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Archive for the ‘Payers’ Category

Healthcare 3R’s Bring Pain and Gain

• Posted May 23rd 2008
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• by Janice

 Arguably the most powerful and actionable of all consumer health information, ratings, rankings ad recommendations (the 3R’s), present both opportunities and minefields, as the Massachusetts Group Insurance Commission (GIC) found out this week when a lawsuit was filed against them by the Massachusetts Medical Society (MMS).   

GIC ranks physicians using cost and quality measures, and its rankings are used for  cost containment; patients have to pay higher copayments for doctors who rank in the lower tiers.  MMS, which has more than 20,000 physicians and student members, alleges that GIC’s system, called Clinical Performance Improvement Initiative (CPI), uses “inaccurate, unreliable and invalid tools and data”.  In particular, the complaint cites miscoding of procedures and inaccurate assignment of patients to physicians who were not responsible for their care. 

A different ratings approach is practiced by the department of Health and Human Services’ (HHS). Its CAHPS program  centers its rankings on patient satisfaction measures.   HHS was also in the news this week with a near-full-page ad in local papers in all 50 states promoting the use of the Hospital Compare site (http://www.hospitalcompare.hhs.gov/). As reported by AP, “the ads reflect an emphasis by the Bush administration to increase transparency in the health care system. Officials say greater public disclosure of costs and quality will drive providers to improve on both fronts.”

Currently, hospitals are penalized with a reduction in their reimbursement rates from CMS if they do not participate in the CAHPS program.  It is expected that HHS will continue down the path of pay-for-performance (P4P) as the CAHPS program develops.  

The 3R’s are shaping up to be a lively and controversial business, and Health Content Advisors and our parent company, InfoCommerce Group, will continue to monitor closely those information products that offer ratings, rankings, and recommendations, and you can look for them to continue to play a prominent role in this year’s Health Content08 conference.

 

New NCPDP Database Boasts Increased Functionality

• Posted May 14th 2008
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• by Marji

The National Council for Prescription Drug Programs launched a new database for pharmacies, pharmacy benefit management companies and health insurers. The application, dataQ, is a new version of the NCPDP’s standard pharmacy database that includes information on nearly 75,000 pharmacies. According to news reports, the goal of the database is to provide information to make pharmacy claims more accurate.

The new web-based database offers users a variety of new features. In addition to instant look-ups and custom reporting functions, the database can also help users with pharmacy network development and credentialing; data validation; drug utilization and product recall monitoring, as well as the ability to pull all of it together through market research and analysis.

Anything that will improve the accuracy of pharmacy claims is a good thing. This database seems to contain all of the content and functionality required of databases today. While a vast number of listings is vital, today’s databases are not nearly as valuable without abilities that make their data actionable. The NCPDP has all of the necessary components here – components that will help users perform their job duties more efficiently and effectively.

 

Consumer Health Sites Not for the Faint of Heart

• Posted March 21st 2008
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• by Janice

Steve Case, the keynote speaker at yesterday’s EconHealth seminar, and CEO of Revolution Health, used the phrase “not for the faint of heart” to describe the current environment for producing healthcare content for the consumer market. Chris Schroeder, CEO of the HealthCentral Network, repeated the phrase in the introduction to his opening panel. It’s an apt way of summing up the themes of the seminar that focused on the money flow in early-stage digital consumer health companies.

Case used the analogy of his experience getting consumers engaged in online communication at AOL and predicted that the time horizon spans 10 to 20 years before the full “sea change” occurs in the healthcare sector. Significant additional hurdles exist in the health market, which has a complex institutional structure with layers of agents that constrain consumer choice and behavior. The agents include employers who remain the primary payers of health insurance, the health insurance companies as payer-intermediaries between consumers and providers, and government agencies that create policy and regulations—and are also a major payer of healthcare services. Layers of constraints also exist for the physicians and other healthcare professionals who offer health services.

Still, Steve and other speakers did not present a gloomy future for health content start-ups and established healthcare publishers. There is overwhelming agreement that the US is moving toward a consumer-centric healthcare system and there are ample opportunities for companies that create innovative applications to improve the efficiency of healthcare consumption. But the timing of adoption by consumers is very difficult to predict, especially in an environment of constrained choice. Deep pockets help. And, it helps to have alternative sources of revenue to keep afloat while the “tectonic shifts” in healthcare settle. Without significant resources, the most likely future for most of today’s consumer health start-ups will be acquisition by a large more diversified health content or health IT company.

 

Health Content: Going for the Gold, Not Glitz

• Posted March 13th 2008
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• by Janice

Healthline, which maintains its own consumer healthcare portal site while also licensing technology and content to other healthcare sites, has announced an agreement with Aetna to supply Healthline’s search and related tools to Aetna’s new SmartSource healthcare search engine.

This deal serves as a reminder that the open Web is not the only place where healthcare consumers connect with online medical information. While much attention is being lavished on the glitzy consumer health portals, few have noted that most of them are too broadly focused and without differentiation. Everything from healthy lifestyle information, disease-specific information, to drug data, calorie counters, and social networking discussion groups are all thrown together on one site. Sites such as Revolution Health, WebMD, iVillage Your Total Health, About.com/Health are all beginning to look alike.

While the overabundance of content is becoming increasingly hard to navigate, the reason behind it is clear – ad dollars. All of these health care portals are following the money, and they need to keep building inventory to attract ever more advertisers. While the potential advertising pot is in the billions of dollars, it is unclear who, among the current crop of consumer healthcare sites, will attract sufficient traffic and ad dollars to be the long term winners in this very competitive space.

What does this mean for publishers of medical information and healthcare-related content. It means that expected revenue from ad-share deals with consumer healthcare portals on the open Web remains unpredictable, and wise publishers should also seek deals with alternative distribution channels like employee benefits sites that are sponsored by the healthcare payers: employers and health insurers. In the Healthline deal, the Aetna Navigator site is on the Internet with access by password. In other cases, employers host Employee Assistance Programs (EAP) on intranets and typically include information about all benefits programs. But regardless of the implementation, these sites deliver a sizeable audience that is craving content that is more tailored to their needs, and health content publishers would be wise to pursue these less obvious but still rich channels.