Provider engagement: Quantia touts the key to unlock health system and pharma success

Mike Coyne, Quantia CEO

Mike Coyne, Quantia CEO

In this podcast interview, Quantia’s CEO Mike Coyne and I discuss what it means to engage healthcare providers and why it matters so much in today’s world of employed physicians and accountable care models. Quantia’s been at the provider engagement game for several years, until recently mostly on behalf of the pharmaceutical industry, which has long understood the power of engagement.

Recently Quantia launched its Provider Alignment Platform for Health Systems, which Mike describes.

By healthcare business consultant David E. Williams of the Health Business Group

Where cash is king, what happens to patients?

How can I help?

How can I help?

I’ve started hearing more about physician practices that are opting out of the health insurance system and taking cash for services. See Cash-only looks good to doctors in Healthcare Finance News as an example. I can understand the appeal. After all, it’s an expensive and frustrating hassle to deal with health plans and Medicare, and can interfere with the doctor/patient relationship. In theory physicians should be able to offer the same level of care while reducing overhead costs and splitting some of the savings with patients. If those patients have high-deductible plans it should work out for everyone.

To some extent in primary care that’s exactly what’s happening, and it’s a trend I support. The logic is especially strong there since third-party reimbursement offers very little in the way of reward for a lot of work. A patient co-pay may equal the amount that gets reimbursed by the health plan; with a high-deductible plan the insurance company may contribute nothing. (Note that this picture is slightly changed by the Affordable Care Act, which mandates full coverage for preventive services –although in my experience the physician office often gets confused about this and ends up collecting a co-pay anyway.)

The Healthcare Finance News article cites a practice in Austin that doesn’t take insurance and has no administrative staff. Result: office visits for $30, which is about the typical co-pay. Well done.

But I do worry about other physicians in both primary care and now specialty care that are moving to more of a concierge model. If it happens in any great numbers there will be a serious capacity problem in the system. That’s because the shift is often accompanied by a dramatic reduction in the number of patients served. It’s sometimes an order of magnitude.

The same article describes a practice that cut its patient panel from 8000 to 1000. I’ve heard of primary care physicians going from 3000 to 350 patients. The big question is what’s going to happen to all the patients who lose access to those physicians –the slack will have to be picked up by other providers. In primary care, maybe the emergence of concierge practices will have a silver lining by boosting compensation for primary care in general and drawing more physicians into the field, helping to correct an historic imbalance in pay ratios between primary care and procedural specialties.

Specialty physicians opting out of insurance is more concerning, but for other reasons. As difficult as insurance companies are, sometimes they do add value by making doctors and patients jump through hoops before approving lucrative –but often unnecessary– procedures like spinal surgery. And there is a tendency to price gouge–which will be only partially mitigated by “transparency” tools that are coming into vogue.

For patients who are willing to spend more money for better care the best value may be in joining a concierge primary care practice rather than opting for cash-only specialists. The primary care doctor will have the time and skill set to consider the patient from a holistic standpoint, to refer to the right specialists and make sure the patient gets seen, to coordinate second opinions and follow-up and to offer their own views about topics such as whether to have surgery.

I’m actually considering a concierge practice for my own care, but I may be too late. A single-doctor primary care practice I spoke with is not taking new patients. Emails I sent to two other local concierge practices inquiring about becoming a patient there were ignored.
photo credit: volperic via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group

Health Business TV: Medical inflation, health kiosks, Home Care Delivered, hospital clowns

In this third edition of Health Business TV, I discuss Home Care Delivered (whose board I’ve just joined), medical inflation and my appearance on Al Jazeera, health kiosks, Hearts & Noses Hospital Clown Troupe and an upcoming webinar about the small group health insurance market.

Please subscribe to the YouTube channel and tell your friends!

If you’re interested in the AIS webinar on July 9, called Insurer Strategies for the Turbulent Small Group Market you can click here to register. You can use the code I mention during the show to get a $75 discount.

There will be no episode next week, since it’s the Fourth of July.

By healthcare business consultant David E. Williams of the Health Business Group

Hospital Clowns meet the Boston Globe

Hearts & Noses

Hearts & Noses

The Hearts & Noses Hospital Clown Troupe, where I’m chairman of the board, is a great organization that provides professionally trained volunteer clowns to hospitalized children in Massachusetts, and trains other hospital clowns from around the US and the world.

So I’m excited to see a feature article about the clowns (Getting silly where the work is serious) on the front cover of the Boston Globe’s “g” section. Author Joseph P. Kahn does an excellent job of explaining what the clowns do to empower children, and the amount of effort and training that goes into preparing the clowns for their gigs.

I’m particularly proud of the work we do with some of the most severely ill and disabled children, and that we are now working with children who are hospitalized for mental illness –kids who have no outsiders but us visiting them. The article quotes our medical director, Dr. Michael Agus (a critical care physician) and Dr. Albert Hyman (child psychiatrist) along with several clowns, our executive director, and me.

Oh, and if you’d like to donate to this great cause, please click here!

By healthcare business consultant David E. Williams of the Health Business Group

Is medical inflation coming back to bite us?

PWC made a pretty big splash yesterday with its projection that medical costs will rise at a faster rate next year than they have in the recent past. The story was picked up by major media and I was on TV last night to discuss it on Al Jazeera’s Real Money with Ali Velshi.

In truth, the story is not so dramatic. The PWC report focuses only on larger employers. Costs are expected to rise around 6.8 percent (versus 6.5 percent in 2014) and most employers are responding similarly to how they have for the past several years: shifting more costs to employees, implementing high deductible health plans, and spending money on wellness programs. These approaches are surprisingly unimaginative and not likely to be terribly effective.

High deductible plans cause patients to be conscious about the first couple or few thousand dollars of costs. After that, they don’t really care since they’ve reached their out-of-pocket max. And high deductible plans are harsh on lower income employees who have a hard time paying the first dollars out of pocket. Upper income employees barely notice the difference.

And wellness programs? PWC didn’t go so far as to endorse this strategy, which is a smart move to preserve their credibility. Some of these programs are nice benefits but it’s awfully hard to find one that is going to reduce medical costs.

What would work better? How about offering employees plans that reward them financially for choosing lower cost, high quality providers?

Even if employers are paying more, things are not necessarily so dire for those buying insurance in the individual market. Average premiums are likely to rise for 2015, and the plans with the biggest market share are raising premiums the most. But thanks to the Affordable Care Act consumers are now dealing with a competitive market in insurance. As long as they are willing to switch plans, in many cases they’ll actually be able to reduce premiums. We’ll see in a few months just how savvy exchange shoppers are.

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By healthcare business consultant David E. Williams of the Health Business Group