th in Berlin.
What is healthcare without patients? For decades physicians have been a one-stop shop for diagnosis and treatment, a trusted source. And yet it’s only been in recent years that the entire healthcare industry has woken up to the notion that patients can and should have an active role in their healthcare and the decision making process. Patients may not have a medical education or clinical experience, but they do have a strong asset going for them: intimate knowledge of their bodies and access to information only they can provide. The rise of wearable technologies over the past decade has only increased patients ability to quantify their experiences, health and otherwise. Diet, exercise, daily habits, stress levels, family life, physical environment all contribute to an overall picture of health. Yet too often, clinicians only see a slice of their patients health picture – the picture that is presented during office visits. The increased importance of tracking lifestyle data has clinicians and technologists asking themselves, How do we unlock more information in order to make better decisions and deliver better care?
The field is called Patient Engagement. And while the industry has mutually agreed upon it’s critical importance, the question remains as to what it looks like.Continue reading…
Health in 2 Point 00, Episode 33, (another!) Takeover Edition
Jessica DaMassa hosts this edition of Health in 2 Point 00 on the Italian leg of her Grand Tour of Europe. This time it’s another takeover with Roberto Ascione, CEO of Healthware dishing on innovation on the Almafi Coast, the impact of GDPR on digital health in Europe and the Frontiers Health Conference in Berlin this November. And yeah, that’s not my office in the background — Matthew Holt
Can Medicaid Expansion Survive?
Amid fresh political rancor and legal machinations in the ongoing war over the Affordable Care Act (ACA), there’s a bright spot: Medicaid. At least for now.
This matters. True to predictions made by Obama and supporters when the ACA became law (2010), it has taken years and a lot of blood, sweat and tears to get to this moment.
As a reminder, the U.S. Supreme Court in 2012 ruled that states could opt out of the ACA’s Medicaid expansion—leaving each state’s decision to participate in the hands of governors and state lawmakers.
On June 7, after a 4-year pitched political battle, Virginia became the 33rd state (plus DC) to expand Medicaid under the ACA. The Virginia expansion is projected to encompass 400,000 low-income Virginians.
The state swung in favor of expansion after Democrats gained the governorship and more seats in the legislature in 2016. But, importantly, key moderate Republicans relented.
Four other non-expansion states could join Virginia over the next year or two. They are Maine, Idaho, Utah, and Nebraska.Continue reading…
Misdiagnosis: Obamacare Tried to Fix the Wrong Things and Prescribed the Wrong Treatments
Today THCB is happy to publish a piece reflecting the learnings from Charles Silver and David Hyman’s forthcoming book Overcharged: Why Americans Pay Too Much For Health Care, shortly to be published by the libertarian leaning Cato Institute. In subsequent weeks we’ll feature commentary from the right radical libertarian zone on the political game board (Michael Cannon) and from the left (Andy Slavitt) about the book and its proposals. For now please give your views in the comments–Matthew Holt
There are many reasons why the United States is “the most expensive place in the world to get sick.” In Part 1 of Overcharged: Why Americans Pay Too Much For Health Care, we show that the main reason is that we pay for medical treatments the wrong way. Instead of having consumers purchase these treatments directly, we route trillions of dollars through third-parties payers – both government and private insurers.
Relying on third party payers has many consequences — few of them good. To start with, this arrangement removes the budgetary constraint that would otherwise cap the amount consumers are willing to spend. By minimizing the direct cost of treatments at the point of sale, third party payment arrangements alter everyone’s incentives fundamentally. Consumers no longer need worry about balancing marginal costs against marginal benefits; instead, they have an incentive to use all treatments that have any potential to help, regardless of their prices. When millions of consumers act on these incentives, total spending skyrockets and consumers collectively wind up worse off, because their fixed costs spiral upward too. Heavy reliance on third party payers creates a classic failure of collective action.
It isn’t just consumers. Providers love third party payment as well. And why not? Once providers have access to the enormous bank accounts of third party payers, the sky is the limit, at least until third party payers start setting limits on the amounts they will pay and saying no to unproven and/or cost-ineffective treatments that doctors want to provide and patients want to receive.
Not surprisingly, it has turned out to be extraordinarily difficult and politically unpopular for third party payers to set such limits. Obamacare’s appeal derives largely from two requirements: health insurance plans must accept all comers, including applicants with preexisting conditions that require expensive medical treatments; and health plans must provide unlimited benefits (i.e., no annual or lifetime spending caps). From an individual consumer’s perspective, what could be better than having access to unlimited amounts of money to spend on medical needs? From society’s point of view, though, this combination is a recipe for disaster.Continue reading…
Health in 2 Point 00 Episode 32 — Takeover Edition
It’s a #Healthin2Point00 #Takeover edition — in which I get the boot and Jessica DaMassa invites Eugene Borukhovich who runs Bayer’s Digital Health Division and oversees the #Grants4Apps program to answer all he knows about ICEE Health (the conference they’re at), startups in Romania & biotech in China in just 2 minutes — Matthew Holt
Health for coins, not dollars ;) – The “not so serious” Mapping of Healthcare Cryptocurrencies
At this years’ SXSW it was all about blockchain and cryptocurrencies, but it was like that at HIMSS, JPM, CES, etc. as well. Since we wrote already about the first of the two buzzwords – blockchain as a trend in Healthcare, we decided to tackle the idea of cryptocurrencies in healthcare. First, we checked around the office and found out that several devs have been in a couple of Telegram chat rooms as they tried to buy “health coins” in a presale (ICO – initial Coin Offering; Pre-ICO).
Will you be buying your next health plan with ethereum? Or is the new health coin going to solve the problem of fragmented healthcare records?
Health in 2 Point 00, Episode 31
Jessica DaMassa asks me about PlugandPlay’s health day, people talking to bots in health care, the rumors of Softbank dropping a wad of cash on Science37, and we can’t resist some Thernos cracks. This one also has pictures! Sadly the video somehow got corrupted so it’s not your eyes, we are looking like green martians! — Matthew Holt
Can Supportiv fill the mental health peer support gap?
As promised I’m going to be featuring more interesting companies I’m working with on THCB. Supportiv, which is launching today in beta (App store/Play) is a thoroughly modern answer to the problem of scaling peer support in mental health. It’s aimed in the space between the mediation apps like Headspace & Calm, and the online therapy services like AbleTo or Lantern. The target market is anyone feeling stress or wanting support in a quick and easy format–that’s basically everyone! Using the magic of NLP, those looking for support are steered into a chatroom where a trained moderator (usually a Masters student in psychology) making sure the experience is smooth. In its trials earlier this year of the 48,000 users, 96% reported improvement. The business model? It costs 15 cents a minute, or $4.50 for 30 mins (which is roughly the expected length of a session). There’s lots of science behind the idea that peer support works but to hear more Jessica DaMasssa interviewed the co-founders Pouria Mojabi & Helena Plater-Zyberk.
