We Still Have Miles To Go…

I was at my doctor’s office recently and noticed something hanging on the wall. So I took a picture of it.  See below. 

If you can’t read the heading under “Patient Learning System” it says “Your Customized Patient Education Resource”.

If this is customization, I’m a little afraid to see what the non-customized material looks like.

Safe to say – we still have a long way to go in engaging, empowering, and educating patients and healthcare consumers…

In Good Companies, Volume II

Working at an insurance brokerage and consulting firm, I have the privilege of seeing some very innovative companies who work with clients at the firm.  I also do quite a bit of research myself on various health care companies – it only helps me to do my job as a client advocate better.  In addition, I’m a bit of a healthcare geek…I know…shocking.  I actually find this stuff fascinating.  Some, if not most, of what you’re about to read below is information I’ve gathered on my own (meaning independent of my work).

With that said, I thought it would be sort of neat to highlight some of these companies in a piece I’m calling “In Good Companies”.  You are now in the midst of Volume II!  And in case you are interested, I’m including a link to Volume I. 

Back to Volume II: here are a few companies I’ve selected – they are in no particular order. If my blog does not do them justice, check them out for yourselves!

Patients Like Me – When you’ve been diagnosed with a rare, complex and/or terminal disease or illness, you can feel quite alone. Hopefully you have family to support you, but even if you do, they are not going through what you’re going through.  There has been research done on how sharing stories and bringing together a community around particular disease states helps patient outcomes.  Started by brothers Benjamin and James Heywood in response to seeking information about their brother Stephen’s ALS, PatientsLikeMe was born using this approach of sharing information.  The data gathered and shared isn’t just amongst patients, however.  Healthcare professionals and medical companies like pharmaceuticals share the data as well.  And with sharing comes better ideas and better treatment so that those afflicted with awful diseases may benefit from those who have walked the path before them.  What a tremendous tribute and show of love from the Heywood brothers for Stephen.

Shape Up The Nation – Rajiv Kumar and Brad Weinberg started Shape Up the Nation…but it wasn’t “nation” back then. It was Rhode Island – the biggest little state in the nation.  Come to find out, their idea was a good one and this Rhode Island company expanded nationally.  What do they do?  Good question!  I would describe it as wellness with a social/community spin. They work with large enterprise employers as well as health plans to gather the company’s employees together into a wellness community and then use that social circle to drive action and healthy behavior.  Statistics show that the social approach drives upwards of 30%-50% participation – much better than the more static “incentive” based wellness and prevention programs out there.  With a vendor agnostic approach and expansion into the smaller markets, they can work with other companies to bring their community approach to prevention and wellness. You will likely be hearing more from the folks at SUTN.

Consumer’s Medical Resource – Healthcare today is changing rapidly.  Those who practice medicine have evidence based guidelines to help determine the ‘best practice’ for particular conditions.  Patients are in high deductible plans that force more involvement and engagement.  The Internet is fast becoming the leading medium in which information in healthcare is shared and exchanged.  EBM + Consumerism + Internet + a dash of patient empowerment = Consumer’s Medical Resource (CMR).  Talk about a needed service.  Those who have chronic diseases are able to gather information and be an active participant when it comes time to discuss treatment options with their physician.  Those who may not be ill but like to be engaged healthcare consumers will also find this service valuable.  I would wager that many more will soon be looking at this company for themselves and their loved ones.

AdhereTx – With the population continuing to age, it’s only a matter of time before you know a loved one, relative, or friend who is sick, getting up there in age, and on multiple medications.  Medication management is a real challenge for some.  AdhereTx is helping to tackle that challenge. With their web-based KnowMyMeds software platform, they are able to help manage the medication regimes for older adults.  Providers can use the software to collect self-reported patient data that can then be aggregated and reconciled automatically with EHRs and claims.  A rules-based engine then conducts an automated medication review for the patient and authenticates data to support medication reconciliation at transitions of care.  The results:  better outcomes, lower costs.  Just another step in the right direction. 

Aliment Health – I must admit that I know very little about this organization. In fact, I don’t even think they’re up and running yet. But here’s what I do know.  They are developing a hand-held diagnostic device for those with food allergies or metabolic disorders like Celiac disease (taken pretty much verbatim from the company’s Linked In profile).  In addition, the founder is Mitch Portnoy, the former President and COO of Symmetry (now part of Ingenix).  Mitch was one of the founding fathers of Episode Treatment Groups (ETGs) and Episode Risk Groups (ERGs) which help determine cost/efficiency and risk for episodes of care.  This standard is used throughout the healthcare industry.  So if Mitch is onto something with Aliment Health, I’d be sure to monitor them closely.

That does it for another edition of In Good Companies.  If you know of an innovative health company, let me know!  You might just see it in Volume III!

[Disclaimer: I am not receiving any compensation or bonus from any of these companies to do this. This isn’t an endorsement of these companies based on personal or professional experience.  I do not speak for my employer.  This post does not influence client placement or recommendations to clients. I just think it is neat to showcase some great minds and great companies at work.]

Health Wonk Review – Spring Training Edition – Up At Pizaazz!

Yes, it’s March Madness. And yes, it’s St. Patty’s Day.

But hey, that means America’s favorite past time (that would be baseball) is just around the corner too – just two weeks away!  But here’s something you don’t have to wait for:  Health Wonk Review – Spring Training Edition!

Glenn Laffel from Pizaazz has compiled a fantastic baseball-themed Health Wonk Review blog carnival full of great posts.

Starters, closers, 5-tool guys, sluggers, base stealers, rabid fans, slick fielders and (drum roll please) “stud prospects” are just some of the health wonkers you’ll get to read. 

Check your third base coach – he’s giving you the sign to check out the latest edition of Health Wonk Review.  While you do that, I’m going to grab a Fenway Frank and a brew.

[A quick comment for Glenn – though the Yankees might “rise up” in 2011 as you claim, they will hit their ceiling, look up and see Red Sox above them.]

Narrow Is The New Broad

When it comes to provider choices, being narrow-minded may be best.

I’ve blogged in the past about how tiered networks will adversely affect patient choice.  But what I’m about to say is nothing compared to that…

There is talk in the healthcare world about provider networks that are limited by design.  Meaning you can only choose from a short list of providers.  Why would one do this?  Believe it or not, there are pretty good reasons behind it. 

Before I dive into this, let me note that this is not a new idea, but an idea revisited (this tends to happen a lot, healthcare fans…) And I’m not the first to blog about it either. Here are a few other posts on narrow networks for perspective:

Let’s Talk Healthcare

Health Business Blog

The Health Care Blog

Back to this blog…

If you are a benefits manager at an employer with 500 employees with costs that are rising and double-digit premium increases from your health insurer year-over-year, your CFO may be leaning on you to do something about it. 

So you look at the utilization reports from your broker and it shows that employees are utilizing high cost hospitals which is contributing to the high costs.  What do you do?  Maybe nothing.  You explore cost cutting measures elsewhere.

But what if the data shows that your employees are using high cost hospitals…that have poor quality?  Perhaps you’re more likely to do something.

Welcome to healthcare – 2011 and beyond.

Everyone knows that health costs are spiraling out of control.  Benefits managers are tweaking plan designs to reduce costs.  Health insurers are creating outcome-based contracts for their providers.  Providers are looking at how to create meaningful ACOs to streamline care and share data.

And John Q. Public continues to blindly go to whichever hospital he wants.

Chances are, John Q. is also not participating in his company’s wellness program.  Maybe he’s a smoker as well.  And maybe he really enjoys Wendy’s for lunch – thus, he is likley obese.

Well, John Q., some might point at you as the reason costs are getting so high.  But hey, you’re paying for health insurance, why not go wherever you want to go, right?

Maybe not for long.

Some employers are working with their brokers and insurance companies to explore the implementation of something known as “Narrow Networks’.  In short, it is a select group of high quality, low-cost hospitals. 

If there is a medium cost, ok quality hospital – sorry – not in the network. You can’t go there without paying the out-of-network costs.  Or maybe…you won’t be able to go there at all depending on which product your company chose from the health plan.

Healthcare consumers may look at this as unfair.  As yet another problem with the healthcare system – no more choice.

In fact, this type of thing may be just what the doctor ordered.

If the average healthcare consumer isn’t savvy about costs and quality, then they will go wherever they’d like. Perhaps a friend recommended it.  If your friend drives a Porsche Boxster and recommends it, are you going to go out and purchase it? If it’s someone elses dollar and you’re only paying a smaller amount – you might.

Then there are the more savvy healthcare consumers.  The ones who actually try to research and learn more about costs and quality. But the data isn’t always readily available. And even when you find it, it’s hard to decipher or the data is not specific to “Hospital A” that you’re exploring. Despite the efforts, the more savvy consumer may still end up at a high cost hospital.

And many probably go to the hospital that is most convenient to them even if it is low quality and high cost.

In all of the above scenarios, the employer ends up looking at the high costs in the utilization reports from their broker.  This may lead them to deduce that leaving patients with a lot of options may contribute to high utilization at high cost, low quality facilities.

Since there is pressure to do something, the employer will explore all options.

Enter Narrow Networks.

Narrow Networks are designed to remove the high cost, low quality providers from the network.  In a way…it’s simplification.

If you are not a mechanic and you’re told to choose the oil for your car’s oil change, you might be looking at a wall of motor oil brands…Quaker State, Pennzoil, Valvoline, Castrol, Mobil 1, Havoline, Interstate, Shell…(I won’t even get into the 10W40 vs. 5W30).

You might make an educated guess – maybe you watch a little NASCAR and you know that your favorite driver is sponsored by Mobil 1.  Great.  That’s a good way to decide how to best protect your $20,000 vehicle. If it’s good enough for Tony Stewart, it’s good enough for my car, right?

But what if that list was cut down to three?  And there was an assurance that the three left to choose are high quality and have reasonable costs.

Well, that’s what Narrow Networks are about.  Think of it as choosing between three dishes at a wedding to which you’ve been invited.  You’re going to get a good meal, but lobster and hamburgers may not be on the menu.

Yes, it’s another step away from patient choice.  Yes, it may be viewed as a little Big Brother-ish.  Yes this type of thing was tried a few years back and was not very popular. And yes, you’ll be pretty ticked off if your local hospital is not on the list.

But until people begin to heed the wellness calls and make significant behavior changes to better manage their own individual health…well, narrow is the new broad. 

Narrow-minded thinking will win the day.

Is it possible that this backfires?  That patients choose out-of-network providers and the non-contracted, non-discounted providers end up at the top of the utilization report from your broker?  Yes, I suppose it is. But it’s not likely.  At least not in this economy. And especially not if high deductible health plans continue to grow in popularity.

The fact is that health plans, employers, and brokers aren’t thrilled about having to choose something like Narrow Networks.  Some insurers already have the products.  They’re just waiting for the employers to ask.

It’s the employers who don’t want to be the first one to roll it out for fear that they will lose employees and fail to attract new ones. But when push comes to shove, there are only so many plan design changes that a benefits manager can make.

So be on the look out for smaller networks with high quality, low-cost providers. Hopefully that provider is located just around the corner.

Now if you’ll excuse me, I need to send back my RSVP card with the “chicken” box checked. Normally I’m a steak guy, but at weddings, they never cook it the way I like it…

A Musing Healthcare Blog Meets Health Wonk Review…

…and there was much rejoicing.

The good people at The Lucidicus Project are hosting this edition of the Health Wonk Review and I decided to throw my hat in the octagon.

You can find the latest edition here.

Thanks to Joe Paduda and Matthew Holt for creating the Health Wonk Review and thanks to Jared Rhoads for hosting this edition…and posting my submission on The Broker (R)Evolution!

Enjoy each and every submission of this blog carnival!