Every industry, including healthcare, has been trying to figure out a way to get the most out of social media in general, and Facebook, specifically. The real winners are, of course, consumers because myriad online ads, coupon sites, and Facebook posts drive prices lower.
Hospitals and health systems trying to compete in this space can't win a price war, but they may win on patient engagement. Unfortunately, the results are soft, at best, as the strategy generally revolves around hoping someone comments on a Facebook post about a wellness goal, such as losing weight, managing stress, or quitting a tobacco habit.
Magellan Health Services, a specialty managed healthcare provider, seems to have hit upon an effective way to not only engage patients, but also change the behavior that is contributing to patients' health problems. And they're doing it with social media.
In 2012, Magellan launched a pilot project with a "large health plan in the Northeast" aimed at reducing the readmission rates of members who had been admitted to a hospital for substance abuse. In addition to a phone call after being discharged from the hospital, health plan members were invited to join a social media site that looks, feels, and functions like Facebook, but is tailored specifically for them.
"The people we're engaging on this [website] we probably never would've gotten on the telephone," says Laurie Gondek, senior vice president of product innovation at Magellan. "You have people who want to engage in many different ways. Some, with their providers… and then there are those who prefer to start out online."
Though the pilot project has ended, the site is still being used by Magellan and for the company's health plan customers who buy it under a private label to brand the site how they want. Gondek says she is seeing a lot of interest from Blue Cross Blue Shield plans and others who are interested in the site's potential for bridging care gaps and for chronic conditions.
"We've started to talk to employers, ACO partners with which our healthplans are collaborating, that are looking for ways to give the medical practitioners something in their toolbox that has some behavioral components to it for those individuals who do not want to see behavioral practitioners or specialists. We have interest in the west and southeast," she says.
The way it works is patients sign in with their usernames (it can be whatever the patients choose) and then check in with an emoticon to indicate how they're feeling. There are 28 different emotions a user can choose from, ranging from happy to in pain. The small icons are also color coded red, yellow, or green. The color is important and can serve as an SOS signal of sorts. For example, if a user checks in as being "in pain," which is red, then everyone in that user's support group—the Facebook equivalent of friends—is notified and they can jump to offer support. Friends can then comment, and also hit the equivalent of a "like" button, except the statements are empathic, ranging from, "I relate," to "I feel like that too" (sic).
Patients can also choose which groups pertain to them, such as depression or alcoholism, and they'll be connected with other patients in a social media forum that offers what traditional support groups do not—anonymity. There are also real meetings online as well as webinars with doctors or other medical experts, explains Gondek.
"What's interesting is as these individuals start out online, they are signing up for the online meetings and the talks with the expert, so we're achieving a kind of a mixed model with them being able to enter with their preference. When we say, 'We have a national expert talking about eating disorders today at noon, would you like to join?' They join, and then they ask them questions."
In the pilot project, which included 1,000 patients, Gondek says the effort generated a 20% engagement rate.
"If you look at a traditional coaching program we'd be fortunate to get engagement of 2 to 3% using a telephonic model," says Gondek. "By reaching out to these individuals with a welcome home call and an invite to the program, we achieved 20%, which, that's pretty high—double what we thought it was going to be."
Gondek also says that once patients engage with the program they're more apt to take a phone call from a coach, if needed.
And while the hard data from readmission rates is still a few months off, Gondek is optimistic.
"I had a goal of reducing it [the readmission rate] from 2 to 5%, and it's a little too soon to tell, but some of our numbers are looking very promising. We're thinking we're going to save somewhere between $1,000–$2,000 per individual, which is pretty significant."
Gondek says Magellan is running with its early success in substance abuse readmission rates and including other conditions such as eating disorders, chronic pain and autism, among others.
"It's HIPAA-compliant; it's got experts [and] we're monitoring the site. I really think that we find ourselves with a helpful solution that will achieve high engagement, utilization, and will improve health while keeping costs down. We actually see this as having tremendous power in a number of ways."
Community health advocates in states that opted for the federally run health insurance exchange model breathed a tiny sigh of relief on Tuesday on news that the Centers for Medicare & Medicaid Services will award $54 million in grants to help states pay for the federally required navigator programs.
But the amount of money CMS is doling out isn't nearly enough to adequately help the number of uninsured Americans who are expected to enroll in the exchanges this October, hence the word tiny.
The Patient Protection and Affordable Care Act requires all insurance exchanges to have navigator programs, which must be comprised of at least two different entities, with one being a nonprofit, community-focused group. The intent of navigators is to help consumers understand the process, the plans, and the choices they have in regard to the exchange.
The rules change slightly according to which type of exchange a state has decided to develop. For example, all exchanges are required to have a navigator program. But, state-based exchanges and federal-partnership exchanges with a consumer assistance component, such as Arkansas, can also opt to have in-person assister programs. The only real difference between the navigators and IPAs is how they are paid.
State-based exchanges can pay for IPAs with establishment grants already given out by CMS to help pay for the program for the first year. Partnerships and some federally run exchanges don't have the option of IPAs. Furthermore, the grants CMS just announced are the only federal money a state will get to pay for the navigators of its federally run insurance exchanges.
What's the difference? Consider that California, with an uninsured rate of 23%, is spending $43 million on its IPA program for its state-based exchange, Covered California.
Texas, which will have a federally run HIX, and has a 28% uninsured rate, stands to receive $8 million for its navigator program from CMS. The formula CMS is using to determine the grant amount uses a state's uninsured rate as a primary factor.
Rachel Dolan, policy analyst for the National Association of State Health Policy, says even though the federally run insurance exchanges won't have as much money for the consumer assistance component, states can supplement the effort.
"If a state is willing to help or get the word out or use community partners in other ways, then they can make sure that people are still getting the information they need. It may just not be a formal program."
The likelihood of a state's willingness to help the federal government out on this component of PPACA will vary from state to state.
In Texas, a state vehemently opposed to the law , the disparity highlights the uphill climb federally run exchanges face. A state's stubbornness on the issue of consumer assistance could spell disaster for other HIX partners.
For example, if the money doesn't go far enough to help the uninsured understand what their choices are, insurers run the risk of enrolling the population they fear they most: the sickest, because it stands to reason they will need the most help the process of enrolling. In Texas and in other states resisting the expansion of Medicaid, this could be particularly acute.
States have until June 7 to apply for the grant money. For those who receive it, the grant requires that navigator programs provide up to 30 hours of training for the actual navigators carrying out the task of helping consumers understand the HIX and their choices. They'll also be given an exam to make sure they understand exchange-related information. CMS will award the grants by August 15th.
A program that is rooted in helping uninformed and uninsured consumers navigate the confusing path of health insurance could, ironically, turn out to be the talking point states opposed to PPACA use to help prove their case against the new law.
The details of rebranding Children's Hospital Los Angeles back in 2011 starts with the tale of a missing apostrophe. According to original documents dating back to 1901, when the Southern California pediatric hospital opened, a defective typewriter left off the important punctuation mark on the incorporation papers.
Despite the obvious grammatical error, the hospital name remained Childrens Hospital Los Angeles until just two years ago when the hospital decided to correct the mistake and kick off a rebranding campaign to coincide with its 110th year anniversary as well as the opening of a new $636 million hospital.
DeAnn Marshall, chief marketing and development office for Children's says building a new hospital and rebranding its presence in L.A. was long overdue.
"The hospital had not invested in building the brand externally or internally in large part because it was a hospital that was at capacity," says Marshall. "Our beds were full, almost all of the time, and there wasn't really an opportunity to really market the hospital externally because we could not accept new demand."
Not anymore. The hospital's new Marion and John E. Anderson Pavilion has 317 beds, 85% of which are private rooms. The old hospital had 286 beds, but Marshall says the figure is misleading.
"We had to cohort and aggregate based on age, sex, and so there were times when yes, we had 286 beds, but [some] children, who, based on their illness, needed a private room… there were two beds in one room; that took a bed out of service. So, that was a key change we made in planning for the new hospital," says Marshall.
Even though 31 beds represents a 10% increase and an opportunity for more patient volume, the hospital decided to keep the old building operational to allow for overflow, which happened during flu season. Since it kept the old building, Children's Hospital Los Angeles is now licensed for 603 beds.
"We wanted to let the greater Southern California community know that this was going to be a different experience than they previously had," says Marshall.
The opening of the new, bigger hospital also launched Children's new logo—a big four-color butterfly with the tagline, "We Treat Kids Better." The look is fresh and fun; a stark departure from the old tagline, "International Leader in Pediatrics."
Marshall says the new logo was developed internally by the creative director and came from a healing garden in the old building.
"You would see butterflies everywhere," she says. "There is a sculpture of a butterfly, and butterfly artwork that was designed by our cancer patients, and a lot of sayings that go along with [the artwork]. The saying that struck him most was 'Butterflies fly and they're free.' That was an important statement from one of our cancer patients and it really served as the creative inspiration for our new logo."
Wanting to weave some of the old logo into the new one, Children's adopted the rainbow color palette.
Documenting the creative process was also an important part of the rebranding campaign, says Marshall, because there were no records explaining how the old logo came to be: a graphical representation of two adult-sized hands reaching up for a child-sized hand amid a backdrop of a rainbow-colored circle. In fact, Marshall says when they started digging through the files, there were too many logos.
"We audited all of the materials and all of the logos that were in use as an institution because, really, it had not been watched for a long period of time," says Marshall. "[As] I shared with the board, we had about 50 different logos in use when I arrived. What that demonstrated to me was… we had degraded our brand awareness, if we had any to begin with."
Making sure that all the rebranding and advertising work the team was doing could be tracked back to measurable results, Marshall set out on aggressive path to start tracking important marketing metrics: top of mind awareness, market share, and brand awareness.
"It's incredibly important to make decisions based on real data, especially in Los Angeles. It's expensive, I can tell them [leadership team] whether we're moving the needle forward," says Marshall.
In 2011, baseline numbers showed Marshall and hospital leadership that Children's Hospital Los Angeles had 37% brand awareness in comparison to its peers. Its pediatric advertising awareness registered at 33.8% of the market. Both figures, says Marshall, showed the hospital leading in comparison to all hospitals in southern California.
Nearly a year and a half out, the rebranding campaign has increased brand awareness by 8%, and Marshall expects that to go higher when it surveys 40,000 households with children later this year.
"This is a journey, a marathon, not a sprint," says Marshall.
She attributes the increase in brand awareness to the advertising campaign premise of "It's the best children's hospital in California," which accompanied the brand re-launch.
"What people in L.A. want is the best of everything. They want the best shoe stores for their kids, they want the best schools, they want the best neighborhoods; it's very much an L.A. mindset," says Marshall.
Marshall cites the hospital's list of accolades from outside quality rating organizations as the reason they can make such a bold statement.
"What we use in our marketing materials and our advertising is our U.S. News & World Report Honor Roll status, which no other hospital in California has, other than us. We are [also] ranked as the fifth best children's hospital in the country by U.S. News and World Report," she says. "We are also a Magnet hospital, which is the highest designation for high-quality nursing care; we are also a Leapfrog hospital … so we're, quite frankly, very comfortable moving forward with the brand platform that we are the best children's hospital in California for the care of your child."
To connect with the L.A. culture of "wanting the best," Children's developed an ad campaign that posed questions to parents conversationally. For example, one of the ads features a pint-sized hockey player above the question, "You know the best leagues for your kids. Do you know the best hospital?"
Other ads featured questions about shoe stores, museums, and preschools. The ads were rolled out in a multi-media campaign through radio ads, bus wraps, and billboards. Marshall describes it as a "one-day media blitz."
A six-member media team at Children's stoked the interest of the community in the brand re-launch and the opening of its new hospital by taking on a unique challenge Marshall gave them: 110 media stories in 110 days. The "110" number hook came from the 110th anniversary of the hospital.
Lyndsay Hutchison, senior public information officer, who was part of the media team trying to push out stories to reporters, says they surpassed their goal.
"The final count was 135 stories," she says. "We had a calendar of events we were rolling out in support of the campaign, the opening of the hospital, and the anniversary of the hospital."
The story that got the most play was the hospital's opening day, when it moved 191 patients—from tiny babies to teenagers—from to the old building to the new hospital, 600 yards away. Nurses wearing black t-shirts with the phrase, "Baby steps to the Anderson Pavilion," held the IV bags carefully while they rolled children to their new rooms.
The human interest details of moving so many young patients got a lot of attention. Every local TV station covered the move and the LA Times ran a story and moving photo essay. "Move Day," as it was pitched to local reporters, resulted in two local TV affiliates covering the move with live hourly remotes during morning drive time.
The increased media attention certainly helped increase Children's brand awareness, but another way the hospital is tracking its progress is by monitoring its payer mix.
As with most children's hospitals, the patient load leans heavily on Medicaid as a payer. At Children's, it's 70%, but since the brand re-launch and advertising campaign, the proportion of families with private insurance has increased by 2% and the mix is now 70/30.
"Part of what we're doing is increasing awareness among those families [with private insurance]. Each payer mix increase equates to almost a million dollars in additional revenue," says Marshall.
Showing leadership how important strategic marketing is starts with giving them baseline numbers and then following up with useful and valuable metrics. Tracking those metrics may be new to Children's, but Marshall is confident in the strategy it deployed in 2011.
"Moving into a brand new hospital necessitated a new identity, a new way of doing things, and a new look … It was important to respect our former identity and the history that it had, and I think we've done that. It's now about moving forward."
Cigna is more than halfway to its goal of having 100 collaborative accountable care (CAC) initiatives with healthcare providers by next year. The insurer announced seven additions to its roster as of April 1.
1. HealthCare Partners Medical Group (CA)
2. Greater Baltimore Health Alliance (MD)
3. Meritas Health (MO)
4. Atlantic Accountable Care Organization (NJ)
5. Novant Health (NC and SC)
6. Cleveland Clinic (OH)
7. Northwest Physicians Network (WA)
With the newest healthcare organizations on board, Cigna now has 58 CAC programs in 24 states covering more than 650,000 patients. Its goal is to serve 1 million patients by next year.
Cigna's CAC with Northwest Physicians Network is the health insurer's first in the state of Washington. The network is an independent physician association that includes 500 providers, 150 are primary care physicians; a "substantial primary care component" is a must-have to partner with Cigna in a CAC arrangement.
NPN is in three other collaborative care agreements with insurers. Two are active contracts, including the one with Cigna. Two others are waiting for approval from the state insurance commissioner: Aetna and Regence BlueShield. NPN is also a strategic partner with Franciscan Health System. The two organizations started a joint venture ACO this year with a contract from the Centers for Medicare & Medicaid Services.
Patricia Briggs, CEO of NPN says it has been collaborating and coordinating care for patients since it incorporated in 1995. While each collaborative care arrangement has positive aspects, Briggs says she is excited about the partnership with Cigna because the insurer is proactively promoting the new CAC.
"Cigna is doing a good job of informing [and] getting their members involved right at the beginning," says Briggs.
Cigna is promoting the arrangement by highlighting NPN as a "high quality provider of care" in its provider directories. Mary O'Neill, MD, Cigna's senior medical director for Washington says it is also reaching out to its group members.
"We have increasingly been asked by employers to feature the most effective members of our network. Some of them are even willing to affect their benefit structure around this," says O'Neill. "Some of them have been inviting people to come by during open enrollment or a health fair to talk about how their healthcare management model would work for individual employees and their dependents."
The arrangement between NPN and Cigna will cover more than 3,000 patients. As with the other CAC arrangements, the clinical care coordinators, who are RNs at NPN, will be key to helping patients navigate the arrangement and as well as achieving the triple aim of improved health, affordability, and patient experience.
NPN will receive incentive payments for meeting quality improvement topics, which include increased screenings and reduced hospital stays, and also lowering medical costs through coordinated care.
O'Neill says it is also giving some financial payment "out of the gate" to help offset the costs of the clinical care coordinators. The incentive payment for meeting quality and cost targets is issued yearly, unless the targets are not met, and in that case, the coordinated care payment remains does not go up.
Under the CAC, NPN patients who are Cigna members will have automatic access the program. Cigna says there are no changes in members' plans, though the patients most likely to see the first benefits of the agreement are those with chronic conditions, such as diabetes or heart disease.
Cigna, like other payers and health systems, is turning to accountable care partnerships to reduce costs and improve outcomes. The insurer's first venture into this arena began with a patient-centered medical home pilot project with Dartmouth-Hitchcock Clinic in 2008.
A recent report from the Society of Actuaries (SOA) projecting a double-digit rise in insurer's costs because of the Patient Protection and Affordable Care Act (PPACA) thrust the normally low-key group into unfamiliar territory: politics.
Groups who oppose the PPACA seized on the report's finding that medical claims costs will rise by 32% on average, as well as vary widely by state. Others questioned factors that the SOA left out of its study, such as not including the varying level of subsidies consumers can use to buy insurance on the exchanges.
Kristi Bohn, SOA's consulting staff health fellow, says the group started this study over a year ago to provide guidance on costs of newly insured, who will be entering the marketplace through federally required health insurance exchanges, compared to those currently insured.
"This is a little too technical for most people's interest levels so I was surprised that it was picked up so much," says Bohn. "We weren't trying to be political; we're not a political organization."
The report bolsters claims from the Association of Health Insurance Plans (AHIP) that premiums will rise under the PPACA. Bohn is quick to point out, however, that the SOA's findings don't implicitly make that conclusion.
"Premiums will be interesting," she says, suggesting perhaps that insurers may work to keep premiums from rising by changing up their networks or making them smaller.
The most surprising finding was the extreme disparities in medical claims costs among states. For example, Wisconsin is projected to see an 80% increase in medical claims costs while North Dakota will see just an 8.4% cost increase.
The variations served as talking points for Republicans trying to make the case that the PPACA isn't working. Utah Senator Orin Hatch used the hash tag #brokenpromises at the end of a message from his Twitter account to detail Utah's cost increase (28.4%). Other states did the same, though a few states—five—were able to announce a projected cost savings.
"We had an inkling that states like New York, or a state like Massachusetts, or Vermont could come down, but we didn't know how much," says Bohn.
The five states estimated to see a claims cost savingsunder the PPACA include:
Massachusetts (12.8%)
New Jersey (1.4%)
New York (13.9%)
Rhode Island (6.6%)
Vermont (12.5%)
Bohn says despite the criticism that the report has received, the group made "reasonable" assumptions based on research that studied behavioral economics.
"We had no idea that this variation would exist, too. We didn't have an end in mind, and we were all surprised by the variation by state," she says.
Factors that influence the variations, according to Bohn, include the health of a state, the current uninsured rate, and whether the state attempted to care for its uninsured previously.
"A lot of these states have already tried to tackle what the Affordable Care Act tackles. So they already tried reducing the uninsured rate and now they get these valuable subsidies to people, so those states stand to benefit," she says.
As to how premiums will be affected by medical claims costs, it's unclear. Only Vermont has released its health insurance premiums for the exchanges. Vermont is running its own state-based exchange, called Vermont Health Connect.
So far, it has two insurers–Blue Cross Blue Shield of Vermont and MVP Health Care. The plans have proposed rates for individual plans that range from nearly $400 to more than $600. Another insurer, the Vermont Health Co-op, is waiting for its license application to be approved so it, too, can sell insurance on the exchange.
The proposed HIX rates are generally thought to be reasonable, but then, Vermont is also one of the only states expected to realize a cost-savings in medical claims over the long-term.
Bohn says actuaries are busy working to come up with rates for insurers that will be accurate. It's another reason she says she's surprised that the report became a political issue.
"Health actuaries, they're busy on all these topics because they have to come up with rates this week or within the next two months, basically. And this is one of the big risks of their decision, and it's also risk for the government because if the actuaries mess up, the government also has this risk corridor program to make up differences when markets are mispriced and so, for us it was not only an exercise to help actuaries, but it was an exercise to help the government, as well."
Montana insurance officials expect to find out in April if a proposal from Health Care Service Corporation (HCSC) to buy Blue Cross and Blue Shield of Montana (BCBSMT) for $17.6 million can go forward. But that may be too late for a sweeter deal for Montana under an agreement that the state's Attorney General signed off on with HCSC officials.
A hearing on the proposal was held earlier in March with former state Supreme Court Justice Bill Leaphart acting as hearing officer. He is waiting on two reports; one from each of the chief counsels for AG, Tim Fox, and Insurance Commissioner, Monica Lindeen.
Lindeen is responsible for evaluating the impact on health insurance members and the health insurance market. BCBSMT is the state's largest insurer. Fox will determine if the price offered by HCSC is fair. The two offices are somewhat at odds over a deal that Fox brokered with HCSC prior to Leaphart's hearing.
The terms Fox agreed to with HCSC include a nearly $23 million increase in the original purchase price, and a new call center in Great Falls, Mont., within a year if insurance regulators signed off on the deal by March 30.
The chief counsels preparing recommendations have until April 19 to submit their findings to Leaphart, who will then issue his own recommendation.
Lucas Hamilton, communications and policy director for the Insurance Commissioner's office says expect Leaphart's opinion is expected "before the end of April." Lindeen told a local paper Fox's agreement with HCSC officials for a March deadline was "premature." At issue is that both Fox and Lindeen have to approve the agreement before it can go forward with or without modifications.
The long and complicated road to approving HCSC's purchase is due, in part, to Montana's conversion law, which is being tested out for the first time, says Hamilton. Passed in 2005, the law is meant to protect the state's consumers if a nonprofit health plan converts to one that is for-profit.
HCSC, also a nonprofit, has said the company's business status would not change. But under Montana's law, the deal has to be brokered as if the insurer was converting to be for-profit because Lucas says HSCS has stipulated to the conversion statute, and BCBSMT is legally losing its nonprofit license.
For Montanans, that means that a nonprofit foundation has to be set up from BCBSMT's current surplus, which is estimated to be $100 million, plus the purchase price, which is now $40.2 million. The AG's office would be responsible for determining how the $140 million trust would be used, though the law spells out that it must be for the public good.
Chicago-based HCSC is a non-investor owned (NIO) mutual insurance company doing business as a nonprofit health plan. It is an independent licensee of Blue Cross Blue Shield Association and operates BCBS plans in four states: Illinois, New Mexico, Oklahoma, and Texas. HCSC has more than 13 million members.
In its original application to state officials, BCBSMT stated it wanted to partner with another BCBS plan to capture economies of scale and compete with national health plans entering the market. The application also makes clear that HCSC's NIO status played a key role in BCBSMT's decision to partner with the insurer.
Paul Keckley, Ph.D., executive director for the Deloitte Center for Health Solutions, is not surprised at HCSC's move to acquire BCBSMT. He says mergers and acquisitions "in the Blues family" is common, and is expected to accelerate.
Deloitte took an in-depth look at the merger and acquisition transactions among health plans. The 10-page report shows no clear path to positive post-deal results.
The report's authors studied 44 M&A contracts 2006–2012. It took into account several balance sheet metrics, including price per share (PPS) of the acquiring company. The PPS was looked at three different times: when a deal was announced, a year after the announcement, and three years post-transaction.
Since the M&A cycle varied among the 44 companies, the number of plans included in the results varied. But among the key findings is 55% of the M&A deals had an immediate increase in (PPS); 36% of the acquiring plans had an immediate decrease in PPS, and 9% had no change. While there were more increases in PPS overall, the average value increase was measly at just one-tenth of 1%.
While consumers continue to give low satisfaction ratings to health plans in general, they assign higher marks to nonprofit health plans, according a recent survey.
J.D. Power and Associates released its annual 2013 Member Health Plan Study for the seventh time last week. It surveyed more than 33,000 members belonging to 136 commercial health plans across the U.S.
Rick Millard, senior director of the healthcare practice at J.D. Power and Associates says on the whole, nonprofit companies, such as Kaiser and some Blue Cross Blue Shield licensees received higher satisfaction ratings than for-profit plans.
"This year, the for-profits are essentially all below average, and that's kind of a pattern we've seen for a while," says Millard.
The nonprofit Kaiser Foundation Health Plans was a top-ranked health plan in seven states as well as Washington D.C. Only two for-profit health plans received a top ranking: Anthem Health Plans of New Hampshire in the New England region and UnitedHealthcare in Ohio.
The study ranks health plans by region, though there are some states that are not included in the survey, such as Hawaii, because there is too little competition (only two health plans operate Hawaii: Kaiser Permanente and Hawaii Medical Service Association). The study analyzed health plans based on seven categories:
Coverage and benefits
Provider choice
Information and communication
Claims processing
Statements
Customer service
Approval process
Since the survey divvies up the country into 17 regions, there are, essentially, 17 different top-ranked health plans. Millard says however, that there are broad conclusions to make. According to the study results, satisfaction is highest among health plan members in three regions: Texas, Michigan, and East South Central, which includes Alabama, Kentucky, Louisiana, Mississippi, and Tennessee. Conversely, health plan members are unhappiest in the Colorado and the Mountain regions, which include Arizona, Nevada, New Mexico, and Utah.
Health plans are given a numerical score based on a 1,000 point scale. The 2013 study shows that overall member satisfaction averages 701 compared with 702 in 2012. The stability of the health plans' satisfaction score isn't necessarily a good thing, especially when compared to other business sectors.
"Satisfaction with commercial health insurance is among the lowest of any industry that we study at JD Power and has been for a while," says Millard. "But, it's not getting worse."
Millard says it's also clear from the study that the focus some health plans have put on improving its communication with members is paying off.
"In the area of online… Kaiser has a lot of applications. Another company that's done strongly in that area is Health Partners in the Twin Cities area," says Millard, who also points to Buffalo, NY-based Independent Health Association as an example of providing good customer service for its members in its high deductible plans.
Another broad conclusion that can be made from the study, says Millard, is that members are placing more importance on coverage and benefits than provider choice and communication.
"In years past they all had comparable influence on member satisfaction. In recent years, coverage and benefits have really pulled away to be the most influential factor driving member satisfaction," he says, adding that it may be because members are becoming more cost-sensitive.
"I think fundamentally people see that they are paying the same or more, but they're not necessarily receiving more coverage, and that's part of the reason this has become a more acute concern year over year," says Millard.
One group is hoping that the higher ranked nonprofit health plans will catch the attention of newly created health insurance exchanges.
The Alliance for Advancing Nonprofit Health Care (AANHC), a group that represents nonprofit hospitals, health plans, and other health care organizations, wants insurance exchanges to include the ownership status when health plan choices are presented to consumers.
Bruce McPherson, president and CEO of AANHC, lobbied the Centers for Medicare & Medicaid Services in 2010 to include the ownership status of health plans on the Summary of Benefits and Coverage form for insurance exchanges.
"CMS did not include our recommendation in the final version, but that doesn't mean individual state exchanges can't add that item if they choose, and we hope that many of them will," says McPherson.
A recent survey of large employers (companies with at least 1,000 workers) shows health insurance benefits for its workers is on shaky ground in the long-term.
Towers Watson/National Business Group issued its 18th annual report on health insurance trends among large employers last week. The results are based on the responses of 583 firms that cumulatively employ 11.3 million full-time workers, 8.5 million of which receive health insurance benefits.
The types of industries run the gamut. Thirty-percent of companies responding represented manufacturing; 16% were from financial services; 13% were from healthcare, and 11% represented the IT/telecom industry.
The report states that only 26% of employers are "very confident" their company will provide health benefits in 10 years. Shocked? I was. Five years ago, that percentage was 73%. But confidence in general is lagging among the employers surveyed about what their roles would be in the future because of the Patient Protection and Affordable Care Act (PPACA).
For example, last year, when asked about the importance of employer subsidies for health benefits, 71% said it was very important. This year, it's down three percentage points, which isn't much, but only 54% of companies surveyed indicated the same level of value in 3–5 years.
The 40-page report also shows employers continuing to lean on workers for more accountability and cost sharing. Nothing new there; however, this year, the report also focused on companies it deemed "best performers," which are firms that held down the rate of health care cost increases over four years.
There were 45 firms that met the criteria. The report doesn't identified them by name, but rather by strategies used to keep its cost increases to about 2.2%, on average, which is just above the rate of inflation. In addition the firms also report reduced employee expenses.
Based on the report's findings among its "best performers," three trends have emerged as takeaways for insurers who are not yet offering these benefits widely or are unsure of their viability:
1. Embrace telehealth. The focus on technology as a solution has never been as intense as now. With consumers using their smartphones to do mobile banking, something that once seemed out of reach because of issues surrounding security and complexity, they are wondering what is taking healthcare so long to catch on.
Private companies with a foot in healthcare via pharmacy and onsite clinics, such as Rite Aid, are stepping into the space offering online visits with a physician. The "best performers" in the Towers Watson study are early adopters to telemedicine, too.
The IT/telecom industry is so far (and unsurprisingly) the biggest fan of using this method as a way to keep its workforce healthy, though other companies lead the way in providing for e-visits, remote monitoring, and like. It's one of the biggest emerging trends; by next year, 34% of the 45 "best performers" plan to expand these offerings to employees.
2.Use outcome-based incentives instead of penalties. As the parent of a rambunctious 6-year old boy, I am very familiar with this strategy. I know, for example, that I have a better chance of getting him to make his bed if I promise him 10 minutes of playtime on the Wii rather than threatening to take it away if he doesn't do what I ask.
The "best performers" know this, too, and have data to back it up. A perfect example is tobacco-use status. According to the report, 42% of companies surveyed penalize smokers about $50 per month. Among the best performers, 51% use an incentive system, such as smoking cessation programs.
Furthermore, 40% of them also extend the incentive to spouses and dependents. Where's the reward? On the balance sheet and at home. The best performers saved more than $2,200 per employee when compared to low performing companies (those with 10.3% cost increases).
These are large firms; thousands of dollars in savings can turn into millions quickly depending on the number of workers employed. But board room members weren't the only ones saving money. Its employees saved, on average, $500 in premiums and $400 in point of care services. Get rid of the stick, and offer the carrot.
3. Use incentives and emerging payment models to increase quality of care. Health insurers are well aware of all the buzzwords in payment: "accountable care," "value-based purchasing," and "bundled payments," but so are employers who see insurance for their workers as a value proposition that needs to be solved today for the long-term.
The report's authors say survey responses point to employers interested in moving into the supply side of plan management. For example, 13% of the best performers currently contract directly with hospitals, physicians, and/or ACOs. By next year, that percentage is expected to grow to 31%.
It's among the top three sharpest increases in strategies the best performing employers say they plan on implementing by next year. The other two involve offering incentives to providers to increase quality (25%) or use a coordinate care approach (22%).
The report offers a lot of insight on employers and insurers, but these three things can affect how quickly a tipping point is reached in care, quality, and cost for both parties.
Dallas-based Parkland Health & Hospital system will have to be on alert for federal safety officials longer than planned.
The troubled hospital is nearing the end of a two-year corrective action plan for myriad quality and patient safety concerns that the Centers for Medicare & Medicaid Services found in 2011. The federal agency was due to inspect the hospital for improvements by April 30, but on Wednesday the hospital announced that CMS would conduct its Medicare certification survey after that date.
In 2011, CMS placed Parkland under a systems improvement agreement (SIA), which means a hospital may continue to receive Medicare reimbursements as long as a third party is onsite to monitor and facilitate changes that need to be made.
The consulting firm Alvarez & Marsal has been working with Parkland to implement some 499 action items CMS deemed critical to the hospital keeping its Medicare certification, thus reimbursements. At Parkland's last board meeting on February 26, the hospital reported it had completed 484, or 97% of those recommendations.
Parkland still has to get that number up to 100% by April 30, but now that CMS has extended the time it will take to survey the hospital's changes, there's what CMS calls an "element of surprise" to the federal surveyors' arrival.
In a statement, Debbie Branson, chair of the Parkland Board of Managers, said the adjustment changes nothing.
"As of April 30, Parkland should be ready for that level of scrutiny on any day at any hour."
April Foran, director of communications for the hospital, says Parkland did not ask for the change.
The hospital has been preparing for the federal survey since December when it announced there would be two mock surveys conducted, also by surprise, as a sort of practice for when CMS showed up.
Parkland says it has already completed one mock survey; its results are confidential. An outside group of 11 "clinical experts" reviewed Parkland's progress in every area for five days. The surveyors also inspected its outpatient clinics and community health centers.
To bring the hospital up to par with the CMS requirements for Medicare certification, Parkland has beefed up its emergency department by adding triage rooms, seating, and more staff on weeknights. It has also started using something the hospital calls a sustainability schedule to document best practices in triage, staffing, and other processes.
The ED changes are supposed to effect patient flow, which was an issue CMS pointed out in 2011. To that end, Parkland also recently named Marilyn Callies, RN, BSN, MBA, as vice president of care coordination. Her focus will solely be on case management and improving patient flow as well as discharge planning. Callies was previously the director of care coordination at Baylor University Medical Center.
One position that is part of the recommended improvements is the role of newly-created Chief Patient Rights and Safety Officer, which Parkland has had trouble filling. The position is supposed to help the hospital show how seriously it considers patient rights and safety.
In December, Alvarez & Marsal acknowledged the delay in hiring a CPRSO, but said it was intentional, to "get the role right." Now, according to Foran, the responsibilities of a CPRSO will be split between an Associate Chief Medical Officer for Quality, who hasn't been hired, and the Senior Vice President for Quality and Performance, Jackie Sullivan, PhD.
Areas that Parkland continues to focus on as the April 30 deadline approaches are care coordination and transitions in behavioral health, as well as continuing to audit departments across the system to determine if the new processes and practices are sustainable.
Despite recent criticism that ACOs will not succeed because the behavior changes required of patients and doctors are "unrealistic," Tennessee-based MissionPoint Health Partners is moving the needle forward.
MissionPoint Health Partners, an accountable care organization launched by Ascension Health's Saint Thomas Health System in Nashville just a year ago, is adding some health insurance heft to its operations. On Tuesday MissionPoint announced that Blue Cross Blue Shield of Tennessee will be joining the ACO in a four-year partnership aimed at self-insured employers.
That's just one indication that this ACO model is not only viable, but could be a lesson in how-to for other hospitals and systems considering plans to set up these new models of care.
Success Factors
In its first year, Jason Dinger, CEO of MissionPoint, says it surpassed membership goals. "We were hoping to manage 15,000 members; we're up to over 50,000 members in our ACO. We've seen considerable growth," says Dinger.
It also added new services, and expanded its telehealth component from one to 44 sites to capture the population residing in the rural area around metro Nashville.
And, Dinger says, the ACO has cut medical costs each year for its 15,000 original members by 12%.
Strategic Market is Key
One key to MissionPoint's progress with engagement may be its strategic target marketing to self-funded employers. According to Dinger, they share only one commonality—commitment to slowing costs for employees.
"They could be technology companies; they could be manufacturing companies. They could be 1,000 employees; they could be 10,000 employees. What's true for all of them is they are fully committed to ensuring that their health benefits are sustainable for their employees long-term, [and] that it doesn't overly burden their employees with growing healthcare costs."
Money is a powerful motivator, and that could be at play with self-funded groups that are closer to seeing to how medical decisions affect their paychecks than those relying on the employer to pick a carrier. Certainly, employees are looking closer at their options during annual enrollment, but Dinger says the self-funded groups it is working with know their populations well and are more engaged.
"We look at over 50 different indicators on a regular basis. We have seen a significant reduction in readmissions. We have seen increased physician visits among the population, and better adherence to medication," says Dinger.
It's important to remember the improved health and cost for MissionPoint's members don't exist in the healthcare industry vacuum of cost curves and new payment models. Health insurance can be a competitive advantage in the workplace for retaining and attracting employees, which could emerge as a sleeper indicator of the success of new payment models, even with a large wave of new members entering the system.
Getting BCBS-TN on board extends MissionPoint's access to the plan's more than 500,000 self-funded members.
Larry Nall, senior vice president of provider network management for BCBS-TN, says the insurer was intrigued with MissionPoint's 2012 ACO announcement and has tracked its progress since.
"One of the things we've been doing is looking for strategic partners around the state," says Nall. "What we will do is make it available for self-funded employer groups as of Jan 1, 2014. As we continue the partnership, [we'll explore] how to make it available for other funding types. There are a lot of details to work out, but we picked the right partner."
Data Sharing
Currently MissionPoint looks at 3-5 years of historical data as a starting point for care. Then it customizes a health plan with interventions designed to improve the health of its members, based on their medical conditions.
When the ACO option is rolled out to employers next year, MissionPoint and BCBS-TN, like other ACOs, will share claims and clinical data to determine the best path of care.
Dinger says employers get health information quarterly, or as needed, depending on the size of the employer group. He points to allied health partners his organization has added to the MissionPoint ACO as evidence the infrastructure exists to take care of the extra patients from BCBS-TN.
"We now have over 1,500 providers in our network throughout the middle Tennessee area," says Dinger. "We've also brought on a number of allied health and post acute care partners in the areas of durable medical equipment and skilled nursing facilities."
'Bear Hugs' for Sickest Members
Dinger offers some lessons learned after a year of running the only ACO in the midstate. He says there are basically three levels of intervention:
Chronic, complex, medical cases
Employees who are regular users, but may need help identifying appropriate prevention strategies
Wellness
The sickest members get what Dinger calls a "big bear hug"—home visits, call center support, and regular engagement based on their daily healthcare needs. This is the group that's seen the most dramatic improvement, according to Dinger.
"The results that we've seen in year one are largely from that first intervention, providing services to people who are managing really complicated illnesses and working with them to reduce their own costs and improve their outcomes," says Dinger.
Is the 12% cost reduction Dinger says MissionPoint accomplished in its first year bending the cost curve enough to silence, or at least hush (they are Tennesseans, after all) the detractors of ACOs? It's unlikely, but first steps are always clumsy.