While the rise of consumerism in healthcare is hardly a new phenomenon, its acceleration has been remarkable; more than 11 million individuals purchased their own health insurance plan through the exchanges in 20151, and 2014 saw the largest one-year increase in “high-deductible plans” (from 18% to 23% of covered employees)2 making consumers responsible for a greater share of their healthcare expenses. Engaging consumers in their health clearly plays an important role in managing costs and improving patient satisfaction. Many healthcare organizations are piloting new ways to engage consumers, and investment in tools and technology to support these interactions is high. In fact, payer and provider executives identified “consumer engagement” as both the key investment priority and top pain point – in HEP’s 2012 and 2013 annual surveys. Read More
Today there are 30M diabetics in the US, or 10% of the population. The disease costs $245B annually. 86% of diabetics do not meet the recommended targets for glycemic control, blood pressure, LDL cholesterol level, and tobacco use. With 79M Americans having pre-Diabetes the societal burden of this disease will only get worse. Today primary care physicians (PCPs) are delivering much of the diabetes care. Growing prevalence of diabetes will require PCPs to do even more, including better addressing the disease’s clinical as well as its behavioral elements. Read More
Of all the truisms associated with healthcare reform, the “transformative power of big data” remains one of the most overused. For all the talk of data’s promise, many hospital systems, health plans, and healthcare companies struggle to unlock the value from the numerous data sources at their disposal. Moreover, sweeping fears persist regarding the data requirements that reform will place on hospitals and health plans. In this context, HEP conducted an industry survey with the goal of identifying how the most progressive organizations are innovating ahead of legislative mandates to reap the rewards of data. Read More
It is no longer taken as a sign of sophistication to say that the Affordable Care Act (ACA) is “undefinable.” With Obama’s re-election on November 6th, certain ambiguities have crystalized into near-certainties. While considerable doubt persists regarding the pace and form of health reform’s implementation, a second Obama term assures us that the central tents of the ACA will not be eliminated. Yet, against this backdrop of reform, it remains unclear how institutions will react to the complex system of carrots and sticks that has been erected around them. It is the purpose of this study to identify what types of bets high-performing hospital systems, health plans, and health care IT companies are making in the wake of reform. Equipped with these findings, we might approach an understanding of what the future holds–and how we might pre-empt legislative mandates in shaping it.
As legislators continue to debate the role of the federal government in administering health care, the need for enhanced coordination between payers and providers has never been more acute. In the last five years, we have seen the most progressive hospitals and health plans enter into partnerships for mutually- beneficial gains. Challenging what was once an openly adversarial relationship, these innovative players are collaborating to share risk, lower cost, and seize market share. Whatever the end result of reform, Health Enterprise Partners contends that the line between payers and providers will continue to blur.
Facebook reached 750 million active users in July of 2011. 13 percent of American adults have a Twitter account. With its rapidly increasing prominence, social media has the potential to significantly impact health care organizations, serving as a communication, collaboration, and information platform. Additionally, individuals are increasingly turning online for instant access to health care information. Yet, the use of social media by hospitals and health plans has remained fairly limited, often for fear of the negative backlash from patients and providers and the inability to control the organization’s message.
During the restructuring of the U.S. healthcare ecosystem, one topic that is not gaining enough attention – which will transform the delivery of care – is risk. The structure of the current system infamously masks risk, where consumers currently do not share much of the burden in healthcare. The fee-for-service model with third party payers and cross-subsidization, combined with the “bigger-is-better” and supersized culture, has led to a discrepancy between those who make decisions about healthcare and those who pay for it.