By George W. Chapman
If insurance companies are investing in or partnering with telehealth companies, then you know telehealth or virtual medicine has arrived. Historically, physicians have been somewhat reluctant to embrace telehealth primarily because of low reimbursement. However several factors are contributing to a change of heart including an aging and less mobile population, consumer preference, improved IT security, the continuing shortage of physicians and value or outcome-based reimbursement from Medicare, Medicaid and commercial carriers. CIGNA and Health Care Service Corporation just invested $50 million with telehealth company MDLive, and Anthem has invested $365 million in Samsung and American Well telehealth companies to make virtual visits available on Galaxy mobile phones. Insurance companies are lowering copays and fees for telehealth/virtual visits to cut into expensive and often unnecessary visits to urgent care centers and emergency rooms. They are focused on providing their members with choice, personalization and affordability.
Three percent of seniors will file for bankruptcy this year, and it is a steadily increasing percentage of all bankruptcies. There are several factors for this: more people are retiring from companies that no longer provide pensions, credit card debt, bad investments, lack of planning and an unforeseen calamity. But the looming reason behind most senior bankruptcies is medical debt. Medicare covers 80 percent of physician claims and some drug costs. A chronic condition, serious illness, accident and out-of-pocket drug expenses can easily wipeout hard-earned savings.
Focus on patients
As the industry transitions to value/outcome based payments, hospitals and physicians are transitioning from being “treatment-centric” entities to “patient centric” entities. Their focus is on attracting, engaging, managing and retaining patients. In order for this to succeed, as patients, we must bear more responsibility for our care. Providers are implementing strategies to make it easier for us to stay in touch, be informed and be proactive versus passive in our care. Patient portals, wearable devices, telehealth, patient education programs, specifically targeted information sent directly to your phone, navigators and digital apps are all there to strengthen the relationship. In addition to a patient focus, healthcare systems must eliminate wasteful practices, many of which were driven by fee-for-service or volume incentives, and rely more on data and analytics to manage their patients and their bottom lines.
Fewer docs feel overworked
According to a recent survey of 3,700 physicians sponsored by two large MD staffing agencies, fewer physicians feel overworked or are considering retiring early compared to just two years ago. While the survey is somewhat heartening, physician burnout is still a serious issue.
• 56 percent of respondents said they feel overworked;
• 55 percent say they have less free time than when they first started practicing;
• 48 percent of physicians said they spend less time with patients now than when they first started;
• 74 percent of the physicians responding said they recognize the signs of burnout in their colleagues;
• 40 percent said burnout effects their job satisfaction and family life;
• Only 17 percent of physicians suffering burnout have sought help.
The study did not attribute the slight “improvement” in results to anything. One reason for the improvement could be that physicians are getting used to and less frustrated with electronic medical records. Many physicians report spending several hours after work and on weekends keeping their records up.
Bigger is better, especially at the negotiating table. In order to get the upper hand at the negotiating table, hospitals are merging with other hospitals while insurers are merging with other insurers. In order to preserve competition and protect consumers from monopolistic pricing, the Department of Justice must approve and then monitor all mergers. While the common justification for both hospital and insurance mergers is cost reduction, it hasn’t always been the case. The DOJ has split apart mergers when the larger hospital or insurer proceeded to take advantage of their newfound clout in the market and raised prices. According to the Commonwealth Fund, 90 percent of metropolitan statistical areas (MSAs) are either “highly” or “super” concentrated provider (hospital) markets and that 54 percent of MSAs were highly concentrated insurance markets. Provider concentration was higher than insurance concentration in 58 percent of MSAs. Premiums have increased and provider choices have decreased across the board for most Americans, not just those covered by the ACA.
A recent article in the Wall Street Journal presented an alarming trend. As the US population grows older, accelerated by aging baby boomers, the age of the average care giver grows younger. An estimated 6.2 million millennials account for 24 percent of unpaid caregivers, averaging 21 hours a week caring for an elderly parent, grandparent or in-law. One-third of millennials are caring for someone with dementia. By 2050, it is estimated that potential caregivers will increase by only 13 percent while those requiring their care will increase by 160 percent. The places a tremendous personal and financial burden on younger generations who are building their careers and starting their families.
Short-term health plans
Under the Affordable Care Act, short-term plans were limited to just three months. They were offered primarily to bridge the time one had to wait until the next open enrollment period. The Trump administration has recently finalized a rule allowing insurers to offer short-term plans covering 12 months and then renewable for two more years. These purported “affordable plans” do not have to cover pre-existing conditions or the essential health benefits that were the hallmarks of the ACA. So buyer beware. According to HHS Secretary Alex Azar, “Under the ACA, Americans have seen insurance premiums rise and choices dwindle.” The problem with that statement is health insurance premiums have risen and choices have dwindled for all Americans. Just ask any employer that pays for most of the premium. The ACA is simply a microcosm of the entire health insurance industry.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.