Exchange enrollees study by Truven Health Analytics reveals surprises

It’s only one study based on the health data of one unnamed state. But if the results of the Truven Health Analytics study are at all typical of the general U.S. population, then insurers offering coverage through health care reform exchanges should be braced for some very high utilization numbers by an unexpectedly older consumer population.

Truven said it used the data provided by “a large health plan to investigate demographics, risk, financial factors, and utilization patterns in the exchange population of its state.” The results of the analysis suggest that some of the basic predictions about those who would purchase coverage through an exchange might have been way off. Truven did not identify either the state or the health plan.

Report findings include:

• Exchange Attracted Older Enrollees: The average enrollee age in the state that was chosen for the study was 46 for the exchange population and 44 for those off the exchanges. Only one plan – the catastrophic level – had an average age under 44 (31 years).
• More Admissions, ER Visits: Exchange enrollees had a whopping 39 percent more admissions and 64 percent more emergency department visits per 1,000 enrollees than non-exchange insureds. Medical and prescription drug utilization increased as the plan design level increased.
• Higher Rate of Chronic Conditions: Exchange enrollees had 44 percent more instances of congestive heart failure and 39 percent more diabetes cases in exchange members. Additionally, exchange enrollees experienced more seizure disorders and convulsions (26 percent), asthma (21 percent), and major depressive disorder (8 percent) versus non-exchange counterparts.
• Silver Plans Dominate Exchanges: Silver plans (including both standard silver and cost-sharing reduction plans) are the preferred plan of choice for exchange enrollees, with an 82 percent market share. Bronze enrollees accounted for just 6 percent, while platinum had 4 percent of the market.
“Now, more than ever, health plan leaders need to understand details about their unique populations to create appropriate product strategies and plan designs for the future,” said Barbara Graovac, senior vice president at Truven Health Analytics. “With this snapshot of one state’s exchange population, it becomes clear how profound the differences between an exchange and off-exchange health plan population can be, and, how different reality is from initial predictions.”

http://www.benefitspro.com/2015/05/19/exchange-enrollees-study-by-truven-health-analytic

Gaming technology saves millions for Spanish healthcare

Technology in health isn’t just about investment, it’s about massive savings

In Spain’s Basque Country patients with chronic diseases including asthma, diabetes and arthritis are turning on their Xbox games consoles with their doctors’ approval. They are using a system called Teki which has been developed for the Basque health authorities by IT consultants Accenture.

Teki takes advantage of the Kinect system on Xbox which has a video camera that tracks a gamer’s movement so they can interact with games without a joystick or controller. The off-the-shelf technology means that patients can be monitored in their homes but also interact with health professionals without constant visits to a clinic or hospital.

Teki is part of a larger move towards using the phone and internet for interacting with the health system. During the first year of the project, Accenture estimates there was a €50 million saving through reducing the number of visits to hospitals. Some 18 per cent of primary care interactions in the Basque Country now happen online or over the phone.

Irishman Sean Shine is Accenture’s senior managing director for health and public service, and has been involved in major healthcare technology projects around the world in recent years including Teki.

He says “connected health” – where medical records are stored electronically and then linked up so that trends in the overall system can be spotted – is key to getting the most out of technology in the health system. Accenture is involved in connected health projects in Australia, Norway, Singapore and the US but Shine says they are not the sole preserve of wealthy countries with well-funded health systems.

“Brazil is beginning to look at connected health and beginning to look at a public-private partnership where they may get the private sector to invest to build some of that infrastructure and provide it back to them on an ongoing basis,” says Shine. “They don’t have the funding to provide for everything up-front but they want to see if they can do it almost on a month-by-month basis.”

In the UK, Accenture delivered a project for Cambridge University Hospital to address acute bed shortage which saved £5.7 million (€6.9 million) annually. One hospital in the group also managed to reduce the average length of stay by five days.

Despite the cost savings, some might be uncomfortable with the notion of a management consultant deciding how long you need to recuperate after a major procedure. “Obviously in order to do that you need to have the right skills because you can’t just have a generic consultant coming in and saying what if we moved this or changed this around. Having the mix of the clinical skills and the typical consulting and engineering type capabilities and bringing those together is essential.”

Shine also points out that Accenture has hired the necessary skills so it can help its clients make clinical decisions. “I’m still amazed when I meet some of the doctors we have on our payroll. They are lifetime physicians, they’ve been around but they’ve moved from being active clinicians into the consulting space.”

The use of technology in the Irish health system has a decidedly mixed history not least because of under-investment. In most European countries, 2-3 per cent of the healthcare budget has been invested in IT, in Ireland it’s been less than 1 per cent. As a result, Shine believes difficult decisions need to be made about investing at a time when costs are under severe pressure.

“There is a recognition [in the health system] that many of these things need to be done. I think we’ve seen a renewed focus on recognising that investments in the IT and administrative infrastructure are needed. And that the benefits of doing that are as significant, perhaps even more so, than some of the clinical things that are being done.

“You say you are putting in a new financial system and everyone falls asleep but actually you need that as a base.”

http://www.irishtimes.com/life-and-style/health-family/gaming-technology-saves-millions-for-spanish-healthcare-1.1744945

Calls for national telehealth strategy within the Australian Health System

A collaboration of health industry stakeholders released a White Paper in Canberra last week to promote the adoption of telehealth nationally.

The group (One in Four Lives) concluded that telehealth could save $4 billion a year in avoidable hospital presentations related to chronic conditions. The group’s name reflects the fact that almost six million, which equates to one in four, Australians are affected by chronic health conditions – and this accounted for 60% of all hospital bed days and an estimated $17 billion annually in public health costs.

The White Paper outlines that the Australian health system is not sustainable in its current form, citing Treasury modeling that predicted healthcare costs would ‘eat up’ more than 100% of the entire revenue collected by the Nation’s states by 2046.

Chair of the body, BT’s Director of Health Lisa Altman said the aim was to encourage industry participation in the large-scale adoption of telehealth – providing faster, more efficient healthcare solutions without imposing an additional burden on the health budget. Ms Altman also said the evidence-base for telehealth already existed, proven by large-scale operations such as the Department of Veterans Affairs in the USA and the Whole System Demonstrator Program in the UK.

Ms Altman reported that the UK program found telehealth could deliver a 15% reduction in emergency visits, a 20% reduction in emergency admissions, a 14% reduction in hospital admissions and bed days as well as a 45% reduction in mortality rates.

One In Four Lives group speaker Dr George Margelis said there were already notable telehealth trials and projects up and running across Australia that demonstrate telehealth works well.

“But the industry believes that there is a need for more flexible funding models for the widespread adoption of telehealth, to help us prevent the thousands of avoidable admissions we have every year because of chronic disease,” he said.

Dr Margellis said telehealth had the potential to revolutionize the way chronic disease was managed, by enhancing communication with patients and improving monitoring of their conditions. The White Paper is an attempt to “kick start the discussion between industry and government,” he added.

http://www.healthcareitnews.com/news/calls-national-telehealth-strategy

ACA data “dashboard” will track chronic conditions

NEWS IN BRIEF

The Centers for Medicare & Medicaid Services on March 28 announced that it was employing a new data tool to advance the health system reform goals of helping Medicare beneficiaries with multiple chronic conditions.

CMS said the new “dashboard” would make it easy for physicians and others in the health system to find current information on where these types of conditions take place, what services these beneficiaries need, and what Medicare spends on them. In 2011, the program spent about 93% of its funding, or $276 billion, on beneficiaries with two or more chronic health issues.

The dashboard is part of a larger initiative, begun in 2009, by the Dept. of Health and Human Services to improve the health of people with multiple chronic conditions.

The majority of Medicare beneficiaries have chronic diseases such as diabetes and heart disease, “and that number will rise with an aging population,” said Marilyn Tavenner, CMS acting administrator. “The Affordable Care Act addresses these health problems by making people with Medicare eligible for recommended preventive care without Part B deductibles or co-payments. The health care law also promotes better health care coordination and management of chronic conditions through analysis of current data.”

http://m.amednews.com/apps/pbcs.dll/article?aid=/20130415/government/130419987&template=mobile_art