Healthcare Experience Blog

Maybe It’s Time to Quit Calling it “Obamacare”

With the Supreme Court ruling 6-3 to uphold a key pillar of the Affordable Care Act, it’s time to accept that this law is the law.  Instead of blaming (or crediting) President Obama with this law and labeling it “Obamacare,” let’s move on.  It’s the ACA, and it’s the official way we’re moving forward.

This law, which was passed by both the Senate and the House, determines how many millions of Americans will obtain some level of health insurance coverage, and its provisions establish the parameters for how much they will pay for this coverage.

You could argue that there’s still plenty of blame to go around for the way the bill was actually written, revised, and never adequately reconciled between the Senate and the House… The bill itself is complex, lengthy, and murky. However flawed, the ACA definitively establishes a framework—now twice upheld by the Supreme Court—that sets the rules and precedent for Payers and Providers.

All parties are starting to figure out how to live with and within the law. Consumers are navigating the ACA website or as is often the case, finding assistance to do so; either way, more Americans are seeking and obtaining coverage. Payers are adjusting their rates as they gain experience about the mix of people who sign up while they continue to analyze what medical services are most in demand.  And providers are now factoring this new reality into their planning and budgeting.

With lots of trade-offs and compromises, the major parties in the healthcare industry ended up supporting the bill; most heaved a sigh of relief that the Supreme Court ruled as it did.

ACA Here to Stay

All in all, we’re moving on—and that’s a good thing.

Now is the time to improve this program to reflect the needs of patients AND highlight the capabilities of America’s robust healthcare system. With patients, providers and suppliers alike asking “what does this mean for me?” we have a few suggestions:

To reduce the level of confusion among the choices, payers could reduce the number of plans they choose to offer.  To help consumers make better choices, providers can continue to offer new buying channels—such  as retail locations and mobile vans—to complement what’s available through their websites and call centers.  And to reach underserved groups, networks can participate even more actively with community-based organizations and events.

It’s been rewarding for us to be involved in conducting research with various types of consumers who are eligible for coverage under the law and to help our clients understand how to better devise and communicate their offerings.  Understandably, many consumers are still confused by the complexity of sorting through the choices, but they are gaining experience and are becoming more informed buyers. At the same time, providers are becoming more nimble at delivering value-based care in the  new environment.

The ACA has been validated.  Let’s honor it: let’s get to work.



Health insurance companies struggle to achieve trust with hospital execs

Trust is a fragile commodity, yet the need for it may never be greater. As the shift from volume to value-based payments accelerates, providers and payers are working more closely together than ever negotiating ACOs, Pay for Quality, and Bundled Payments. Trust underlies these contracts, which is why asking about it is the central theme of our annual survey done collaboration with ReviveHealth.

Using a Trust Index we developed based on relevant academic literature on the topic, hospital executives reported on the amount of behavioral reliability, honesty, and fairness they experience with the nation’s largest health insurance companies.

Now in its 9th year, this research shows that overall the level of trust between payers and providers remains low. Some payers are seen as more trustworthy than others—with Cigna scoring the best marks multiple years in a row and UnitedHealthcare the worst.

But all the major payers included in this year’s study have relatively low scores, and the scores have not materially changed year over year, except in one case, where Anthem saw a big dip.

Those are three major findings from our just-released 2015 National Payor Study, conducted jointly by ReviveHealth and Catalyst Healthcare Research.

The survey was conducted using both online and telephone methods, and included just over 200 participants. Respondents were executives with US hospital and health systems, particularly those who negotiate and handle contracts with payer organizations. The survey conducted in 2014 had a similar sample size.

To view a brief PowerPoint deck showing the results for this year and how they compare to last year’s please click here.

Technology bridges the generation gap

Healthcare going online may not seem like an earth-shattering concept to you–unless you’re in the midst of adapting to the requirements of Meaningful Use in your hospital, system, or practice.

Patients interacting with their healthcare is, however, a relatively new phenomenon but it’s rapidly taking hold.

In our 2014 “What’s Reasonable?” study, we, not surprisingly, found that the younger generations, X (ages 21-33) and Y (ages 34-48) are the ones that are most likely to prefer online access to healthcare information and providers. They’re the ones most likely to want to pay their medical bills, look at their lab results and make a future routine appointment online, versus more conventional means.

More of the consumers in older segments (ages 49 and up) did tend to prefer traditional rather than online methods of communication with a doctor’s office, at least for certain functions including reviewing/paying their medical bill and making a future appointment.

While Generations X and Y are more strident in wanting healthcare to move online, Baby Boomers are actually the biggest consumers of healthcare services in the U.S. right now. And keep this in mind: 84% of our Baby Boomer respondents, more than in any other age cohort, are already using the Internet to find out information about a medical condition or drug.

How long will it be before they also start putting pressure on healthcare providers to “get online” and make it easy to set appointments, refill a prescription, get medical advice, and view their lab results? Meaningful Use can’t get here fast enough for lots of Baby Boomers who already use smartphones.

The use of technology is certainly not limited to just Generations X and Y. Baby Boomers’ huge presence in healthcare makes them a significant influencer in healthcare’s future–and the move for 24-7 online access and information.

To learn more about our 2014 “What’s Reasonable?” study and download a full deck of the results, click here.

McKinsey says “Digitize Healthcare Access”

Earlier this month, McKinsey & Company published a study that resonates with much of what we found in our 2014 “What’s Reasonable” Study among American consumers.

They surveyed consumers in the UK, Germany, and Singapore.  They said the belief by many healthcare executives that consumers don’t want to use digital services to meet their healthcare needs is flawed.  They suggest that when executives point to the low level of usage of digital healthcare services, it’s because “existing services don’t meet their needs or because they are of poor quality” (meaning, a bad user experience, I believe).

Their study shows that more than 75% of the consumers in these countries expect to use digital services for healthcare related activities. McKinsey also says in their report that “across the globe, most people want the same thing:  assistance with routine tasks and navigating the often-complex healthcare system.”

The one service patients most often cite as most needed is an easy and efficient means of “finding and scheduling physician appointments.”  They also found people want basic services including help finding the right specialist and refilling prescriptions digitally.  Their report adds “What most of these services have in common is that they do NOT require massive IT investments to get started.”

A final point to bear in mind:  The authors of the McKinsey study suggest that a health system’s success in implementing a digital strategy “depends very much on first understanding patients’ digital preferences in both channel and service.”

I recommend you take a look at their study, and our recent study, and then contact us to help you assess the needs and priorities of consumers in your marketplace.  That way, you can make investments that will pay off in terms of finding new patients for your physicians, increasing the level of loyalty among your patient base, and meeting your Meaningful Use requirements.

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