A recent conversation reminded me of the forgotten population in health care — the non-utilizers. I was speaking with a physician leader in Lancaster, Pa., about his program that emulates the good work of Dr. Jeff Brenner and his team in Camden, N.J., that has targeted the 1 percent of patients responsible for 30 percent of the cost. In similar fashion, the program in Lancaster targets 10 percent of the population that account for 50 percent of the cost. Dr.
I was amused and somewhat unsettled when I heard of Kaggle, a company with a novel approach to data analysis. As I understand it, Kaggle is a middleman between companies that have large amounts of data and are looking for certain kinds of analysis and the people or companies that can provide that analysis. But with a twist.
Three times during the past month a friend has asked for advice regarding his/her personal health care or that of a family member out of frustration and concern stemming from not receiving clear communication/information about the health problem(s). This scenario is all too common. Despite the ostensible focus on patient experience/satisfaction, the informed patient, and shared decision-making, health care professionals, health plans, and plan sponsors too frequently are not providing the explanation/information that patients and/or their caregivers seek.
The Affordable Care Act codified the worksite wellness exemption to the federal medical underwriting provisions in the group health plan market. This means companies are allowed to use an “outcomes-based” incentive model that provides financial rewards for those who satisfy a prescribed health standard such as a BMI of less than 30 or who meet a “reasonable alternative standard” or obtain a waiver from their physician. What some see as “rewards” others view as penalties or surcharges and, given the absence of evidence to confirm the role of such incentives in actually improving population health, the new provisions have unleashed a debate about the ethics and putative effectiveness of the new provisions.
When an employer group shifts from one health plan to another, why not allow them to take their claims data to the next health plan? That way, the new plan would gain immediate knowledge of the specific disease burden faced by its new members and be able to act accordingly vis-à-vis care management programs and other interventions. As it stands now, the new plan would have to wait many months and even then would lack the history that the earlier plan no longer needs. And when the new plan “finds out" about a member's condition, it might be due to a claim for an event that could have been prevented had the carrier had access to the earlier data.
Here’s how the system would work. When a group signs up with a carrier, it could reserve the right to have its data transferred if it changes carriers. Obviously, it wouldn’t be able to “see” its own patient-identified data any more than it does now, but the data would accompany the change of carriers.
Life is change. We here at Managed Care are breathing new life into our website by changing its look, but not only the look. Sure, it is more streamlined and easier on the eyes, but the change that excites us is in the content, which is richer and more interactive.
As we move Managed Care into the blogosphere, my curiosity was arosed about the number of active English language blogs. As with many internet related statistics, I found a wide range of estimates from 152 million (BlogPulse, February 2011) to 450 million — Hat Trick Associates. I unsuccessfully spent a bit of time searching for the number of healthcare specific blogs.