Enrollees show signs of pent-up demand with acute healthcare needs early in their enrollment, but over time costs increase substantially and shift toward chronic care.
Spending for the Medicaid expansion population increased steadily over time for beneficiaries who remained enrolled in the program, according to a new analysis from Avalere Health.
The study found that the average monthly costs for expansion enrollees who gained coverage in the first half of 2014 were $324 during the first six months of coverage. Two-and-a-half-years later, for those who were still enrolled, the average monthly costs over six months rose to $389—a 20% increase.
The analysis also found that younger enrollees are more likely to disenroll, which means that healthier enrollees may be disenrolling or losing Medicaid eligibility, while expansion enrollees with sustained enrollment in the program are more likely to have chronic health needs.
"Contrary to some expectations that Medicaid expansion enrollees would be relatively healthy, beneficiaries who have remained on the program have increasing healthcare needs, likely due to previously unidentified or untreated conditions," said Caroline Pearson, senior vice president at Avalere. "Healthier, lower-cost enrollees may be more likely to churn off Medicaid after a shorter period of time."
The share of spending for inpatient hospital care and emergency room visits decreased over time among the expansion population, especially in the first few months of coverage. However, spending increased for chronic care services, such as prescription drugs. Among those enrolled in early 2014, inpatient spending initially made up the largest share of costs, but was surpassed by prescription drug spending by the eighth month of enrollment.
Avalere said those finding suggest that expansion enrollees, largely uninsured before 2014, had significant medical needs when they enrolled, or that many expansion enrollees enrolled as a result of an inpatient encounter. As beneficiaries spend more time with insurance coverage and establish relationships with physicians, their healthcare costs shift toward outpatient visits and prescription drugs, and away from hospitalizations, which reflect acute health needs.
Avalere examined claims data from January 2014 through December 2016 from three Medicaid managed care organizations offering coverage in states that expanded Medicaid on Jan. 1, 2014.
The Affordable Care Act gave states the option to offer Medicaid to childless adults aged 19-64 who earn less than $16,643, which is 138% of poverty. Medicaid covers approximately 76 million Americans, about 15 million of whom are on the expanded population. Eighteen states have declined to expand their Medicaid programs.
The 455-bed nonprofit medical center and teaching hospital was one of the last independent hospitals on Long Island. It becomes the eighth hospital in Mount Sinai Health System.
South Nassau Communities Hospital will become the flagship hospital on Long Island for the Mount Sinai Health System under an acquisition announced Wednesday.
Financial terms were not detailed, but Mount Sinai said it will provide $120 million for South Nassau’s five-year master facility plan, which will expand surgical facilities, intensive care units, and South Nassau's emergency department, according to a joint media release.
"The addition of South Nassau to our Long Island network represents our commitment to broadening access to innovative treatment and research in this region," said Kenneth L. Davis, president and CEO of Mount Sinai Health System.
"This transformative partnership will complement our existing network of talented clinicians and facilities," Davis said. "We are thrilled about what this means for patients and families on Long Island, and look forward to working closely with our Long Island partners to continue advancing care in the region."
South Nassau's board of directors will retain governance over the day-to-day operations of the 455-bed hospital, until now one of the last independent hospital on Long Island. South Nassau CEO Richard J. Murphy will report to the board and to Davis. The South Nassau Board will include two new members from Mount Sinai's Board, and two members of South Nassau's Board will join the Mount Sinai Board.
The two health systems signed a nonbinding letter of intent last May. Now, a state regulatory review is underway, but hospital officials said they anticipate final approval within months.
"We are in the midst of tremendous growth and expansion at South Nassau," Murphy said. "Our plans to renovate and nearly double the size of our emergency department in Oceanside are already underway, as are plans for a new, four-story, high-intensity building in Oceanside, as well as expanded medical services in Long Beach. The relationship with Mount Sinai will accelerate our plans and provide essential services to patients throughout Long Island."
South Nassau, a nonprofit medical center and teaching hospital, has 3,500 employees and 900 affiliated physicians. It will become the eighth hospital in Mount Sinai’s $7 billion health system, which includes the Icahn School of Medicine, seven other hospitals, 300 ambulatory practices and more than 6,500 physicians.
"Long Islanders shouldn't always have to travel into Manhattan for advanced cardiovascular, cancer, orthopedic, or neurological care," said South Nassau Board Chairman Joseph Fennessy, who led the negotiations. "Our goal from the outset was to find a partner seeking to expand services on Long Island who, like us, puts patients first, employing cutting-edge science and treatments."
Sanford World Clinic now operates in nine countries in more than 30 locations with services that include primary and pediatric care, research, and health system operations.
Sanford Health will expand its international healthcare services to seven countries on four continents in 2018, the health system has announced.
"With these partnerships, we are creating unique opportunities for shared learning," said Kelby Krabbenhoft, president and CEO of Sanford Health. "This is not something we are pursuing for financial gain, but we believe this type of collaboration will help further our mission of health and healing."
This year, Sanford Health will enter New Zealand, Ireland, Vietnam, Costa Rica and South Africa and increase its presence in China and Ghana. Last year Sanford acquired a minority stake in Munich-based ISAR Klinikum, which provides clinical applications for stem cell therapies.
Sanford Health’s international healthcare arm, Sanford World Clinic, will now be in nine countries with more than 30 locations. Launched in 2007, the initiative supported by philanthropy and is designed to foster partnership with healthcare leaders in the development of sustainable services around the world.
"We want to go where we can be impactful and create partnerships that will stand the test of time," said Dan Blue, MD, executive vice president of Sanford World Clinic. "We have outstanding partners in each of these countries who share a common goal – to advance health care around the world."
Sanford World Clinic identifies three to five new partnerships each year. Each collaboration is different in terms of scope of service and type of agreement and range from primary and pediatric care to research and health system operations.
New Zealand: Sanford and Omni Health Limited will open a general practice clinic in February, within Auckland’s Central Business District.
Ireland: Sanford and Hermitage Medical Clinic will establish a clinical research office to extend precision oncology services through a clinical research protocol supported by Sanford Research in the United States.
Costa Rica: Sanford is providing strategic and operational support to the fast-growing Hospital Metropolitano health system.
Vietnam: Sanford is collaborating with Victoria Healthcare to support clinical and health care management education programs for Victoria physicians, nurses and staff.
South Africa: Sanford is supporting the development of clinical research and educational programs in fetal alcohol spectrum disorders at Stellenbosch University and in partnership with a series of collaborators.
Ghana: Sanford is continuing its partnership with the Ghanaian government to expand upon its current 23 clinics.
China: Sanford will provide oncology support for the Ciming Health Checkup Group. This collaboration will be a remote physician-to-physician partnership.
Spending growth from 2012 to 2016 was almost entirely due to price increases, particularly for prescription drugs, emergency department visits, and inpatient surgical procedures.
Consumers used the same amount of healthcare or less in 2016 than in 2015, but paid more for it because of rising prices, and that pace is accelerating, according to a new report from the Health Care Cost Institute.
"It is time to have a national conversation on the role of price increases in the growth of healthcare spending," said Niall Brennan, president of HCCI.
"Despite the progress made in recent years on value-based care, the reality is that working Americans are using less care but paying more for it every year. Rising prices, especially for prescription drugs, surgery, and emergency department visits, have been primary drivers of faster growth in recent years."
The report covers the period 2012 through 2016 and includes national claims data from Aetna, Humana, Kaiser Permanente, and UnitedHealthcare.
Key findings:
Over the five years examined in the survey, prescription drug spending had cumulative growth of 27%, despite flat or decreasing generic drug pricing and a decline in the use of brand name prescription drugs. The increase in spending was driven by double-digit price increases from 2012-2016 for brand prescription drugs.
The overall number of emergency department visits rose only slightly over the five-year period, but the average price for an emergency department visit increased 31.5%.
The average price for surgical admissions increased by nearly $10,000, or 30%, over the five-year period, despite a 16% cumulative decline in use. The price for outpatient surgery rose more than 19% over the five-year period.
Total spending per person is now growing at faster rates than prior years, with 4.6% growth in 2016 compared to. 4.1% growth in 2015, which followed 2 years of sub-3% growth from 2012 to 2014.
Utilization of most healthcare services remained unchanged or declined, both year-over-year and over the 2012-2016 period.
Consumer out-of-pocket spending per person increased, but grew more slowly than total spending. This difference in growth led to a decline in out-of-pocket spending as a share of total spending.
"While consumers, especially those with employer-sponsored insurance, may not feel the direct impact of these charges via out of pocket payments, they ultimately pay through increased premiums and decreased benefits," Brennan said.
PhRMA has challenged the HCCI findings.
"The latest annual report from HCCI overlooks key data published on drug prices included in the years covered by the report. More recent data provides key insights into the spending and costs of prescription medicines," PhRMA said in an email to HealthLeaders Media.
In 2016, spending on retail medicines grew just 1.3%, as reported by CMS.
2016 spending rates published by a number of sources cite a decline in medicine cost growth, on average of 3%-5% for the year. (Express Scripts, CMS, CVS/Caremark, Quintiles)
"In addition, HCCI does not factor for discounts drug makers provide to payers," PhRMA said. "In 2015, more than $100 billion in savings for patients were negotiated with drug manufacturers. That number is increasing year on year. These discounts rebate more than one-third of the list price back to payers and others in the supply chain."
Allegations in a whistleblower lawsuit claimed that the San Diego-based health system improperly billed government-sponsored health plans for physical therapy services.
Scripps Health will pay $1.5 million to resolve False Claims Act allegations related to improper billing for physical therapy services, the Department of Justice announced.
The services were provided by a therapist who did not have billing privileges with TRICARE or Medicare, and who was not properly supervised by a physician, DOJ said.
"Federal healthcare programs require that services are rendered by authorized providers or under the appropriate supervision of an enrolled physician," Acting Assistant Attorney General for the Justice Department's Civil Division Chad A. Readler said in prepared remarks.
"These requirements help protect patients from unscrupulous or unqualified medical professionals," he said.
Scripps Health said in prepared remarks that it self-reported the infractions and settled with the government to avoid costly and uncertain litigation.
"Contrary to what was said in the Department of Justice news release, this was a civil investigation focused on the technical billing issues only; there were no allegations related to quality or medical necessity of care in this investigation. The technical billing issue had no financial benefit to Scripps (it did not increase reimbursement rates or reduce costs)," Scripps said.
Medicare and TRICARE limit billing privileges to enrolled providers. Services from unenrolled providers can be billed as "incident to" the services of an enrolled physician, but only if the physician provided direct supervision, DOJ said.
The settlement resolves False Claims Act allegations in a lawsuit filed by former Scripps employee Suzanne Forrest, who will receive $225,000 under the settlement.
"Unlawfully obtained payment from taxpayer-funded programs harms the entire healthcare system," said Adam L. Braverman, U.S. Attorney for the Southern District of California. "We will hold accountable all providers who defraud these programs."
"The Department of Justice and Scripps Health have reached a settlement agreement related to a technical error in the processing of some Medicare bills for physical therapy treatments. Scripps provided all the services for which it billed Medicare and ensured patients received high quality care. Scripps reached a settlement to avoid continuing legal costs and uncertainty.
Scripps issued the following statement in response:
"Scripps became aware of the situation on our own and reported to the Medicare contractor, the party responsible for the handling of Medicare claims, that we had found the billing anomaly and we asked them for guidance on how to address it. The federal attorneys on the case and the relator were unaware of Scripps' self-disclosure when they reached out to Scripps, and Scripps was not aware that the relator had filed a lawsuit against Scripps when Scripps made the self-disclosure. Therefore, Scripps diligently investigated the issue and attempted to resolve it through appropriate channels."
"It is important to note that there were and always are physicians on site during the provision of physical therapy services and available to assist with any patient needs that arose. There is no evidence of any patients requiring physician intervention. Further, all physical therapists were licensed and provided medically necessary, appropriate care."
In less than one decade the number of ER visits involving alcohol consumption increased 61.6%, from 3 million to 4.9 million, and the total cost increased 272%, from $4.1 billion to $15.3 billion.
The rate of alcohol-related visits to U.S. emergency departments increased by nearly 50% between 2006 and 2014, and the cost of providing care more than tripled, according to a new study from the National Institutes of Health.
"In just nine years, the number of people transported to the ED annually for medical emergencies caused or exacerbated by alcohol increased from about 3 million to 5 million," said NIAAA Director George F. Koob, director of NIH's National Institute on Alcohol Abuse and Alcoholism.
"These findings are indicative of the detrimental effects that acute and chronic alcohol misuse have on public health, and the significant burden they place on our healthcare system," Koob said.
Researchers gleaned data from the Nationwide Emergency Department Sample, involving 945 hospitals in 33 states. The results were published this month in the journal Alcoholism: Clinical and Experimental Research.
Among the key findings, between 2006 and 2014:
The number of ED visits involving alcohol consumption increased 61.6%, from 3 million to 4.9 million. The rate of all alcohol-related ED visits increased 47% between 2006 and 2014, which translates to an average annual increase of 210,000 alcohol-related ED visits.
The total cost increased 272% from $4.1 billion to $15.3 billion.
The number of acute alcohol-related ED visits increased 51.5% from 1.8 million to 2.7 million, and the rate increased 40% from 720.9 to 1,009.6 per 100,000 population.
The number chronic alcohol-related visits increased 76% from 1.3 million to 2.2 million, and the rate increased 58% from 502 to 793 per 100,000 population.
Men account for more alcohol-related ED visits than women, but the annual percentage change in rates of all alcohol-related ED visits was larger for women than for men (5.3% vs. 4%). This increase was driven primarily by a larger increase in the rate of chronic alcohol misuse-related visits for women than men (7% versus 4.5% annually).
"During the study period, the number of people in the United States who drank alcohol and the total amount of alcohol consumed each year remained about the same," said lead researcher Aaron White, a senior scientific advisor at NIAAA. "We suspect the increase in ED visits is related to an increase in the intensity of alcohol use among a subset of drinkers."
"Recent studies suggest that the drinking habits of females and males are becoming more similar in the United States," said White. "The larger increase in the rate of ED visits among females compared to males provides further evidence of narrowing gender gaps in alcohol use and related harms. This trend is concerning given that females appear to be more susceptible to some of the detrimental health effects of alcohol."
Hany Atallah, MD, chief of Emergency Medicine at Grady Health, was not involved in the NIH study but says the ER at Atlanta's safety net hospital deals with lots of intoxicated patients.
"In my mind it divides itself into two spectrums: No. 1 is the medical and No. 2 is the surgical," Atallah says. "No. 1, you’ve drank enough and fallen and hit your head and cut your face and broke a bone. We see that a good bit, and we do see it more in the older patient population. That is the surgical problem."
"The medical problems we see are people who have just been drinking long enough that they have managed to damage parts of their body. The volume has been increasing," he says.
"Obviously the surgical treatment is straightforward. You figure out if something is broken or bleeding and if it is, you need to figure out what you need to do about it," Atallah says. "For those who show up drunk, which is a fair bit, typically we are watching them until they are sober. Once they are sober and safe and if everything else is OK we discharge them."
"We do admit a fair number of chronic alcoholics for alcohol withdrawal. That is a problem as well. It takes up hospital resources and those people can get very sick," he says.
"On the flip side, for the folks who drink and sober up, if they are regretful, we have added substance abuse counselors in our emergency department," he says. "If you're 50 years old and you wind up in the emergency room because you drink too much, then you have a problem. So, we recognize our opportunity to intervene and do the general population some good by trying to get them the help they need."
Atallah says the rise in alcohol-related ER visits is challenge, but it’s been manageable.
"We work in the emergency department. We see 146,500 visits a year. We manage the unmanageable every day, simply because of the volume," he says. "Emergency departments across the country have seen increasing volumes over the past several years and decades. This patient population volume based on the study has also increased and has added to that stressed emergency department capacity for the country. So, it's certainly contributed. I don't think that those patients in particular have made emergency department care as challenging as it is today but it certainly has contributed."
One strategy at Grady has been to "cohort" drunk patients into specific areas of the ER and provide appropriate levels of resources.
"Someone who is waiting to sober up doesn't need four-to-one nursing. It can be eight- or 10-to-one," Atallah says. "We have high volumes of very sick patients coming in. Those patients are in rooms. We have an ambulance triage area, and as long as the person who is intoxicated isn’t unruly we can let them hang out there and sober up and then we see them. That doesn’t necessarily require intensive monitoring. With as crowded as emergency departments are now, you don’t want them taking up valuable resource and real estate. You try the best you can to find the right place to take care of them."
Physician burnout, medical marijuana, and interstate medical licensure also top the list of concerns for the nation’s state medical boards.
Opioid prescribing and telemedicine are the most important regulatory issues for state medical boards, according to an annual survey by the Federation of State Medical Boards.
"Our member boards play a central role in providing guidance to policymakers and healthcare professionals on how to navigate some of our nation's most pressing medical issues," said Humayun J. Chaudhry, DO, president and CEO of the FSMB.
"Anticipating these trends will help the FSMB provide boards with resources they need to address these challenges and continue their mission," Chaudhry said.
Each of the 51 medical boards was asked to choose five of the most important topics from a list of 16. The top five issues and the percentage of boards that chose them were:
Resources related to opioid prescribing (74%)
Telemedicine (74%)
Physician stress and burnout (44%)
Medical marijuana (42%)
Interstate Medical Licensure Compact (38%)
The FSMB has model guidelines and policies for four of the regulatory topics that boards deemed most important:
Interstate Medical Licensure Compact (IMLC):Model legislation (22 states are now members of the IMLC, with seven more states considering adopting legislation to join)
Physician stress and burnout: In 2016, the FSMB formed the Workgroup on Physician Wellness and Burnout to identify, manage and prevent physician burnout and reduce the stigma associated with seeking help for burnout. A report is expected in April 2018.
Surveys glean information not otherwise found in traditional mortality reviews, including the importance of advance care planning and the strain on clinicians whose patients die.
Surveys of care teams after unexpected patient deaths can provide learning opportunities for hospitals, and catharses for clinicians, a new study in the Joint Commission Journalof Quality and Patient Safety suggests.
"Oftentimes if there is an error, the care team is not going to write in their notes, 'Oh we committed this error!' A lot of times the medical record is not the best source of truth for something like this," says study lead author David Lucier, MD, a hospitalist and director of Quality and Patient Safety at Massachusetts General Hospital.
"What we do know is that when patients pass away unexpectedly there is this pit-of-the-stomach feeling for providers and we were trying to get at that with this project," he says. "It's that gut feeling that maybe something could have been done differently. Is there some truth to that, and if so, how much truth? That's why we did this project, to see if we could augment the existing process that we had in place."
Lucier says that essay opportunities provided to clinicians can often be the most illuminating parts of the survey.
"The idea is to prime them to think about improvements and provide them with a space to write whatever they thought. There was no guidance on what to write. They just wrote it," he says. "In doing so, we found we had a very rich data base of written comments. Some answers were very short. Some were very, very long."
The researchers created a taxonomy from the essays to understand what the clinicians were saying and how they were saying it.
"We were interested in the 'how' in particular. Were people writing blaming comments? Did they feel they needed to be defensive in a patient's death? Were they trying to explain something with emotion because that’s how they were feeling, using descriptive words," Lucier says. "You could say 'a large volume GI bleed,' or you could say ‘the patient had a tremendous amount of bleeding, and it’s shocking how much he bled.' They both describe the same situation, but the words used relay a different provider experience of that patient’s death."
Lucier says many mortality reviews start with the premise that every death might be a preventable death. While laudable, Lucier says that premise is not necessarily congruent with the care goal of the patients, which might be to pass away comfortably at home or in the hospital surrounded by loved ones.
"What we found in the free text comments were repetitive themes about patients' goals of care and whether they had been discussed, and if the care provider was congruent with the understanding of it," Lucier says. "That was the main finding: We are not doing as good a job as we can with understanding patients' goals of care when they are coming in. These are hard conversations to have, and this is at a patient's time of need, so it's a complex issue."
Lucier says the surveys also find that frontline clinicians are not particularly good at identifying preventable deaths.
"Providers overestimate the preventability of death by almost 10 fold," he says. "While something may have happened that didn’t go right, it didn't lead to the death being preventable. If it stopped, the patient likely would have died anyway."
That problem of accurate reporting is compounded by the harried pace of hospital work.
"This is a big problem in safety reporting in general. We rely on the frontline to tell us when something goes on," Lucier says. "The problem is that it's tough to report something when you have a million other tasks at hand, all these patients' demands that are far more important than submitting an adverse event report."
Still, the surveys exposed vulnerabilities in care coordination that would have otherwise gone unnoticed, Lucier says.
"For example, from this we were able to look at the massive GI bleeding pathway, which is a complex dance between multiple services, and look at the drip medications in the critical care units and rework those," he says. "These vulnerabilities were not brought up in any other system that we had within quality and safety to identify vulnerabilities and make improvements."
While the cathartic effect of the survey on clinicians was not examined in his study, Lucier believes that it could also provide an outlet.
"If you have a patient die expectantly, it weighs on you. It makes you question what you did and the care you provided. All of us have this moment where 'did we do something wrong?' Over time that continuous questioning can lead to burnout," he says.
"Providers compartmentalize any emotional distress they might have from an unexpected death. This project was the first step in trying to identify that and provide an outlet to dissipate that emotional distress."
The former Health and Human Services secretary, who was forced to resign last fall after a scandal-shortened eight-month tenure, is hailed for his 'profound understanding of the national healthcare landscape.'
Tom Price, MD, the scandal-plagued former secretary for the Department of Health and Human Services, has been named to the advisory board of Jackson Healthcare.
A spokesperson for the Atlanta-based healthcare staffing firm said that the company is privately held and would not detail Price’s compensation.
"Nobody has as profound an understanding of the national healthcare landscape as Dr. Price," Richard L. Jackson, chairman and CEO of Jackson Healthcare, said in a media release. "Tom has exhibited an unwavering commitment to preserving the patient-physician relationship. That mindset, along with his physician, business and policy experience, will make him an invaluable addition to our board."
Price, an orthopedic surgeon, and former Congressman from Georgia, was the first physician to serve as HHS secretary, a term that lasted from February to September, 2017. He was forced to resign in late September amid media reports that he’d racked up at least $400,000 in expenses for unauthorized chartered jet services.
Price’s short stint at HHS was marked by controversy from the onset. Senate Democrats during confirmation hearings last winter raised ethics concerns because Price, while a member of Congress, had bought shares of a medical device company days before introducing legislation that would have been beneficial to the company.
Price spent much of his tenure at HHS attempting to dismantle the Affordable Care Act, a top priority of President Donald Trump and Republican leaders in Congress.
"I am honored to join the advisory board at Jackson Healthcare," Price said. "Jackson Healthcare’s mission of working to improve patient care is wholly aligned with the work I have done for over four decades, and I look forward to helping them navigate the always changing healthcare environment."
The industry is riding sustained tailwinds that will push growth of 30% to more than 40% in coming years. Factors include a growing dearth of clinicians, an aging population, and technological innovations that will improve patient access and experience.
If Teladoc, Inc. is a bellwether for the telemedicine industry, the outlook is bright.
Jason Gorevic, CEO of the Purchase, NY-based telemedicine provider, called 2017 "a landmark year as we redefined the virtual care delivery landscape with our acquisition of Best Doctors."
"Through rapid integration, Teladoc has brought to market innovation that gives members a single point of access for a wide array of medical needs. We are seeing a tremendous reception from both clients and prospects to this unique, comprehensive solution," he said.
Preliminary numbers provided by Teladoc support Gorevic’s claims. According to unaudited 2017 financial results, the company saw:
Total revenues of $232 million, an 88% increase over 2016
Total membership of 23 million, a 31% increase over 2016
Total visits of 1.46 million, a 53% increase over 2016, and representing utilization of 7%, compared to 6% utilization in 2016.
Teledoc finished 2017 on an upswing, with unaudited fourth quarter results showing:
Total revenues of $76 million, a 103% increase over 2016
Total adjusted EBITDA of $2.5 million compared to a loss of $8 million in the fourth quarter 2016
Total visits of 460,000, a 48% increase over 2016, and representing utilization of 2%, compared to 1.8% utilization during the same period in 2016
"Building on our strong momentum in all segments of the Teladoc business, we head into 2018 extremely well positioned to deliver on our targets for all key operating and financial metrics," Gorevic said.
Robert Annas, senior managing director at SOLIC Capital, said much of Teladoc's strong growth can be attributed to the Best Doctors acquisition in July, 2017, which is expected to add about $100 million in revenue annually.
"If you assume the Best Doctors acquisition happened on Jan. 1, 2016, year-over-year growth is in the mid 20% range, which is more reasonable," Annas said. "I would anticipate they will continue to be acquisitive and, with a fuller platform offering, be able to accelerate growth at a faster pace in the next few years."
Annas said Teladoc is expanding its service lines beyond behavioral health, dermatology, and tobacco cessation. "Best Doctors’ typical patient profile is more acute, dealing with musculoskeletal conditions and cancer and typically second opinion type scenarios,” he says. "Close to 40% of Best Doctors' revenue is outside the U.S. so this will create a larger international footprint for Teladoc."
Industrywide, Annas believes telemedicine is riding strong tailwinds that will push growth of 30% to over 40% in coming, in large part due to a growing dearth of clinicians.
"Demand for primary care providers will continue to outstrip supply," Annas said, citing studies showing that 65 million Americans live in "primary care deserts."
"In addition, to help control costs, companies, healthcare systems and insurance companies are going to look to companies like Teladoc to have overall better visibility on their individual patient populations, particularly those with chronic diseases," he says. "This trend falls in line with the overall concept of value-based payments, where Medicare awards healthcare providers for overall healthier patient populations."
And there are simple demographic stressors coming into play, Annas says, including an aging population, a dearth of healthcare providers globally, the prevalence of chronic diseases such as diabetes, obesity and heart disease, technological innovations that allow for remote deployment of healthcare services, and the movement toward disease prevention.
Within the telemedicine space, Annas sees three areas for potentially faster growth, including: remote monitoring to keep people out of the hospital; primary care services for patients with no direct access to physicians; and inpatient telemedicine, as the internal medicine provider shortage accelerates.
The big challenges ahead for the telemedicine that could dampen growth include potentially inconsistent reimbursements for telemedicine services from payers, primarily Medicare and Medicaid, and the as yet unknown effects from the repeal of Net Neutrality.
