Friday, March 27, 2015

2015 County Health Rankings Released

The County Health Rankings & Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The program helps communities identify and implement solutions that make it easier for people to be healthy in their homes, schools, workplaces, and neighborhoods.

Published online the Rankings help counties understand what influences how healthy residents are and how long they will live. The Rankings are unique in their ability to measure the current
overall health of each county in all 50 states. They also look at a variety of measures that affect the future health of communities, such as high school graduation rates, access to healthy foods, rates of smoking, obesity, and teen births.

Nationally, this year’s Rankings show that the healthiest counties in each state have higher college attendance, fewer preventable hospital stays, and better access to parks and gyms. The least healthy counties in each state have more smokers, more teen births, and more alcohol related car crash deaths. This report also looks at distribution in income and the links between income levels and health.

The County Health Rankings & Roadmaps program offers data, tools, and resources to help communities throughout their journey to build a Culture of Health. Also part of the program is the RWJF Culture of Health Prize which honors communities that are working together to build a healthier, more vibrant community.

Communities can use the Rankings to garner support for local health improvement initiatives among government agencies, health care providers, community organizations, business leaders, policy makers, and the public.

Wednesday, March 18, 2015

Biosimilars: What employers need to know

Earlier this month, Novartis’ Zarxio was the first biosimilar product approved in the United States, ushering in a new era for the drug industry, consumers and third parties who manage medical and drug benefits.

Given the confusion over the U.S. Food and Drug Administration’s approval process and specialty-related product availability, Cheryl Larson, vice president for the Midwest Business Group on Health, and Randy Vogenberg, principal for The Institute for Integrated Healthcare, wrote an article on questions employers should be asking related to biosimilars.

So what’s an employer to do?
1. Have a conversation with your pharmacy benefit management organization and/or health plan regarding their coverage approach or policy related to biosimilars. If you have questions about how biosimilars are different, ask them.

2. Review your vendor contract and coverage of specialty drugs to determine the impact on current or future plan costs to your organization.

3. Review your own plans’ drug use patterns and if this type of approval would make a cost savings difference to your members.

4. Determine if this will make any difference on annual cost trend for the plan versus just the unit cost of a particular drug for an individual medical condition like cancer-related anemia.

5. Continue to advocate for full cost transparency on all specialty drug products by your vendors.

The full article published in Employee Benefit News can be found here

Additionally, MBGH offers free tools and resources to help plan sponsors stay current on issues related to specialty pharmacy drugs, benefit design and contracting strategies at

Wednesday, March 11, 2015

NASI: Little Evidence Integrating Hospital and Physician Care Helps Promote Quality and Reduce Costs

The National Academy of Social Insurance, a nonprofit, nonpartisan organization made up of the nation's leading experts on social insurance, has released the results of a recent study of the performance of Integrated Delivery Networks (IDNs).

Conducted by a team led by Jeff Goldsmith, the premise of the analysis was that any examination of the role that hospitals play in health care cost growth is complicated by the fact that in most large markets, the significant hospitals are part of larger, multi-divisional health enterprises.

The report offers sobering information:
There is little evidence that integrating hospital and physician care has helped to promote quality or reduce costs. Indeed, there is growing evidence that hospital-physician integration has raised physician costs, hospital prices and per capita medical care spending. Similarly, hospital integration into health plan operations and capitated contracting was not associated either with clinical efficiency (e.g. shorter lengths of stay) or financial efficiency (e.g. lower charges per admission).
 From the provider perspective, the available evidence suggests that the more providers invest in IDN development, the lower their operating margins and return on capital. Diversification into more busi­nesses is associated with negative operating performance. This is consistent with the management literature, which shows that diversification increases a firm’s size and complexity, in turn increasing its cost of coordination, information processing, and governance/monitoring.
 Moreover, there are few or no scope economies within health plans, hospitals, or physician groups — let alone between these lines of business contained within IDNs. Provider-sponsored insurance plans face similar problems regardless of whether they were formed by hospitals or physician groups: poor capitalization, lack of actuarial and underwriting expertise, limited marketing capability both to employers and consumers, adverse selection risk, and an inability to reach minimum sufficient scale of enrollment.
Despite more than 30 years of public policy advocacy on behalf of IDN formation, there is scant evidence in the literature either of measurable societal benefits from IDNs or of any comparative advantage accruing to providers themselves from forming IDNs. We have similarly found no such evidence in our analysis of 15 IDNs. Serious data limitations hamper anyone attempting to evaluate IDN performance based on publicly disclosed information. IDN financial disclosures obscure the operating performance of their hospitals and physician groups.
There does not appear to be a relationship between hospital market concentration and IDN operat­ing profit. However, if the performance of the IDN’s flagship hospital is any indicator of overall sys­temic efficiency, the IDNs’ flagship hospital services appear to be more expensive, both on a cost-per-case and on a total-cost-of-care basis, than the services of its most significant in-market com­petitor. This runs counter to the theoretical claim of IDN operating efficiency. Further, the flagship facilities of IDNs operating health plans or having significant capitated revenues are more expensive per case (Medicare case-mix adjusted) than their in-market competitors.

Download a copy of the report, Integrated Delivery Networks: In Search of Benefits and Market Effects, here.

Friday, March 6, 2015

Good Health is Good Business

The CDC Foundation is a non-profit organization that connects the Centers for Disease Control and Prevention (CDC) with private-sector organizations and individuals to build public health programs that make our world healthier and safer. The Foundation produces Business Pulse, a quarterly online series which offers useful CDC health resources to Fortune 500 businesses, executives, employers and employees.

The latest issue, Business Pulse: Healthy Workforce is now available and explores how the CDC can help employers maximize their worker health and safety while improving their profitability and productivity. 

The piece links to many tools that coalitions and employers may find of value including business-focused CDC resources, the Total Worker Health program and the interactive infographic below.

Key takeaways from the Supreme Court’s Obamacare hearing

Oral arguments were heard in the Supreme Court on March 4 for King v. Burwell. The case centers on the constitutionality of IRS regulations that provide federal subsidies to just over 9 million people, totaling $28.8 billion in tax credits and cost-sharing reductions in 2016, in states that did not establish their own health care exchanges.

Several good resources providing an overview of what's at stake include:

The Washington Post offers a guide and an article from Jason Millman on five important takeaways:
  1. The vote will be close.
  2. Kennedy's skepticism could be good for the Obama administration.
  3. The Supreme Court could offer a temporary 'fix' if subsidies are struck down.
  4. Court standing likely won't be an issue.
  5. No one knows what Chief Justice John Roberts is thinking. 
Jason Adler posted a helpful overview here.

And, the SCOTUS Blog can be found here.

Monday, March 2, 2015

ACA 101: What You Need To Know

**Editing Note: This is an in-person briefing, not a webinar (as previously noted) and registration is closed.**

On Friday, March 6, from 11 a.m.-12:30 p.m. Eastern the Kaiser Family Foundation and the Alliance for Health Reform are hosting a briefing to review the Affordable Care Act (ACA).

Speakers will answer and discuss critical ACA questions, such as:
  • What are the key provisions of the ACA? 
  • How did the ACA extend coverage to the uninsured? 
  • How does the ACA impact private and public insurance coverage, marketplaces and employer-sponsored coverage? 
  • What is the role for states? 
  • What are the requirements on employers and individuals? 
  • How was Medicaid changed by the ACA and then the Supreme Court? 
  • How is the Children’s Health Insurance Program (CHIP) affected?
Moderated by KFF’s Diane Rowland and the Alliance’s Ed Howard, Friday’s discussion will include:
  • Jennifer Tolbert, director of state health reform, Kaiser Family Foundation, will provide a broad overview of the key provisions in the ACA, including private and public coverage provisions, quality and delivery system reforms;
  • Sabrina Corlette, research professor and project director at the Center on Health Insurance Reforms, Georgetown University’s Health Policy Institute, will address the changes in private insurance, requirements on individuals, the creation of marketplaces and the implications of the King v. Burwell Supreme Court case on subsidies;
  • Paul Fronstin, director of the Health Research and Education Program, Employee Benefit Research Institute, will explain employer-sponsored coverage and requirements; and
  • Charlene Frizzera, senior advisor, Leavitt Partners, and former CMS acting administrator, will address the Medicaid and CHIP provisions in the ACA
Here's a link to registration information.

Changing How We Pay for Health Care: Value-Based Reform

Dr. Jack Cochran and Charles Kenney wrote an article on The U.S. Department of Health and Human Services’ recent announcement to move the Medicare program toward value-based payments.

Posted today in The Health Care Blog and originating from a February post on the Kaiser Permanente blog, the authors noted that this effort "is among the most promising recent developments in health care. While changing the way we pay for care will not be easy, we believe that shifting away from fee-for-service to value-based payments could be a catalyst to a better, more affordable health care system in our country."

Also included was an excerpt from NBCH's Value-based Purchasing Guide.
According to the National Business Coalition on Health, a nonprofit organization of “purchaser-led health care coalitions … dedicated to value-based purchasing of health care services through the collective action of public and private purchasers,” the impact would be significant. The coalition takes this position:
 As the business community has learned over the past several decades, maintaining workforce health and preventing illness – particularly chronic conditions – improves productivity and competitiveness, and can lower health care costs over time.
Value-based purchasing can help shift the paradigm of why employers offer health benefits from seeing it as an employee recruitment and retention tool, to seeing it as a chance to improve population health and increase productivity, and ultimately the employer’s bottom line.
The authors concluded that this may be the tipping point in our nation’s complex, often difficult, health care journey. What do you think?

Friday, February 27, 2015

Millenson in Forbes: How Mayo's "Dr. Google" Deal Disrupts Medicine

In his latest column in Forbes, health care quality consultant Michael Millenson examines the implications of Google joining with the Mayo Clinic to provide consumers with medical information, which he says quietly signals a powerful disruption for all of medicine.

Now when people search their health questions on Google they will get relevant medical facts up front that have been reviewed by teams of doctors including expert clinicians at Mayo Clinic for quality and accuracy.

Millenson writes:
Recommending a Google search “as the first stop for those needing health information,” in the words of a Mayo physician executive, represents a true paradigm change.
But there’s much more going on here than search. From the Fitbit to medicine’s front lines, information technology is forcing a new doctor-patient relationship with new rules for new roles.
If information is power, digitized information is distributed power. While “patient-centered care” has been directed by professionals towards patients, collaborative health – what some call “participatory medicine” or “person-centric care” ­– shifts the perspective from the patient outwards.
Genuine collaborative health will require incorporating information technology into relationships that harmonize both those views

Google image of medical conditions on mobile phone

Thursday, February 26, 2015

Kaiser Family Foundation: A Guide to the Supreme Court Argument in King v. Burwell

The Kaiser Family Foundation has released new materials examining the policy implication and legal arguments in the U.S. Supreme Court’s King v. Burwell case.

The Supreme Court is set to hear oral arguments on March 4. A new Policy Insight from the Kaiser Family Foundation's Larry Levitt and Gary Claxton explores the policy implications for consumers and insurance markets if the Court were to side with the plaintiffs in the challenge to the Affordable Care Act’s consumer subsidies. 

A second issue brief by KFF’s MaryBeth Musumeci, a policy analyst and an attorney, explains the legal arguments underlying the case.

At issue in the case is whether the federal government can provide premium and cost-sharing subsidies to consumers who buy insurance in states that do not establish their own ACA Marketplace and instead rely on a Federally-facilitated or Partnership Marketplace. In 2015, roughly 7.5 million people who have signed up for coverage in the 34 states that use the federal Marketplace qualify for subsidies, or 87 percent of all people who picked a plan in such states.

The new Policy Insight, Insurance Markets in a Post-King World, explains that a Court decision to cut off such subsidies would cause millions to go without coverage, make the vast majority of consumers who were receiving subsidies exempt from the ACA’s individual mandate, and disrupt insurance markets by leaving insurers with a sicker pool of people to cover and limited ability to generate enough premium revenue to cover health costs. In some cases, insurers may choose to exit the individual market in affected states rather than face significant losses, according to the analysis. Governors, state legislatures and Congress would face pressure to take steps to preserve subsidies, but there are political and logistical challenges to doing so quickly.

The issue brief, Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell, walks through legal aspects of the case, from who the plaintiffs are to what each side is seeking from the Court and how this legal challenge differs from other ACA cases already decided by the Court. It also explains the legal test that the justices are likely to apply in the case and the potential actions the Court could take.

For more on health reform and the King v. Burwell case, visit

The Leapfrog Group Releases Maternity Care Report

This week The Leapfrog Group released its Maternity Care Report, an in-depth examination of hospital quality and safety for early elective deliveries, episiotomies and high-risk deliveries, with data analysis by Castlight Health.

Though the analysis of hospitals nationwide demonstrates substantial progress in recent years, it also reveals significant room for improvement on maternity care standards. In fact, less than a third of hospitals meet Leapfrog’s standard for high-risk deliveries of very low birth weight babies, while rates of episiotomies are still too high at 35 percent of birthing hospitals.

The report is the first in a series of six reports examining key quality and safety measures at hospitals nationwide based on data from the 2014 Leapfrog Hospital Survey of 1,501 U.S. hospitals.

Several NBCH-member coalitions have focused on preventing medically unnecessary early elective deliveries. The Midwest Business Group on Health received a grant from NBCH and the United Health Foundation to convene health care stakeholders in Illinois and develop a community action plan to reduce the high number of early inductions and C-sections performed. And the Virginia Business Coalition on Health Foundation also has a program focused on education to ensure babies are born full term.

Health Affairs: Engaging Health Care Consumers: The Lowe’s Experience

Image result for health affairs

Worth reading and NBCH's recent study with Benz Communications is noted...

A recent post for the Health Affairs blog by Bob Ihrie, senior vice president of compensation and benefits for Lowe's, and Dr. Alan Spiro, chief medical officer for Accolade, outlined Lowe's evolution to better engage employees through its population health and benefits program.

Time will tell, but it appears that employers are not giving up on providing health insurance to their employees — even with the availability of health care exchanges. That’s at least what the results of a new study sponsored by the National Business Coalition on Health (NBCH) suggest.
Brian Klepper, CEO of the NBCH, speculated in his recent Health Affairs Blog post: “…there is an alternative view of what is possible in health care, and that self-funding and a willingness to continue trying to control the health care value monster remains alive and vibrant.”
As self-funded employers strive for a value-based health care marketplace, they’re looking at ways to drive value at an individual level — through strategies to engage employees as better consumers and managers of their own health care.
Over the last couple of decades, Lowe’s has been on a journey to encourage its employees to become engaged health care consumers. What Lowe’s experience teaches us is that health care systems are complex, and individuals value guidance from a trusted source, particularly when faced with difficult or challenging decisions...

Wednesday, February 11, 2015

A Detailed Analysis of the Republican Alternative to Obamacare

GOP vs Democrat
Reposted 2/11/15 from The Health Care Blog
House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

Republicans will now argue they have a better health insurance reform plan and that Obamacare should be repealed and replaced by it––particularly if the Supreme Court plunges the new health law into chaos by throwing the subsidies out in 37 states.
They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.
My sense is that voters will end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can’t we take the best from both sides?

Tuesday, February 10, 2015

Employers: What the Anthem Breach Means to Employer Health Plan Sponsors

Advisory Information from the law firm Davis Wright Tremaine LLP

By Adam H. Greene, Sarah L. Bhagwandin, Sean B. Hoar, Christin S. McMeley, Dipa N. Sudra, Rebecca L. Williams, and Anna C. Watterson

On Feb. 4, 2015, Anthem announced a data breach involving the personal information of more than 80 million individuals resulting from what it characterized as a sophisticated, targeted cyber-attack. Group health plans may be affected because Anthem: (1) provides insured health benefits; (2) administers health benefits for a self-insured plan; or (3) administers out of area/network claims.

Employers, as plan sponsors on behalf of their group health plans, need to identify how the Anthem breach may affect them, if at all, and get their arms around what they need to do in response. The following is practical guidance on what employers need to know and do now and in the coming weeks to comply with their legal obligations.

Thursday, January 29, 2015

Can Business Savvy, Clout And Charisma Supercharge Patient Safety?

Michael Millenson

Originally published 1/29/15 in Forbes

At the recently concluded Patient Safety Summit organized by Joe Kiani, the dynamic CEO of Masimo Corp., a star-studded parade of political clout stepped up to support the goal of eliminating all preventable medical errors by 2020.

Vice President Joe Biden announced, “The president and I are with you on this.” Similar endorsements came from former President Bill Clinton, former Surgeon General Richard Carmona, a U.S. senator and two Congressmen.

“This isn’t another academic conference,” proclaimed Jim Bialick, president of the Patient Safety Movement Foundation that Kiani founded.“ This isn’t the same old thing.”

Wednesday, January 28, 2015

Health Savings Account-Eligible High Deductible Health Plans: Updating the Definition of Prevention

Note from  Brian: Here's an interesting article for health plan benefits managers, released last May by Mark Fendrick et al. at the University of Michigan's Center for Value-Based Insurance Design. It models the potential benefits that might accrue if HSA-eligible High Deductible Health Plans (HDHPs) were allowed to use an expended definition of preventive services. Given the popularity of HDHPs, especially among large, self-funded health plans, the findings, while speculative, are compelling. The authors assert that:

Utilizing the well-accepted and medically common definition of prevention that encompasses both primary and secondary preventive services could enhance HDHP attractiveness to potential purchasers and accelerate benefit design innovation. Expanding the definition of prevention to include evidence-based services that prevent chronic disease progression and related complications could enhance the ability of HDHPs to improve clinical outcomes while preserving the well-documented capacity to engage consumers and contain costs.

See here for the article's full detail.