By WAYNE OLIVER AND JEFFREY SEGAL, MD

Insurance carriers large and small have started submitting premium hikes for the next 12 months for approval by federal and state officials. The picture is not pretty particularly for companies that sell the new plans designed under the Affordable Care Act. Those premiums are destined to climb 40 percent or more in some states in 2016.

Health insurance companies are getting squeezed as spending goes up and not enough young, healthy people enroll and pay premiums. As result, healthcare premiums, co-pays, deductibles and out-of-pocket co-insurance costs for individuals, employers and taxpayers will continue to soar ever-higher.

Estimates are that the ACA will add between $140 billion and $500 billion to the deficit over the first decade of the law’s existence. That’s because more will be spent on Medicaid and subsidies than is found in cost savings to healthcare. All truth be told, the ACA did nothing substantive to ensure healthcare cost savings.

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By NICHOLAS ORLOWSKI

A lesson from the future:

We look back at the years between 2010 and 2016  (The lifespan of Meaningful Use) as a dark age in healthcare software.

It was an era where software companies bound by government mandate to churn out horrible software tried to pretend their products increased productivity. “Eligible” providers were brow-beaten to click buttons and fill forms, print things and perform medical decision making without being paid.

Some software companies were successful, in a financial sense, as their armies of sales experts and market segmenters conquered their unassuming customers, brandishing the sabre of “ONC-ACB certified”. Those companies unwittingly managed to stamp out the potential of small physician offices, increasing consolidation to hospitals – and healthcare costs. Eventually, the ONC crest once emblazoned proudly on their chests, became a warning: “This software was designed for Meaningful Use, not Actual Use”.

Linguistically, the term “Meaningful Use” became entwined with “Electronic Health Record”. People forgot that medical software could improve patient care and not tout it’s Meaningful Use certification. An effort was made to ridicule those who believed that government regulations were legitimately harmful to the healthcare industry. The sky was lassoed and we were pulling it down.

A healthcare IT Renaissance:

The tides did turn, however. Visionaries and industry leaders came to realize how harmful Meaningful Use was to innovation.  Lawmakers were educated on how destructive constantly changing software and workflow requirements are to software development and medical workflow management.Continue reading…

By JOE FLOWER

So it’s all over the news space and the shrieking blogosphere, with headlines like, “Obamacare Rates To Spike Up To 51%,” “Obamacare Hell…” and “Obamacare Inflationary Deluge…”

And online friends are commenting about “Obamacare premiums set to rise next year as much as 51% in some states…”

Hey, hey, hey. No need to panic. “Set to rise.” Stated as an actual set-in-stone future. See, kids, this is why I tell you not to try this at home. Being a real futurist takes a professional.

You might remember in spring of 2014 we saw headlines about how 2015 rates would “skyrocket.” And I said, “Nope.”

So what’s really happening this year? Do we each have to imagine our present rates suddenly rising by 40 or 50 percent? Here’s my reasoning.

First, these are rate hike requests, not actual rate hikes. They are not “set” at all. Think of them as opening bids by individual companies in the current round of rate adjustments, which have to pass muster in their particular states. Like any group of numbers, they fall on a bell curve. The headlines are about the extreme outliers in a few markets.

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By ROB LAMBERTS, MD

It’s been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we’ve been quiet in nearly every way – few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question.  This is exactly what should be happening when things are going right.  My patients are happy.  My patients don’t need me now.  My patients are satisfied with my care.  This would be a problem in most offices, as revenue depends on people having problems, having questions about their care, or anything else that would fill the schedule.  In practices like mine, however, this is what we want; after all, I am paid just as much for an empty office as a full one.

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 By DAN HOUSMAN

The Internet has taught us valuable lessons about what works and what doesn’t in regards to identifying, engaging, and retaining customers.

Retailers are increasingly using sophisticated data aggregation and customer stratification methods to build business and grow revenues. Other industries are also leveraging technological advances to directly improve and enhance customer relationship management (CRM).

The health care industry? Not so much.

For a variety of reasons related to regulatory requirements, competitive pressures, cost considerations and privacy concerns, health care has lagged behind other industries in the development of effective CRM strategies. The industry has been slow to adopt data collection and communication models that promote value-based care and the inclusion of care team members (both clinical and non-clinical).

Since I first entered the health care industry many years ago, I’ve been surprised by the absence of innovative CRM capabilities that are typically commonplace in other industries.

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By JULIE SCHNEIDER

There are a growing number of exciting opportunities to think about leveraging health data globally.  Just imagine the possibilities when you bring open health data initiatives together with creative tech entrepreneurs across countries to address key health and health care issues.  More solutions, greater global impact?  This was a key area of exploration at the 2015 Health Datapalooza, and a special session featuring government representatives from India.   

Health Datapalooza welcomed a delegation from the Government of India (GOI), including two representatives from the Office of the Registrar General (ORG), Ministry of Home Affairs: Rohit Bhardwaj, Deputy Registrar General, and Rajeev Kumar, Deputy Director. Both participated in a panel titled, Using Open Data to Promote Entrepreneurship and Innovation in India, chaired by Indu Subaiya, Co-Chairman and CEO, Health 2.0.

“India is poised for major growth in health IT innovation. We are excited to both share our experiences with open health data and learn from them as they leverage more than 900 million mobile phone users and a growing community of technology entrepreneurs,” said Susannah Fox, Chief Technology Officer of the Department of Health and Human Services (HHS).

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By DAVID DRANOVE and CRAIG GARTHWAITE

Not long ago we received our first signs that all may not be well in the land of milk, honey, and low priced insurance, i.e. the ACA insurance exchanges.  Many insurers, including some of the largest in each state, have requested double digit rate increases, with some asking for raises that exceed 30 percent. A casual review of these requests suggests that the increases are largest in areas where the premiums were initially lowest. If these increases are approved, it will mean dramatically higher payments for enrollees, and escalating tax bills for the rest of us.  This is particularly true when the premium hikes affect the lowest priced “silver” plans available in the market (as the subsidies are tied to premiums for the second cheapest silver plan). Of course, the premium increases might backfire on insurers, but only if enrollees opt to switch to cheaper plans.

However, we have grave doubts about whether this will be the case. If participants in the exchanges behave like enrollees in employer-sponsored plans, then it seems unlikely that there will be much switching out of plan. This is a natural consequence of the way the exchanges work, combined with well documented inertia on the part of health insurance enrollees.

What is this inertia?  Academic research performed here at Northwestern University and elsewhere convincingly shows that employees are reluctant to switch health plans, even if they stand to save $2000 or more without sacrificing quality or access.  In addition, a pair of studies of Medicare Part D prescription drug plans also demonstrate that consumers switch plans infrequently and those that switch do those mostly in response to changes in the design of their own plan (i.e., are their preferred drugs on formulary) rather than in response to the relative financial attractiveness of theirs versus competing plans.

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By MOLLY MALOOF, MD                                Sponsored Content

Medical technology has undergone dramatic changes in the last 10 years. Right now, I make and cancel appointments, get prescriptions filled, look at test results, pay bills and email my doctor—all from my computer. I track multiple health markers on my cellphone, and am proactive about my preventive screenings. I am the definition of an engaged patient.

But, I know how the system works from the inside out. The question for most doctors is how to teach patients to be more engaged with the convoluted, fragmented, and confusing healthcare system. They are asking this because they are struggling to meet Meaningful Use Stage 2 requirements.

Most docs complain that the 5% patient portal requirement is unfair because it is out of their control. Maybe it is, or maybe there are smarter ways to work the system in their favor that they just don’t know about.

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