Seasons come and seasons go. Yes, in healthcare, too. We’ll open this week’s HOT Health Wonk Review looking at an enduring issue as Roy Poses of Health Care Renewal very nicely summarizes pharmaceutical marketing tactics and their effect on physicians and patients as it pertains to opiates. Some practices just keep coming around again.

Hope in a Bottle: Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee

The return of the good old days, sort of: a legal filing from the Tennessee Attorney General’s lawsuit against Purdue Pharma revealed multiple internal Purdue documents showing elements of the company’s stealth marketing campaign for Oxycontin.  These included: implied psychological manipulation of vulnerable physicians; perverse incentives for sales representatives; and use of third-party strategies (including creation of “astroturf” organizations) and miscellaneous deceptions.  More awareness and better understanding of such integrated, but deceptive marketing campaigns enables better resistance to them, and hence hopefully better professional decision making leading to better patient outcomes.  Previous stealth marketing campaigns have been revealed through litigation by the US government.  The Trump administration seems uninterested in pursuing corporate health care’s bad actors, but at least the baton has now been picked up by some state law enforcers.  Read more from Roy here.

While We’re Talking about Opioids…

Louise Norris of HealthInsurance.org tells us this year there has been an abundance of discussion about our national opioid abuse crisis and about strategies for addressing that challenge. But was the Affordable Care Act already helping address that crisis? Louise looks at how that ACA improved mental health coverage – including dramatically expanded access to additional treatment in some of the states hardest hit by the opioid crisis.

#CareTalk Podcast: Wry Healthcare Commentary with David Williams and John Driscoll

Podcast time, today our hosts David Williams and John Driscoll opine about the Right to Try law. “A great impulse and a dumb law,” says Carecentrix CEO John Driscoll. David Williams of Health Business Group agrees, “Right to try…who could argue with it, but it is a pretty cynical law.” It is redundant with compassionate use, and just removes the FDA to “take the smartest people out of the way,” says John. Lots of good stuff here as they look at a few other ways politics uses healthcare as a football. Watch, listen, learn right here.

High Deductible Health Plans: A Blunt Instrument that Doesn’t Work

High deductible health plans don’t work, so says Joe Paduda of Health Strategy Associates. Hear about why Joe calls high deductible plans “the bluntest of instruments” that has lots of nasty side effects and doesn’t reduce costs or improve care. Joe wonders “why the health plan industry is still selling these crappy plans.” Read more at Managed Care Matters where Joe talks about the ill effects of this health plan variant.

Much Ado About a Rounding Error? Looking at Sharing Ministries

Henry Stern of Insureblog channels Shakespeare while he questions if the faith-based ACA-compliant alternatives to ObamaPlans – now topping 1 million members – are such a good idea for people who need the assurance and reassurance of insurance or reinsurance. He’ll explain it all at this link.

Exploring Ethics: Is the Cost of Dying Worth It? Research Says Yes

Jason Shafrin at the Healthcare Economist asks if we are spending too much on end of life care and puts a new spin on the answer backed by research. He says we recognize that end of life care is expensive.  Conventional wisdom holds that we are spending too much on end of life care and we should just let people die at home in peace with hospice.  If only things were so simple.  The Healthcare Economist reviews new research that shows that end of life healthcare interventions may, in fact, by worthwhile. Paddle over to Jason’s blog at this link for a good discussion on an important topic.

Brush Up on Your Latin: Quo Vadis, Kentucky?

Tom Lynch of Workers’ Comp Insider recently attended a forum where he heard a presentation on the work requirements for Medicaid beneficiaries, a program called Kentucky HEALTH. Tom offers his perspective on the plan. It should be noted that a federal judge subsequently ruled the plan unlawful, but three other states are still developing plans for work requirements and other states are waiting in the wings. And this entire issue begs the question, where are we going, America? Is healthcare a right for all or privilege for those who can afford it? Tom kicks this football around a bit – on his private beach right here.

So now it’s time, dear Wonkers, to kick back, read the healthcare blogs and enjoy this summer day.

Photo by Anton Karatkevich on Unsplash

“Beware the Ides of March” –Soothsayer to Julius Caesar
“Fear not the Ideas of March” –Health Business Blog to the wonkosphere

Your friendly neighborhood drug dealer

Count on Drug Channels to make sense of even the most convoluted pharmacy business models –and convoluted they are. This time the topic is the emerging trend of point-of-sale (POS) rebates. Did you know that many pharmacy benefit plans act like reverse insurance, with the sickest members subsidizing the healthiest? POS rebates start to right this wrong and bring forth uncomfortable questions such as: Where have the rebates been going until now?

Crocodile tears

Managed Care Matters shares its perspective that the Administration’s efforts to undermine the ACA have yielded bitter fruit on the marketplaces. Some premiums are up by 30% and meanwhile Congress is doing little or nothing.

Two years ago you couldn’t read the news without hearing about the disastrous premium increases due to “Obamacare,” but the media is silent now.

So what’s going on? Our blogger has a theory: The media is being manipulated and chasing bright, shiny objects.

Skimpy is as skimpy does

InsureBlog likes CMS’s proposal to restore the maximum policy length of short-term medical plans to 12 months from three. That’s even though some news outlets call the plans “skimpy” and some healthcare policy analysts consider such plans to be leeches on Obamacare, because they may siphon the healthiest people out of the marketplace risk pool and drive up premiums.

Location location location

When my son was a toddler, we trained him to say “location location location” when asked, ‘what are the three most important things about real estate?’ I still remember him driving a realtor crazy when one tried to pitch us on a house we didn’t like.

Now, Workers Comp Insider has decided that location is destiny in healthcare, too, declaring ‘It’s the Zip Code Stupid.’ Insider cites a recent JAMA Internal Medicine study that shows geography is “the biggest X-Factor in today’s American Hellzapoppin version of healthcare.”

Location: Wonk zone

The Hospital Leader (not to be confused with the Dear Leader) helpfully explains that “We need creative solutions” really means “the problem we are trying to solve has no answer.” Case study: Hospitals, hospice and SNFs – The big deceit.

A pending bill seeks to establish a state-based individual mandate in New Jersey. But a provision targeting employees of small businesses could inhibit Association Health Plans from selling insurance that does not comply with small group rules. Xpostfactoid explains.

Who knew? Health Care Renewal informs us that the ostensibly libertarian Washington Legal Foundation has become a front for healthcare corporate leaders –and leaders from other fields— to operate with impunity. The foundation’s campaign to abolish the Responsible Corporate Officer Doctrine failed, but the damage was done. (Hat tip to Health Care Renewal for anticipating today’s theme by including “methinks” in its cover note.)

Local talent

The Health Business Blog is now a teenager. I ran the annual round-up of favorite posts by month.

CareCentrix CEO John Driscoll and I rant and rave about Amazon and innovation in the latest monthly episode of #CareTalk.

Singing from the himmnal

Health System Ed shares results from the 2018 US HIMSS Leadership and Workforce Survey, a survey of providers and vendors.

Top themes: privacy and security, process improvement and workflow, data analytics, business intelligence to inform clinical decision-making remain top of mind. 

Well that’s it for the Ideas of March edition. Watch your back today!

—

By healthcare business consultant David E. Williams, president of Health Business Group.

Here’s Joe:

“Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!”

Thanks much for kicking off the new year, Joe!

Julie Ferguson at Workers’ Comp Insider is our creative mistress of ceremonies this week. Here’s what she has to say:

It’s quite the day to be going to press with a new Health Wonk Review. We were trying to think of  a movie themed metaphor for today’s edition but can’t decide between Back to the Future, Groundhog Day or a zombie flick, so we’re going for a mashup.  Click here to read more.

I also want to add my mea culpa that I have not been a good corporate HWR citizen and contributed lately. Writer’s Block? Actually, it’s been Writer’s Overwhelm…there is just so much I am still figuring out where to start. In the meantime, let’s all be thankful that the HWR crew remains faithfully on the job.

We live in a technology-driven world so no matter how we feel about it, that train has left the station. The potential of technology will continue to improve our ability to monitor our own health and for providers to cure disease. Admittedly, some of it is expensive but much of it, such as personal wearables, are inexpensive and allow patients to self-monitor. We all have friends and family who track the number of steps they take every day.

The wellness movement is another trend that is making a difference in the cost and effectiveness of the care we provide. This week I saw an interview with a leading light in the wellness movement, Dr. Mark Hyman, who is the founder of the Cleveland Clinic’s Center for Functional Medicine in which he discussed the fact that people’s health status is most heavily influenced by the health status of their friends. He talked about the implication of this finding for population health.

Dr. Hyman’s main message is that the food we eat is the key driver to our health. He is behind movements to change the way people eat and focuses on implementing the social supports around their habits. On the one hand, his message is not new or revolutionary. On the other, as our country faces a way to pay the health bill for an aging and chronically ill population, perhaps these messages will begin to make serious inroads in the public consciousness.

As we look at a possible post-ACA world, perhaps the discussion can revolve around health and health care, and move away from health insurance. When we squarely face the unsupportable cost of our healthcare system,  that may be the trigger for us to reframe what we actually seek – health or a way to pay for healthcare products and services that we may not need in such great amounts if we change the way we live.

In this week’s health policy roundup, Brad Wright posts Health Wonk Review: The Game 7 of Politics Edition  at Wright on Health. His post skillfully ties two of America’s favorite and most contentious pastimes together: sports and politics. Something here for everyone.

And next Tuesday, don’t forget to “Play Ball!”  

An educated populace is the bedrock of a sober and productive small “d” democratic society. Our Health Wonk Review contributors are doing their part to keep democracy alive. Let’s start by reading this positive post by our friends at Health Affairs about  opportunities for continued progress in the U.S. health care system that are not necessarily dependent on the outcome of the election.

Health Affairs Blog this week discusses What Bipartisan Opportunities Will the Next Congress and President Have to Improve Health Policy? by Anand Parekh, Ashley Ridlon, Katherine Hayes, Janet Marchibroda, Lisel Loy and William Hoagland of the Bipartisan Policy Center. In it, we learn that while larger ideological questions divide the two major parties regarding whether the Affordable Care Act should stand and how payments for programs should be structured, voters across party lines may still look forward to progress on issues that directly affect the quality of patient care such as the move to value-based care, the steady advance of technology, and the emergence of care coordination. The article’s introduction tells us that “there will be several potential opportunities for bipartisan agreement to further advance the health of the American public” and concludes, “Whether the political will exists to reach across the aisle and work together remains to be seen. If so, bipartisanship may very well contribute to having a positive impact on the nation’s health.”

Technology: The Promise and the Dark Side

Julie Ferguson at Workers Comp Insider also brings some heartening news on the potential for catastrophically injured workers to be enabled with new functionality via exciting new assistive technologies. See her post Cyborgs and Workers Comp where she defines the term “cyborg” to orient her readers to the promise of technology: A cyborg (short for “cybernetic organism”) is a being with both organic and biomechatronic body parts.

More on the promise of technology as David Williams asks Is Radiology Doomed? In this article, David explains that captured radiologic images may be delivered directly to the patient record completely bypassing a human radiologist. That prediction begs the question: Is machine learning going to replace radiologists? He says, “Eventually yes, unless radiologists figure out how to be diagnostic quarterbacks.”

Next, Roy Poses tells us that not all wonder drugs are all that wonderful. In his entry at Health Care Renewal, Not So Wondrous Drugs: New Warnings about Severe Adverse Effects of New, Heavily Marketed Drugs for Hepatitis C, Roy digs down into the clinical trial data of recently approved Hepatitis C cures. Roy discusses whether trial results really support claims for pricey and highly-touted Sovaldi. He concludes saying, “The skepticism [evidence-based medicine] should engender could lead to health care that is more about patients and their outcomes, and less about hype ideology, hype, and hucksterism. If only such skepticism were easier to find.”

Speaking of Evidence-Based Medicine

Another blogger this week is also questioning the evidence, or lack of same, from another quarter, and that is the legitimacy of a 30-day readmission rate as a quality benchmark for hospitals. In The Hospital Leader, Brad Flansbaum shows us data that reveals a hospital’s influence on a patient’s post-discharge condition falls off a cliff after about a week, at which point the readmission rate is influenced far more by factors outside the hospital’s control. Read more as The Hospital Leader considers ways this issue can be handled to the advantage of patient outcomes and a hospital’s liability for them.

Paying for Care – Proven and Unproven

You’ll never know whether a treatment works if you can’t pay for it. Several bloggers this week turn their attention to whether the nation’s Affordable Care Act is, indeed, affordable.

Hank Stern at Insure Blog submitted a blog written by his colleague Patrick Paule that looks at a shell game where taxpayers funded a non-profit health plan to participate as an Obamacare co-op in the state health exchange to the tune of $65 million under the condition that it remain a non-profit. However, as one of the few co-ops that have remained standing – albeit on wobbly legs – it just announced its acquisition by a private equity group and conversion to a for-profit entity – moves that create a dilemma for the Obama administration. Read details here about this political sticky wicket that catches 38,000 patients in its grip.

Another blogging HWR regular, Louise Norris, also digs into a detail of the ACA that snags another small subset of patients. In this two-part series at Healthinsurance.org , Louise analyzes the data on who is actually impacted by rising insurance rates. She concludes that while rates are going up, only a small sliver of the U.S. population are “being crushed by rate increases”. For those who are part of the non-subsidized, median-income crushed, she offers advice for dealing with premium hikes.

In a separate blog at Health Insurance Colorado , Louise Norris tells readers that while Colorado rates are rising an average of 20 percent for the combined subsidized and unsubsidized individual markets, the people of Colorado will be getting more for their Obamacare premiums. Specifically, benchmark plans for 2017 will include chiropractic care, bariatric surgery and fertility treatments.

Back to the Voting Booth

We will wrap up this edition of Health Wonk Review by revisiting the voting booth. Our contributor, Shalvi Prasad, writes for Health Access: California’s Health Consumer Advocacy Coalition asking readers in California to push the lever for Proposition 56 that would add $2 to each pack of cigarettes to fund smoking cessation programs and boost funding for Medi-Cal. Find details on Prop 56 in Health Advocates Protest Big Tobacco’s Lies at Health Access.

And don’t forget to eat your peas!

“At Lemonade…their hope is to remake insurance as a social good, rather than a necessary evil.” – Dr. Peter H. Diamandis

The structure of ObamaCare® requires people who don’t have health insurance to purchase it; if you can’t afford it, the government will subsidize your payments. If you don’t sign up, you pay a penalty. If you wait until you are sick, you can sign up and your bills get paid. This system turns traditional actuarial science on its head because the insurer can’t reject applicants – all comers are in – so the insurer has no control over its insured pool.

Insurance of all sorts is based on predictive analytics derived from retrospective data. Experience would suggest that if you have run a bunch of red lights and have a drawer full of speeding tickets, that you are a higher risk to insure for a car accident than someone who drives the speed limit and obeys all the laws. Based on retrospective data, the car insurance company can make predictions about your future behavior and the amount of risk that it is assuming by issuing you a policy.

But what if a car insurer – or health insurer – could track your behavior in real time, perform some predictive analytics based on the collected data, and generate a premium based on that real-time data?

Ah, the Joy of Data

Our man at Singularity University  and Human Longevity Inc., Peter H. Diamandis, MD, is exploring what he describes as the “demonetization of insurance.” In an email last week, he described a new insurance model that is already in practice in homeowner’s insurance and the effect it will have on health insurance in the future.

The future of healthcare is about real-time data collection, analysis and informed action.  His concept takes the value of informed decision making to its logical conclusion.

Where Health System Ed imagined just a few years ago that the collection of health data from the universal set of all patients – and the resultant best practice clinical protocols – would reside in a big electronic patient record database to determine the best course of action during a single encounter, technology galloped ahead of that concept. The proliferation of personalized health information and tracking devices appears to allow patients to go straight to self-management of disease. It also goes straight to self-determining your health insurance risk to create your own risk pool.

Whaaattt???

Here are excerpts from Dr. Diamandis’ September 26 email where he describes Lemonade Insurance Company   in New York State – a peer-to-peer homeowners’ insurance company that is making the traditional insurance model obsolete. Lemonade isn’t just an insurance company; it is a non-profit organization with a humanitarian mission.  It’s worth reading through his description of the homeowners’ and car insurance concepts because when you get to the upshot, the application to health insurance will be obvious.

Dr. Diamandis:

…I have been advising and am a proud board member of a new company called Lemonade Insurance Company that is rebuilding the insurance model from the bottom up — it is the world’s first “peer-to-peer” (P2P) insurance company.

Imagine just 90 seconds to get insured, 3 minutes to get paid. Zero paperwork.

P2P reverses the traditional insurance model. They treat the premiums you pay as if it’s your money. With P2P, everything becomes simple and transparent. Lemonade takes a flat fee, pays claims really fast, and gives back what’s left to causes you care about.

This week Lemonade launched their service and announced that they’ve been licensed as a full-stack insurance carrier by New York State for homeowner and renter’s insurance…

Fraud consumes as much as 38% of all the money in the traditional insurance system, inflating premiums by $1,300 and making the claims process protracted and unpleasant.

This happens because there is a lack of transparency in a largely analog (rather than digital) system with many humans in the loop.

If you could digitize the entire process – from signing up to submitting a claim – and give the insured individual full transparency over the status of their request, adding in automation and machine learning, you can dramatically reduce processing time and costs.

This is what Lemonade does at its core. “Technology drives everything at Lemonade,” said Shai Wininger, president and cofounder. “From signing up to submitting a claim, the entire experience is mobile, simple and remarkably fast. What used to take weeks or months now happens in minutes or seconds. It’s what you get when you replace brokers and paperwork with bots and machine learning. Zero paperwork and instant everything. . .

Imagine finding a group of peers, who you trust and can vouch for, and coming together as a group to self-insure.

You skip the centralized, expensive middleman insurance carrier – instead, a technology stack (app, database, AI-bot) manages a decentralized network of people who pay premiums and file claims that the group approves.

This takes out an enormous percentage of the cost structure of traditional insurance. Instead of paying fees and insurance company salaries, your peer group will be able to decide what to do with the extra cash that wasn’t paid out.

At Lemonade, you actually have the option to donate underwriting profits to nonprofit organizations of your choosing. Their hope is to remake insurance as a social good, rather than a necessary evil. . .

When talking about life insurance, it’s going to be difficult to ignore genomic data. Your DNA is your medical future. It’s predictive of what’s likely to inflict or kill you…It’s in their best interest to do so. [Click here to see Health System Ed blog on Human Longevity Inc.] You’ll be able to upload your genomics data and find others in your peer group that have similar or better risk profiles than you do…

For life insurance companies, I believe there is a beautiful alignment of incentives coming soon. These life insurance companies will use genomics information to help their clients stay alive longer.

Why? Because the longer they are alive, the more premiums they can pay…

Sensors will allow insurance policies to be based on actual data (e.g. usage, health), rather than general heuristics and rules. As an analogy, check out Progressive Insurance’s SNAPSHOT Automotive Sensor package – it’s a sensor you put in your car that tracks how well you drive. (Do you brake hard? Speed? Take high-speed turns?)

When your insurance policy is based on how you actually drive, rather than just your age, gender and what kind of car you own, safer drivers win.

Sensors will have the biggest impact on health insurance, as hundreds of new health sensors are coming to market in the next 5-10 years.

Sensors tracking healthy behavior such as how much you exercise and what you eat, will get you low insurance costs…

In the near future, with the peer-to-peer model, you’ll soon upload everything from what you eat to the number of steps you take per day, and find a group with similar health profiles and self-insure.

Thus spake Dr. Diamandis. The pace of innovation just may outrun our problems.

What do you think?