by Renzo Luzzatti | Jan 22, 2020 | Health care costs
One of the fastest growing parts of the health care system, and which touches significantly on group health plans, is telemedicine.
From 2016 to 2017, insurance claims for services rendered via telehealth ― as a percentage of all medical claim lines ― grew 53% nationally, faster than any other avenue of care, according to “FH Health Indicators,” a white paper published by the nonprofit FAIR Health.
Telehealth uses technology to provide remote care via video conferencing and other means and is proving to be more and more effective, especially for time-pressed individuals or people who live in rural areas where patients often have to travel great distances for care.
Elderly patients especially find it useful, since it eliminates the need for transportation.
But as telehealth gains traction, the focus is shifting away from the novelty of connected devices and new technology and more toward providing patients with top-notch care ― and giving providers, physicians and nurses alike the power to deliver it effectively. As it evolves, it is also a promising new trend in terms of reducing health care delivery costs.
Telehealth can reduce the cost of care by eliminating the physical barriers that prevent patients from managing their health. As more patients take advantage of digital services like remote patient monitoring, automatic appointment reminders, and remote physician consulting using live video and audio, patients can use these services to reduce the cost of care and improve their chances of early detection.
And that can reduce your overall group health plan costs, as well as out-of-pocket costs for your employees.
Tech firms are coming up with more efficient ways for patients to communicate with their doctors that save time and money, and reduce liability for doctors as well. For example, more and more health care practitioners are adopting an online patient portal as a direct link between the patient and the doctor.
Doctors, patients embrace online portals
The portal can easily be password-protected for each patient and streamline routine interactions from appointment-setting to refilling prescriptions ― and everything in between.
For example, when it’s time to get a prescription refilled, the patient simply makes a request to his or her doctor, via the patient portal or even via a cell phone or tablet app that can be proprietary to the practice. The doctor checks the dosage and approves the request in a few clicks, and in seconds the information is sent directly to a pharmacy so the patient can pick up the prescription.
The patient doesn’t have to get the doctor on the phone or bug the staff for a moment with the doctor, and the doctor doesn’t have to do additional paperwork or get on the phone with the pharmacy to call in the prescription after already having spoken with the patient on a separate call. The result is tremendous time savings ― and ultimately, cost savings for both the doctor and patient.
Online portals also facilitate communication between doctors and patients between appointments. If a patient has a question or clarification that does not warrant an additional office visit, the doctor or staff can quickly respond in an instant, without playing phone tag, and without having to route calls to busy doctors who can’t always be on the phone.
Physicians can also leverage these portal technologies to send lab results and images directly to the patient using a secured and encrypted link, and to make clinical summaries easily available online. When the doctor adds new information to the file, such as a lab report, the portal system can be programmed to automatically send an e-mail alert to prompt the patient to log onto the portal.
For all the technology though, we still have a way to go in implementing it. According to a recent study in the Journal of General Internal Medicine, 57% of respondents said they want to use their doctor’s website to review their medical records, but only 7% of those polled reported having made use of that technology to access their own information online.
A study from the Annals of Internal Medicine found that 77% to 87% of individuals who used their physician’s portal to open at least one note, and who completed a post-intervention survey, said that the process helped them be more in control of their health care.
by Renzo Luzzatti | Jul 23, 2019 | Uncategorized
The heat is growing on the pharmaceutical
industry after more than 40 US states filed a lawsuit accusing generic drug
makers of engaging in a massive price-fixing scheme.
The lawsuit accuses 20 companies of conspiring
to fix prices of more than 100 generic drugs, including some that are used to
treat cancer and diabetes. The defendants include the largest producer of
generic medicine in the world: Teva Pharmaceuticals.
The new lawsuit comes after a five-year investigation that uncovered a scheme through which “coordinated price hikes on identical generic drugs became almost routine,” according to an investigative report by the Washington Post. The suit covers the period from July 2013 to January 2015.
The
companies and executives would “routinely communicate with one another
directly, divvy up customers to create an artificial equilibrium in the market”
to keep generic drug prices artificially high, the lawsuit says.
The scale of the alleged collusion was summed up by Joseph Nielsen, an assistant attorney general and antitrust investigator in Connecticut, whose office has taken the lead in the investigation: “This is most likely the largest cartel in the history of the United States,” he told the Washington Post last December.
In
announcing the recent lawsuit, he cited e-mails, text messages, telephone
records and testimony from former company executives that indicate a “multi-year
conspiracy to fix prices and divide market share for huge numbers of generic
drugs.”
This
is not the only litigation. Pharmacies and other businesses have filed their own
lawsuits against the generic drug makers. One such suit documents huge price
hikes – like a 3,400% increase in the price of an anti-asthma medication – and
investigators believe that generic drug producers colluded to raise prices in
tandem or not make their products available in some markets or through specific
pharmacy chains.
Significance of the states’ suit
The multi-state lawsuit is important because
generics account for 90% of pharmaceutical spending in the U.S. Despite that, they
only account for 23% of the total drug spend in the country, according to the
Association for Accessible Medicines.
With so many prescriptions being written, the
savings to consumers could be huge if the drug makers are found to have fixed
pricing and they subsequently change their ways. What’s not clear, though, is whether
it would actually spur changes in pricing by the companies.
According to the lawsuit, the drug companies
allegedly conspired to manipulate prices on dozens of medicines between July
2013 and January 2015.
It accuses Teva and others of “embarking on
one of the most egregious and damaging price-fixing conspiracies in the history
of the United States.”
Connecticut Attorney General William Tong,
who filed the suit, said the investigation had exposed why the
cost of health care and prescription drugs was so high in the U.S.
by Renzo Luzzatti | Jul 16, 2019 | Uncategorized
As more people struggle with their medical
bills, Congress has been introducing a raft of new legislation aimed at cutting
costs and making pricing more transparent.
The multi-pronged, bipartisan effort targets
the lack of transparency in pricing particularly for pharmaceuticals, as well
as surprise medical bills that have left many Americans reeling, and there are
also other efforts aimed at reducing the cost burden on payers: the general
public and employers.
And since consumers are affected regardless
of their political affiliation, congresspersons are reaching across the aisle
to push through legislation to address this crushing problem.
There are several draft proposals, but word
is a number of bills are expected to be introduced soon.
Surprise medical bills
One of the top priorities seems to be
surprise medical bills, which are in the administration’s crosshairs. President
Trump in January 2019 hosted a roundtable to air the problems people face when hit
with what are often financially devastating surprise bills after they venture
out of their network for medical services for both emergency and scheduled
medical visits.
After the roundtable, he directed a
bipartisan group of lawmakers to create legislation that would provide relief.
The House Energy and Commerce Committee in May responded by introducing draft
legislation that aims to ban surprise medical bills.
Also, Sen. Maggie Hassan (D-N.H.) and Sen.
Bill Cassidy (R-La.) have said they hope to introduce legislation to end the
practice of surprise bills. With the White House and both sides of the aisle
talking the talk, observers say that there are a number of ways legislation could
tackle these surprise bills. That could include:
- Setting caps on how much hospitals
and service providers can charge, or
- Requiring hospitals and service
providers to turn to the insurance company (and not the patient) when they are
seeking additional reimbursement.
- Requiring the insurer to share
more of the cost burden for the out-of-network services.
At this point legislation is still being
formulated, but chances are good that we could see a bipartisan push to fix
this problem. The biggest issue will be how to calculate what are “reasonable”
costs for out-of-network services.
Pharmaceutical costs, transparency
The Trump administration has also made it a
priority to reduce the costs of medications and tackle pricing transparency in
the system.
While both Republicans and Democrats have
decried the skyrocketing costs of prescription medications, the inflation for
which is outpacing all other forms of medical care, so far there has been only
one piece of legislation introduced tackling transparency.
Unfortunately, it’s part of a larger bill
that aims to preserve the Affordable Care Act and reverse some recent policy
decisions by the Trump administration, so the chances of that measure going
anywhere in the Senate are slim to none.
The good news is that members from both
parties have been talking about cooperating on legislation, and political
observers say the chances are good some type of measure will be introduced this
summer.
Other costs
Sen. Ron Wyden (D-Ore.) in February introduced
legislation that would require insurers to tell people what they would have to
pay out of pocket for any in-network treatment or prescription drug.
On top of that, the Senate Health Committee
will soon introduce a number of bills aimed at reducing frictional costs in the
system.
In addition, the Senate Finance and
Judiciary committees are both in the process of formulating measures aimed at
reducing health care costs, as well as prescription drug prices.
by Renzo Luzzatti | Jul 15, 2019 | Uncategorized
Retail prescription drug spending grew 36% over the four-year period ended Dec. 31, 2016, but out-of-pocket spending for health plan enrollees remained steady, according to a recent study by the Pew Charitable Trusts.
The study, “The Prescription Drug Landscape, Explored,” found that patients are covering the lion’s share of the cost through higher premium outlays, while large pharmacy benefit managers are passing on a larger portion of the manufacturer rebates they receive to insurance plans.
The study found health plan enrollees have largely been sheltered from rapidly rising drug costs due to:
- More of the health insurance premium being dedicated to pharmacy benefits. The percentage of health insurance premiums allocated to pharmacy benefits increased to 16.5% in 2016 from 12.8% in 2012.
- Policies that cap out-of-pocket expenses.
- Cost-sharing assistance from manufacturers (like Medicare Part D coverage gap discounts and copay coupons).
Overall health retail prescription drug spending grew to $341 billion in 2016 from $250.7 billion in 2012. Here’s who spent what:
Patients: $103.8 billion – This includes the percentage of the premium they pay that goes towards drug benefits, in addition to out-of-pocket spending.
Employers: $97.5 billion – The premiums that employers pay that go towards drug benefits.
Government: $139.8 billion – This is both federal and state spending on retail drug coverage through Medicare Part D, Medicaid fee-for-service, and the share of premiums for retail drug coverage in Medicaid managed care.
Employers have grown increasingly concerned by the rapidly increasing cost of medications and the effect on the premiums they and their employees pay.
The National Business Group on Health in 2018 surveyed 170 large employers and found that:
- 14% said the pricing and rebate system needed to be more transparent,
- 35% said rebates needed to be reduced,
- 50% said the pharmaceutical supply chain was inefficient and too complex and needed to be overhauled and simplified.
- 56% said rebates were not an effective tool for helping drive down costs.
- 53% said rebates did not benefit customers at the point of sale.
Tackling drug costs
The National Business Group study also looked at what employers are doing to combat drug costs, including:
- Adopting recently developed capability by pharmacy benefit managers to pull rebates forward at the point-of-sale to benefit consumers.
- Implementing point-of-sale rebates to benefit the enrollees.
- Educating employees about the value of buying generic, so they can save money for you and themselves. According to the Federal Drug Administration, generic medications save more than $150 billion annually.
- Half-tablet programs – These programs aim to reduce the number of tablets participants consume, while still receiving the same strength of the medication. For instance, individuals might need 15 milligrams of daily medication, so they receive a prescription for 30 tablets. With the half-tablet program, individuals would receive a prescription for 15 tablets, with 30mg strength each.
Instead of taking one daily, they would only take half of a tablet. Despite the higher-strength pills, participants in this program only pay half of their usual prescription copay because they are receiving half the number of tablets. Likewise, individuals who pay coinsurance would be paying a smaller percentage for fewer tablets.
