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Advice on navigating narrow networks

June 15, 2016by Robert Whitcomb in Uncategorized tagged , , ,

narrow

Herewith advice via a Janet Kidd Stewart article in Medical Economics on how physicians and other providers can negotiate the increasing number of narrow networks.

In the piece, Jonathan Gruber, Ph.D., an economics professor at MIT, asserts that early evidence shows that narrow networks cut patient costs without lowering quality.

“Payers already are building algorithms to better answer the outcomes issue, and providers must decide if they will sit back and wait for the results or build their own data sets,” he told Ms. Stewart. “There will definitely be winners and losers.”

She says that Donald Fisher, Ph.D. president and chief executive of the American Medical Group Association, says that providers need to continue to fight  plans that  cherry-pick certain providers for narrow networks and and to  question  insurers’ quality and cost data.

Americans look more skeptical about cost-quality link

April 6, 2016by Robert Whitcomb in Uncategorized tagged ,

 

 

Americans may be becoming more skeptical  and careful consumers of healthcare.

Most people in a U.S. questioned for a study said that healthcare costs weren’t necessarily tied to quality.

That (and greater price transparency) is good news.

“It’s really important to know how people are perceiving price and quality,” said  the lead author, healthcare economist Kathryn Phillips, Ph.D., of the University of California at San Francisco said in a HealthAffairs piece. “If you don’t know how they perceive price and quality then we don’t know how they will use price information.”

Still, the proportion of people who said there is no link varied according to how the question was worded of the question.

For example,  reported Reuters, 71 percent said “higher price is typically not a sign of better care. But 40 percent thought a doctor might be providing lower-quality care if he charged less than other doctors for a service.”

“That suggests we need to think about how we describe things to consumers in order to help them understand what’s being asked,” said Ms. Phillips.

“We need to develop the right tools and policies to help consumers use this information. You can’t just assume you can put price information out there and people are going to be able to use it,”

 

Study details how incentives boosted patients’ compliance

April 6, 2016by Robert Whitcomb in Uncategorized tagged ,

 

A study looks at how a value-based insurance program in Connecticut raised medical-advice compliance as shown by patients having more preventive visits and adhering more rigorously to medication directives.

MedPage Today, citing a HealthAffairs article, says “Giving patients economic incentives to participate in health screenings and take their prescribed medications resulted in decreased hospitalizations and increased medication adherence….”

“The positive results in this case should encourage other payers to incorporate reduced cost sharing for high-value services across entire episodes of care in their benefit plans,” wrote Richard Hirth, Ph.D., of the University of Michigan, and colleagues in the April issue of Health Affairs.

 

 

 

Nurses urged to get more active in policymaking

March 2, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

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Citing the effects of the Affordable Care Act and nurses winning a wider scope of practice in many states,  the author of an article in Minority Nurse says nurses ought to become more active  in healthcare policy as they gain more authority in hospitals.

Janice Phillips, Ph.D., R.N., noted that conducting research among underserved populations on breast-cancer disparities led her to lobbying and public-policy advocacy to reduce these disparities.

Becker’s Hospital Review summarized her suggestions:

  • “Take health-policy courses during their nurse training.
  • Attend in-person and virtual lobby days.
  • “Analyze publications and presentations for policy implications.
  • “Read policy journals.
  • “Share personal policy-related experiences.
  • “Factor policy components into day-to-day clinical work, such as student interviews with legislators.
  • “Identify policy implications in everyday practice.”

 

 

5 systems scramble to address nursing shortage

January 22, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

nursing

Here’s a look at how five hospital systems are recruiting and retaining nurses  to address the looming shortage in many places of registered nurses. Of course, nurses and other non-physician clinicians are taking on larger roles these days because of the financial incentives and punishments for healthcare institutions to move to  value-based population-health models and simply because nurses are paid less than physicians.

The flood of aging Baby Boomers is the major reason for the worry about a nurse shortage. Indeed, a surge of  retirements among Baby Boomer nurses will be part of the problem.

Among the incentives to get and keep nurses:  Bonuses and tuition reimbursement,  career-development opportunities and partnerships with educational institutions.

Marcia Faller, R.N., Ph.D., chief clinical officer at AMN Healthcare, said:  “{T]he harm to the healthcare industry  {of a nursing shortage} goes beyond the numbers. The loss of this intellectual asset may be acutely felt in terms of quality of care and patient satisfaction. To withstand this loss, healthcare providers need help in preparing for the nursing workforce of the future.”

 

 

 

 

 

 

 

 

 

 

Arthritis drug may help fight Alzheimer’s

September 29, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

badbrain

In Alzheimer’s disease, changes in tau protein lead to the disintegration of microtubules in brain cells.It’s early on, but a prescription drug used to treat rheumatoid arthritis offers hope for treating  Alzheimer’s disease, research at the Gladstone Institutes, associated with the University of California at San Francisco, strongly suggests.

Gladstone researchers  discovered that salsalate blocked the build-up of a protein that collects in Alzheimer’s patients’ brains. The study showed that the drug reversed cognitive decline and prevented the loss of brain tissue  essential for memory.

The drug is considered  fairly safe but is associated with the  risk of heart attack and/or stroke in some patients.

Salsalate inhibits an enzyme in Alzheimer’s patients’ brains that makes tau  toxic, prompting memory loss. Tau has been a focus of other Alzheimer’s research. Scientists don’t understand why tau builds up some brains or how it causes disease.

This is the first time that researchers have reversed the toxic aspects of the protein tau with a drug, said Li Gan, Ph.D.,  one of the senior researchers.

“Remarkably, the profound protective effects of salsalate were achieved even though it was administered after disease onset, indicating that it may be an effective treatment option,” Ms. Gan said.

The research was conducted on mice at the Gladstone Institutes. The animals had a rare form of dementia associated with Alzheimer’s.

 

Questions to ask when private-equity firms come fishing

September 14, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

fishing

Becker’s Hospital Review notes that “Private equity investment in healthcare has grown considerably in recent years, with global healthcare private equity deals doubling from 2010 to 2011, according to KPMG. In 2014, strategic merger and acquisition deal value in the healthcare industry nearly doubled from 2013, according to Bain & Co.’s 2015 Global Healthcare Private Equity Report.”

Tom Schramski, Ph.D., is a certified M&A advisor who is president and managing partner of Vertess Advisors, which  provides advisory and consultation services to healthcare and human-service organizations.

Becker’s asked him these questions (you’ll find his answers in the link)  for the benefit of hospital executives and boards considering  selling their institutions to private-equity firms.

“What are the biggest trends you’re seeing in healthcare M&A today? What are the drivers behind those trends?

“In what situations should a healthcare company consider a private equity group as a buyer? Are there any situations where they shouldn’t?

“What are some of the key considerations for healthcare companies looking to sell to a private equity group or any other buyer?”

 

 

 

 

Bundled payments or population health?

September 9, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

Ian Morrison, Ph.D., a consultant and futurist based in Menlo Park, Calif. , writes about whether hospitals should focus on population health or bundled payments.

He notes that there’s  “growing skepticism among many respected industry experts who question whether population health, providers at risk and Accountable Care Organizations are really the right answer. They fear these models may all turn out to be a bridge too far. Instead, they argue, we should get the basics of healthcare delivery right first. Then we should use bundled payment–type models as our lead foray into financial incentives that promote improved care coordination and clinical performance delivered by focused, high-performing teams.”.”So, there is a plausible … conclusion that meaningfully incenting providers to deliver care by taking financial risk for a defined population they serve (across the continuum of care) is an impossible dream that will end in failure. Therefore, we should settle back on bundles and other less grandiose improvement initiatives instead.”On the contrary, I still believe that our best hope for sustainable health care may well come from large integrated systems of care competing on the basis of cost and quality for a defined population.”

“Overall, my forecast can be summed up as follows:

“Integrated systems with their own health plans, regional scale, direct contracting and Medicare Advantage contracts is the end game for some large players who are preparing for population health risk.”

“Many hospitals will be caught between two paradigms for the next five years (at-risk vs. fee-for-service), but the direction is toward more risk-bearing on the basis of value through a variety of constantly evolving partnerships and risk-sharing arrangements.

“Bundled payment for procedure-oriented care presents a major step toward promoting value and care coordination that does not require population health (frequency risk).

“And finally: Value-based payment trends are not enthusiastically embraced by providers. So expect public payers to make more payment innovations mandatory, not just voluntary.”

 

 

Dutch, too, struggle for healthcare-cost containment

September 7, 2015by Robert Whitcomb in Uncategorized tagged , ,

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An article about Dutch healthcare reform by Ewout van Ginneken, Ph.D.,  in The New England Journal of Medicine may have lessons for U.S. reform efforts. He writes:

“The Dutch health system has a strong penchant for reforms of all shapes and sizes, achieving varying degrees of success in a long struggle to contain costs and improve quality. Recent governments have invested in facilitating the introduction of more market-based mechanisms to reach these goals, while trying to uphold such social values as solidarity through care financing and accessibility.”

And,

“Dutch experience shows that implementing regulated competition takes time, is technically and politically complex, and requires many ad hoc corrections — and that good outcomes are far from certain. More practically, it underlines the importance of risk adjustment, strict mandate enforcement, effective mechanisms for managing subsidies, and purchasing reform. Almost 10 years in, the reforms have not led to the desired cost containment or a leap in quality. Consumer organizations have welcomed increased choice, but individuals increasingly worry about cost-related access problems.”

Sounds a bit familiar!

 

Physicians’ new world of high deductibles

February 6, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

The new world of high deductibles to be paid by patients means that physicians must change their billing and communication practices, says this Medical Economics article.

“Operating successfully within this framework requires greater awareness of differences among insurance policies and discussions of treatment options that are sensitive to patients’ out-of-pocket expenses.”

“Doctors need to understand the landscape has changed. A doctor’s primary concern used to be whether a patient had insurance. Now, it’s the type of insurance,” Devon M. Herrick, Ph.D., a senior fellow at the National Center for Policy Analysis, told Medical Economics.

As for patients, they are already showing a disinclination to have as many healthcare-system interactions as they used to  now that the per-visit and per-procedure costs are becoming far less opaque and thus much more daunting.

This, understandably, scares many clinicians fearful of lower income.

Still, the “Silver Tsunami” of aging and thus ailing Baby Boomers probably ensures that business will remain generally good and that U.S. clinicians will remain by far the highest paid in the world.

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