Archive for the ‘Transparency’ Category

Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’

March 13th, 2017 by Patricia Donovan

American Health Care ActLast week's unveiling of G.O.P. legislation designed to repeal and replace the Affordable Care Act (ACA) triggered a flurry of concerns and criticisms from healthcare industry sectors.

The proposed American Health Care Act (AHCA) would eliminate Obamacare's individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood. However, the bill seeks to maintain protections for individuals with pre-existing conditions and to permit children to remain on their parents' insurance plans until they reach the age of 26.

As of last Friday, the proposed American Health Care Act (AHCA) had cleared two committees in the U.S. House of Representatives; a final House vote on the bill is expected the week of March 20.

In a letter to leaders of the House committees that will mark up the AHCA, the American Medical Association (AMA) rejected the ACA replacement bill. In the letter, AMA CEO and Executive Vice President James L. Madara, MD, stated that his organization "cannot support the AHCA as drafted because of the expected decline in health
insurance coverage and the potential harm it would cause to vulnerable patient populations."

In particular, the AMA, the nation's largest physicians' group representing more than 220,000 doctors, residents, and medical students, objected to the bill's proposed restructuring of Medicaid, claiming it "would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes."

The AMA's position was also outlined in a statement issued by Andrew W. Gurman, MD, AMA president.

Meanwhile, the American Hospital Association (AHA), which counts 5,000 hospitals among its members, also opposed the AHCA. In a news release, Rick Pollack, AHA president and CEO, stated that the AHA "cannot support The American Health Care Act in its current form." The AHA stated that it would be difficult to evaluate the bill without coverage estimates by the Congressional Budget Office (CBO).

Echoing AMA apprehension over proposed Medicaid restructuring, Pollack stated that the AHA feared the bill "will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care."

Although Pollack lauded recent Congessional efforts to address behavioral health issues, including the growing opioid abuse epidemic, he stressed that "significant progress in these areas is directly related to whether individuals have coverage. And, we have already seen clear evidence of how expanded coverage is helping to address these high-priority needs."

Also seeking adequate Medicaid funding in the AHCA was America’s Health Insurance Plans (AHIP), a national association whose 1,300 members provide coverage for healthcare and related services to more than 200 million Americans.

In a letter to two key House committees, AHIP President and CEO Marilyn Tavenner stated that "Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts."

However, AHIP commended the proposed legislation for its "number of positive steps to help stabilize the market and create a bridge to a reformed market during the 2018 and 2019 transition period" and "pledged to work collaboratively to shape the final legislation."

"AHIP members are committed to reducing cost growth by using value-based care arrangements and other innovative programs to address chronic illnesses and better manage the care of the highest-need patients," Tavenner concluded.

In a statement on Friday, Secretary of Health and Human Services Tom Price, MD, committing his agency to using its regulatory authority to create greater flexibility in the Medicaid program for states, including "a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes."

2017 Healthcare Success Formula: Care Management Sophistication and ‘Patient Stickiness’

November 29th, 2016 by Patricia Donovan

HIN's 13th annual planning session provided a roadmap to key healthcare issues, challenges and opportunities in 2017.

Whether concerned with healthcare delivery or reimbursement for services rendered, providers and payors alike will need to be nimble in the coming year to survive and thrive in a sharply shifting, value-based marketplace, advises Steven Valentine, vice president, Advisory Consulting Services, Premier Inc.

"Be aware: the competitors you've had in the past are changing, and you're seeing more competition with various Internet providers, CVS, Apple, Watson. It's all going to change," said Valentine during Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay.

But what healthcare shouldn't panic about, at least for the immediate future, is the demise of the Affordable Care Act (ACA).

"[The ACA] is not going to be canceled any time soon," Valentine emphasized during the thirteenth annual planning session sponsored by the Healthcare Intelligence Network. "We would expect it would take two years, at least, to begin to put in some kind of a replacement program."

Assuring participants that within all this industry flux are opportunities, Valentine suggested they follow the lead of retail pharmacy CVS. "CVS envisions itself as a full service healthcare organization with a goal of 'patient stickiness.' In other words, CVS is saying, 'I need patients to rely on me as their source of getting started for healthcare.'"

Later in the program, he offered participants a four-point plan for improving patient stickiness.

As for care management sophistication, Valentine pointed to the pairing of hospitals with a case manager, with incentives for care managers and hospitalists to manage down length of stay, or manage resource consumption.

"We're probably gravitating more toward care management models that are outside the four walls of the hospitals...which will give us better economies, better outcomes, people more specialized in the areas they're in that could really help provide better quality at a lower cost."

And while the healthcare thought leader believes Medicare will remain essentially untouched by the incoming presidential administration, he did identify nearly a dozen areas where President-Elect Donald Trump's 'Better Way' might eventually make its mark on healthcare, including more price transparency and the sale of insurance across state lines.

Moving on to sector-specific forecasts, Valentine outlined four expectations for health plans, including a push for more access points like telehealth and urgent care centers and added pressure to reduce chronic care costs.

Healthcare providers should focus on population health and immerse themselves in data analytics to better prepare for MACRA and the narrow, quality-based provider networks that will result.

Both sectors should expect more consumer demand for accountability, Valentine said, since patients and health plan members are fed up with rising costs and armed with more transparency information and health awareness.

Valentine concluded his presentation with eight guiding principles for 2017 success, including collaboration between health plans and physicians.

And in the Q&A that followed, Valentine offered guidance on a number of issues, including how providers can grow their population bases; identifying and addressing social health determinants; succeeding in value-based healthcare, and offering efficient, integrated behavioral healthcare services.

Click here to listen to advice from Steven Valentine on employing technology for patient engagement.

Infographic: Physician Quality Transparency

January 12th, 2015 by Melanie Matthews

Independent and objective public quality data are only available for 16 percent of U.S. physicians, and in some states no data is available, according to the second annual State Report Card on Transparency of Physician Quality Information report from the non-profit Health Care Incentives Improvement Institute (HCI3).

HCI3 has released an infographic on the study results that details the importance of transparency as the growth of high-deductible health plans for healthcare consumers continues, along with details on the availability of quality information.

Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry From collaboration and consolidation to the inevitable acceptance of a value-based system, the state of healthcare continues to stimulate health plans, providers and employers.

Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry, HIN's eleventh annual industry forecast, examines the factors challenging healthcare players and suggests strategies for organizations to distinguish themselves in the steadily evolving marketplace.

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Infographic: The Value of Price Transparency in Healthcare

December 15th, 2014 by Melanie Matthews

Increased price transparency could save the nation as much as $36 billion per year, according to a new infographic by Truven Health.

The infographic looks at variations in healthcare costs and consumer perceptions on healthcare price and quality comparisons.

Data Sources for Rate-Setting in ACOs, Exchanges and Narrow NetworksGreater cost transparency and consumer engagement are front-and-center in the health insurance revolution that is underway, and the use of data is driving these monumental changes.

Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks examines the various ways claims data can be used in the new health insurance marketplace. In addition to helping support the adjudication of out-of-network claims, claims data can provide the building blocks for ACO development, as well as the foundation for pursuing a narrow-network strategy, developing consumer-oriented tools to promote effective plan selection and plan management, and building internal dashboards for strategic decision making.

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3 Factors Driving Healthcare’s Transition from Volume to Value

December 9th, 2014 by Patricia Donovan

Long term, the healthcare industry's well-documented transition from a value-based system to one that rewards value will ultimately promote consolidation in the industry, putting some companies out of business while making consumers more accountable for their care, predicted Steven Valentine, president of The Camden Group, during HIN's eleventh annual healthcare trends forecast.

But how rapidly will the market complete this transformation? Valentine shares three factors that will impact the change.

People always say how fast our market will change. There are three factors to consider as the market transitions from volume to value.

The first is the time frame for the transition. Driving the time frame are concerns such as competitors’ activities, payor payment models (capitation, shared savings, case rates). What is going on in payor models that will help move the market? Another driver is managed care penetration. Some parts across the country have little to no managed care penetration. Those will be areas with lower change in terms of that market.

The second factor is the delivery system change. Impacting this is the physician-hospital economic alignment. We look for contiguous geography. A hopscotch strategy doesn’t work very well for transitioning the market. We look at the integration along the continuum, starting with doctors through a minimum, then the ambulatory and acute area. Our belief is that this year, post-acute begins to show up. We see most of the money that can be made in bundled payment really comes from a longer period of time to be at risk: 90 to 120 days. We find it in the post-acute care arena to save the money. Other drivers for change in the delivery system include the use of population health tools (PCMH, ACOs and chronic care centers), as well as clinical integration.

Finally, we look at the payment system—incentives, pay for performance, shared savings—any value-based purchasing programs put in place. You will need to take risks. Organizations that take risks, especially well organized medical groups, will help to drive a market and the transition to value much more quickly.

healthcare trends 2015
Steven T. Valentine, MPA, is president of The Camden Group, a national healthcare management consulting company. With more than 35 years of healthcare consulting experience, he has considerable expertise in the areas of strategic planning, business transactions, mergers, hospital-physician relationships, and financial analysis.

Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

Healthcare Trends 2015: Transparency, New Players Narrow Payor-Provider Divide

November 20th, 2014 by Patricia Donovan

Trends 2015
To paraphrase Bob Dylan: Healthcare roles, they are a' changin:'

For example:

  • Providers are moving into payor spaces, assuming care coordination roles.
  • Payors are expanding into provider businesses.
  • Hospitals are being repurposed as post-acute care centers.
  • Empowered consumers are diving into data analytics for cost and quality information.
  • Innovators launching new care models abroad are poised to test them on U.S. soil, turning healthcare into a global market.

Given these role reversals and emerging players, the challenge of distinguishing oneself organizationally in the marketplace is a formidable one. Healthcare payors and providers received targeted advice for achieving this goal during Healthcare Trends and Forecasts 2015: A Strategic Planning Session.

And as Dorothy Moller, a managing director at Navigant, and Steven Valentine, president of The Camden Group, both attested to during the eleventh annual planning session from the Healthcare Intelligence Network, the biggest threat may come from outside the industry.

"Payors are experiencing new threats to their core business from new market entrants and competitors," noted Ms. Moller, who offered the payor perspective. "Those could be anything from new health plans to new technology companies or companies chipping away at components of their core business, offering new services or decision-making tools to their existing customers."

Walgreen's retail clinics were on Ms. Moller's list of nine such companies to watch in 2015. Similarly, Walmart's venture into Direct Health is one example of a 'disruptive strategy,' contributed Valentine, representing the providers' viewpoint. "We begin to see what direct health is doing. Walmart is getting people in their stores because they still sell goods. What happens when Walmart acquires a health plan or starts to offer its own healthcare products? If we think of some disruptive strategy, you might look at what a Walmart would do."

Within the marketplace, Vivity, Anthem Blue Cross's new, low-cost, patient-centered Southern California health plan that targets employers, is challenging Kaiser Health Plan for market share, added Valentine. Similarly, health plans are also threatened by 'disintermediation,' offered Ms. Moller— the movement of payors out of the value exchange, such as in the case of direct primary care.

Both thought leaders analyzed factors driving healthcare change, including the steady shift toward value-based reimbursement, changing healthcare delivery models and the increasing reliance on remote patient monitoring, then outlined areas ripe for potential innovation and growth.

While each proposed sector-specific coping strategies, payor-provider integration, collaboration and partnerships were also strongly encouraged.

Pressure for increased transparency also is taking its toll, with myriad sites and sources offering healthcare cost and quality data. "Healthcare systems can look at their competitors. They can get a sense of pricing in their market," said Valentine, who advised providers to focus on pricing now in anticipation of increased awareness by 2016 and 2017, when he expects more states to include claims and pricing in exchanges.

"We used to say that healthcare was recession-proof; we now know healthcare is price-sensitive," he said. "People's copays and deductibles have grown enough that consumers will shop price."

Ms. Moller advises payors to proceed carefully when considering new development. Her suggestions include collaborations with non-traditional industries, conducting long-term strategizing, and monitoring the global market.

In the closing Q&A, Ms. Moller and Mr. Valentine addressed more 2015 concerns, including the anticipated impact of Chronic Care Management reimbursement. Hospice and palliative care will likely be affected by the updated 2015 Physician Medicare Fee Schedule, predicted Valentine, who views chronic care management as a critical focus for healthcare providers in the year ahead.

"The area in which we see the most growth, and where we'll see continued growth in 2015, is in the center for chronic care management. For example, we identify a diabetes care team, which is the diabetes center for chronic care. We find this is better in terms of using a multi-disciplinary team and it improves throughput for the primary care patient-centered medical home (PCMH)."

Commenting on impact from the numbers of newly insured on the system, Ms. Moller responded it is still too early to see the true effect, due to slow implementation and a claims lag.

For more provider predictions from Steven Valentine, including a surge in telehealth, e-visits and physician-hospital organizations, click here.

To listen to Ms. Moller's expectations for payors in the year ahead, including co-located care management and progress by safety net payors, click here.

Have predictions of your own? Our 10 Questions on 2015 Healthcare Trends Survey runs through December 13. One winner who completes the survey will be eligible to win an on-demand recording of the 2015 strategic healthcare planning session described in this post.