Health Wonk Review is up at Colorado Health Insurance Insider

The Aye or Nay on AHCA edition of the Health Wonk Review has just been posted at Colorado Health Insurance Insider. You’ll find a number of fascinating policy posts related to the American Health Care Act that’s due for a House vote today.

Thank you to our host, Louise Norris for prominently featuring my 12th birthday edition.

Drug treatment for opioid addiction: Podcast interview with CleanSlate CEO Greg Marotta

freedom-1886402_1280

The opioid epidemic gives addiction treatment providers an opportunity to demonstrate what they can do to stem the tide. CleanSlate operates treatment centers in multiple states, employing a medication assisted approach. In this podcast interview, CEO Greg Marotta describes what he’s seeing and how the company is responding.

We discussed:

  • (0:10) How serious is the opioid epidemic?
  • (1:09) What kind of approaches are traditionally to treat addiction? What works well and where are there shortcomings?
  • (2:22) Are people coming to treatment through primary care? Or the behavioral health system?
  • (4:06) How does medical/behavioral integration work? What does it really mean?
  • (6:56) CleanSlate is well know for medication based treatments. What kind of medications are available? Who is the approach best suited for?
  • (8:09) What is the typical course of treatment?
  • (9:49) As addiction has become more visible, it’s now front and center for others in health care. Do you collaborate with other organizations and if so, how has it gone?
  • (12:52) You operate in a variety of states, with different cultures. Do you see key differences between Massachusetts, and other states like Texas, Indiana and Wisconsin?
  • (14:53) Will we still be talking about an opioid epidemic in five years? What will it take to get out of it?

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

Happy 12th birthday to the Health Business Blog

happy-12th-birthday-marisa-s-kitchen-talk-b39hYk-clipart

The Health Business Blog has turned 12 years old! Continuing a tradition I established with birthdays onetwothreefourfivesixseveneightnineten and eleven I have picked out a favorite post from each month. Thanks for continuing to read the blog!

March 2016: Health Wonk Review -Tales of the Trump

My roundup of policy posts from the blogosphere took Trump seriously and literally.

April 2016: Listen app – ResApp diagnoses respiratory ailments

An Australian company developed a smartphone app to diagnose respiratory diseases by analyzing the sound signatures of coughs. I interviewed the CEO, Dr. Tony Keating via email.

May 2016: Biosimilars are “me-too” drugs, not generics

Returning to a favorite theme, I explain why the biosimilar market will not develop the way the generic drug market did. If we instead think about biosimilars as me-too drugs it will help in devising policy solutions.

June 2016: Amazon Echo for healthcare

I bought an Amazon Echo and could immediately see the potential in healthcare for a hands-free, voice activated device that could be used at home and in the hospital. I wasn’t surprised to see that my friends at Boston Children’s were already working with the Echo.

July 2016: Sutter’s Dr. David K. Butler on EMR-enabled transformation

Dr. Butler came to healthcare as a digital native, unwilling to accept the paper-based status quo. In about a decade he went from using Microsoft Word to make medical notes legible to being named Epic Systems Physician of the Year for his contributions to the field of EMR implementation and optimization. I recorded this podcast interview with him.

August 2016: EpiPen may still be too cheap

I’m not usually a glutton for punishment, but I thought it was worth taking a beating to make some points that went against the conventional wisdom. An EpiPen isn’t just a few dollars of generic drug and a syringe. It’s a whole system that enables children and adults with life-threatening allergies to live normal lives.

September 2016: Are men comfortable with female physicians? Other factors to consider

An athenahealth analysis demonstrated that men are less likely to return to female physicians than to males, but for female patients the sex of their doctor doesn’t make a difference. I shared my own anecdotal experience in primary care to help answer the riddle.

October 2016: Why I’m voting against marijuana legalization in Massachusetts

After recovering from the EpiPen smackdown, I shared another unpopular view: let’s not rush into the legalization of marijuana for recreational purposes.  Legalization passed pretty easily despite my post, but implementation may proceed slowly especially if the federal government decides to step in.

November 2016: Goodbye Obamacare? More like hello single payer!

President-elect Trump told 60 Minutes, “I am going to take care of everybody. Everybody’s going to be taken care of much better than they’re taken care of now.” He also promised to provide “quality, reliable, affordable health care.”

I said I’d support him if managed to do so, but it was much more likely that the GOP would implement a number of lame ideas they have been kicking around. Looks like I’m right so far.

December 2016: Would an FDA radical make any real difference?

The Trump Administration started nominating proponents of radical change. I argued that even if the FDA loosened up requirements considerably, it still wouldn’t make much of a difference. Payers won’t pay for drugs unless they are persuaded that they work. And patients want safe medicines. Pharma companies would still need to satisfy these groups even if the FDA got out of the way.

January 2017: Medicaid block grants would be ok for Massachusetts

I don’t think it’s a good idea to shift to block grants, because it will likely result in people losing coverage and an increase in healthcare disparities. Nevertheless, block grants would have a more modest impact on Massachusetts than on other states.

February 2017: Due diligence in middle market healthcare M&A. The boutique consulting firm advantage

In case you couldn’t guess, I don’t make a living from writing this blog! In this post I explain why boutique consulting firms such as my own Health Business Group are so good at commercial due diligence for private equity investors and strategic acquirers.

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

Bringing on-demand rideshare to medical transport. Interview with Veyo’s CEO

 

Uber and Lyft have transformed (and largely destroyed) the taxi industry. Now startup companies like Veyo are applying similar approaches to the medical transportation field. I interviewed Veyo’s CEO, Josh Komenda to get his take.

1.How is non-emergency medical transportation (NEMT) defined? What’s included? How big is it?

Non-Emergency Medical Transportation (NEMT) is a transportation benefit for Medicaid or Medicare members who need to get to and from medical services, but have no means of transportation. NEMT provides eligible patients with trips that are non-emergency in nature, meaning there is no immediate threat to the health or life of the participant, and no elements of life support are required in the vehicle during the trip. This includes transportation to medical appointments, urgent care, or the hospital. NEMT exists to ensure that participants have access to routine and preventative care, increasing overall health outcomes and avoiding costly ambulance bills or emergency room visits and it’s especially important for those with chronic conditions such as diabetes, heart disease, cancer, COPD, or asthma. As of December 2016, just under 70 million Americans were eligible for Medicaid NEMT benefits.

2.How is NEMT provided today? What’s good and bad about the traditional model?

Today, a large majority of NEMT benefits are managed under the brokerage model. State Medicaid agencies and health plans contract with an NEMT broker to manage their NEMT benefits for them. The broker is responsible for ensuring their members have access to transportation and managing the transportation providers who perform the actual services. Brokers must manage provider procurement, provider credentialing, trip scheduling, eligibility, reporting, FWA monitoring, provider payments, etc.. NEMT benefits may cover a variety of transportation modes, including sedan, wheelchair van, taxis, stretcher cars, and mileage reimbursement. It also may include reimbursement for public transportation or long-distance accommodations such as air travel if a member requires long-distance or out-of-state treatment. NEMT benefits cover all regions from urban to rural, and transportation is always the least costly and most appropriate mode, which is determined on a case-by-case basis for each member.

Quality of service in the NEMT field is plagued by inadequate technology, outdated business models, inconsistent and unprofessional medical transportation providers, and virtually non-existent transparency for the customer. The issues stem from an overly complex, fragmented, and difficult to manage process that has not changed in decades. For example, limited communication between the broker and transportation provider means little to no data is collected around the actual trips. Important metrics like on-time percentage or customer satisfaction are often self-reported by the provider. And the fixed fleet model that traditional brokers employ leaves little opportunity for flexibility – any issues stemming from scheduling, traffic, or weather can throw off the entire system. Even with current NEMT benefits, over 3.6 million Americans still miss or delay medical care due to transportation issues.

3.What are the characteristics of NEMT users?

Those receiving NEMT benefits are often frail, handicapped, disabled, in rural areas and without smartphones. Patients may require NEMT for a variety of reasons, including: lack of a valid driver’s license, lack of a working vehicle, geographic isolation, or the inability to take traditional transportation for physical, mental, or developmental reasons.

4.Who pays? What is the role of government and private insurers?

Medicaid NEMT is a $5 billion industry, funded by state and taxpayer dollars, and overseen by the Center for Medicare & Medicaid Services. Over the past several years, Medicaid spending for NEMT equates to approximately 1% of total Medicaid expenditures.

5.Have the rideshare companies like Uber and Lyft had an impact? What has limited their effect?

Some traditional NEMT brokers have begun exploring partnerships with consumer TNCs such as Uber and Lyft, although due to credentialing and training requirements set by CMS, most trips completed by those TNCs are consumer trips based in a healthcare setting (aka the member or facility is paying), instead of true NEMT trips. It’s important to note that this results in a solution that is not as efficient, coordinated, or suited to healthcare as Veyo’s. Veyo’s vertically integrated model is far superior for a number of reasons. Veyo is directly connected to its own TNC supply that it controls. When a traditional broker partners with a consumer TNC, it necessarily includes an extra administrative middleman in the value chain which is less economically efficient. What’s more, Veyo directly controls and oversees all aspects of its Independent Driver-Provider (IDP) network, meaning it can directly affect credentialing, training, background checks, messaging, etc., ensuring that its network is optimized and trained specifically for its customers. In addition, it can directly monitor, track, and manage its supply to ensure it always has the right vehicles in the right places, and it can directly control matching, routing, and scheduling tactics to make sure that it solves transportation needs for all member needs in all areas.

6.What does Veyo do? How are you different or better? What barriers do you face?

Veyo is a next-gen tech solution for patient transportation. The traditional NEMT model utilizes commercial fleets that are inflexible, expensive to maintain, and managed using traditional dispatch models. These fixed fleets have a difficult time scaling when demand is high, and leave providers with a surplus of vehicles on the road when demand is low. Unlike a fixed fleet, flexible fleet models allow capacity to be rapidly scaled up and down in minutes to meet demand changes. Our dynamic supply system constantly manages and optimizes the right supply levels for different modes across geographies (both urban and rural), ensuring that every member gets picked up on time.

The Veyo Virtual FleetTM is composed of traditional transportation providers and our flexible independent driver-providers (IDPs). Our cost-effective fleet provides the safest, most reliable, on-time service possible. Veyo’s model is a complete, end-to-end NEMT solution that matches supply with demand, making it more efficient and effective, and ensuring the right vehicles are dispatched each and every time. This provides a better participant experience and more efficient use of vehicles. Launched in November 2015, Veyo is changing the face of what it means to be a non-emergency medical transportation broker by bringing this innovative ride-sharing technology to the antiquated NEMT industry.

Here is how we are different and better:

  • Veyo brings innovation for the very broad needs of health plan memberships. Consumer TNCs are built to primarily serve individuals without any special needs in urban geographies. Veyo’s virtual fleet model seamlessly includes its network of IDPs (Independent Private Drivers), and traditional, specialized NEMT fleets to meet the broad array of needs from ambulatory, wheelchair, bariatric, stretcher, and other modes as required. Our IDP drivers are trained and credentialed to federal and state CMS requirements, including First Aid, CPR, HIPAA, ADA, patient sensitivity, and hand-to-hand service. We serve members in big cities, small towns, and rural areas, and use a variety of scheduling, routing, and matching techniques that are designed to get every member to their appointments on time with efficiency and high quality service no matter where they live or what their needs are.
  • Veyo’s platform is designed for management of a transportation benefit. Government agencies and managed care organizations spend millions of dollars on a critical benefit that ensures their memberships can get to and from their appointment reliably. Veyo’s system is designed to bring next-generation tools to manage this benefit to ensure maximum effectiveness. Veyo supports call centers, booking portals, and member apps that verify eligibility, determine the most appropriate mode of transportation, and ensure the highest-quality access, reliable on time performance, and trackability and transparency, while employing sophisticated mechanisms to detect and prevent fraud, waste, and abuse. In addition, it can support customized eligibility criteria and steer members to alternative cost-saving modes such as mileage reimbursement and public transit where appropriate.
  • Veyo is built from the ground up to be a healthcare ally and use data and technology to cut costs and improve outcomes. From basic requirements, like managing eligibility files, PHI, and providing encounter data, to more advanced dashboards, reports, caseworker/intervention alerts, and app campaigns, Veyo’s platform, data, and tools are at plans’ disposal to drive initiatives aimed at understanding their membership better and piloting new programs to drive better outcomes. More than just a basic transportation service, Veyo understands that it is part of the continuum of care, and uses its ability to interact with members and collect data to help plans make the most of their investment in NEMT.

Some barriers we are currently facing include hesitation in the market about such a new solution. Because Veyo was built on technology for the healthcare market, our model is drastically different than the traditional players in the market and our results can often seem too good to be true. As we continue to record data and results from our current markets, it allows us to prove that the Veyo model does work for the NEMT market and can make huge changes for health plans and state agencies alike. For example, in our current markets, after completing 3.4 million trips, we are seeing on-time performance percentages of 98% and an overall grievance rate of just 0.09%.

7.Where do you go from here?

We are continuing to expand our model into new states, with plans to double in size in 2017. We are continually adding new benefits and features to the Veyo model, including a member-facing app that will allow members to book and manage trips on their own schedule. In addition to managing their own trips, members will be able to manage their own information, ensuring that health plans always have the most up-to-date contact information for their member population. In addition to focusing on improving the trip lifecycle, we’re also looking for ways to better increase the transparency between health plans and their members. Wellness initiatives such as flu shot reminders and annual wellness exam reminders can be built into member-facing apps, giving health plans one more connection to their members.  Our high-powered, data-oriented technology team and strategic focus allows us to reimagine many processes within the broker’s function, introduce new automation and efficiency, and provide new NEMT-specific tools and data insights for plans, agencies, and members.

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

 

eCOA in action: Podcast interview with iCardiac CEO, Alex Zapesochny

from-rbj-article-headshot-21

Alex Zapesochny, CEO, iCardiac Technologies

Electronic clinical outcome assessment (eCOA) platforms collect data from patients, clinicians and caregivers to make clinical trials more efficient and accurate. iCardiac Technologies, an innovative core lab where I am a board member, just introduced its QPoint eCOA platform to complement its existing cardiac safety and respiratory function product lines.

In this podcast interview, iCardiac CEO Alex Zapesochny shares more about the launch.

  • (0:11) What are some of the key trends you are following in clinical drug development?
  • (1:04) You started with cardiac safety testing and then added pulmonary function testing. How do those fit together?
  • (3:00) Now you have a new platform, QPoint. What is it, and why is it the next logical service?
  • (4:44) For those who are less familiar with eCOA, what is it? And what are some of the challenges that are typically encountered?
  • (7:09) Compliance is often an issue with patient reported outcomes. Do you address compliance with QPoint?
  • (10:30) How important is eCOA for drug development? Is it a major change or incremental?
  • (12:20) You have explained the move from cardiac safety to respiratory to eCOA. What can we expect next from iCardiac?

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

What’s wrong with Trumpcare (so far)

 

false-98375_640

As a college student many years ago I had a summer internship at a top consulting firm, where I learned an important lesson from my boss: “Don’t come tell me about a problem without proposing a solution.” It went without saying that before speaking up I was expected to focus only on real problems, analyze the situation, and propose realistic, logically consistent solutions.

I’m reminded of this lesson pretty much whenever I hear Donald Trump say something, on subjects ranging from immigration to the environment to foreign policy. If he were a summer intern he would have been fired, and We the People should have known better than to hire him for his current gig.

Trump has no problem calling the Affordable Care Act (ACA) a “complete and total disaster” and saying everything should be thrown out the window and replaced with “something terrific.” But if you listen in recent days it’s become clear to me that Trump doesn’t even know what the Affordable Care Act includes. I’m sure if a reporter asked him to name five key elements of Obamacare he couldn’t do it, not that he could be bothered to try.

The things Trump says he wants to achieve are mainly in line with the objectives of the ACA itself. Furthermore, the ACA has achieved some or a lot of success in many of these areas. To the extent Trump has backed different approaches, they are either irrelevant, ineffectual, contradictory, or fiscally unsound.

Trump said in his speech to Congress that he wants to replace the ACA “with reforms that expand choice, increase access, lower costs, and at the same time, provide better healthcare.” He continued with talking points that he and Congressional Republicans have used in the past:

  • Allowing the sale of insurance across state lines –which unlike what Trump said, will not lead to a national market nor achieve the other goals. In any case, selling across state lines isn’t forbidden today but there’s little interest in it from health plans themselves because they would have to set up local networks and wouldn’t have leverage to negotiate with local providers. It’s just policy ideologues and ignoramuses who think this will work. (It also requires contradicting typical Republican views about states rights.)
  • Ensuring that people with pre-existing conditions have access to coverage is a cornerstone of Obamacare, and a successful one at that. So it isn’t something Trump or Republicans can take credit for and was never a GOP goal before the ACA. If we’re going to be pure about a full repeal of Obamacare, why leave this –and other popular provisions—in place?
  • “Giving our state governors the resources and flexibility they need with Medicaid to make sure no one is left out.” –Well if making sure no one is left out is the goal then the states should accept the Medicaid expansion. Shifting to block grants may provide flexibility but won’t add resources
  • The use of tax credits and Health Savings Accounts to allow individuals to buy plans of their choice (not ones “forced by the government”) is just fancy words. Tax credits would have the same objectives as the current subsidies for premiums and out-of-pocket costs but they would probably be less efficient. If the credits aren’t refundable and/or they are based on age but not income, it won’t help poor people buy insurance. And if people can buy whatever plan they want it will help young, healthy people who want bare bones coverage but will make insurance more expensive for everyone else. Already, Trump’s instructions to the IRS not to penalize people who don’t buy insurance is undermining the Obamacare exchanges rather than helping them
  • Malpractice reform. Sorry, that will have no meaningful impact
  • “Bring down the artificially high price of drugs and bring them down immediately” –No word on how that would be done, certainly not immediately.

It’s notable that none of these so-called principles actually deals with improving the delivery of healthcare. They’re all about insurance and financing.

He concluded “On this and so many other things, Democrats and Republicans should get together and unite for the good of our country and for the good of the American people.”

Amen to that. A good way to start would be for Trump and the rest of the GOP to apologize for demonizing and undermining the implementation of Obamacare and then work on improving it. With hardliners from the ironically named Freedom Caucus likely to oppose pragmatic policies, it’s up to the GOP to persuade Democrats why they should go along.

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