Category: Uncategorized

Can Oscar Succeed In Making Health Insurance Fun? Maybe Not Just Yet. But the Startup Is Shaking Things Up …

Feb 24, 2014• 3

By Kate Greenwood

Last week I went to a panel presentation sponsored by the group NYC Health Business Leaders on the rollout of New York State’s health insurance exchange. Among the speakers was Mario Schlosser, the co-founder and co-CEO of the venture-capital-backed start-up health insurance company Oscar Health, which offers a full range of plans through New York’s exchange.

As NPR reported last month in a story about Oscar, “it’s been years since a new, for-profit health insurance company launched in the U.S.”, but the Affordable Care Act created a window of opportunity for new entrants.

Schlosser began his talk by giving us a tour of his personal account on Oscar’s website, www.hioscar.com. Among other things, he showed us the Facebook-like timeline, updated in real time, which tracks his two young children’s many visits to the pediatrician.

He typed “my tummy hurts” into the site’s search engine and the site provided information on what might be wrong and on where he might turn for help, ranging from a pharmacist to a gastroenterologist, with cost estimates for each option.

Additional searches yielded information on covered podiatrists accepting new patients with offices near his apartment and on the out-of-pocket cost of a prescription for diazepam (which was zero, since there is no co-payment for generic drugs for Oscar enrollees).

As an audience member noted, none of this is new exactly. What is new is to have this kind of data-driven, state-of-the-art user experience being offered by a health insurer. Schlosser told the audience that Oscar’s pharmacy benefit manager and other vendors are providing the company with real-time data that other insurers have not demanded.

Box & Dignity Health Name Five Semi-Finalists in Patient Education App Challenge

Feb 24, 2014

By Kim Krueger

Back at the Seventh Annual Health 2.0 Fall Conference in September, Box launched a Patient Education App Challenge with Dignity Health and The Social+Capital Partnership.

It was an appropriate launch pad to say the least, being like-minded as we are when it comes to our opinions regarding the cloud. Yet, as we know, health care is still relatively new to the cloud, and the entry of major cloud (and now HIPAA compliant) vendors like Box is a big deal.

Phase one of Box’s entry into the health care vertical has been largely centered on getting a diverse client base securely onto the cloud. Device companies, big pharma, life sciences, biotech, and health insurance companies are using Box just as cloud tools should be used — for storing, sharing, collaborating, and enabling mobility.

As most of us know from varied personal and professional use of the cloud, easy access to every piece of collateral in a remote or collaborative working environment increases velocity and enables relationships.

The Patient Education App Challenge is part of Box’s move into a phase two of sorts: “strategic data liquidity or care coordination in the cloud” as Box’s Managing Director of Healthcare and Life Sciences Missy Krasner called it.

The challenge developed out of talks between Dignity Health, the nation’s fifth largest hospital system, and Box around how hospitals can better deliver the huge amounts of content generated within any given hospital division. It launched with the Box API as a foundation for innovative opportunities to deliver appropriate materials to patients in engaging ways.

What You Need to Know About Patient Matching and Your Privacy and What You Can Do About It

Feb 21, 2014• 4

By Adrian Gropper, MD

Today, ONC released a report on patient matching practices and to the casual reader it will look like a byzantine subject. It’s not.

You should care about patient matching, and you will.

It impacts your ability to coordinate care, purchase life and disability insurance, and maybe even your job. Through ID theft, it also impacts your safety and security. Patient matching’s most significant impact, however, could be to your pocketbook as it’s being used to fix prices and reduce competition in a high deductible insurance system that makes families subject up to $12,700 of out-of-pocket expenses every year.

Patient matching is the healthcare cousin of NSA surveillance.

Health IT’s watershed is when people finally realize that hospital privacy and security practices are unfair and we begin to demand consent, data minimization and transparency for our most intimate information. The practices suggested by Patient Privacy Rights are relatively simple and obvious and will be discussed toward the end of this article.

Health IT tries to be different from other IT sectors. There are many reasons for this, few of them are good reasons. Health IT practices are dictated by HIPAA, where the rest of IT is either FTC or the Fair Credit Reporting Act. Healthcare is mostly paid by third-party insurance and so the risks of fraud are different than in traditional markets.

Healthcare is delivered by strictly licensed professionals regulated differently than the institutions that purchase the Health IT. These are the major reasons for healthcare IT exceptionalism but they are not a good excuse for bad privacy and security practices, so this is about to change.

Health IT privacy and security are in tatters, and nowhere is it more evident than the “patient matching” discussion. Although HIPAA has some significant security features, it also eliminated a patient’s right to consent and Fair Information Practice.

In Defense of Corporate Wellness Programs

Feb 21, 2014• 37

By RAJIV KUMAR, MD

A recent blog on HBR.org proposed to deliver “The Cure for the Common Corporate Wellness Program.” But as with any prescription, you really shouldn’t swallow this one unless all your questions about it have been answered. As a physician, a patient, and a businessman, I see plenty to question in Al Lewis and Vik Khanna’s critique of workplace wellness initiatives.

With their opening generalization that “many wellness programs” are deeply flawed, the authors dismiss a benefit enjoyed by a healthy majority of America’s workers. Today, nearly 80% of people who work for organizations with 50 or more employees have access to a wellness program, according to a 2013 RAND study commissioned by the U.S. Department of Labor and the U.S. Department of Health and Human Services.

It’s not clear whether the authors are intentionally dismissing or simply misunderstanding the wealth of data that shows how wellness programs benefit participating employees. The RAND study summarizes it this way: “Consistent with prior research, we find that lifestyle management interventions as part of workplace wellness programs can reduce risk factors, such as smoking, and increase healthy behaviors, such as exercise. We find that these effects are sustainable over time and clinically meaningful.”

Lewis and Khanna, however, don’t focus on such findings. Instead, they question the motives of a company for even offering a wellness program, which they slam as an “employee control tool” and “a marketing tool for health plans.” And, in perhaps the most baffling statement of all, the authors suggest that workplace wellness initiatives are “trying to manipulate health behaviors that are largely unrelated to enterprise success” (emphasis mine).

Let’s consider that piece by piece. What are the behaviors that corporate wellness initiatives are trying to influence? According to the RAND study, the most common offerings — available in roughly 75% of all wellness initiatives — are on-site vaccinations and “lifestyle management” programs for smoking cessation, weight loss, good nutrition, and fitness. In short, companies want to reduce the risk that their workers will get the flu, develop lung cancer, or suffer from the many debilitating conditions linked to overweight and a sedentary lifestyle. How could these initiatives be deemed “largely unrelated” to the company’s success?

Do Workplace Wellness Programs Make Business Sense?

Feb 21, 2014• 6

By Soeren Mattke

The press and trade publications strongly endorse workplace wellness programs as a good investment for employers. Soeren Mattke, a physician and RAND senior scientist, explains why his work tells a different story.

Why are workplace wellness programs so popular?

Because employers think the programs make business sense. They are supposed to improve employees’ health, increase their productivity, help control their chronic conditions, and reduce their risk of developing a chronic disease in the longer term. Employers believe that the dollars they spend on these programs will come back to them in avoided health care costs. For example, a recently published review suggested that employers gained three dollars in health care savings for every dollar spent on a workplace wellness program.

What does a typical workplace wellness program look like?

They usually have two components: lifestyle management and disease management. Lifestyle management focuses on employees with health risks such as smoking or obesity. The goal is to help employees reduce those risks, thus steering clear of serious disease down the line. In contrast, disease management is intended to support employees who already have a chronic disease by helping them take better care of themselves, e.g., reminding them to take their medications.

So are the programs living up to their press?

Perhaps in part. We recently published a study that included almost 600,000 employees at seven firms. We found that lifestyle management reduced health risk, like smoking and obesity, but no evidence that it lowered employers’ health care spending. Our new analysis extends that finding. Looking at 10 years worth of data from a Fortune 100 employer, we found that its program generated a reduction of about $30 per member, per month in health care costs. But disease management was responsible for 87 percent of the savings.

How does this disparity translate into return on employer’s investment?

The return on investment is strikingly different. For the disease management component, the employer earned a $3.80 return for every dollar invested in the program. For lifestyle management, the return was only $.25 for every dollar invested.

Bigger Hospitals Mean Bigger Hospitals with Higher Prices. Not Better Care.

Feb 20, 2014• 52

By Shannon Brownlee & Vikas Saini, MD

Hospitals are busily merging with other hospitals and buying up groups of doctors. They claim that size brings efficiency and the opportunity to deliver more “value-based” care — and fewer unnecessary services.

They argue that they have to get bigger to cut waste. What’s the evidence that bigger hospitals offer better value? Not a lot.

If you think of value as some combination of needed services delivered for the right price, large hospitals are no better than small hospitals on both counts.

The Dartmouth Atlas of Health Care and other sources have shown time and again that some of the biggest and best-known U.S. hospitals are no less guilty of subjecting patients to useless tests and marginal treatments.

Larger hospitals are also very good at raising prices. In 2010, an analysis for the Massachusetts attorney general found no correlation between price and quality of care.

A study published recently in Health Affairs offered similar results for the rest of the country: On average, higher-priced hospitals are bigger, but offer no better quality of care.

I’m a Doctor. And This Stuff Even Confuses Me!!!

Feb 20, 2014• 29

By THCBist

Extremely irate on the East Coast writes:

I’m a doctor. I have an MBA from a prestigious business school. I understand medical billing. Here’s a story for you that sums it all up.

After many years as an independent, my OBGYN recently joined a large physician group affiliated with a nationally known academic medical center.

(I’ll keep the name of the institution out of this since I like my OBGYN and several of my friends work at the medical center.)

Late last year I had a minor procedure at the academic medical center. My OBGYN handled the surgery. Everything went smoothly.

When the bill came I was charged a reasonable $600. This year I had to have a repeat of the same procedure. My OBGYN again performed the procedure. Same outcome. Same nurses. Same specialist. Same room. When my bill came in the mail I got the shock of my life. The total was four times as much as it had been a year earlier!!!! I had no idea.

My OBGYN’s office told me there is nothing they can do. Prices are set by the new academic medical center supergroup. As far as I can tell, the only thing that has changed is the sign over my doctor’s door.

What recourse do I have? What consumer protections does the ACA contain designed to prevent this kind of behavior?

I’m a doctor. I understand the issues involved. If I’m confused, how is the average consumer supposed to deal with this? This is extremely bad.

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

Healthwise Adds Informed Medical Decisions: Don Kemper Interview

Feb 20, 2014• 1

By Matthew Holt

Today venerable health content creator Healthwise merged with the Informed Medical Decisions Foundation which was previously funded by (and had an exclusive relationship up until last month with) Health Dialog. I asked Healthwise CEO–and old friend of Health 2.0–Don Kemper what was happening and what it meant. I also snuck in a smidgen of snark about a conference we worked on together five years ago.–Matthew Holt

Matthew: Don, you’re merging Healthwise with the Informed Medical Decisions Foundation. So I know the two organizations are both non-profits but as a poorly informed outsider I always thought of you as rival content creators, with Healthwise selling your content and services to insurers and providers and Informed Medical Decisions being funded by Health Dialog which then got to use and sell the content and decision support aids it created to its customers. Am I wrong?

Don: You aren’t completely wrong—but then not overly well informed either. We have always thought of ourselves as sister organizations rather than rivals. We have collaborated well in advocacy efforts to promote the role of the patient. Health Dialog has had a near exclusive relationship with the Foundation until recently. Health Dialog has been a long-term client of Healthwise, too—just not an exclusive one. When the restructured Health Dialog-Foundation relationship dropped the exclusivity requirement it allowed us to proceed with the merger discussions.

Matthew: Now that change occurred for Informed Medical Decisions and you two can merge, what do they have that Healthwise hasn’t got, and vice versa?

Don: The Foundation has three things that will add greatly to the Healthwise mission:

1. Medical Evidence—Their assessment of medical evidence in key areas goes deeper than we have been able to go. Whereas we have often waited for treatment guidelines to change before reflecting the changes in our content, their medical editors are often involved in making the guideline changes. Getting that information into the patient’s hands six months earlier could make a life or death difference.

2. Value Demonstration—The Foundation has developed research relationships with many health services researchers around the country. By setting up and evaluating demonstration sites for shared decision making (SDM) they have proven how SDM improves decision quality and reduces the use of expensive but preference-sensitive treatments.

3. Practice Change Management—The Foundation has gained a great deal of experience in helping clinicians build SDM into their workflow. Those learnings will help as we integrate patient engagement into the mainstream of care.

What they get from us is “reach.” People now turn to our information, tools and solutions over 340 times a minute. (180 million times a year). Fifteen percent of US physicians can now prescribe Healthwise patient instructions through their EMRs.

Healthwise has invested heavily in the technology needed to integrate into EMRs and has excelled at building broad-based solutions that fit within a health plan’s or health system’s workflow. It would have been hard for the Foundation to have matched that without us.

Matthew: So how will this actually work. How many people do you have, how many do they? Who gets to keep their jobs? Is this a real merger or a takeover?

Don: This is a merger made in heaven. No one will be out of work. Continue reading…

The Weightlessness of Obamacare

Feb 18, 2014• 3

By J.K. Wall

So many old rules in health care and insurance no longer seem to apply.

I keep stumbling upon situations, where, what used to be up is now down and what used to be down is now up.

No one seems to know for sure how things will settle out under the new reality created by Obamacare and the even more unpredictable reactions to the law by health care companies, employers and, most especially, you and me.

I’ve started using the term “weightlessness” to describe this state we’re in. Picture the astronauts on the international space station, floating through a room, flipping at will, as likely to settle on a wall or on the ceiling as on the floor.

That’s what life is like under Obamacare now—for physicians, hospital administrators, insurance executives, benefits brokers and employers.

Here are a few examples:

1. I wrote last week about how a chunk of workers, even at large employers with generous benefits, would actually get a better deal on health insurance from the Obamacare exchanges than from their employers. So their employers are starting to consider whether they should deliberately make health benefits unaffordable for those low-wage workers, so they can qualify for Obamacare’s tax-subsidized insurance.

That could be good for both employers and employees. The effect on taxpayers, which would switch from granting a tax credit to employers to instead granting it to the employees, is unclear.

2. Even though insurers were certain that price would be king on the Obamacare exchanges, that hasn’t led most customers to buy the plans with the cheapest premiums. As I wrote Friday, 76 percent of those shopping on the exchanges in my home state of Indiana have picked the higher-premium silver and gold plans, with only 24 percent picking bronze plans.

“There are a few geographies where we believe we are gaining share despite lower price competition which points to the value of our local market depth, knowledge, brand, reputation and networks,” WellPoint Inc. CEO Joe Swedish said during an January conference call with investors.

It’s possible that’s a result of older and sicker patients being the earliest buyers on the exchange, and that as healthier people buy coverage, they’ll gravitate to the low-cost bronze plans. But that hasn’t happened—which, as I wrote on Friday, has proved wrong hospitals’ concerns about the super-high deductible bronze plans.

In Defense of the Defense of Mammograms

Feb 18, 2014• 12

By SAURABH JHA, MD

To the two certainties of life, death and taxes, add another two: mammograms and controversy surrounding mammograms.

The Canadian National Breast Screening Study (CNBSS) has reported results of its long term follow-up in the BMJ: no survival benefit of screening mammograms.

To paraphrase Yogi Berra “it’s mammography all over again.”

Is the science settled then?

No.

Before I wade further it’s important to understand what is implied by “settling the science.”

Einstein said “no amount of experimentation can prove me right; a single experiment can prove me wrong.”In physical sciences a theory need only be disproven once for it to be cast aside. Heliocentricity cannot coexist with Ptolemy’s universe. The statement “all swans are white” is disproven by a single black swan.

What do we do with the studies that showed survival benefit of screening mammograms? Why does the CNBSS not close the debate over mammograms, like Galileo did with celestial egocentricity?

The simple and simplistic answer is because there are powerful advocacy groups, special interests; the pink-industrial complex who have a vested interest in undermining the science.

But that lends to conspiratorial thinking. Special interests cannot undermine Maxwell’s equations or Faraday’s laws just because they do not like them.

The testability of Maxwell’s equations is inherently different from verifying that screening mammograms increase life expectancy. We must acknowledge two types of science; the former, physical science, a hard science; the latter, a hybrid of biology and epidemiology, soft science.

Soft science is a misnomer. There is nothing soft about performing a randomized controlled trial (RCT), the methodological gold standard; in ensuring factors that falsely augment or attenuate impact of screening mammograms are evenly distributed, data reliably collected, cause of death accurately recorded and correctly inferred. But the human factor and all its inevitable foibles are unavoidable in soft sciences.