Sunday, May 22, 2016

Ten Takeaways from Health & Benefits Conferences [#BenefitsConf & #WHCC]


I recently attended the HRE Health and Benefits Leadership Conference in Las Vegas and the World Heath Care Congress in DC. I sat down after the two events and made some notes about what stood out for me. Here are ten takeaways.

Bob Merberg, Fran Melmed and I at the HRE Conference.
One: We Need to Agree on What Matters

There was lots of agreement that we need one set of measures about what creates value and indicates quality. And, agreement that we need good functional level measures for patients too. This is the discussion that kicked off the Health Care Congress and Rajiv Leventhal captured it well in this post, so I won’t try to recap it again here.

Two: Technology is Our Nemesis and Our Savior

I found myself bouncing between feeling optimistic and feeling frustrated. The dichotomy between how technology is being used in diagnosis and how it’s being used for record keeping leaves you shaking your head. On one hand, we have IBM Watson partnering with the American Cancer Society to advise patients and Under Armour to provide benchmarks to athletes and exercisers everywhere. (It was kind of cool to hear about it from Gini Rommety, the CEO of IBM.) On the other, health care systems with multiple EMRs (electronic medical records) that can’t even share patient data across sites.

Three: Consumer Engagement and Customer Satisfaction Are Not the Same Thing and We’re Too Focused on the Latter

All of the major health plans seem to be doing the same research about their members and it’s all telling the same story. Why don’t they just rely on existing studies? Why waste time and resources to document in another way what we already know? Insurers are very focused on communicating with people who are newly enrolled through the exchanges. They’re spending tons of money and time on this. It’s something they typically rely on employers to do. It evidently makes it much more difficult to turn a profit if they have to do it themselves. I wonder if this was a factor in UHC pulling out of a bunchof private exchanges? When the health plans said “consumer engagement” what they meant was “customer satisfaction.” It seems to me they simply want people to opt for their coverage again next year.  

Four: Telemedicine Could be a Real Game Changer in Behavioral Health (Ok, so this a repeat headline from last year, but some things are worth repeating.)

There is still lots of buzz about telehealth. We implemented Teladoc this year after I met them at the World Congress last year. I like that they’re providing behavioral health services. The needs in that space are huge. One in five people have a mental health condition and only one out of every seven people affected gets effective treatment. The average wait time to see a psychiatrist for the first time is 25 days. It’s estimated that 78% of behavioral health visits can be treated via telehealth. And, of course, it breaks down all the challenges of getting to appointments and being seen in a public setting when people might prefer the privacy of their own homes. Some of these services are moving to a subscription model. I’ve seen this in real life and heard about it at conferences. Right now, our health plans don’t allow for reimbursement for these subscription services, it’s something I’m looking to fix. Dermatology care can also be delivered well via telehealth. Snap a picture of a mole or rash and send it off to a doc.

Five: Wellness Initiatives Are More Holistic and Include Financial Health and Caregiver Support

A couple of years ago, the buzz started about financial wellness and it’s still going strong. One of the most interesting conversations I found myself in was with Mike Muller at Common Bond. Common Bond refinances student loans for people at better rates. I had been thinking about doing something for our staff, but my conversation with Mike got me to thinking about this as a member benefit. 70% of graduates have student loans. No surprise, our team that handles membership benefits back at the ASHA National Office was already on it. We’re continuing to explore things with Common Bond. 

We’re also hearing about caregiver support and, no surprise, Fran Melmed has already been exploring this need. She led a panel discussion--Wanted: Elder-Care Support at Work. Two in five employees is juggling work with caring for an aging or ill parent, spouse or sibling. If you are a caregiver, you are two times as likely to have chronic disease or depression. AARP has a ReAct Toolkit that provides resources for working caregivers and their employers.

Six: Solve the Problems We Actually Have (My New Mantra)

I walked away from the HRE conference reminding myself that I need to make sure I’m solving problems we actually have. It sounds kind of silly, but I hear about things, get interested and excited without necessarily starting with a problem I can articulate. In other words, I have a tendency to do things ass-backward.

Ron Leopold did a good session at the HRE conference on making your data tell a story. I returned to this thought at the World Congress event when John Henshaw said, “Big data is the solution, but what is the problem?” I’m working on making our data tell a story. Now here’s a problem I’m certain I have.

We need an integrated digital health platform. I want our staff to have one place to go where all their benefits information is available with a single sign on. Right now, they have to remember to go to UMR to see an EOB or price a procedure using the health cost estimator; Magellan to price a medication or request a refill; VSP to get info about their vision coverage; Guardian for dental coverage information; Health Advocate for disease management support and wellness coaching; Optum Bank if they have an HSA; and BRI if they have an FSA. Big shocker – no one can keep this straight or remember all the different passwords. 

Steve Boese was kind enough to walk me around the exhibit hall at the HRE conference and introduce me to a few vendors. (Gamecocks are kind like that.) By the end of the event, I had a list of 19 companies to check out and had scratched a bunch off the list because they just focus on open enrollment. I find it curious that so many solutions focus on the one week a year people are enrolling in their benefits and so few focus on the other 51 weeks of the year when you’re trying to use what you chose. This remains high on my to do list, so please pass along any suggestions. I’m determined to fix this.

Seven: Wellness Meets Green Living

There was an interesting session on built design and Vegas is the perfect place to have the discussion. Even the carpet in Vegas is designed to confuse your sense of direction and keep you in the casinos. (I heard Gary Loveman, the CEO of Caesars Palace, speak at the World Health Care Congress in 2015. And, I do wish someone with his perspective had been included in the panel.) The panelists, Tama Duffy Day, Joanna Frank and Bob Merberg, pointed out that bad design helped to get us into some of the problems we face with inactivity and good design might be the ticket out. I’m going to be looking into the Well Building designation for ASHA. It might be the perfect project to tackle with our green team.

Eight: We Need to Teach People How to Engage as Health Care Consumers

Ok, so this was the topic of my presentation at the HRE Conference, but smart folks like Jen Benz at Benz Communication are in agreement. Check out their post Simple Ways to Build Better Health Consumers—Now. (And, the blog post I put up before this one.) This came up at the World Congress event too in terms of it being difficult to simplify communication in system that is so complex. And, also on the toll limited health literacy takes. Health Affairs published a whole issue on patient’s use of evidence.

Nine: Don’t Get Too Focused on What’s Happening in Washington -- It’s What We Do Locally That Matters Most

The JAMA study on the impact of wealth on health and mortality was realized during the World Congress event and Ezra Klein, Editor in Chief of Vox.com, talked about it in the closing session. He emphasized that health is primarily influenced at the local level, not on Capitol Hill. This tied right into what I heard during one of the break out sessions about how the health care system relies on local community organizations to provide food, shelter and transportation for their patients and the need for more of this community based, non-medical support. In the Medicare space, 70% of needs are social.

At the HRE conference, Alexandra Drane said, “When life goes wrong. Health goes wrong.” Someone asked, who helps to clean a house that’s been infected with lice? (Ick, not me.) We also heard from Dr. Jim Withers who founded the Street Medicine Institute in Pittsburgh, PA. He told the story of how he started providing care to people in Pittsburgh that are homeless. It was moving and inspirational. All this really caused me to stop and think. I went home that night and volunteered to collect food from the vendors at our neighborhood farmers market and stock our local food pantry with it.

Ten: The Employer Perspective Grounds the Discussion of Health Care in the U.S.

The World Health Care Congress used to have a track for employers. This year, it appears they broke the employers off into a separate conference. I stuck with the Health Care Congress because I like the high level look at health care from diverse perspectives, but found it was missing an important perspective. It’s often the employers that provide a reality check for how things are working and that wasn’t present this year. For example, Joanne Kenen asked a great question about transparency tools that let consumers see cost and quality data and no one on the panel responded – it was like they didn’t get it. An employer on that panel would have had a response. It came up again when there was a panel talking about interdisciplinary care and having mental health professionals in primary care facilities. The reality is that few mental health professionals accept insurance and there are not enough of them. The discussion never touched on these issues. Employers help separate fantasy from reality. I hope they go back to including employers next year. 

Monday, March 28, 2016

10 Behaviors of An Engaged Healthcare Consumer Infographic

Just in time for my presentation at the HRE Conference in Las Vegas, I'm introducing my first infographic -- Ten Behaviors of An Engaged Healthcare Consumer. Practicing these ten behaviors will assure you receive the best and safest medical care. 

Unfortunately, few people have the knowledge necessary to successfully navigate the healthcare system and get themselves and their loved ones quality care when they need it. In most organizations, healthcare is the second-largest expense — second only to salaries — yet most employers don’t teach people how to get the most out of their investment. Employers implement consumer-driven health plans to encourage employees to behave as consumers, but until now no one had defined the behaviors an engaged healthcare consumer demonstrates, so employees don’t understand what they’re being asked to do. I've been on a journey to educate people to be more healthcare savvy and I hope to inspire other employers to do the same. 

You can view my presentation on Haiku Deck. I'm still putting the finishing touches on the slide notes, but they'll done before my presentation on Wednesday. I've included links to some useful studies and resources. 

Many thanks to Samantha Allen for developing this infographic with me. And, many thanks to all those who contributed to defining the behaviors. I'm eternally grateful. 

Tuesday, March 22, 2016

A Clear View of Our Own Data


The first time I loaded the Moves app onto my iPhone and looked at it, it creeped me out. I promptly deleted it from my phone. Then, I realized the app was just allowing me to see data that already existed and could be accessible to others. I thought, "Why shouldn't I have a clear view of my own data?" I downloaded Moves again. Maybe it's more cool than creepy. 

This seems to be a trend as our society moves toward greater data transparency. Now I can log onto my electronic medical record at my doctor's website and see her notes about my visit. I can log onto UMR and see information about all my health claims. I can create an account on Magellan RX and see every prescription I've filled. My credit union account shows every banking transaction I've made. And, the Fairfax County Government site shows all my tax payments right down to the $10 licenses for our dogs.

This week we rolled out a new human resources information system that integrates payroll. Staff can now see their salary, social security numbers, date of birth etc... ASHA has always had this information that's required to employ us, but now we can see it too. I think this fits with our organizational value of being transparent and I like that each staff has a clear view of their own data. Some folks were concerned about security, but once our IT Director assured us that our information is appropriately protected calmer heads prevailed. 

Our staff will have the same experience when they log into Health Advocate for the first time and see their personal health dashboard. It includes key information about benefits use and specific health indicators. Will they find it cool or creepy?



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Thursday, March 10, 2016

The Dark Art of Prescription Drug Pricing

Have you wondered how prescription drug prices are set? I attended a pharmacy seminar with Mike Zucarelli, a pharmacist and the National Pharmacy Practice Leader for CBIZ, to learn more this morning. Mike shared the chart in this image that illustrates how the money flows between drug manufactures, pharmacy benefit management companies, employers as plan sponsors and us as consumers or beneficiaries. No wonder I'm confused!

The incentives are crazy and unknown to most of us. Drug manufactures pushing off-label drug use -- doctor's prescribing medications for uses that have not been approved or proven to work. Insurance companies providing incentives for doctors to prescribe certain classes of drugs. Pharmacy benefit management companies negotiating rebates (aka kick backs) from drug manufactures not just based of the volume they purchase, but to take a competitors drug off the formulary. 

Folks at CBIZ referred to pharmacy benefit management (PBM) pricing as a dark art. If that's the case, Mike may be Harry Potter. Our relationship with CBIZ is new. Zack Pace is now ASHA's broker and he's put together a great team for us that includes Mike. We definitely need someone with his expertise to help us get the right drugs to the right people at the right time for a fair price. 

Mike recommended this John Oliver video on Marketing to Doctors. Watch it and you'll have a better sense of the warped incentives in prescription drug dispensing and pricing. I promise you'll be entertained -- probably horrified too. And, check out openpaymentsdata.cms.gov to see the payments your doctors received from pharmacy companies.    





Wednesday, February 17, 2016

More Commonly Used Medications (PPIs) Linked to Dementia


See PPIs listed by NIH
We're bombarded with news about drug safety issues and it's easy to tune out. The last thing I read could impact a lot of folks I know--and a lot of ASHA staff--so I want to point it out. There was a study published in JAMA on February 15 linking dementia in older adults to the use of proton pump inhibitors like Nexium which is now available over the counter. Last year, it was anticholinergic drugs, including popular non-prescription sleep aids and the antihistamine Benadryl, and increased risk of developing dementia. This is scary stuff. 


Tuesday, February 2, 2016

10 Behaviors of an Engaged Healthcare Consumer


In the health and wellness arena, everyone talks about engaging consumers, but are we clear about what we're asking people to do? As far as I am aware, no one had defined the specific behaviors an engaged healthcare consumer demonstrates, so I crowd sourced a definition. This has been months in the making. Many thanks to everyone who contributed. Now, drum roll please... 


10 Behaviors of an Engaged Healthcare Consumer

An engaged healthcare consumer...

  1. Has a primary care physician who is a partner in managing his or her health—with scheduled visits as recommended, whether for regular follow-ups for existing conditions or according to the age-related recommendations for prevention by sources such as NIH
  2. Asks the 5 questions recommended in the Choosing Wisely campaign before getting any test, treatment (including taking a medication), or procedure and carefully considers all options before deciding among them:
    ► Do I really need this test or procedure?
    ► What are the risks?
    ► Are there simpler, safer options? 
    ► What happens if I don't do anything? 
    ► How much does it cost?
  1. Reviews hospital safety data—from sources such as Hospital Compare - Leapfrog, Hospital Quality Ratings - CareChex, and Surgeon Scorecard—before deciding where to seek care.
  2. Actively monitors and tracks personal health indicators like weight, as well as any indicators related to existing conditions such as high blood pressure or diabetes.
  3. Maintains a list of medications taken and shows it to medical providers when seeking care, and keeps the list up to date in electronic medical records. 
  4. Makes day-to-day decisions that support good health and takes any medications as prescribed and instructed.
  5. Develops a personal/family budget to manage healthcare expenses.
  6. Uses available tools to make cost-conscious decisions.
  7. Has an income-protection plan (e.g., short-term and long-term disability coverage) to rely on in case of an injury or illness that makes working impossible or limited. 
  8. Has an advanced healthcare directive that has been discussed with family members.

Monday, January 25, 2016

How to Clean Your Dryer Vent

Snowzilla 2016
Snowed in? Use the time at home to clean your dryer vent. When we got a new washer and dryer, I was shocked at how much lint was in the vent tubing. According to the U.S. Consumer Product Safety Commission, more than 15,000 fires are sparked every year by clothes dryers. 

First, make sure your vent to the outside is clear and not blocked by snow. Then, follow this step-by-step guide for cleaning out your dryer vent.

And, just in case, don't forget to clear the snow from around the fire hydrant in your neighborhood.