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Ominous threat to employer sponsored healthcare July 25, 2012

Posted by medvision in Chronic Disease, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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If your job involves managing employer sponsored health plans, on behalf of employers, there’s an article out (http://tinyurl.com/d836mol) that  says the following:

One in 10 employers plan to drop health benefits.

Employee Health, Wellness, Health Plan, DataI hope this is a huge wake-up call for employers.  Over the past 10 years, I’ve pounded the pavement trying to explain the necessity for plan executives to utilize actionable, independent, member-centric data to manage the financial and clinical aspects of their health plans. Some employers have adopted this model and, as a result, their trend/health inflation has become virtually nonexistent over the past several years. Just look at Med-Vision’s news page for examples.  Many others, however, have declined and are flying, virtually blind.

Let’s think about the impending threat to our current system of healthcare delivered at work. First, which types of employer plans are at the highest risk? To make my point, I’m borrowing from the comedic styling of Georgian funnyman, Jeff Foxworthy:

(1)        If you report to an elected board, commission, mayor or any other type of politician who grovels every few years to be reelected, you might have a problem

(2)        If your annual per employee plan costs are $8,000 plus, versus the penalty of $2000 PEPY to drop coverage, you might have a problem

(3)        If your plan design pays claims for an unlimited maximum, while you attempt to save money by preventing care during the first $10,000 of expense, you might have a problem

(4)        If your plan advisors, broker, consultants tell you your existing 10% trend fits the norm, you might have a problem

(5)        If your plan pays hundreds of thousand dollars annually for disease management and the only result you see is one out of 100 members talking to a nurse, you might have a problem

So, maybe you fall into a few of the top Foxworthy-isms. Believe it or not, this performance can be turned around in as little as a year or two. What do you do?  Here’s my advice:

•           Work with advisors/vendors who win solely when you win. If you’re partnering with a public company, MCO/consultant/broker, look at their financial performance on one of the multiple finance websites. Yahoo finance is a great spot. How is their stock, profits, cash flow performance? If they are succeeding wildly while your plan fails, you probably are not receiving the best advice? Why would you pay more in fees and commission while your plan performs negatively? Pay for performance and zero for failure. Make your advisors stay awake at night worrying about the care/lack of care your members receive. If your plan is failing, yell, scream and threaten firing all vendors. Here’s a nice take-away. MCOs are dumping huge sums of cash into client wellness funds to be selected during bidding competition. If you are humming along with an MCO/TPA, demand some wellness cash!  Ask $40K per thousand employees covered.

•           Are you treating plan reports, performance metrics from your MCO/TPA as gospel? Do you think they report on failures/weaknesses concerning your plan while you pay fat ASO fees? (If so, I have some beautiful, airboat accessible, home sites in the center of the Everglades for you to consider purchasing). This is where plan managers fly blind. Identify and implement services from an independent, patient centric deep data mining company. Analyze health data as a risk manager focusing on prevention, disease mitigation and financial accuracy. Read and analyze your existing employee benefits contracts closely. With your data mining functionality you’ll be able to determine if your plan is paying 2000% markups for cheap generic drugs delivered via mail. PBM performance is an easy way for plans to save $10-$15 PEPM. Ask simple questions like, what percent of our women members are receiving breast cancer screenings past age 50?

•           Where is your health plan money being spent by service category? Plans performing in the top 10% spend over 15% of their total budget on primary care services. The vast majority I see spend less than 10% on primary care.

Furthermore, please don’t be assured a Republican win in November will clear the threat. The “right” wants to remove the corporate tax deductions for employer sponsored healthcare.  An era of employer-driven healthcare reform is needed to mitigate risks and lower costs.

And a last thought. Worry about your plan members receiving appropriate health care services in the same manner you worry about your family members receiving correct care. The higher the quality, the lower the cost!

As Geoffrey Hickson said: “If you forget you have to struggle for improvement you go backward.

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Managing employer sponsored health plans–some good news! January 30, 2012

Posted by medvision in Chronic Disease, health data, Healthcare Costs, Insurance Plans, Risk Management, Uncategorized.
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healthcare data analysisLooking over my prior postings, I seem to have identified some problems. Now let’s highlight solutions starting with the foundation which should guide every plan decision focused upon “mitigating” risk while sequentially improving quality. Define quality anyway you want! Prevented disease, better disease outcomes, enhanced member wellness behaviors, however better quality, “always on aggregate”, means lower cost!

The foundation is an independent, HIPAA compliant, patient-centered database. A quick meaning of independent data:Loaded “flat” files from the TPA which are assembled by a data mining company, not associated with the TPA/MCO claims administrator. We don’t want the administrator to put any spin on data reporting. By omitting elements, highlighting others and changing metrics, virtually any recommendation can be validated.

Also, let’s not discuss normative data. Although sometimes useful to compare performance against peers, let’s not go into rear-view mirror data yet. Here’s a 10K foot look of the process to utilize an actionable database! (1) What are our plan problems/precursors to problems? Why? Because they will repeat in the future. (2) What strategies can be implemented to mitigate these problems? (3) After a strategy/s are decided, how are they implemented and (4) How can we measure the results? (5) Repeat

The market is overrun with data vendors purporting the ability to perform as above. Additionally, some of their “dash boards”, or reporting output look beautiful. If you are dealing with a “top” vendor, a major portion of the sales presentation should be focused upon their ability to quickly and completely scrub healthcare data. To say healthcare data is dirty is akin to describing the condition of the worst gas station bathroom in Panama. MCOs grew by mergers of multiple health plans, each with 1980s-1990 based IT legacy systems. Claims paid in Atlanta are merged with member eligibility sourced in Oakland, each data feed pulled by a different MCO employee each month. Recently my data partner described a site visit to and insurance company claim office as comparing our use of the I Phone S4 to their use of tin cans connected by string. One last time, if the database vendor doesn’t describe data scrubbing as their major challenge, run away!

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