Florida Blue and Tampa Bay Integrated Healthcare Network Form Accountable Care Arrangement

Florida Blue and Tampa Bay Integrated Healthcare Network Form Accountable Care Arrangement 

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2015 Health Plan Member Satisfaction Study Released by J.D. Power

Health plan overall member satisfaction averages 679, a 10 point improvement from 2014, found a new study by J.D. Power.

The study now in its ninth year measures satisfaction among members of 134 health plans in 18 regions throughout the U.. by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service. Satisfaction is calculated on a 1,000-point scale, the firm said..

“Following a year filled with negative news coverage about health insurance, a bumpy start to the launch of the Affordable Care Act, and an atmosphere of fear, member satisfaction with health plans has increased significantly as plan administrators take a customer-centric approach, helping to build member trust and loyalty,” the study revealed.

The increase in satisfaction is driven by improved performance across all factors, most notably in information and communication (+17 points), which is primarily a result of efforts among many of the health plans to retool their approach by refining messaging, adjusting message frequency and upgrading their website. Satisfaction in the customer service factor has increased by 11 points, driven partially by matching communication methods to member preferences, such as mobile and text. Cost satisfaction increases by 13 points while fewer members indicate having experienced an increase in their monthly premium, as well as a decline in overall out-of-pocket expenses for individuals and families.

“Health plans have come a long way since last year as the focus has shifted toward better serving member needs and building trust. However, there is still a lot of work to do,” said Rick Johnson, senior director of the healthcare practice at J.D. Power.

“Health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy.”

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The study found that overall satisfaction is significantly higher among the 19 percent of members who strongly agree their health plan is a trusted partner in managing their health. Among members who say they “strongly agree” that their health plan is a trusted partner, satisfaction increases by 201 points.

 KEY FINDINGS

  • Members who say they “strongly agree” that their health plan is a trusted advisor are less likely to switch health plan providers.
  • Within information and communication, satisfaction ratings have improved from 2014 in the factor’s four attributes: ease of understanding your plan’s benefits and services (6.4 vs. 6.2, respectively, on a 10-point scale); frequency of communications (6.3 vs. 6.1, respectively); usefulness of information (6.4 vs. 6.2, respectively); and variety of communications (6.3 vs. 6.1, respectively).
  • Similarly, satisfaction ratings have also improved year over year in the attributes within the cost factor: premiums (5.9 vs. 5.7, respectively); deductible amount (5.8 vs. 5.7, respectively); co-pays for prescription medication (6.4 vs. 6.2, respectively); and co-pays for doctor visits (6.3 vs. 6.2, respectively).
  • Overall member satisfaction is 108 points higher among members who have contacted their plan via mobile app at least once in the past 12 months than among those who haven’t.  While members under 40 years old contact their plan via text and mobile app at a significantly higher rate than older members, the telephone is still the most frequently used contact method across all age cohorts.

Study Rankings

Satisfaction is highest among health plan members in the California (695), Northwest (693), IllinoisIndiana (689), Michigan (688) and Mountain (686) regions. Satisfaction is lowest among members in the New England (664) and the Southwest and MinnesotaWisconsin regions at a tie (665).

In a related development, J.D. Power plans to release a Health Insurance Marketplace Exchange Shopper and Re-enrollment Study (HIX), focused on member satisfaction with health plans purchased through public exchanges, as well as the shopping experience on those exchanges, this month. In October 2015, J.D. Power will also release a Medicare Advantage Study, focused on member satisfaction with Medicare Advantage plans.

The 2015 Member Health Plan Study is based on responses from more than 31,000 members of 134 commercial health plans across 18 regions in the United States. The study was fielded in November and December 2014. For more comprehensive health plan rankings for all 18 U.S. regions, please visit www.jdpower.com.

Following Are Member Satisfaction Index Rankings :

Trends That We Are Reporting On Our Facebook Page

Almost 70 percent of Americans now have access to an accountable care organization for their health needs

Although growth slowed the number of ACOs still rose by about 16 percent; number of patients served rose 6 percent, said consultant Oliver Wyman.

Almost 70 percent of the U.S. population now lives in localities served by accountable care organizations, and 44 percent live in areas served by two or more, found new research by the Oliver Wyman consulting firm.

The total number of ACOs participating in Medicare programs has increased to 426, up from 368 in January 2014, the study found.

About 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, now receive their healthcare from ACOs participating in Medicare’s ACO programs.  https://www.facebook.com/TheMCIC

Source:  Oliver Wyman Study  http://www.oliverwyman.com/

What ‪‎Physicians‬ Earned in 2014 – New Results

“On average, specialists earned $284,000 a year while primary care physicians earned about $195,000, according to a new survey, which polled 19,500 physicians across 25 specialties.”

Orthopedists‬ earn an average of $450,000 a year. Cardiologists were earning a average total of $395,000 a year, the survey found.

On the lower end, pediatrics showed the lowest total compensation at $196,000, though exactly half said they felt fairly compensated. Also, 50 percent of pediatricians polled were women.

The average compensation for a self-employed male physician was $324,000, compared to $259,000 for female physicians.  https://www.facebook.com/TheMCIC

Source: Health Care Finance  http://www.healthcarefinancenews.com/

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Directories of Healthcare Payers and Provider Organizations From the Managed Care Information Center

Searching for contact information about managed care organizations, health systems and hospitals or such physician organizations as independent practice associations or physician hospital organizations visit our Directories of Health Insurers and Providers page at Health Resources Online.

https://www.healthresourcesonline.com/directories-of-health-insurers-and-providers.html
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“A small percentage of patients are responsible for the majority of healthcare spending in the United States,” study finds.

The top three percent of patients categorized as persistent high users accounted for 21 percent of total annual healthcare expenditure for a typical large business in Pennsylvania, found the study published this week in the American Journal of Managed Care.

Persistent high users incurred annual expenses of more than $38,000 compared to just $2201 for patients who never crossed the “high use” threshold, the study researchers said. While some patients experiencing acute issues or hospitalizations temporarily incurred high expenses, patients experiencing a higher burden of sustained chronic conditions were significantly more likely to be frequent users of healthcare services. https://www.facebook.com/TheMCIC

Source: Healthcare IT Analytics  www.http://healthitanalytics.com/

 

Focus On Data in Era of Value-Based Models of Reimbursement

“Despite the continued prevalence of the traditional fee for service reimbursement models as the primary method of payment, over time healthcare’s reimbursement will give way to value-based models of reimbursement.”

That prediction made by longtime friend and consultant Russell Foster surrounding the need for accurate data as value-based models of reimbursement continue to emerge has come true.

You know that valued-based reimbursement today is a significant focus. Payer reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses.

Payment Bundling, PHO Shared Savings, and Pay for Performance are all in the mix of emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

One major health payer’s 6,300 enrolled primary care physicians can earn bonus payments across six measure sets — a broad spectrum of measures from clinical and quality measures to prescribing Continue reading

Pioneer #ACO Repurposes Care Management for Accountable Care

As a top performer in Year 1 of the CMS Pioneer ACO program, the 2500-physician Monarch HealthCare is paving the way to accountable care with a foundation of patient- and provider-centered strategies that support Triple Aim goals.

Those goals – to improve quality, improve health outcomes and reduce cost, are detailed in Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care.

Colin LeClair, executive director of ACO for Monarch HealthCare, recounts how Monarch recast its Medicare Advantage (MA) care management program to target about 1,200 high-risk patients who have a similar constellation of issues.

“Monarch repurposed our Medicare Advantage (MA) care management program for the ACO,” LeClair said.

Monarch’s ACO care management team was designed to anticipate and prevent acute events and then to facilitate transitions of care for patients post-discharge, he said.

This interdisciplinary team is “comprised of a primary care physician who quarterbacks the team, and a care navigator, also known as a care coordinator, who performs most of the patient onboarding into the care management program and performs an initial triage of the patient’s needs,” LeClair explained.

The care manager is often a non-complex patient’s primary point of contact. The complex care manager is responsible for most of the complex cases, he said.

Then as needed, “we also deploy a behavioral health clinician, a community services coordinator, a clinic dietician and a palliative care nurse. The other resources may include a pharmacist or Pharm D to perform post-discharge medication reconciliation.”

Then, LeClair continued, “we have a team of medical directors, employed and contracted hospitalists, and employed and contracted skilled nursing facilitators (SNFs) to support us as well.”

The idea is that the team is tailored for the patient’s need at enrollment, and it can then be augmented as the patient’s health status changes, he observed.

This model scales best when you can target large patient populations with a fairly common list of conditions, which allows you to hire and assign clinicians with the appropriate expertise to each patient.

“For example, we can afford to hire and assign a registered nurse (RN) or a nurse practitioner (NP) who has experience in a dialysis clinic or a nephrologist office if we have enough renal disease patients to fill their case load,” LeClair said.

For more information or to order your copy of Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care today, please visit: http://store.hin.com/product.asp?itemid=4841

Managed Care Organization ACO Initiatives; Provider Reimbursement Shift

Managed care organizations’ adoption of accountable care goes well beyond the accountable care organization (ACO) initiatives of caring for the Medicare population.

Health plans see the potential of ACOs in terms of the quality of care and reimbursement models.

Among the managed care organizations partnering with providers to launch ACOs are UnitedHealth Group, Aetna, Humana, Cigna, Highmark and others.

For instance, Cigna is involved in 86 collaborative accountable care initiatives in 27 states. These programs encompass more than 880,000 commercial customers and more than 35,000 doctors, including more than 16,000 primary care physicians and more than 19,000 specialists, Cigna said.

The health plan’s goal is to have 100 accountable care relationships reaching one million customers in 2014.

UnitedHealth Group has ACO initiatives underway in eight states.  And, $28 billion of the Continue reading

Physician Organizations – IPAs – PHOs Can Improve Care Management For Smaller Practices, New Study Finds

On average, physician practices participating in independent practice associations (IPAs) and physician hospital organizations (PHOs) provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did, the results of a new study found.

The difference is dramatic – 10.45 percent versus 3.85 percent, found the researchers. And, half of these processes were provided only by IPAs or PHOs.

All the recent initiatives surrounding physician practice including pay-for-performance, public reporting, and accountable care organization programs places pressure on physicians to use health information technology and organized care management processes to improve the care they provide.

The problem is physician practices that are not large may lack the resources and size to implement such processes.

The researchers said they used data from a “unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which IPAs and PHOs might make it possible for these smaller practices to share resources to improve care.”

Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients, the study found.

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IPA-PHO Database – The National Directory of Physician Organizations profiles more than 1,300 physician organizations. Listings include: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, physician primary care networks, and management service organizations (MSOs) The National Directory of Physician Organizations

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These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations, said the researchers.

“The data presented suggest that IPAs and PHOs may be able to provide an additional, potentially viable organizational alternative during an era of major changes in how health care is delivered and paid for,” the study authors wrote.

The research team was led by Lawrence P. Casalino, MD. The study results appeared in the August Issue of Health Affairs.