The rapid rise of telehealth has led a growing number of employers to explore a virtual-directed health plan model with an online primary care platform.
The nation's employers are increasingly adding coverage for virtual and mental healthcare benefits in their employee insurance plans, Aon plc says.
The move is largely a response to the tremendous increase in virtual care visits during the coronavirus public health emergency, according to Aon's new report released Thursday.
That shift in consumer behavior has led 36% of employers to say they are interested in exploring a virtual-directed health plan model with an online primary care platform that directs all care, including coordination with traditional health providers.
Aon estimates that a virtual-directed model could reduce employer medical plan costs by as much as 15%.
"Just like countless other aspects in our lives, the COVID-19 pandemic will accelerate innovation and evolve future total rewards programs to build a more resilient workforce," said Janet Faircloth, senior vice president for Aon's Health Solutions.
The survey identifies several ways the pandemic has pushed employers to adapt their health and benefits packages, including:
Digital health apps (47%), self-management tools (41%) and navigation and consumer engagement platforms (41%) are leading areas of interest for employers.
Mental health (72% ranked in the top 5) and work/life balance (57% ranked in the top 5) were the two most important wellbeing issues. Mental health moved to the most mentioned issue in the latest survey in comparison to pre-COVID-19, when it was third highest.
COVID-19 comes in third with 52% mentioning it as a top wellbeing issue. Financial stress, which was the top wellbeing issue pre-COVID-19, moved to fourth overall in importance.
Employers want to steer participants through plan design or other financial incentives to high-quality, cost-effective hospitals and physicians, with 45% of survey participants saying they were interested in implementing these features, while 32% already are steering members.
Employers are focused on creating an inclusive and diverse workforce in which all individuals feel valued and respected and have an equal opportunity to succeed. While 23% of firms indicate having benefit programs that effectively support and advance diversity, equity and inclusion initiatives, half of the firms surveyed stated they were interested in adding this.
"Employers have the unique opportunity to enhance the value of their health and wellbeing benefits to better meet the career, financial and health needs of a wider spectrum of employees and improve the lives of millions of people in the process," Faircloth said.
Excluding CARES Act money, revenues hit $8 billion, operating income was $70 million, a 0.9% margin, and EBITDA was $544, a 6.8% margin.
The coronavirus pandemic continues to strain CommonSpirit's volumes and financials, but the situation is manageable and improving, the Chicago-based health system said Wednesday in a quarterly report.
Adjusted admissions were 9% lower for the second quarter of CommonSpirit's fiscal 2021, when compared with Q2 of FY 2020, owing largely to a shutdown in profitable elective surgeries and procedures that was not offset by an increase in COVID-19 patients.
As of Dec. 31, CommonSpirit's 140 hospitals and other venues in 21 states had cared for more than 144,000 COVID-19 positive patients while expanding staff and capacity during the fall and winter surge.
"The organization is effectively managing expenses," the report said, "but continues to incur costs related to ensuring appropriate staffing and capacity, expanding testing capabilities, and procuring freezers and other equipment as well as developing new digital platforms for distributing COVID-19 vaccine."
CommonSpirit's revenues for Q2 FY 2021 rose $8.28 billion, up 7.5% compared to the FY 2020 Q2, when the prior year is normalized to include three months of California provider fee revenues.
The health system recorded operating income of $363 million, compared to $161 million in the previous year’s quarter. EBITDA was $837 million, a 10.1% margin for CommonSpirit, one of the nation’s largest nonprofit health systems.
However, those numbers relied on federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funds.
Excluding CARES Act money, revenues totaled about $8 billion, operating income was $70 million, a 0.9% margin, and EBITDA was $544, a 6.8% margin, the report said.
"The last year has been challenging for our organization, but we are incredibly proud of the way our employees and facility leaders have stepped up to meet the health needs of our patients," CommonSpirit CFO Dan Morissette said.
"Now, COVID-19 vaccines and a decline in cases are bringing new hope, and we are similarly seeing improvement with our organization's performance," he said. "Clearly there are still challenges for us ahead, but our coordinated and effective response to the pandemic means we are well-positioned to sustain our operations and thrive in the post-pandemic healthcare landscape."
The proposed integrity audit on inpatient rehabilitation facilities in four states during the public health emergency raises a number of concerns for hospitals.
Stakeholders are asking the federal government to withdraw proposed model "integrity audits" of hospital inpatient rehabilitation facilities that are scheduled to launch in four states later this year.
In a letter this week to Elizabeth Richter, acting administrator for the Centers for Medicare & Medicaid Services, the American Hospital Association complained about the launch of a review choice demonstration (RCD) in the middle of a pandemic.
"One of our top concerns is the timing of these new audits, which would begin during the COVID-19 public health emergency and divert critical resources from the IRF field’s efforts in helping fight the pandemic," Thomas P. Nickels Executive Vice President Government Relations and Public Policy, said in the letter to Richter.
"During the pandemic, IRFs are treating patients with and recovering from COVID-19, as well as those transferred from overwhelmed general acute-care hospitals," Nickels said.
"These pandemic-driven IRF admissions often include patients who, as a result of the virus, face a longer-term and often complex recovery trajectory requiring specialized care to address pulmonary and other complexities and debilities – these patients have become known as “long-haul COVID patients.”
Under the five-year proposed model, which CMS says is designed "to improve methods for the identification, investigation, and prosecution of potential Medicare fraud," integrity audits would examine both pre-claim and post-payment Medicare fee-for-service admissions at IRFs in California, Texas, Pennsylvania, and Alabama.
Auditors in the four model states would examine all IRF claims until the facility hits an approval rate of at least 90%, after which it would be subject to spot checks for continued compliance.
Nickels said the AHA also has "numerous additional operational and design concerns about the RCD that justify its withdrawal," namely:
The long-standing problem of Medicare auditors lacking adequate knowledge of IRF-specific coverage and payment guidelines would be perpetuated under this proposal.
Administrative burden would materially and needlessly increase for IRFs in the target states.
The across-the-board design of the proposed demonstration would place unwarranted burden on IRFs with no history of noncompliance.
Nickels noted that the PHE waivers gave IRFs flexibility to collaborate with acute-care hospital, including IRF units that were repurposed during surges to accommodate patients overflow.
"Given the rapid development of need in many COVID-19 hotspots, the varying resources across communities, and the complex needs of some COVID-19 patients, these waivers have been instrumental in enabling IRFs to help fight against the virus," Nickels said.
"However, despite the waivers, the pandemic has imposed numerous and unprecedented operational challenges, such as shifts in case-mix, inadequate testing supplies, personal protective equipment, fill-in personnel for infected staff, and, more recently, unsteady vaccine supply and distribution planning."
Nickels said the pandemic's strain on the nation's healthcare system is not taken into consideration in the IRF RCD notice.
"Indeed, there was not one mention of the PHE," Nickels said. "We urge CMS to refrain from implementing this burdensome new demonstration. IRFs need to remain focused on the full-court press required to slow and then stop the virus."
CMS will also launch outreach efforts to encourage enrollment.
A three-month-long Special Enrollment Period for the Health Insurance Marketplace will open on Monday in the 36 states that use the HealthCare.gov platform, the Centers for Medicare & Medicaid Services said.
Another 13 states and the District of Columbia, which operate their own Marketplace websites, are also expected to open new enrollment periods during the Public Health Emergency, which was authorized under the January 28 Executive Order by President Joseph R. Biden.
The SEP ends on May 15.
"This Special Enrollment Period will give Americans who need affordable, quality health insurance an opportunity to get covered, and we encourage folks to head to HealthCare.gov starting on Monday to explore their options," HHS Acting Secretary Norris Cochran said in a media release.
CMS on Monday will also launch outreach efforts that will include broadcast, radio and digital advertising touting the ACA's affordable coverage and premium assistance for families in need.
CMS says that 90% of ACA enrollees get financial help and 75% of consumers can purchase a plan for $50 or less per month after financial assistance.
Consumers can visit HealthCare.gov or CuidadoDeSalud.gov to view 2021 plans and prices and enroll in a plan that best meets their needs.
Additionally, consumers can call the Marketplace Call Center at 1-800-318-2596, which provides assistance in over 150 languages. TTY users should call 1-855-889-4325. Consumers can also find a local assister or agent/broker in their area by visiting: https://localhelp.healthcare.gov.
Some frontline providers affected by the COVID-19 pandemic could receive up to $2,000 to offset costs for mental health counseling.
Frontline healthcare workers who have been traumatized by the COVID-19 pandemic could be eligible for up to $2,000 in copayment assistance for behavior health counseling under an initiative announced Wednesday by the nonprofit HealthWell Foundation.
The financial aid for out-of-pocket, treatment-related copayments for prescription drugs, counseling services, psychotherapy, and transportation is available over the next 12 months to healthcare workers who have an annual household income of up to 500% of the federal poverty level ($64,400 for an individual, $132,500 for a family of four), the Germantown, Maryland-based independent charity said.
"History has taught us that the psychological impact of traumatic events doesn't always reveal itself immediately," said HealthWell board member Suzanne M. Miller, Ph.D. "For healthcare workers dealing with the often-tragic outcomes of COVID-19 cases, stress and anxiety can have serious, long-term effects on their mental wellbeing."
Healthgrades analyzed the performance of nearly 4,500 hospitals nationwide across 32 conditions and procedures.
Healthgrades this week released its 2021 America's Best Hospitals report, ranking the nation's top 50, 100 and 250 top performers for treating 32 of the most common conditions and procedures.
"Now more than ever, consumers understand the importance of researching hospitals and finding the best organization to meet their healthcare needs," said Healthgrades CMO Brad Bowman, MD.
Healthgrades analyzed the performance of nearly 4,500 hospitals nationwide across 32 conditions and procedures, including heart attack, heart failure, pneumonia, respiratory failure, sepsis, and stroke.
Patient in hospitals that make the Healthgrades list have a 27.4% lower risk of dying than if they were treated in hospitals that did not receive this award. If all hospitals were as successful as Healthgrades' top hospitals, 167,235 lives could potentially have been saved, the report states.
Healthgrades says the top hospitals on its list share common characteristics, including: a full embrace of patient-centered care; setting aggressive goals to improve outcomes; recognizing that all employees, from brain surgeons to janitors, are stakeholders in quality improvement; and having the courage to admit what isn’t working and removing obstacles to quality improvement.
"Especially in this era of COVID-19, we commend the recipients of the Healthgrades America's Best Hospitals Awards for their commitment to providing superior outcomes and keeping their communities safe," Bowman said.
Healthcare executives see telehealth competency as a foundational block for value-based care.
When it comes to developing competencies to prepare for value-based care, an overwhelming number of healthcare executives (81%) responding in a new HealthLeaders Intelligence Report say building their telehealth platform is their top priority.
That was no surprise to Kevin J. Conroy, MS, Chief Financial Officer and Chief Population Health Officer at CareMount Medical in Chappaqua, New York, who sees telehealth competency as a foundational block for value-based care.
"Given the costs of patient care, telehealth is an important option to have, especially in rural areas where access to providers is perhaps more difficult and in more urban areas where it's difficult to get an appointment," Conroy says.
Medicare's move last spring to reimbursement parity for telehealth during the coronavirus pandemic was a key driver for virtual care that "incentivized physicians to actually make the time to participate in telehealth as a means of providing care," Conroy says.
"Having the opportunity to stay in touch with a patient, particularly those with multiple chronic conditions, is critical," he says, adding, "I believe that to be true regardless of whether an organization is under a value paradigm or a fee-for-service paradigm."
Jaewon Ryu, MD, JD, President and CEO of Geisinger, a Danville, Pennsylvania, health system that has been on the vanguard of the value-based movement, says the pandemic has demonstrated the importance of telehealth.
"We've seen COVID serve as a catalyst really for all telehealth," he says. "The comfort level of people launching telehealth programs and the comfort levels of consumers and patients has inspired a lot of confidence, and so that 81% is absolutely real and this is one of the strange silver linings of COVID."
Ryu says providers rightly see telehealth as "an enabler" for other value-based competencies such as care coordination, clinical integration, patient engagement, and access. "That's the right way to look at it. It's really everything else that's further down the line," he says.
"Think of it as another mode of communication that allows either providers or care teams to connect with patients or care teams to connect with one another," he says. "When you enhance communication in that way, we've seen good things happen."
To download the full January/February 2021 HealthLeaders Intelligence Report, "Value-Based Care Advances, But Transition Proves Challenging," click here.
The accusations come just days after a RAND Corporation report noted that U.S. consumers pay 2.56 times more for prescription drugs than consumers in 32 other nations.
Hospitals are making big bucks by jacking up the price of prescription drugs and passing that inflated cost along to patients and their employers, according to a new report from the Pharmaceutical Research and Manufacturers of America.
The report claims that hospitals use a murky and confusing set of pricing schemes to routinely extract "two to three times more revenue from the sale of a medicine than drug makers" using markups, hospital consolidation, the 340B program, and other tactics.
The accusations levelled in the PhRMA report are the latest round in a finger-pointing blame game between payers, providers, and drug makers, that ultimately ends with consumers picking up the tab.
Last month, a RAND Corporation report noted that U.S. consumers pay 2.56 times more on average for prescription drugs than consumers in 32 other nations. That gap is even wider for brand-name drugs, with U.S. prices averaging 3.44 times those of other nations in the Organisation for Economic Co-operation and Development, RAND found.
"Brand-name drugs are the primary driver of the higher prescription drug prices in the United States," said lead authorAndrew Mulcahy, a senior health policy researcher at nonprofit, nonpartisan RAND.
Many of the accusations levelled in the PhRMA report have been raised for years. A spokesperson for the American Hospital Association declined to comment and said they were still reviewing the report.
PhRMA President and CEO Stephen J. Ubl said the report shows that "many actors – including hospitals, insurers and other middlemen – influence what patients pay out of pocket for prescription medicines."
"In recent years, nearly half of spending on brand medicines went to someone other than the research companies that developed the medicines," Ubl said. "This new report brings transparency to the role hospitals often play in determining the cost of medicines and ultimately what patients pay out of their own pockets."
"These routine markups increase costs for patients and employers and the amount a hospital receives from administering a medicine may exceed the net revenue earned by the manufacturer who researched and developed the medicine," PhRMA said. "The way in which hospitals set their prices is often opaque and unclear to patients, whose own out-of-pocket costs can be influenced by the rates charged by the hospital."
The drug makers' lobby also alleges that hospital consolidation means patients and payers are paying more for care, because bigger health systems can leverage their volumes to extract higher prices from commercial plans.
Healthcare, once a job-creating dynamo in the U.S. economy, has shed 542,000 jobs since February 2020.
The healthcare sector lost nearly 30,000 jobs in January, continuing a year-long trend for an industry that has seen 542,000 job losses since February 2020, new data from the Bureau of Labor Statistics show.
Ambulatory services saw an increase of 3,500 jobs for the month, but those gains were more than offset by 2,100 job losses in hospitals, 19,000 jobs losses in nursing homes, 13,000 in home healthcare services, and 7,000 job losses in communicate care facilities.
The healthcare sector for years has been a job-creating engine for the U.S. economy. But job growth in the sector collapsed in the spring of 2020 with the spread of the coronavirus pandemic, which forced hospitals and other care venues to shut down elective surgeries and procedures, and leery patients stayed away.
The January job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.
In the overall economy, payroll employment grew by a sluggish 49,000 in January, and the unemployment rate nudged down 0.4 percentage point to 6.3% for the month.
Fitch Ratings sees financial good news for providers as the Biden administration moves to strengthen the Affordable Care Act.
President Joe Biden's executive order opening a three-month enrollment period for health insurance under the Affordable Care Act "would generally improve the financial position of not-for-profit hospitals," Fitch Ratings says.
In an issues brief published this week, the bond rating agency notes that hospital margins have been squeezed by several factors during the public health emergency, including higher volumes of uninsured patients who've lost job-sponsored coverage, high COVID-related caseloads, increased costs for medical scarce personal protective equipment and other medical supplies, regulatory uncertainties, and reductions in money-making elective procedures and surgeries.
"Reducing the number of uninsured and shifting the payor mix towards Medicaid coverage and privately insured will help mitigate revenue pressures," Fitch says.
Fitch notes that Biden did not campaign on an aggressive expansion of healthcare, such as the public option or Medicare for All.
Instead, his administration is expected to reduce the numbers of uninsured Americans with a focus on raising the upper-income eligibility for health insurance premium subsidies, increasing premium tax credits for coverage obtained through ACA Marketplaces, and raising the Medicaid poverty-level threshold, which could encourage the 12 hold-out states that have not expanded Medicaid to relent and adopt the ACA.
"This latter change would be credit-positive for hospitals in states where Medicaid has not been expanded, although political headwinds in key states like Texas persist," Fitch says. "It remains to be seen whether certain Medicaid waivers such as work requirements or block grants granted by the Trump administration will be rescinded by the Biden administration."
Democratic control of Congress and the White House also means that hospitals can breathe a little easier knowing that the ACA is no longer under threat of elimination, Fitch says.
The U.S. Supreme Court is expected to rule at mid-year on California v. Texas. However, even if the high court agrees with the plaintiff states that the individual mandate is unconstitutional and inseverable from the rest of the ACA, Democratic majorities in the House and Senate could easily remedy the matter legislatively.
More than 20 million people would lose health insurance coverage if the ACA were eliminated.
"This would generally reduce hospital revenues and could exert downward rating pressure on hospitals, particularly in states that expanded Medicaid coverage under the ACA," Fitch says.
Hospital stakeholders will also wait to see if the Biden administration rescinds other Medicaid waivers approved by the Trump administration, including Medicaid block grants and work requirements.
A proposal by the Biden administration to lower the age eligibility for Medicare to 60 is expected to have mixed results for providers "if a significant number of people move to Medicare from commercial payor coverage," Fitch says.
It's also not clear how much support that proposal has in Congress.
