January 30th, 2015
In a recent post, we agreed with Goetzel et al. about the advisability of moving away from a preoccupation with the return-on-investment (ROI) of wellness programs and toward the more systemic, iterative view required to make progress toward workplace “cultures of health.”
At the same time, we acknowledged Lewis et al. and others for helping to usher in a new and needed scrutiny of the fairness and effectiveness of employment-based wellness programs. But, we also cited peer-reviewed evidence that counters Lewis et al.’s conclusion that there are no conditions under which employer wellness programs, and by extension employer efforts to manage their core health-related value/sustainability challenge, can achieve a return-on-investment (ROI) ratio of better than 1-to-1 savings to cost.
Lewis et al. have added their voice to the scrutiny increasingly applied to employer use of outcome-triggered incentives or penalties to promote employee behavior change in the context of health-contingent programs under financial provisions in the Affordable Care Act. The momentum fueling these developments could soon extend far beyond wellness programs. Read the rest of this entry »
January 29th, 2015
Health care administration educators are at a crossroads: the health care sector is rife with inefficiencies, erratic quality, unequal access, and sky-high costs, complex problems which call for innovative solutions. And yet, according to our content analysis of top U.S. health administration schools and a recent article in the Lancet, our educational systems focus their curricula on isolated, theoretical subjects, such as analytics and quantitative problem solving, rather than the team-oriented, practical problem-solving skills required for innovation.
All too often, when graduates of these programs enter the workforce, they find themselves unequipped to meet the challenges for innovation of 21st century health care. The following blog post examines the current educational gaps in traditional health care administration and efforts underway to address them. One such effort is the Global Educators Network for Health Care Innovation Education (GENiE) Group, created by Harvard Business School (HBS) Professor, Regina Herzlinger, whose members are working to make innovation a central part of the education of the future leaders in health care. Read the rest of this entry »
January 28th, 2015
The frustrating labor and delivery experience shared by physician and ethicist Carla Keirns in her Narrative Matters essay, “Watching The Clock: A Mother’s Hope For A Natural Birth In A Cesarean Culture,” published in the January issue of Health Affairs, was unfortunate. That is not debatable. That her outcome was favorable—a healthy baby ultimately delivered in the way that Keirns had hoped—does not excuse the less-than-ideal coordination, and communication, of care that she received.
Fortunately, Keirns had the tools at her disposal—such as medical training and solid relationships throughout the provider community—to help ensure that she was able to have the birth that she had planned. But few women have those tools. It is time for us to work harder to ensure that the voice of the mother is factored into the birth experience — both before labor and during delivery. Read the rest of this entry »
January 27th, 2015
January 29 update on open enrollment data and IRS rules for CO-OPS: On January 27, 2015 the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services released a report on the first two months of the 2015 open enrollment period, spanning November 15, 2014 to January 16, 2015. During that period, more that 7.1 million individuals selected plans or were reenrolled through HealthCare.gov, which serves 34 states using the federally facilitated marketplace (FFM) and 3 states with state exchanges. State-operated marketplaces signed up an additional 2.4 million, bringing the total number of enrollees for 2015 to over 9.5 million.
With a month to go, marketplace enrollment has already reached the 9.1 to 9.9 million range projected by ASPE for 2015 at the beginning of open enrollment. Given the fact that the heaviest enrollment in marketplace-type programs usually takes place in the last month, it is possible that enrollment might reach the enrollment estimate of 12 million projected by the Congressional Budget Office in its recent baseline report.
Of the 7.1 million individuals who have selected plans or were reenrolled through the FFM, 42 percent (3 million) were new enrollees, and 58 percent (nearly 4.2 million) were reenrolled. The group is comparatively young: 35 percent of enrollees were 34 or under, compared to 30 percent for the first five months of the 2014 open enrollment period. It is also heavily dependent on federal assistance: 87 percent received financial assistance and 70 percent selected a silver plan (qualifying them for cost-sharing reduction payments), higher than the comparable numbers of 83 percent and 65 percent for the first five months of 2014. Ten percent were Latinos, compared to 7 percent for 2014. Read the rest of this entry »
January 27th, 2015
Editor’s note: This post is part of a series of several posts related to the 4th European Forum on Health Policy and Management: Innovation & Implementation, to be held in Berlin, Germany on January 29 and 30, 2015. For more information or to request your personal invitation contact firstname.lastname@example.org or follow @HCMatColumbia.
Many health systems are experiencing shortages of health care workers. Policymakers and practitioners have tried for a long time to figure out how to assess workforce productivity, skills and roles, in order to achieve the best mix of professionals needed to deliver high quality care while preserving sustainability.
Unfortunately, many obstacles have slowed progress toward this goal. Open questions still concern not only how many doctors or nurses are needed in any given system or organization level, but also over what roles and responsibilities fall to different health professionals and specialists. Read the rest of this entry »
January 27th, 2015
In October 2014—nearly three years after an auto-pedestrian accident that left me unable to walk—I embarked on a six-day bicycle trip through the Sicilian countryside. An account of the earlier accident and my uneven care experience appeared in the June 2014 issue of Health Affairs (‘Nothing is Broken’: For an Injured Doctor, Quality-Focused Care Misses the Mark), and excerpted in The Washington Post.
Despite major improvements in my gait at the two-year mark of physical therapy, I am still cane-dependent, and my orthopedist noted to me that I would never be able to bike again.
Surely, this was on my mind when I arrived at the hotel in Sicily and was sized up and down by 22 other members of the biking group, many looking like veteran cyclists. They all watched closely as I ambled toward the hotel…with my cane. Their warm welcome belied a willing suspension of disbelief. Read the rest of this entry »
January 26th, 2015
In this post, I want to focus on the key role economic analysis plays in the Federal Trade Commission (FTC)’s health care enforcement program. I use this lens to look first at how the FTC has become more successful in challenging hospital mergers, and then to rebut the notion that the Affordable Care Act is somehow a “free pass” for health care industry consolidation.
After the federal antitrust agencies successfully challenged a number of hospital mergers in the 1980s and early 1990s, we suffered a string of court losses in the mid- and late-1990s, even in cases involving highly concentrated hospital markets. In 2002, the FTC decided to take a step back and examine the reasons for our losses, and whether our analysis of hospital markets was correct.
We engaged in an in-depth retrospective study, used our authority to collect data from hospitals and insurance companies, and held workshops along with DOJ. (See here, here, here, and here.) Cory Capps of Bates and White, and other economists contributed significantly to our understanding as well. This intense period of reflection led to several important papers demonstrating that the consummated mergers stemming from the hospital merger challenges we lost—including those involving non-profits—resulted in anticompetitive effects, particularly increased prices. We also determined that our losses were due in part to the courts’ acceptance of faulty economic analysis of geographic and competitive effects. (See here, here, and here.) Read the rest of this entry »
January 26th, 2015
By now, the Federal Trade Commission’s (FTC) law enforcement efforts in the health care area are well known. We have successfully challenged several hospital and physician practice mergers in the last few years. We also continue to pursue anticompetitive pharmaceutical patent settlements, following a victory at the Supreme Court in the Actavis case. Speaking of the Court, it is currently reviewing a case we brought against the North Carolina Board of Dental Examiners, alleging that its members conspired to exclude non-dentists from providing teeth whitening services in North Carolina.
Perhaps less publicized are the FTC’s various non-enforcement efforts in health care. Arguably most significant among those is the advocacy that the agency conducts in favor of competition principles before state legislatures and other policymakers. I will discuss our advocacy efforts in the health care space in this post, and then turn to the subject of telemedicine, an area in which FTC competition policy may play a significant role. Read the rest of this entry »
January 26th, 2015
With their recent post declaring that employment-based wellness initiatives “increase rather than decrease employer spending on health care with no net health benefit,” Al Lewis and coauthors are continuing to exert a clarifying presence in a field with a history of unsubstantiated claims and suspect methods. This conclusion is not supported by the work with which we and others have been associated and is thus not one with which we agree.
Nevertheless, Lewis et al. are to be acknowledged for fueling the need for a sharper focus on the core challenge at hand for employers: how best to improve the value of their health care investment—that is, how to manage health care costs while improving employee health and productivity—in ways that are sustainable. Incremental, inconsistent and, at times, maddeningly slow progress has been made. Employment-based wellness has been at the forefront, even as the need for quality improvement continues.
Moreover leading employers with well-developed management and measurement approaches have moved well beyond calculating the return on investment (ROI) of individual wellness efforts and are demonstrating the more comprehensive value of building “cultures of health.” Read the rest of this entry »
January 23rd, 2015
On December 29, the Department of the Treasury and the Internal Revenue Service released long-awaited final regulations implementing Affordable Care Act provisions that impose additional obligations on charitable hospital organizations covered by §501(c)(3) of the Internal Revenue Code. Published in the Federal Register on December 31 2014, the regulations are massive, consolidating a series of prior proposals into a single final body of regulatory law. The regulations affect more than 80 percent of U.S. hospitals, both the 60 percent that operate as private nonprofit entities and the 23 percent that operate as governmental units.
Because state and local governments typically condition their own sales, property, and corporate income tax exemptions for nonprofit entities to a hospital’s §501(c)(3) status, the final regulations carry broad and deep implications from both a policy and financial perspective. According to the Congressional Budget Office the 2002 the national value of the federal tax exemption exceeded $12 billion, a figure that undoubtedly has risen considerably. Read the rest of this entry »