Archive for 2004

Guest Blogger #2

December 5th, 2004 by Melanie Matthews

Another member of our editorial staff at the Healthcare Intelligence Network will be “guest blogging” for us in the coming months.

Patricia Donovan is the managing editor of the Healthcare Intelligence Network. She has edited over a dozen reports produced by the Healthcare Intelligence Network, on topics ranging from physician and patient engagement to cultural diversity to pay for performance and predictive modeling.

She has nearly 20 years of experience as a technical writer, editor and project manager in the telecommunications industry. She previously worked in corporate communications and as a journalist for several New Jersey-based newspapers. She has a bachelor’s degree in journalism and urban communications from Douglass College.

Healthcare Industry in 2005

November 23rd, 2004 by Melanie Matthews

While the healthcare crisis did not play a critical role in the 2004 Presidential election, one industry expert predicts that it will be the single biggest issue in the 2008 election.

We tend to agree here at HIN, after hearing from some of our members about the health insurance premium increases that they are facing in 2005. One member reported a 30% increase in premium costs in 2005.

While these double-digit increases from the insurance companies are expected, according to Nathan Kaufman, senior vice president of healthcare strategy for Superior Consultant Company, Inc., “these increases in insurance companies
were independent of hospital rate increases.”

One of the major misconceptions in the industry is if
hospitals keep charges down, there’ll be fewer uninsured and less
healthcare cost escalation. That’s not true. If hospitals keep charges down,
the insurance companies make more money and the hospitals go without
capital, Kaufman said during a recent audio conference, “Healthcare Trends & Forecasts in 2005,” sponsored by the Healthcare Intelligence Network.

This results in more uninsured individuals, and more bad debts. The
uninsured problem is a government problem. Kaufman predicts that there will be 55 million uninsured
people by 2008. When the government gets involved, the expectation is that these
uninsured patients will be paid some rate—the Medicare rate. And today,
most hospitals are losing money on Medicare. So there are four years
remaining to reduce cost structure and infrastructure to prepare to start
making money from Medicare reimbursement.

Guest Blogger

November 20th, 2004 by Melanie Matthews

I’d like to introduce our first Guest Blogger at the Healthcare Intelligence Network. Posting as a guest blogger will be Jennifer Millman, a member of our editorial staff here at the Healthcare Intelligence Network.

Jen has been analyzing our survey results posted on our site and has been a contributing editor to several new special reports that we’ve published, on topics ranging from predictive modeling, healthy lifestyle incentives, depression and disease management. Jen brings a passion to the healthcare business news topics that she covers for HIN.

We look forward to some thought-provoking posts from Jen in the future.

Employer Healthcare Costs Continue To Rise

August 31st, 2004 by Melanie Matthews

Employers are facing continued double-digit increases in health care costs in 2005 and likely will require their workers to pay an even greater share of the bill, according to a new survey of more than 900 firms.

The survey, released August 26 by Mercer Human Resource Consulting, found that employers expect health care costs to rise 12.9 percent on average next year if they leave benefits unchanged.

Meawhile, payor are continuing to look at a number of strategies to control these costs and improve quality, such as disease management, consumer driven healthcare, pay for performance programs.

These strategies are being met with resistance from employees. The 2004 Health Care Consumerism Survey: Aligning Employer and Employee Interests shows a widening gap between employers and employees in terms of attitudes about health care, creating even greater challenges for employers who want and need to enlist employees as consumer allies in the fight against rising costs.

The gaps that need to be closed include:

Issue: Goals
Employers View: Employers tend to focus on the company’s interest in dealing with changes to health programs and to underscore financial concerns, both financial and emotional.
Employee View: Employees focus on their own self-interest when it comes to health care.
Solution: Successful employee outreach must include both elements.

Issue: Healthcare Consumerism:
Employers View: Employers generally don’t feel employees are strong health care consumers, making thoughtful decisions about when to seek care, the choice of provider, etc.
Employee View: Employees overwhelmingly feel they are already good consumers.
Solution: This split may reflect differences in important areas such as how to explore alternative treatments and whether the financial consideration is based on the total cost or the employee’s out-of-pocket cost.

Issue: Controlling Healthcare Costs
Employer View: Employers have typically tried to control health care costs through higher premiums, copayments and other cost-shifting measures.
Employee View: Employees, however, are increasingly resistant to such increases and even doubt they are necessary for business reasons.
Solution: This difference, which ties back to the need to appeal to employees on
more than a pure financial basis, has been fueling increased resistance to health care program changes and impeding the success of employer efforts.

Preventative Medicine

July 29th, 2004 by Melanie Matthews

Yesterday during our audio conference on The Role of Behavior Modification in Disease Management: How To Maximize Your Program’s Effectiveness, one of our speakers mentioned the shift that needs to occur from sick care to preventive care in the U.S, remarking that we take better care of our cars than we take care of our bodies.

And while I eat my five servings of vegetables and fruits a day, exercise at least five days a week, drink 8 glasses of water daily, and am in “good health,” I hardly ever go to the doctor for “prevention.” I do, however, change my car’s oil every 2,000 miles.

It seems that even though my habits are healthy I still need “behavior modification.” 

Highlighted during yesterday’s conference, was a pilot project conducted by CorpHealth for a large employer group with 75,000 lives. The pilot project included 20,000 lives, Richard Citrin, vice president of health and productivity at CorpHealth. Based on an identification process, nearly 7 percent of the group was identified as being at risk for high healthcare utilization. The project used a variety of engagement and intervention strategies to address this group.

Also presenting was Gregg Lehman, president and CEO of Gordian Health Solutions. Gordian uses a combination of tools for effective behavior modification, including personal physicians, health coaches, educational materials and a supporting care team. 

July 15th, 2004 by Melanie Matthews

Even though managed care rates are increasing at slightly slower rates, the industry is still bracing for double digit increases in HMO and PPO rates in 2005, according to early results of the annual Milliman and Robertson survey. Final results will be published in October.

The industry will undoubtedly continue to turn to other methods to control these rising rates, including disease management, predictive modeling, consumer driven healthcare. During Controlling Healthcare Costs in 2004: A Three-Pronged Approach,an audio conference hosted by the Healthcare Intelligence Network in February of 2004, Lora Hedin, Senior Director, Product Management, HealthPartners, Alexandria Schweitzer, Assistant Vice President Consumer Driven-Health Care, Tufts Health Plan and Jim Woodburn, MD, MS, Major Account and Corporate Medical Director, Blue Cross Blue Shield of Minnesota, described how these strategies were working in their organizations.

Hedin said their organization is working toward creating a traditional marketplace where the consumers, buyers and providers of a product are aligned appropriately. Cost-shifting gets the consumer’s attention. By educating members on price and quality differences, it drives members into the most efficient, effective providers or makes them share in the cost.

Liberty by Tufts Health Plan is a second-generation consumer-driven health plan that combines the best of consumer-driven healthcare with the best of managed care, Schweitzer said. The plan provides incentives to control discretionary spending and protects against less controllable expenses. It also provides members with a variety of tools to help members become better consumers of healthcare, including online health content, and audio library, a symptom checker, a nurse advice line, HRAs and decision support tools.

Anecdotal evidence confirms that the plan helps members behave like active consumers and adopt healthier lifestyles. Data confirms that the plan components reduce high-cost utilization, lower costs for controllable expenses and increase members’ preventive activities, Schweitzer explained.

The disease management program at BCBS of Minnesota began in March 2002 and now provides disease management programs for 17 conditions. The combination of the 17 conditions impacts between 12 and 15 percent of a commercial population, accounting for between 40 and 45 percent of total claims expenses.

The care support program was implement by stage, Dr. Woodburn said, with diabetes and heart program starting in March 2002 and the 11 extended conditions beginning in June 2002. Enrollment in the program was triggered by claims data. Overall, there was a 11 percent decrease in ER visits and a 14 percent drop in inpatient admission. The intervention was most effective for members with heart conditions – ER visits were down by 10 percent and inpatient admissions were down by 46 percent.

Electronic Medical Record — Friend or Foe?

July 8th, 2004 by Melanie Matthews

In just two weeks, the first installment of a national health information technology plan will be delivered when HHS convenes Cornerstones for Electronic Healthcare. on July 21-23 at the Washington (D.C.) Convention Center.

With President Bush’s mandate for a national EMR within 10 years, healthcare organizations are beginning to debate the benefits of the EMR and whose is going to foot the bill.

While the benefits of the EMR are not doubted – improved efficiency and patient safety – the cost of the technology has prohibited many organizations from implementing healthcare information technology.

During recent testimony before the Subcommittee on Health of the House Committee on Ways and Means, Andrew M. Wiesenthal, M.D., Associate Executive Director, Kaiser Permanente, called on Congress to provide financial incentives to healthcare organizations to implement electronic medical records. To read the full testimony of Dr. Wiesenthal and others, visit:

We’ll keep you posted after July 23.

Welcome to the Healthcare Intelligence Network Blog

June 30th, 2004 by Melanie Matthews

Hello and welcome to the first edition of the Healthcare Intelligence Network (HIN) Blog. My name is Melanie Matthews and I’m the executive vice president at HIN.

The HIN Blog’s purpose is to keep you better informed about resources and services at HIN and the healthcare industry in general.

For those of you who are new to “blogging”: a blog is basically an on-line journal that offers news, perspectives, opinions, and insights, and even links out to other sites, creating a new avenue of communication and community.

We are working on several new audio conferences, including childhood obesity, predictive modeling, and pay for performance programs. If you have topics or speakers that you’d like to suggest for our programs, please post them here.

We’ve also been analyzing the impact that the recent Supreme Court’s decision on patient lawsuits. To download a copy of “Reaction: Supreme Court Rules In Favor Of HMOs In Patient Lawsuits At State Level,” please visit: