Superbugs are a growing threat to health systems
As it turns out, superbugs are actually a bigger threat at this point than the CDC previously estimated. According to the agency, superbugs now cause almost 3 million infections and 35,000 deaths a year.
U.S. Healthcare Spending Increased 4.6% in 2018
That’s $3.6 trillion, or 17.7% of GDP.
CMS released its yearly National Health Expenditures report, covering 2018’s spending on healthcare services.
Results are in: Healthcare decreased 0.2% as a percentage of overall GDP, but still makes up 17.7% of our economy. That’s probably gonna get bigger too, as the U.S. population ages. CMS estimates that healthcare spending will grow at around 5.5% a year for the next 10 years as the lumpy Baby Boomer population gets on Medicare.
2020: The Evolution and Explosion of Medicare Advantage
Wi(Medicare Advantage Supplemental Coverage)nter is Coming.
Brace yourself for Medicare Advantage explosion in 2020. All of the major payors are gearing up for the year. Cigna is planning its biggest ever MA expansion. UnitedHealth is expanding into 100 more U.S. counties (and you thought they ALREADY were everywhere, didn’t you?).
Supplemental Coverage
Anthem, Aetna, and Humana are in the mix too of course. What’s interesting about the plans going into 2020, though, are the supplemental coverage options that CMS is phasing into Medicare Advantage plans. For instance, Anthem is getting creative with these alternative options, including such services like…pest control. Other offerings might include odd benefits like acupuncture, transportation assistance (shout out Uber and Lyft), and other similar services that could be beneficial to seniors.
Doctors are Shifting to the Left
Political Physicians.
The WSJ took a deep dive this week into physician political leanings. The reporters found that in 2018, about two thirds of political donations from doctors went to Democrats, which is, interestingly, the exact opposite of donations made in 1990.
Why the shift?
Plenty of reasons. The WSJ thinks the shift is being caused by more physician employment by health systems, more female physicians, more physicians in urban areas, and the increasingly leftward shift of educational institutions. It’s probably not helping the overall Republican cause that Trump is somewhat shaky on his healthcare policy – as a reminder, the ACA is still currently in court, and the White House has no known healthcare backup plan (yet).
A trend to keep an eye on.
This policy uncertainty, combined with the above factors, probably explains most of the physicians’ political donations to Dems. If I had to guess (don’t put any money on me – I just lost some in Vegas), I would wager that most physicians are uncomfortable with the current political environment, which is driving the trend. Don’t forget – just last year, the AMA narrowly voted to continue opposing Medicare for All (as opposed to adopting a new “neutral” position on the big-time disruptive healthcare proposal)
Humana Study Suggests that 1 in 4 dollars spent on healthcare is wasted
Wasted.
A JAMA study jointly conducted by Humana and UPMC found that approximately 1 in 4 bucks spent on healthcare – between $760 billion and $935 billion total – is wasted yearly among 6 defined categories:
Failure of care delivery (102.4b – 165.7b),
Failure of care coordination (27.2b – 78.2b),
Overtreatment or low-value care (75.7b – 101.2b),
Pricing failure (230.7b – 240.5b,
Fraud and abuse (58.5b – 83.9b); and
Administrative complexity (265.6b).
While the study cast a wide net for the total cost (essentially +/- $100 billion), the authors urged readers not to focus on the exact figures cited, but rather to discover directionally how much wasteful spending seems to be out there.
How to FIND the answers to the perceived waste is a whole ‘nother can of worms.
Humana weighs in.
In an Op-Ed on CNBC, Humana’s President and CEO emphasized the need to switch to value-based care, calling for an integrated healthcare delivery approach in order to counteract wasteful spending – namely, combining different healthcare delivery systems and services (e.g., pharmacy, home health, primary care) to ensure the best possible care outcome for each patient.
The bigger picture.
The shift from volume-based-care to value-based-care is speeding up, but the definition of what “value-based” reimbursement should include is lagging just a bit behind. Better alignment between payors and providers at different sites of care, more efficient regulation, and cracking down on fraud could go a long way in themselves to lower wasteful healthcare spending.
Amazon joins the trend of paying employees to travel for cancer care
Amazon lets employees travel for cancer care.
As employer health costs continue to rise for its employees, some companies have gotten pretty creative with how they reduce their costs. We’ve covered how Walmart and other large firms are very hands-on with controlling healthcare costs. Now, Amazon is joining the trend of allowing its employees to travel for cancer care (paywall – WSJ).
The partnership with City of Hope.
Whereas Walmart lets workers diagnosed with cancer to seek treatment at the Mayo Clinic, Amazon is partnering with City of Hope hospital in California. The e-commerce giant will cover all of the travel costs for its workers to seek opinions from City of Hope.
It’s a win-win: employees get access to coverage outside of just the local options, and Amazon aims to lower its healthcare costs when its workers receive arguably better, more effective care from a reputable provider.
UnitedHealthcare decides to implement site-neutral payments itself
A push away from hospital based facilities.
Similar to Anthem’s outpatient imaging policy back in 2017, UnitedHealthcare is trying to shift its covered lives to ‘lower cost’ settings by limiting who can receive outpatient surgeries and procedures at a hospital-based facility an “HOPD” (i.e., an outpatient clinic or surgery center that is actually a department of a hospital).
Beginning in November, UNH will cover the costs of a procedure at an HOPD only if it determines that the site of care at the hospital outpatient department was medically necessary.
The bigger picture – site neutral payments.
Earlier this year, HHS’ site neutral payment policy – meaning that hospital outpatient departments and freestanding facilities would be paid the same – was shot down in court. Insurers are always in favor of steering patients to lower cost settings. In this case, freestanding ambulatory surgery centers should be the big winners – and hospitals are getting left out to dry.
The Healthcare Payments Trend.
Another day, another healthcare entrant.
This week, Mastercard launched a suite of services aimed at healthcare specifically.
Mastercard Healthcare Solutions will target typical wasteful areas of healthcare, like fraud, revenue cycle management, IT security, and general waste.
I’m most interested in the revenue cycle management component embedded in Mastercard’s statement. The firm will use ‘predictive analytics’ to make billing easier both for patients, providers, and payors.
But they’re not the only players entering the billing space.
JP Morgan also pushed into healthcare payments by buying InstaMed. Back in May, the banking giant purchased InstaMed for $500 million – its largest acquisition since the financial crisis.
Then, of course, there’s UnitedHealthcare. They bought healthcare payment firm Equian for $3.2 billion in June in more of a strategic alignment (meaning they’ll be able to integrate the service with Optum).
What’s the bigger picture here?
Providers, Patients, and employers all want to get rid of administrative burden in healthcare, and a huge part of that is billing – what patients owe, how much a procedure will cost, how to receive payment – you get the picture.
As the push for price transparency in healthcare continues, providers’ revenue cycle management and billing capabilities will only become MORE important. Which is why, I think, these payments firms are getting snatched up.
Apparently Millennials will get Sicker and Die Sooner than Any Previous Generation.
A study from Blue Cross released this week pointed out what we millennials have known all along: we’re the worst-off generation as far as health concerns go. In fact, we have excessively higher levels for conditions like hypertension, cholesterol, and depression.
The future is…bleak?
If millennials don’t get healthier, their mortality rate could increase by 40% (!!) as compared to Gen X. These statistics could significantly affect economic growth in the U.S. – not to mention the healthcare costs millennials would have to face as they age into poorer health.
Blue Cross Blue Shield’s National Plan(s).
Blue Cross Blue Shield unveiled plans for a national provider network on November 27th. The “Blue high-performance network” will cover 185 million people in 55 markets!
Telemedicine and the $2.1 billion Medicare fraud case
The FBI gets a big win in a huge Medicare Fraud bust.
Under the guise of Operation Brace Yourself (nice name, FBI), the FBI made a major bust in one of the biggest Medicare fraud schemes to date – 24 people were charged in the $2.1 billion heist.
This isn’t GTA.
The ring of 24 decided that they were going to inappropriately bill Medicare for medical equipment that patients didn’t need. As a part of the scheme, the equipment companies told patients to use virtual care to expedite the process and have it billed by Medicare. After scamming Medicare for $20 million a week, the government finally caught on and brought down the hammer.
Two peas in a pod – healthcare and fraud. (I seriously did not mean to rhyme that).
Healthcare and fraud go hand-in-hand, especially with Medicare (search ‘Medicare Fraud’ on Google and let me know how many hits you come back with). Unfortunately, elderly folk are easy targets for scammers. This type of fraud might be a bad side effect of telehealth, since the physicians unknowingly involved in the scam could not physically examine the patients.
Read the NPR Feature story on the increasing number of Medicare Fraud cases here.