Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Agenus plans digital security offering. PCG’s Jeff Ramson explains in this podcast

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Biotech company Agenus is launching a “digital security offering” that will let people invest directly in a single biotech product, rather than the whole company. Jeff Ramson, founder and CEO of strategic communications firm PCG Advisory Group, became fascinated by the concept and reached out to me to discuss it, even though he is not involved in the offering. (And neither am I.)

In this podcast, we cover the following topics:

  1. Agenus is launching the first asset-backed digital security offering in healthcare. What does it mean?
  2. What is a Biotech Electronic Security Token (BEST)? What are the trends it leverages?
  3. How is it being used?
  4. Has something like this already been used in other industries?
  5. What are the advantages? How does it preserve shareholder equity?
  6. Any disadvantages?
  7. Why not a traditional stock offering?
  8. What is PCG Advisory Group and what is your role?

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

Experiencing Patient Experience results from MHQP

For the past 14 years, Massachusetts Health Quality Partners (MHQP) has published results of its primary care patient experience survey. The information is useful to the practices themselves as they seek to improve, and to health plans looking to evaluate their networks, improve member service, and pay bonuses to the best practices.

This year MHQP added an analysis of free text feedback to its analysis, to give practices more color on the scores.

The consumer-facing site, Healthcare Compass lets users view ratings for individual practices and compare up to three at a time. Users can click on the individual categories to learn what each one means, what patients can do, what doctors can do, and where to find additional resources. For example, the “what you can do” tab in the communications section includes suggestions to speak up if you want your doctor to make eye contact and to ask the doctor to repeat back what you just said.

I used the site to compare three practices I am familiar with and the results match up well with my perceptions.

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Comparing MD offices
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Click on the Harvey ball to see the underlying data

There is a lot to like about MHQP’s patient experience reporting including:

  • It provides validated information on key elements of practices, for both adult and pediatric
  • The site is easy to navigate. The information is communicated in plain English and with simple, intuitive graphics. For even more detail, you can click on the Harvey balls (I didn’t realize this at first) to get the detail behind the score.
  • Providers have responded to the feedback by improving performance in key areas over the years, including communications and care coordination
  • The bottom line “willingness to recommend” percentage provides a useful benchmark for comparing practices
  • For the first time this year, MHQP issued awards for the highest performing practices for adults and pediatrics and for each domain of care. You have to go to the MHQP site itself to see it, but you can bet the doctors know it’s there!

MHQP has built trust with providers and payers by working collaboratively with them and taking their sensitivities into account when publishing the performance data. Here’s how public reporting of survey results could expand, subject to the consent of providers and payers and additional funding:

  • Provide more prominence to the actual scores for the measures, rather than just a three-level Harvey ball (full, half full, empty) showing relative performance. The current approach obscures the fact that median scores for certain categories are much higher than others. For example, the mean score for pediatric practices on patient-provider communications is 97.3% compared with 50.3% for empowering patient self care. While we’re at it, it might also be nice to see the range of scores. Does everyone cluster around 50% for self care or do some practices get into the 70s or 80s?
  • Provide reporting at the level of the individual MD for measures where that’s relevant, e.g., “how well doctors communicate with their patients” and “how well doctors know their patients,” while keeping practice-level reporting for measures such as, “getting timely appointments, care, and information.” The challenge here is that it would require a much bigger budget to reach the needed sample size
  • Provide a synthesis of the qualitative comments
  • Provide ratings of specialists as well as primary care

The pushback will be that there are valid reasons to present the information as it is and that expanding will be cost prohibitive, but on the other hand it would make this reliable and validated information more likely to be used.

Congratulations to MHQP for its continued success in shining a light on patient experience and making useful information available to all the stakeholders in the Massachusetts healthcare system.


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

 

Medicaid Buy-In: A sensible approach for coverage and cost

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Show me the coverage!

The term ‘Medicare for All’ is being bandied about as the campaign for the Democratic Presidential nomination gets underway. Declared and potential candidates are warming to the idea.

It’s easy to see why:

  • After years of trying to defend complex, compromised Obamacare from GOP rhetorical attacks and legislative and administrative undermining, Democrats are going with a program that is popular and well funded
  • Medicare especially appeals to the middle-aged and older population, who tend to vote. There’s no stigma attached to it
  • It could be funded and implemented as a sweeping program at the federal level, which is ideal for a Presidential candidate to talk about.

However, I’d much rather see attention turn to continued expansion of Medicaid, specifically by offering people the opportunity to “buy in” to Medicaid coverage. This has real advantages:

  • It’s the prices stupid,” we have been told since 2003. Price, not utilization, is the main reason the US spends so much more than other countries. By design, Medicaid puts the squeeze on costs through lower reimbursement rates
  • Medicaid has provisions to squeeze drug prices, too, something Democrats and Republicans favor
  • Medicaid coverage is more holistic than Medicare. It includes programs to address social determinants of health, and is suitable for younger people including parents and children
  • Medicaid is a partnership between the states and federal government, enabling individual states to craft solutions that fit their specific populations

Several states are already looking at Medicaid expansion as a way to address their specific issues. For example, New Mexico (a purple state) is getting serious about further use of Medicaid. The state has some distinctive characteristics:

  • Medicaid is by far the largest player already, covering 40% of the population
  • The uninsurance rate remains stubbornly high at 9%
  • There are many undocumented and mixed status families who are shut out of the current coverage system

New Mexico is studying four approaches. (You can read the assessment here.)

  1. Targeted Medicaid buy-in: Medicaid-style coverage to those ineligible for Medicaid, Medicare, or the Obamacare marketplace. The state would subsidize premium costs
  2. Qualified health plan public option: A variant on the program originally proposed in Obamacare, with coverage on the marketplace in partnership with an insurer
  3. Basic Health Program: An Obamacare option already
  4. Medicaid buy-in for all: An off-marketplace program available to anyone except Medicare eligibles

The analysis leads me to the idea of starting with Option 1 as a trial run for Option 4. The advantage of Option 1 is that it doesn’t require federal approval, would bring uninsured people into the system who are currently discriminated against, and provide a test bed for further expansion. It would not disrupt the current market by drawing away healthy people, because it is only open to those currently outside the system.

Option 4 could come into force after the 2020 election, when the federal environment is more favorable and once New Mexico has learned from its initial experience.

Sometime down the road, an even more radical version would shift everyone into Medicaid. Private health plans would still have a role since everyone could be enrolled in Medicaid managed care. Providers and drugmakers won’t like the compressed reimbursement, but maybe it will encourage them to innovate on efficiency.

All of these proposals can be combined with value based approaches, which enable the efficient, high quality providers to succeed while containing costs and potentially boosting the patient experience and outcomes.

For now, I’d like to see the debate start up as part of the presidential race. Candidates visiting early primary and caucus states should dig in. In Iowa, for example, Medicaid for all is being discussed by local Democrats.

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

MHQP shines a light on MassHealth patient experience

For many years Massachusetts Health Quality Partners (MHQP) has collected and published information on the patient experience of care in Massachusetts. The outputs have been revealing and very helpful for physician groups seeking to improve and for patients trying to identify the best places to receive care.

But Medicaid (aka MassHealth) patients have never been included. Considering that Medicaid serves more than one million patients and is the biggest item in the state budget, it’s about time to at least understand what’s going on.

MassHealth has contracted with MHQP to conduct a large-scale patient experience survey of Medicaid patients. It was a big enough deal to merit front page, lead article placement in yesterday’s Boston Globe (edging out stories about the shutdown and the Patriots) so it has people’s attention.

The state government will have access to the full results and promises to make some of the findings public. Frankly I hope they’ll publish everything so the general public, physicians and MassHealth patients can learn as much as possible. The more widely the information is publicized, the more likely it will be to have an impact.

I’m looking forward to reviewing and writing about the results of the first survey, which should be available around the start of next year.


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

Will single-payer go mainstream in 2019?

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The Democrats are braying

I have long predicted (Goodbye Obamacare? More like hello single payer) that if the GOP succeeds in undermining the Affordable Care Act it could hasten the move toward single-payer. Well, the undermining has been reasonably successful. And I think 2019 will shape up as the year that formerly taboo proposals like single payer health insurance go mainstream.

Despite what opponents say now, the Affordable Care Act was a moderate bill that sought to work within the existing system and incorporate bipartisan elements, including 188 Republican amendments. Before the individual mandate was pilloried as a threat to freedom, it was upheld as a virtuous plan of personal responsibility by the Heritage Foundation and American Enterprise Institute. Democrats tried to get Republican votes for the ACA. It was a GOP strategy to refuse.

When Republicans tried Repeal and Replace, they didn’t even pretend to include Democrats in their solutions. And of course, Candidate Trump’s promise to replace Obamacare with “something great” was a lot of nonsense.

With all this history, mainstream Democrats are feeling freer to jump to more radical and comprehensive proposals. After all, the ACA was complicated, messy, and full of compromises largely because of its attempt to be bipartisan and incrementally change the existing system. Why not jump to something purer and simpler that doesn’t need GOP input?

As the race for President gets underway, Democrats will start to feel their way on healthcare. Defense of the ACA is a pretty modest, minimum requirement. You can expect to hear calls for Medicare for All, which is a way to offer a popular benefit to more people without creating a whole new system.

But I’m also on the lookout for more radical approaches and it looks like we won’t even need to wait for the Presidential campaign to heat up in order to hear about them. Newly installed California Governor Gavin Newsom is ready to take on Donald Trump directly, calling for a single-payer system, mandatory coverage, expanding access for undocumented immigrants, and regulating drug prices. California is holding an early primary this cycle, so the ideas Newsom is setting out now will influence the debate.

I’d like to see serious discussion of Medicaid for All (rather than Medicare for All). Medicaid pays providers and drugmakers less and is also more comprehensive than Medicaid and better suited for younger adults and children. It’s a more affordable way to provide coverage, provides discretion to the states, and would drive down overall costs by driving down reimbursement rates. Medicaid for All would be a mixed bag for providers and pharma, so would unleash a very passionate debate.

A likely compromise is to offer Medicaid to everyone as a fallback, while retaining commercial and Medicare coverage for those who are eligible and want it.


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