How a bite from a stray dog shows the sick state of U.S. healthcare

http://www.latimes.com/business/lazarus/la-fi-lazarus-rabies-vaccine-prices-20160906-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=34073641&_hsenc=p2ANqtz-_UzP0FJwNSr06pbn6txjInxbNNHUAh9wO8NHxkBnVs85MxYQFyPtYaPatHWZG7uvo1VuZtlGtNcs7YcTj5-1_zPdkfkQ&_hsmi=34073641

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Jan Kern was bitten by a stray dog while traveling abroad and ended up with a jaw-dropping illustration of why the U.S. healthcare industry is completely sick.

That’s because she underwent a series of rabies shots in three countries at four medical facilities. What that revealed, and which will surprise no one, is that Americans pay way more for the exact same treatment than people in other nations.

Moreover, her experience highlights the lack of uniformity for drug prices, including commonly used medications. One facility might charge a few bucks for the same drug that costs thousands of dollars at a U.S. hospital.

“There’s no rhyme or reason to our medical system,” said Rick Kern, 61, who contacted me about his 62-year-old wife’s global healthcare adventure after reading my recent column on drug prices.

What’s great about his story as well is that, after I shared it with about a dozen healthcare experts, the consistent reaction was one of utter disbelief. We’re accustomed to shaking our heads at U.S. healthcare costs. Things become significantly more absurd when a couple of overseas medical facilities are stirred into the mix.

“It’s obvious that our system is unlike any other health system,” said Uwe Reinhardt, a healthcare economist at Princeton University. “Other systems were set up to care for patients. Ours was set up by the providers — the hospitals and drug companies — for their own benefit.”

How some providers are stoking entrepreneurial fires to ensure healthy financials

http://www.healthcaredive.com/news/how-some-providers-are-stoking-entrepreneurial-fires-to-ensure-healthy-fina/425725/

In an era of falling inpatient rates and value-based reimbursement, hospitals and health systems are seeking new ways to grow their revenue streams. For some, that has meant wearing an entrepreneurial hat and marketing home-grown solutions.

One example is the University of Pittsburgh Medical Center, which two years ago created UPMC Enterprises to develop and commercialize novel technologies.

Cleveland Clinic details hits to operating margin

http://www.healthcaredive.com/news/cleveland-clinic-details-hits-to-operating-margin/425703/

  • The Cleveland Clinic’s latest financials show the hospital system ended the first half of 2016 with a significantly lower operating margin than at the same time in 2015, landing at 1.2% after the six-month period that ended June 30, 2016 vs. 5.6% in June 2015.
  • Although the system’s revenue went up 17% during this period compared to last year, reaching $3.93 billion, that revenue failed to keep pace with a 23% increase in expenses.
  • The system had anticipated a smaller margin this year, Cleveland Clinic chief financial officer Steve Glasstold Modern Healthcare, partly as a result of increased investments in new care-delivery models and consultants to manage those projects, as well as providing raises to medical and other employees to retain in-demand clinicians.

As Healthcare Changes, So Must its CEOs, CFOs, COOs…

http://www.healthleadersmedia.com/leadership/healthcare-changes-so-must-its-ceos-cfos-coos%E2%80%A6

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To keep up with big changes in how healthcare is administered, financed, and organized, top leaders are finding a need for new talents and organizational structures.

High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?

http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1

A Population-Based Comparison of Demographics, Health Care Use, and Expenditures

Abstract

Issue: Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics.

Goal: Examine demographics and health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks.

Methods:Analysis of data from the 2009–2011 Medical Expenditure Panel Survey.

Key findings: High-need adults differed notably from adults with multiple chronic diseases but no functional limitations. They had annual health care expenditures that were nearly three times higher—and which were more likely to remain high over two years of observation—and out-of-pocket expenses that were more than a third higher, despite their lower incomes. On average, rates of hospital use for high-need adults were more than twice those for adults with multiple chronic conditions only; high-need adults also visited the doctor more frequently and used more home health care.

Conclusion: Wide variation in costs and use of services within the high-need group suggests that interventions should be targeted and tailored to those individuals most likely to benefit.

A “Volatile Marketplace”: Second Quarter Earnings Calls Offer Glimpse of How Insurers Are Faring on ACA Marketplaces—and What 2017 Might Bring

http://www.commonwealthfund.org/publications/blog/2016/sep/volatile-marketplace?omnicid=EALERT1094761&mid=henrykotula@yahoo.com

This has been a turbulent year for the Affordable Care Act (ACA) marketplaces. As part of our ongoing efforts to better understand how the post-ACA insurance markets are evolving, we reviewed the 2016 second-quarter (Q2) earnings calls and financial filings of several large, publicly traded insurers that participate on the marketplaces: Aetna, Anthem, Centene, Cigna, Humana, Molina, and United.1  While the picture provided by these calls and financial reports is limited – dozens of other participating insurers are not required to report to investors because of their nonprofit or private status – they can help us better understand some of the trends affecting the marketplaces’ stability, including insurer exits from some health insurance marketplaces and increases in 2017 premiums.

 

Kaiser CEO Bernard Tyson on Balancing Technology and Human Touch

http://www.medscape.com/viewarticle/867711#vp_1

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In this One-on-One with Medscape Editor-in-Chief Eric Topol, Bernard Tyson outlines his remarkable career at Kaiser Permanente, where he advanced from a position in the medical records department to become CEO of the $60 billion-a-year company. He also talks about why the human touch will always be at the center of healthcare, even as technology revolutionizes patient care.

http://www.fiercehealthcare.com/it/how-kaiser-permenente-aims-to-boost-cool-factor-health?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTURka05USTVOV1V5TWpBeSIsInQiOiJSR3lDRUVFXC83UUZQbklYNkpoXC85cUpLWE1FdThtSlhudzFVY2hOWEFSZWVsbnEzTWxRWTdPSDdiRXBpY3BTSDdldG5CazMrZlh3YmU4a3hQOFVkcStGQ2xlR0RsM29tNkZrRHp0UGd1NmdZPSJ9

 

Chris Van Gorder on the changing face of healthcare

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Scripps Health CEO discusses the changing face of healthcare and his hope for the future.

CEO Power Panel: Are your physicians ready for reform?

http://www.modernhealthcare.com/article/20160903/MAGAZINE/309039989?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

Modern Healthcare CEO Power Panel

Like it or not, ready or not, MACRA is coming.

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare’s new payment system for physicians fast approaches. Modern Healthcare’s latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by the law, formally titled the Medicare Access and CHIP Reauthorization Act.

This coming phase will be extremely painful for doctors, CEOs worry, even as they applaud the overarching goal of paying for healthcare on the basis of quality over quantity. They are keenly aware of the near-term challenges of managing these growing pains and of successfully mitigating potential negative consequences. But they are also optimistic—even confident—that patients and physicians stand to benefit in the long run.

Fewer than one-third of ACOs qualify for Medicare bonuses

http://www.fiercehealthcare.com/payer/cms-acos-generated-466m-savings-2015?mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

CMSCMS

Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.

And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.

CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program,” Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.

The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.

The National Association of ACOS “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” Clif Gaus told FierceHealthcare via email, adding, “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”