Category: Insurance

Payers In The Future…

Screen Shot 2017-03-10 at 8.19.39 AM Check out this story. What you will find are the results of a PWC survey of more than 100 health insurance executives. The topic? What will the payers of the future need to look like. The big piece here is that in the future, insurance companies will need to work with providers rather than abusing them. Collaboration in such areas as data sharing, for example, might help to break down the silos that currently exist and the current tendency for payers to abuse, rather than please, practitioners. Bottom Line. I’m guessing that these executives have this spot on. How many stories have you heard about the aggravation that practitioners must go through in dealing with payers, and the negative impact all of this has on patient care.  Amazing that this shameful state of affairs has been allowed to exist this long. Unlikely that this nonsense will continue much further into the future!

Being Proud Of Being A “Terrible Doctor”

Dinosaur Among the musings of this private practice dinosaur we find this post. In it, we see a thoughtful explanation by this physician as to why she is proud to “fail” at meeting many of the “quality” criteria that have been established for the evaluation of physicians and for the determination of a part of their compensation from insurance companies. Bottom Line. Two of the points that Lucy makes in this post are especially significant and clear.  First, the metrics that are proffered as measuring quality actually, and unabashedly, measure cost reduction behavior. Period. AND. Many of the parameters on which physicians are being measured are outside their control. Yes, we have talked about all of this before.  But it keeps not changing!

Breast Milk As A Medical Benefit

Breast milk As everyone knows, breast milk provides significant health benefits to newborns. What I had never considered, however, is that the babies who need these benefits the most, e.g. preemies, are often unable to obtain them. Mothers who give birth prematurely are often unable to produce milk. Thus, there is a significant need for donated breast milk, and a commercial opportunity in managing the supply chain. But who pays? Check out this article. Here you will learn that New York will apparently soon be covering breast milk under its Medicaid program. Makes sense! Bottom Line. Interesting stuff. The article makes an excellent point that covering breast milk under Medicaid removes one of the important ways in which socioeconomic status determines health. One wonders what other good uses of funding, currently being spent/wasted on other things, could make similarly significant reductions in dollar-based health disparity.   

Systematic Incompetence

Health Care Blog Check out this blog post. Immerse yourself in the cases reported there. Ponder how preapproval, billing codes, etc. are simultaneously making the costs of medical care higher and the quality of care delivered lower. Quite a combination, especially since the original intent of  third party payers was to do the reverse. While Frank Lloyd Wright spoke eloquently about form following function, this is a clear case of function following form. Bottom Line. My key takeaway here is in the first couple lines of the post. I’d never really thought about this before, but I am struck by the profundity of the thought that while competence is by definition homogeneous, incompetence displays itself in many different forms. Some of these forms are random and idiosyncratic, others are more dangerous because they are actually engineered into systems. Like third party payment rules!!!

Paging Dr. Kirsch

Screen Shot 2016-08-01 at 10.10.47 AM Ain’t technology wonderful. When I got into the healthcare vertical almost a half century ago (AAAHHH!!!), doctors wore “Pagers.” Some of us called them “Beepers,” because basically that’s all they did was beep. The doctor receiving a page then had to make her way to a landline, call her “service,” and find out why she was needed. Scroll forward a few decades, and we have the marvel of the smartphone. Be they BlackBerries, iPhones or Androids, these amazing devices have to make this process a lot more efficient, right? Check out this blog post. What you will find is that due to a headset that appears to favor documentation over doctoring, the major function of 2016 technology is to check the box that indicates that a physician was notified, rather than focusing on helping him to do something about it. Bottom Line. As usual, there is a general learning here. Great though technology may be, somebody really has to think about how to us it!

Sort Of Creepy

Screen Shot 2016-02-09 at 6.54.41 PM   All in all, I am a big supporter of hospices. They do great work. BUT. A recent report published in JAMA notes that 12% of hospice patients received no visits from hospice professional staff during their last two days of life. 12% is not a huge number, UNLESS you or a loved one happens to be in that group. How do you avoid being in that unfortunate group? The report makes it clear that you want to choose to die in the correct area of the country, you don’t want to be black and you certainly don’t want to die on a Sunday! Bottom Line. Once again we seem to have a problem in metrics of medical care. The Medicare Hospice Benefit compensates hospices, many of which are for-profit organizations, for each “day” of patient care. The benefit is in no way tied to timing, number or duration of patient visits. As usual, it is difficult to determine the basis for compensating for patient care. But something seems to be fundamentally wrong here!

Meet Picwell

Picwell Boy is there a need for something like this. Simply put, it is a “decision support” system that purports to assist patients in choosing the “ideal” healthcare insurance packages for them. Scroll down on that page, and drill down into the section that describes “How it works.” Bottom Line. Yes, there is indeed a real need for a system that will help patients select “ideal” insurance coverage. However, the skeptical side of my brain lights up as usual and asks whether the use of this system will be too complicated for those who need it the most. I sincerely hope not!

Big Data

patientsafe Look here if you want to see a laundry list of patient data points, and applications there of, that can feed and spit forth from deep dives into big healthcare data. Bottom Line. Picking up where yesterday’s post left off, this patientsafe solutions piece cranked my juices and got me thinking about how big data, predictive analytics, etc. will be used five years from now to drive health care. I am far from sure as to exactly how this turns out, but am thoroughly convinced this will be an epicenter of disruptive evolution in health care. Watch for it!

Another Double-Edged Sword

Forecast Health Take a look at the Forecast Health Home Page. Maybe even dig around a little bit. What you will see is the “next generation” in predictive analytics. Analytics that can provide hospitals with a variety of important predictive scores at the individual patient level. Embed this software in an EHR system and, using such basic information as patient zip code; it can predict specific difficulties that a patient will experience, e.g., drug non-compliance. Who cares? Hospitals that increasingly will be compensated based on outcomes, readmissions, etc.! Bottom Line. Pardon my skepticism yet again, but I’m thinking that this analytical approach could be either a blessing or a curse for the individual patient. A blessing if it guides a hospital to interact with a patient in a more tailored way to optimize outcomes. A curse if it cues a hospital to avoid interacting with a patient altogether to avoid outcome-based penalties.

Happy Patients=Big Improvements In Hospital Margins

Happy Really big? You bet. A recent Accenture report indicates that hospitals that provide their patients with positive experiences can expect to see up to a 50% jump in their margins. True across the U.S., across hospital types, etc. You should look over the entire report. But pay specific attention to the action recommendations in the Infographic that the report makes for improving patient engagement/patient satisfaction/profit margins. Bottom Line. I’m thinking that this finding, and these recommendations, set up an interesting tension in health care. In my previous blog, I talked about how preauthorization processes are allowed to run amok, denying patients access to desired treatments and medications. Will these insurance company shenanigans lead to patient dissatisfaction with the hospital that finds itself squarely in the middle? You bet!