A recession is coming: What it could mean for healthcare

https://www.beckershospitalreview.com/finance/a-recession-is-coming-what-it-could-mean-for-healthcare.html?origin=cfoe&utm_source=cfoe

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More than half of 147 CFOs surveyed by Deloitte believe the U.S. will be in a recession by the end of 2020.

Eighty-eight percent of CFOs rated the North American economy “good” in the fourth quarter of 2018, but just 28 percent expected conditions to improve in 2020. Larry Summers, former U.S. Treasury Secretary, has also warned of recession twice in the past three months, Fortune reports.

What would a recession mean for healthcare? We looked back to the effects of the 2008-09 recession:

1. A recession could temporarily alleviate or delay workforce shortages. A 2011 report from The Washington Post indicated the 2008-09 recession partially addressed nurse shortages at Washington, D.C., hospitals because some retired nurses rejoined the workforce, some delayed retirement and some part-time nurses sought full-time work.

2. Underemployment and unemployment can lead to significant declines in hospital admissions and elective surgeries for commercially insured patients. A 2013 report from PwC indicated the 2008 financial collapse drove many patients to delay elective procedures, negatively affecting hospital earnings for years after the fact. In fact, the decline in commercially insured patients due to underemployment and unemployment caused the average 300-bed hospital to lose $3.7 million from 2009-11 due to declining admissions, according to a 2012 infographic from Objective Health.

3. A slowdown in healthcare spending could continue to push the industry toward outpatient care. The 2013 PwC report indicated the slow growth rate of healthcare spending post-recession continued to push care to the outpatient setting, which is more consumer-friendly and less expensive.

4. Pediatric care could be recession-proof. A 2014 report from the Health Care Cost Institute found spending on children’s healthcare services under employer-based plans grew an average of 5.5 percent from 2009-12.

5. Healthcare fundraising could decline. In 2011, an Association for Healthcare Philanthropy report indicated fundraising was starting to improve after the recession, but 71 percent of healthcare fundraisers said the recession was still having negative effects.

 

 

Insurance start-up launches on-demand health coverage

https://www.cnbc.com/2018/06/27/insurance-start-up-launches-on-demand-health-coverage.html

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  • Start-up Bind uses proprietary algorithms, powered by machine learning, to lower health-care costs.
  • Bind discovered that it could break out certain procedures and reduce health benefit costs more effectively than with a high-deductible plan.
  • It is backed by Ascension Ventures, Lemhi Ventures and UnitedHealthcare.

Technology has made on-demand services a reality for everything from food deliveries to gym classes and car-sharing. What if you could have on-demand health coverage for big-ticket procedures like knee surgery?

On-demand health insurance seems like an oxymoron, but digital health insurance firm Bind is betting that by structuring health plans so that people can add coverage and pay for it when they need it, companies and employees can save money in the long run.

“It’s not intuitive for people, but I think when we started this we thought, ‘how do people really use the health-care system?’ And we used it in an on-demand way,” explained Tony Miller, co-founder and CEO of Bind.

The two-year old start-up is not a full-fledged insurer, it administers benefits for self-insured employers using UnitedHealth Group’sprovider networks and data analytics. Using its own proprietary algorithms, powered by machine learning, Bind discovered that it could break out certain procedures and reduce health benefit costs more effectively than with a high-deductible plan. It is backed by Ascension Ventures, Lemhi Ventures and UnitedHealthcare.

Plans are designed with basic co-pays and no deductibles for core medical coverage. In addition to free preventive care required under the Affordable Care Act, Bind’s plans cut out deductibles for primary care and specialist visits, maternity coverage, hospital care, medications and even cancer treatment. Co-pays are priced on a sliding scale — from $15 for a visit to retail clinic to $100 at an urgent care facility.

The big-ticket out-of-pocket costs kick in for elective procedures, such as knee replacement or back surgery. The extra co-pay for those procedures is based on the total cost, with consumers being given the full price of the procedure up front and no surprise bills on the back end. The co-pay can be structured so the worker can pay it off through payroll deductions, like a premium.

By outlining the total costs, Bind said it helps employees generate 10 to 15 percent in savings for themselves and for their employer compared to traditional out-of-pocket deductible plans.

“A market might be $6,000 to $24,000 for knee arthroscopy,” explained Miller. “What Bind does is says (for) the $6,000 performer — you only have to pay $1,000 to have access to them. If you want to go to the $24,000 knee arthroscopy with no difference in quality, no difference in performance, you have to pay $6,000 as a consumer.”

“What happens is the consumers actually go and buy the more cost-effective provider and they save money. But more importantly, the entire pool saves money … we save $18,000 for the group,” he said.

That was the way high-deductible plans were supposed to work, with consumers making the most cost-effective choice. Miller should know. He co-founded Definity Health in the late 1990s, which helped pioneer so-called consumer directed health plans; UnitedHealth bought that firm in 2004.

Does he worry that employers could use Bind’s on-demand plans to skimp on core benefits, and shift more costs to their workers? He does.

“What I would worry about is, taking this very novel plan design and if someone wanted to create a skinny plan out of it,” which he admitted would defeat the goal of Bind plan designs.

“Let’s make sure we fund the things we all need in health insurance and make sure that’s a part of everyone’s core benefit,” he said.

Bind has so far signed up small regional employers for its plan, but hopes to launch with a large Fortune 500 company for 2019 coverage.

 

Hospitals work to ensure high-risk patients are ready for surgeries

http://www.fiercehealthcare.com/healthcare/hospitals-work-to-ensure-high-risk-patients-are-ready-for-surgeries?mkt_tok=eyJpIjoiTVdZNE9UbGtZemxtTXpBMCIsInQiOiJVS01rMXhPNVNhS1c0V2JKaE53TSthTHg0dWFnaXVtcUtXeEZlK0VqQTk3SFBNTG01aEJpVVN0aFhqRDZ5cmFGYitGUmtrZHV0K0JGMHBcL2twN2RBeUpSSk5MaW5vS0NcL25JQTk3T2FFTUhrPSJ9&mrkid=959610&utm_medium=nl&utm_source=internal

As healthcare becomes increasingly value-based, surgical outcomes are more important than ever, leading many providers to assess patients’ fitness for elective procedures.

Increasingly, providers make an effort to learn more about patients’ health before operations such as hip and knee replacements, according to The Wall Street Journal, looking for evidence of dangers of infection and other complications. Patients with chronic conditions or lifestyles that put them at higher risk may be directed to “pre-habilitation” programs to increase the odds that their procedures go off without a hitch. These initiatives can involve medical treatments or simply improved diet and exercise, according to the article.

This approach builds on strategies surgeons have employed for years, including advising patients to quit smoking or get in better shape ahead of a procedure, but the range of risks they focus on has broadened considerably to encompass everything from sleep disorders to mental illness, according to the article.

“In health care, we often bring patients into surgery without fully addressing their chronic medical conditions,” Solomon Aronson, M.D., executive vice chair in the anesthesiology department at Duke University School of Medicine in Durham, North Carolina, told the WSJ, and when patients are healthier pre-surgery, “we can significantly diminish the risk of complications.”

For example, Duke Health’s “Poet” (Peri-Operative Enhancement Team) program has focused its efforts on patients with anemia, malnourishment, poor tolerance for exercise, complex pain disorders and diabetes. The fixes the provider offers range from pre-operative iron infusions for anemic patients to a protein shake regimen for older, malnourished patients. In the cases of patients who need such fixes as weight loss or blood sugar control, the Duke team employs longer-term regimens as well.

 

The Side Effects of a Better-Informed Patient

http://healthleadersmedia.com/page-2/QUA-325618/The-Side-Effects-of-a-BetterInformed-Patient

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Surgeon Scorecard

https://projects.propublica.org/surgeons/

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Guided by experts, ProPublica calculated death and complication rates for surgeons performing one of eight elective procedures in Medicare, carefully adjusting for differences in patient health, age and hospital quality. Use this database to know more about a surgeon before your operation.

https://projects.propublica.org/surgeons/state/CA/procedure/8154/

Top 10 California Healthcare Foundation Releases of 2014

http://www.chcf.org/publications/extras/top-ten

California HealthCare Foundation – Supporting ideas and innovations to improve health care for all Californians.