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Kaiser Permanente Hires Harvard Professor to Lead Medical School

Posted by Laura McMullen on Thu, Nov 02, 2017

medical school students.jpgThe lines of communication between doctors and insurance companies are key elements to make sure that patients get the treatment they need. Kaiser Permanente established a medical school affiliated with its hospital system with a vision “to provide a unique medical education embedded in a physician-led health care delivery system, that ignites a passion for learning, a desire to serve, and an unwavering commitment to improve the health and well-being of patients and communities.” The school broke ground in September 2017 and will enroll its first class of students in the fall of 2019.

Carey Goldberg, CommonHealth blog editor at WBUR, interviewed Dr. Mark Schuster about his plans for the Kaiser Permanente School of Medicine. Here are some highlights:

  • Students will have experience in clinical settings from the very beginning. Schuster says, “our students will be in clinical settings from the start, doing work that’s appropriate to their level of experience. They might be interviewing patients or serving as navigators for them. We want our students to understand what it's like to be a patient who is intimidated by the health care system, fearful of potential diagnoses, confused by the jargon.”
  • Courses will use a variety of teaching and learning methods. Classes will be small-group and case study-based. Spiral learning techniques will be used – introducing concepts early and returning to them regularly as students progress. Some classes will be ‘flipped’; where students watch videos, complete exercises, and read ahead of class so that class time can be spent in more interactive pursuits.
  • Graduates will contribute to a wide variety of communities. Schuster wants “students to be able to choose their field and where they practice without the constraints of the high debt that so many medical students have.” And Kaiser Permanente is providing the school with significant financial aid. Additionally, students will not be obligated to work for Kaiser Permanente after graduation. “The goal is to teach students who will spread out around the country and beyond, and take their skills everywhere and teach others around them,” said Dr. Schuster.

The Kaiser Permanente system is unique in that it is an integrated delivery system that also offers insurance. Their goal of preparing doctors who are lifelong learners, focused on health instead of disease, go beyond the clinical setting to understand patients’ needs, and use data to find gaps and solve problems who can share that knowledge throughout the healthcare system is admirable. The first class of prospective doctors will have 48 students and subsequent classes will grow to 96 students.

Is this a strategy that other public and private health insurers would benefit from? Are there opportunities for collaboration in areas like evidence-based medicine and establishing coverage in health professional shortage areas?

Tags: health insurance, health insurers, healthcare system, healthcare providers, medical school, hospital system

Pros and Cons of Health Insurer Mergers for Employers

Posted by Laura McMullen on Wed, Aug 05, 2015

mergerAetna acquires Humana. Anthem acquires Cigna. Centene acquires Health Net. Assurant Health is bought by National General. These are big moves that are creating bigger companies in an already huge $2.9 trillion industry. There’s been lots of analysis about the acquisitions, like this Modern Healthcare article from July 2015 that explains how gaining more Medicare Advantage business is the purpose of these mergers, but the perspective that I’m finding most interesting is what employers are saying.

Consolidations Are a Mixed Blessing

A Business Insurance article published after the Aetna/Humana and Centene/Health Net deals were announced described the results of an Aon Hewitt employer survey of nearly 100 employers. Jim Walker, Aon Hewitt’s global chief innovation officer for health and benefits consulting, wasn’t surprised at the results. “On the one hand, consolidation will give insurers more clout in negotiating with health care providers. On the other hand, employers are concerned that fewer and bigger health insurers will mean they have less leverage in negotiating with insurers.” Here are some of the top line results of the survey:

  • Three-quarters of the employers surveyed thought the impact would reduce options or have no effect.
  • More than half said they were considering changes to their health plan strategies.
  • More than three-quarters said the industry consolidation would not affect their short-term decision-making about retiree options.

Another Business Insurance article published a week later, after the Anthem/Cigna deal was announced to result in the nation’s biggest health insurer, offered similar perspective. Here are a few quotes:

“From the employer side, the deal can be ‘good news,’ if the much larger Anthem can ‘cut better deals with medical providers,’ concurs Dave Osterndorf, a partner and chief health care actuary at Health Exchange Resources in Mequon, Wisconsin.”

“Adding Cigna's book of business ‘may rebalance provider negotiation leverage in Anthem's favor after years of provider consolidation that has gone pretty much under the radar screen,’ says Brian Marcotte, president of the National Business Group on Health in Washington. “Large employers will have concerns about the merger between Anthem and Cigna because employers will be left with only three major insurers who can support large multi-state employers on a nationwide basis.”

PricewaterhouseCoopers predicts medical cost trend to increase 6.5% in 2016, with a projection of 4.5% after benefit design changes, in their Behind the Numbers 2016 report. The trend is increasing more slowly than in years past although healthcare costs continue to outpace inflation so employers are understandably still interested in reducing the impact of healthcare costs in their bottom lines.

Balancing Cost and Choice

I’ve written that headline a million times in my healthcare career. Most of the time, I’ve been describing benefit options to employees but it applies to the choice facing employers as well. They want to offer health insurance for a variety of reasons – the other companies in their industry offer it, they’ve always offered it, healthy employees are more productive than sick employees, etc. As the costs continue to rise, employers hold the line on their costs and shift more to the employees through higher deductibles and more premium cost-sharing.

The mergers and acquisitions we’re seeing now are bringing that choice to the forefront again for employers. Which way are your customers leaning?

Tags: health insurance, healthcare reform, healthcare benefits, health insurers, medicare, medical insurance, health insurance mergers

Five Best Practices to Find the Right Provider Network for Your Customers

Posted by Laura McMullen on Thu, Jul 24, 2014

In a recent blog post entitled, Five Best Practices to Use Network Data and To Grow Your Business, we wrote about the ways carriers and network leasing companies can improve their position in network comparisons by better cleaning their data. Another point of view is from the brokers and consultants who use network analyses to help their customers choose the right benefit plans.

health insurance plansShopping for employee benefits is complicated and time consuming. Employers and other plan sponsors typically rely on a broker or consultant to help them through it. Brokers and consultants know that network issues can turn a satisfied customer into one that goes out to bid in the blink of an eye. Even if everything else is right: price, benefits, service, and timely and accurate claims payments can’t outweigh a network that doesn’t fit the employee population.

As we pointed out in our other post, the best networks:

  • Offer a wide range of choices: multiple general and specialty providers are included in the network
  • Are convenient to use: providers are located near home or work
  • Include popular providers and facilities: providers are the ones that members and their families want to use
  • Save employers and employees money: in-network providers offer meaningful discounts that reduce out-of-pocket expenses and claim costs

Depending on the number of employees your customers have, different types of network analyses are probably available from your carrier partners. Generally, we see four types of network analysis:

  • Network Counting – measure the quantity of providers in each network (available for groups of all sizes)
  • Accessibility Analysis – correlate network provider locations to employee home and work locations (available for groups of all sizes)
  • Disruption Reporting – match historical provider utilization and claims experience for a group to the providers in a different network (available for groups with at least 200 employees)
  • Repricing – compare cost of claims for all providers (in- and out-of-network) if a different network were in place to the cost experienced in the current network (available for very large or self-funded groups)

Download our whitepaper, The Network Analysis Pyramid, to learn more about each method.

As the primary users of network analyses, brokers and consultants are in a unique position to influence the requirements of each type of analysis. Keep these five best practices in mind as you work with carriers on your customers’ behalf:

  1. Insist on clean, accurate data so you get clean, accurate reports.
  2. Clearly identify required fields and formats in all file requests.
  3. Obtain claim data from the incumbent carrier whenever possible.
  4. Choose a consistent counting method for all reports to ensure that you are comparing apples to apples.
  5. Evaluate key specialties separately from the overall network based on your client’s needs.

With all of the changes from the Affordable Care Act, employers and other plan sponsors are relying on brokers and consultants more than ever.

How do you evaluate networks today?


 

Tags: compare networks, data management, market comparison, network metrics, dental network, network providers, health insurance, Affordable Care Act, network comparison tool, disruption reporting, data analysis, network change, Healthcare, healthcare reform, health reform, ACA, healthcare exchanges, provider networks, health insurers

More Health Systems Becoming Payers

Posted by Aaron Groffman on Thu, Sep 05, 2013

More than 20 percent of hospitals and health systems in a recent survey said they are planning to launch a health insurance plan by 2018.

Another 34 percent of respondents said they already own health plans. The June 2013 survey was conducted by by the Advisory Board Co., a Washington, D.C.-based research and consulting firm, and included more than 100 U.S. hospitals and health systems.

Health insurance exchanges, the aging boomer population, increasing cost and reimbursement pressures and an industry-wide move toward population health are driving many health systems’ decisions to become payers, despite the risk of that move in the continually changing healthcare industry.

North Shore-LIJ Health System, a Long Island, NY-based hospital system, plans to offer its health plan called CareConnect on the state health insurance exchange beginning October 1st.

Providers that offer health insurance typically offer a narrow network composed of their own hospitals and affiliated physicians. But in order to be successful, a network must include enough facilities and physicians to provide access and member convenience. Therefore, some health systems are joining forces to create health plans with stronger networks than either could offer on its own.

For example, Piedmont Healthcare and WellStar Health System, two Atlanta-based systems, are partnering on a health plan called the Georgia Health Collaborative that will offer commercial and Medicare Advantage products starting in 2014.

If you were starting a health plan, how would your network compare to your competitors?

Tags: network growth, network providers, health insurance, Affordable Care Act, Healthcare, Healthcare, healthcare reform, health reform, healthcare benefits, Obamacare, health insurers

Is the Health Insurance Company a Good Friend?

Posted by Aaron Groffman on Fri, Mar 08, 2013

Medical 000005787159Medium(2)The next decade will be about bringing down the costs of health care in the U.S., says venture capitalist and blogger Todd Hixon, in a recent Forbes article titled “The Health Insurance Company Is Your Friend.” The biggest drivers of healthcare spending in the U.S. are the over-utilization of advanced medical care and the high earnings of the providers of that care, he says.

It’s payers versus providers, and health insurers are in the payers’ corner.

Hixon shares one of his own healthcare experiences in which “the insurance company paid about 30% of the face value of the bill, due to a combination of lower negotiated prices and striking off major billing errors and duplications.” 

The takeaway for insurers is that finding the right network providers is more important than ever. Insurance companies can help keep healthcare costs down by shifting away the high-end risk as well as building provider networks with good value for the cost, Hixon says in his follow-up article. Look for providers who offer good discounts, have a good utilization track record, and who participate with other networks so they know what’s expected. 

This is the right dynamic: how the insurance company becomes a better friend.

Tags: network providers, health insurance, Healthcare, dental insurance, health reform, health insurers, payers

 

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