Uncategorized

A Lot of Americans Eat Fast Food. Do You Know What That Means?

By M2|2018-10-09T14:06:16+00:00October 5th, 2018|Public Health, Uncategorized|

A Lot of Americans Eat Fast Food. Do You Know What That Means?

I eat fast food and I don’t mind saying so. My favorite is a Big Mac meal at McDonald’s and I have the blanket to prove it. I also eat my fair share of hot fudge sundaes at Dairy Queen.

Although it isn’t clear which fast food outlets are people’s favorites, a recent study shows a lot of people eat fast food, but maybe not the people you might have thought.

As part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of about 5,000 people were asked what they ate in the 24 hours before the survey. As reported this week in the data brief, Fast Food Consumption Among Adults in the United States, 2013–2016, about 37% of people over the age of 20 ate fast food in the previous day. Younger people were more likely than older people to have enjoyed fast food, men typically eat their fast food at lunch time, and women evidently are more likely than men to have fast food as a snack (probably hot fudge sundaes at McDonald’s or Dairy Queen!). As the chart below shows, at dinner time, fast food is equally popular with men and women.

These survey results were a popular news item, so you probably saw the information somewhere already. But a few points stood out to me about the importance of updating information we may have learned in the past, either because new data has become available, or simply because we haven’t yet had an occasion to refresh our knowledge. If you haven’t read it, Factfulness: Ten Reasons We’re Wrong About the World–and Why Things Are Better Than You Think by Hans Rosling is a great book about various facts we might have learned that need to be updated.

First, as a person trained in public health, I have been taught that people consume more fast food if they have lower incomes, in part because fast food is most affordable and available to them. This data brief indicates the relationship between income and fast food consumption goes the other way. That is, people with higher incomes ate fast food more frequently than people with lower incomes as shown in the chart below.

Yes, you could calculate “fast food consumption” in different ways, and perhaps the quantity of calories consumed as fast food is higher for people with lower incomes, but an idea I had in my head about who eats fast food needs to be updated. Maybe an idea in your head needs to be updated too.

Second, I also know as a person trained in public health, that most people, even those who eat fast food, also eat other things, and that the relationship between food, weight, exercise, and metabolic and cardiovascular health is very complicated. Still, a first of its kind study published in 2014 found that, at least for kids, poor dietary habits outside the fast food environment “may be more strongly associated with overweight/obesity than fast food consumption itself.”

Let’s add that information to our brain’s database as well.

The fast food consumption brief created lots of headlines this week. Hopefully we all took the opportunity to read the articles that went with the headlines and update our point-of-view on what the information actually means.

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The Rising Cost of Health Care – a 360 Degree Perspective

By M2|2018-09-21T20:19:20+00:00September 21st, 2018|Health care spending, Health Reform, Insurance, Out-of-pocket spending, Uncategorized|

The Rising Cost of Health Care – a 360 Degree Perspective

The Colorado Women’s Alliance surveyed 2,000 swing women voters in Colorado earlier this year and asked them to identify their top issues of concern, as well as what they hoped the new Governor (who will be elected in November) and Colorado legislature will focus on in the coming session.

The rising cost of health care was the number one issue.

In response, Joni Inman, the Executive Director of the Alliance, in partnership with the Summit Chamber, organized a series of events, including a panel discussion in Frisco, Colorado last week titled “The Rising Cost of Healthcare – a 360 Degree Perspective.” I was honored to serve as a panelist alongside Colorado House Representatives Millie Hamner (D) and Bob Rankin (R), and professionals from the local hospital, a statewide health insurer and the Summit County Care Clinic.

While I am often asked to share policy ideas, for this panel, we were asked to share thoughts on what the consumer can already do that they might not realize is a good strategy available to them to lower their health care costs.

This is of particular relevance in Summit County as it is one of the healthiest places in the U.S., but also has some of the highest health insurance premiums in the country. Not surprisingly, Summit County health care consumers, as the audience quickly proved once the panel discussion started, are highly informed and interested in being proactive about their health care and the health care of their families.

My primary message was simple. When it comes to health care, we need to be much more demanding.

Be a demanding constituent

Sharing the stage with elected officials, I acknowledged the state legislature and Governor’s administration has some ability to make changes to how health care, and health insurance is financed and delivered. With that in mind, yes, it is important to advocate for policy changes. Vote. Call your representative. Send letters. Participate in hearings. Get involved in local politics. Make your opinion and preferences known.

This seems simple, but Reps. Hamner and Rankin were clear that they wanted to hear more from constituents, and individuals in particular, not just from lobbyists. Still, this can be hard to do. We all have busy lives and sometimes it is hard even to know what is happening regarding legislation or proposed policy ideas.

Be a demanding consumer

In addition to being a demanding constituent, it is important to be a demanding consumer. What can consumers already do that are good strategies to lower costs? Know more and ask questions.

First, know as much as you can about what your health insurance costs. What is the premium amount? What is the deductible? What types of services are covered at what levels? What are your rights to appeal a denial? Lots of resources exist. A great place to start is this compilation of websites from the Institute for Healthcare Improvement.

Second, as a consumer and as a patient, it is important to ask questions. Especially about how much a health care service will cost you. Of course, if you have been transported by ambulance to the emergency department, you aren’t going to be able to demand pricing information, but in the many instances you can ask, you should.

For example, as of May of 2018, 26 states, including Colorado (see map) have passed laws banning a practice that forbid pharmacies from informing consumers if and when the drug they were seeking to buy would be cheaper if they paid out-of-pocket instead of using their insurance. Yes, you read that right! Before these laws, many pharmacists were contractually forbidden by so-called “gag clauses,” from answering a direct question from a consumer at the pharmacy counter about the purchase price of a drug.

Ask this question: What is the price of this medicine, or this procedure, or this lab test, if I don’t use my insurance?

This strategy works outside of the pharmacy too. A consumer in the audience at the Summit County event gave an example of going to a local hospital with her husband over the fourth of July after he broke his elbow. When they asked the hospital about the price for the scan a provider recommended, they were told they could receive a 50% discount if they paid cash or used their credit card instead of using their insurance.

When I went to my dermatologist recently, I signed a document saying I wouldn’t submit a claim to my insurer if I agreed to use a specific pathology lab that would only charge $65 for lab tests. While my dermatology office wouldn’t tell me exactly how much I was saving (I was saving it since I was out-of-network and have a $7,600 deductible even in-network), they implied the insured rate for these pathology labs was hundreds of dollars more.

Demand more

Yes, call your legislator. Participate. Organize. Vote. But, we should all demand more of our employers, our health plans, and our health care providers, too. Ask for price lists. Ask for discounts. Ask what care options you have. Ask whether cheaper alternatives exist and how you can access them. Tell your employer you want choices.

We are all health care consumers, even if we aren’t all patients. Make your voice heard and your preferences known. Consumers can change the way the system works, but we have to demand that change.

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It’s finally September!

By M2|2018-09-05T19:54:39+00:00September 5th, 2018|Uncategorized|

It’s finally September!

M2 is looking forward to an exciting fall and busy 2018-2019 state legislative session across the U.S. We love this time of year and we just found out it could be because peak cognition seems to happen around the fall equinox – though that study focused on older adults and we like to think of ourselves as experienced, not old!

Our best wishes to everyone for a productive and super-brain-powered fall!

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Are $59 Virtual Visits at CVS Health a Play for Women?

By M2|2018-08-23T13:49:46+00:00August 22nd, 2018|Health Care Trends, Innovation, Retail Health, telehealth, Uncategorized|

Are $59 Virtual Visits at CVS Health a Play for Women?

Last week we wrote about how CVS Health offering $59 telehealth video visits through the company’s retail medical clinic, MinuteClinic, would significantly change the health insurance market. This week, we are going a step further to consider the specific effects of the CVS Health offering for women.

As covered previously, CVS Health is looking to serve people with routine health needs who are shopping for lower costs. Who is doing that shopping? Primarily women. Women make “80% of the health care decisions for their families.” If the woman is a mother, surveys show more than 75% of the time, she is responsible for choosing a child’s health care provider and taking the child to health care appointments. Women who aren’t mothers are also often caregivers – nearly 50% of women without kids make health care decisions for a family member.

The combination of increasing deductibles – more than half of cost-sharing payments were in the form of a deductible for the first time in 2016 – and increasing need for health care at convenient times has already driven women to be the most likely users of retail clinics.

According to FAIR Health, in 2016, women accounted for a higher percentage of retail visits covered by insurance than men in nearly every age group. For people between the ages of 19 and 30 who visited a retail clinic, nearly 70% of visits were by women, as the chart below shows.

CVS Health, no doubt, already knows women are the primary users of their in-person MinuteClinics. Converting women MinuteClinic visitors to $59 telehealth visits shouldn’t be too difficult since women are the primary health care decision makers, and the virtual visits are cheaper and more convenient than going in-person to a CVS store.

Will other health care organizations follow CVS Health’s lead and start to cater more to women as health care consumers? Theirs seems like a data-driven strategy that other entities might be wise to emulate. Just as the $59 virtual visit will disrupt the health insurance market, the new CVS Health offering could also change the way the health care system meets the needs of the primary health care decision-maker in the U.S. – women.

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CVS Health Just Upended the U.S. Health Insurance Market

By M2|2018-08-15T13:38:07+00:00August 14th, 2018|Health care spending, Health Care Trends, Health Plans, Health Reform, Innovation, Insurance, Out-of-pocket spending, Retail Health, telehealth, Uncategorized|

CVS Health Just Upended the U.S. Health Insurance Market

For $59, CVS Health will now offer telehealth video visits through the company’s retail medical clinic, MinuteClinic. The video visits will be available through the CVS Pharmacy App to anyone interested who lives in Arizona, California, Florida, Idaho, Maine, Maryland, Mississippi, New Hampshire, and Virginia – and Washington D.C.

This move will significantly change the health insurance market, and CVS’s merger with giant insurer Aetna isn’t even final, though reportedly, the “Justice Department’s antitrust division hasn’t turned up vertical competition concerns from the merger,” increasing the odds significantly that the deal closes before the end of the year.

What does CVS Health see that is driving this strategy? A shifting private health insurance market that requires people to pay up front for routine care, making consumers more sensitive to costs and less obligated to use a provider that is “in-network.” In the olden days (2006!), as the chart below shows, patients paid the majority of their cost-sharing payments in the form of copayments or coinsurance, that is, payments to providers who had an agreement with a health insurer. In 2016, for the first time, more than half of cost-sharing payments were in the form of a deductible, as the chart below from the Peterson-Kaiser Health System Tracker shows.

MinuteClinic video visits for $59 (paid for directly by the consumer) capitalize on three ongoing trends: 1) Patients have to pay more, before insurance starts to pay for claims, making consumers more sensitive to cost; 2) Patients want more convenience and CVS can deliver it more cheaply, in no small part because there are no insurance forms or administrative costs; and 3) Payers are reluctant to pay for virtual visits.

First, CVS Health is looking to serve people with routine health needs who are shopping for lower costs.

According to FAIR Health, the median charge for a new patient office visit at a retail clinic in 2016 was $109, compared to $294 in an office setting. The average charges and allowed amounts for the most typical retail clinic visits are shown in the chart below from the FH Healthcare Indicators™ and FH Medical Price Index.™

Simply put, the video visits will be cheaper than retail clinic visits. And, even if a patient is referred from the MinuteClinic video visit to one of the 1,100 MinuteClinic physical locations, that patient is likely to save more than $100 for the visit compared to going to a physician visit.

Second, CVS is looking to leverage the steep rise of people seeking care in retail clinics, by offering a clear value proposition to use a MinuteClinic virtually because it’s cheaper and more convenient. As the chart from FH Healthcare Indicators™ and FH Medical Price Index™ below shows, retail clinic visits increased by 847% from 2011 to 2016 with growth in rural areas increasing by 704% and in urban areas by 865%.

Clearly, CVS Health knows their potential customer well. A survey of 5,000 virtual visit users published by the Advisory Board in April shows more than 33% of people who had a virtual visit lived in a city, compared to 9% who lived in the suburbs or rural areas. Virtual visit users are also high earners – 52% “make more than $71,000 a year,” and are more likely to have private insurance.

Third, CVS Health sees that getting insurance companies to pay for virtual visits is hard. Forbes recently touted telehealth in article titled, “Lower Cost Higher Quality Health Care Is Right At Our Fingertips“ but the author was blunt in his explanation of what is holding telehealth back:

“The biggest obstacles? Government. Insurance companies. Employers. They pay the bills. Not only have they been slow to take advantage of telemedicine, they are refusing to pay for most of it…”

Getting a virtual visit via the free CVS/pharmacy app for just $59 means a person can go around his or her insurance company – and CVS avoids that hassle, too. Here are just a few ways that CVS Health’s approach differs from regular health insurance: You don’t need a referral. You don’t need to wait days for an appointment. You probably don’t have to take time off work because the virtual visits are available 24 hours a day, 7 days a week.

If you are one of the 40% of people who has employer-sponsored insurance but is enrolled in a high deductible health plan (HDHP), you probably love the idea of a cheaper alternative to a retail clinic since you are accustomed to paying out-of-pocket for your basic care now. Even if you have insurance, it doesn’t matter, because the virtual visits can only be paid for with a credit or debit card (CVS Health said they will add insurance coverage and national coverage by the end of the year).

Insurers have been offering limited products, in limited geographies, with limited providers, their “network,” for years. The launch of MinuteClinic video visits will be trumpeted as a huge value for consumers. That is only half the story. How will health care providers convince people who are mostly healthy that they have to wait for appointments between 10am and 3pm at a complex, integrated health system where they have to pay to park? How will insurers convince people to continue to buy the expensive, comprehensive coverage on offer today? This move will start to change the way people think about what insurance is even for. Now THAT is disruptive.

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Pondering Policy: What Would a World Without Rebates Look Like?

By M2|2018-08-09T20:10:16+00:00August 6th, 2018|Uncategorized|

Pondering Policy: What Would a World Without Rebates Look Like?

In mid-May the U.S. Department of Health and Human Services (HHS) posted a request for information (RFI) titled, HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. The comment period closed in mid-July and more than 3,000 comments were received. Rebates paid from pharmaceutical manufacturers to purchasers, for example, pharmacy benefit managers (PBMs, insurers, employers, government payers, etc.) was a key topic in the Blueprint. In the section called “Create Incentives to Lower Prices,” the RFI asks several questions: whether PBMs should have a fiduciary duty, how to reduce the impact of rebates, what incentives could be used to lower or not increase net prices, and whether Medicaid should change inflationary rebate limits, to name a few.

The Pharmaceutical Care Management Association (PCMA), which represents PBMs in the U.S., responded with 170 pages of reasons the RFI has all sorts of bad ideas in it, especially those that would change the way the rebate process works today. PCMA wrote about the RFI’s proposals: “Perhaps most importantly, HHS’ policy suggests a drug supply chain that functions under entirely different rules than the current one…”

This is, in fact, exactly where the fun begins! What would a system look like under entirely different rules? At M2, we are honored to work alongside a wide range of clients who ask us to help them think through that very question, on all sorts of health care payment and delivery issues.

This week, the Drug Channels Institute published a model of what a new “system without rebates” might look like. “A System Without Rebates: The Drug Channels Negotiated Discounts Model,” is an exploration of how a system without rebates might work. As with any discussion of the drug supply chain in the U.S., a helpful graphic of the proposed system is included, which we have reproduced below.

This proposed model addresses some key issues in the current system:

Out-of-pocket costs for drugs would decrease because payment would be based on the net discounted price;
PBMs would perform tasks more akin to a group purchasing organization (GPO) or benefit plan administrators;
Supply chain intermediaries such as wholesalers and pharmacies would be paid for their services, not based on a percentage of list price; and
“The warped incentives of the gross-to-net bubble would vanish or be minimized.”

Implementation issues and challenges abound, but we appreciate that someone has put pen to paper (hands to keyboard!) and come up with a draft model ready for those of us who are interested to improve and refine.

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Right Care at the Right Time in the Right Way – The Case of Antibiotics

By M2|2018-07-26T19:36:55+00:00July 26th, 2018|Evidence-Based Medicine, Health Care Trends, Retail Health, Uncategorized|

Right Care at the Right Time in the Right Way – The Case of Antibiotics

One of the most difficult problems to address in the U.S. health care system is treatment recommendations that are out-of-date, inaccurate, or based on an incorrect diagnosis. We write about this topic frequently () and Dr. Atul Gawande (who was recently named as the CEO of the new company being formed by Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co.) highlighted it most recently in a conversation with reporter Judy Woodruff at the Aspen Ideas Festival. Gawande argued there are three sources of waste that require different work but the biggest bucket is misutilization, “meaning the wrong care, at the wrong time, in the wrong way.”

A perfect example is antibiotic use. According to the Centers for Disease Control and Prevention (CDC) about 30% of antibiotics prescribed in physician’s offices and other outpatient settings are unnecessary. Further, says the CDC, “even when antibiotics are needed, prescribers often favor drugs that may be less effective and carry more risk over more targeted first-line drugs recommended by national guidelines.” In other words, clinical recommendations are often out-of-date or simply not following guidelines.

In urgent care centers, an increasingly popular site of care, the problem is even worse. According to a brief published this month by The Pew Charitable Trusts, “46% of all urgent care visits for non-antibiotic recommended diagnoses resulted in an antibiotic prescription,” compared to 14% of the time in retail clinics, 25% of the time in emergency departments, and 17% in office-based clinics. Acute respiratory conditions, for example, asthma and allergy, bronchitis, flu, and pneumonia are common reasons for a visit to a physician’s office or clinic, but in urgent care centers, it is fairly likely an antibiotic will be prescribed for these conditions, when they shouldn’t be, as shown in the table from Pew below.

Considering urgent care usage has skyrocketed in recent years, increasing by 1,675% (that is not a typo!) in rural areas and 2,308% in urban areas between 2007 and 2016, the higher rate of inappropriate antibiotic use is an even bigger problem than just comparing prescribing rates across site of care might indicate.

Inappropriate antibiotic prescription use plus skyrocketing urgent care visits equals a perfect case of “wrong care, at the wrong time, in the wrong way.”

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Consumerism: “Activity in Search of Strategy”

By M2|2018-07-17T19:59:47+00:00July 17th, 2018|Health Care Trends, Health Reform, Hospitals, Providers, Retail Health, Uncategorized|

Consumerism: “Activity in Search of Strategy”

Consumerism is a hot topic in health care. Whether you define it as (a) improved personalization (as Robert Sahadevan, Senior Vice President of Consumer Marketing & Analytics at Humana and formerly the VP of United Airlines’ Mileage Plus frequent-flier program does), or (b) understanding and meeting/exceeding customer expectations, or (c) encouraging patients to act like consumers by actively choosing where to spend their health care dollars, consumerism is a focus in practically every health care business across the country.

The trouble is, while consumerism is a focus, it seems much of this work in health systems and hospitals at least, is “activity in search of strategy,” according to KaufmanHall, a strategic, financial, and operational performance advisory firm.

The KaufmanHall 2018 Healthcare Consumerism Survey included more than 425 respondents across 200 health systems, stand-alone hospitals, children’s hospitals, and specialty hospitals. “Improving customer experience” was a top strategic priority for 90% of the respondents. Still, the survey found “these efforts need to be more strategic, more effective, and more rapidly implemented if legacy healthcare organizations are to grow and compete in an increasingly consumer-focused world.”

Where is the disconnect? Why is there so much activity that isn’t strategic or likely to be effective? Seemingly, it’s because these health care organizations are focused on the ways they would like to improve customer service, not necessarily on the ways consumers would like to see access and care changed.

Example 1: Consumer Access

The KaufmanHall 2018 survey respondents ranked high on access to bricks and mortar health care facilities. More than half said their organization had an urgent care center, 40% said they offered access to freestanding imaging sites, and outpatient centers were widely available.

More innovative care options, that some studies show are preferred by consumers, were not as common. Video visits were only available at 14% of the respondent facilities, and retail clinics were only available at 27% of health systems or hospitals surveyed.

Example 2: Consumer Convenience

Consumers who are accustomed to clicking a button and receiving a shipment later that day, or horrors, the following day, don’t want to wait a week or a month for an appointment to see a health care provider. Conveniences such as same-day scheduling of appointments, online scheduling, and extended hours are expected by consumers, but few organizations are delivering. The chart below shows only about a third of the KaufmanHall respondents offer same-day appointments or extended hours for primary care. Only 20% have fully implemented online self-scheduling.

Example 3: Consumer Frustration

Notably, interactions with the health care system that patients and consumers find frustrating are not typically much of a focus for health care organizations. One example is reducing office wait times. Just 17% of the KaufmanHall respondents have a full implemented initiative to address wait times. Another example is billing. It isn’t for lack of understanding billing as a customer pain point that organizations aren’t prioritizing it: “Billing is confusing and frustrating and stressful, and it is their last interaction with us,” one executive explained in the survey, yet only 28% of respondents had fully implemented customer-friendly billing statements. Organizations instead seem focused on changes easy for them to make, such as ensuring phone numbers are easy to find and providing customer service training for staff (see chart below).

Example 4: Pricing

“Of all the key areas related to consumerism in healthcare, pricing strategy provides the most room for improvement for the nation’s hospitals and health systems,” according to KaufmanHall. Asking any person who has interacted with the system, and indeed, most policymakers, you will get the same answer. Consumers need more information about the prices of the services or products they have been told to buy by their health care provider – whether a surgical intervention or prescription medication. Only 5% of the KaufmanHall respondents are “aggressively pursuing” consumer initiatives related to pricing strategy and/or price transparency. Only 10% list prices online and less than half can provide a consumer-requested price quote in a defined period of time.

Design Thinking Opportunity in Consumerism

We have written a book chapter titled, Using Small Step Service Design Thinking to Create and Implement Services that Improve Patient Care, for the upcoming book, “Service Design and Service Thinking in Healthcare and Hospital Management” from Springer Publishing (due out this fall). The chapter is about using design thinking in health care services and provides two case studies about organizations that have done it well. As the KaufmanHall 2018 State of Consumerism in Healthcare showed, many organizations are involved in activities that address the consumer experience, but most of these activities are not strategic aligned with what consumers actually want. Better understanding the customer – for example, by using the five-step design process – would likely improve these organizations’ efforts to exceed customer expectations. Until health care organizations can look outside their own experience, improving consumerism is likely to be very slow going.

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Avoidable ED visits – what does “avoidable” mean and what can we do about this issue?

By M2|2018-07-10T18:48:57+00:00July 9th, 2018|Evidence-Based Medicine, Hospitals, Uncategorized, What do we pay for and why|

Avoidable ED visits – what does “avoidable” mean and what can we do about this issue?

An employer group in Massachusetts is coming together to reduce avoidable emergency department (ED) visits, in large part because they claim ED visits are a key driver of health care costs in the Commonwealth. According to the coalition, “ED visits can be five times more expensive than primary care or urgent care visits.” Not only are ED visits expensive compared to other health care services, the coalition cites a Massachusetts Health Policy Commission estimate of $300-350 million in annual costs, in total, just for commercially insured people in Massachusetts.

While this seems laudable, it turns out there’s a big difference of opinion about the definition of “avoidable ED visit.” The coalition’s statement claims studies show more than 40% of ED visits are avoidable. Some of the most common conditions for avoidable ED visits, accordingly to this employer group, include acid reflux, allergies, back pain, bronchitis, sinusitis, stomach pain, and urinary tract infections. At first glance, these maladies don’t seem like they need to be treated in an emergent setting.

At issue is the definition of “avoidable.” According to the American College of Emergency Physicians (ACEP) only 3.3% of ED visits are avoidable. In a study based on data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for years 2005 to 2011, Renee Hsia, MD, MSc, of the Department of Emergency Medicine at the University of California, San Francisco, found many of the visits to EDs that are classified as “avoidable,” such as those listed above, also involve either mental health or dental issues.

Dr. Hsia argues, “This suggests a lack of access to health care rather than intentional inappropriate use is driving many of these ‘avoidable’ visits. These patients come to the ER because they need help and literally have no place else to go.”

So, are more than 40% of ED visits avoidable or is it less than 5%? This is a fairly big difference. In ACEP’s view, the entire concept of “avoidable ED visits” should be questioned. “Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise,” said Becky Parker, MD, FACEP, the president of the American College of Emergency Physicians (ACEP). “Most patients who are in the emergency department belong there and insurers should cover those visits. The myths about ‘unnecessary’ ER visits are just that – myths.”

It seems essential to know more about why people are going to the ED for health issues that don’t fall into the category of: I was taken to the ED in an ambulance because I was unconscious, or my friend drove me after I sliced off my finger…The Massachusetts Health Policy Commission has been gathering all sorts of data the past few years, and below is the chart they have published on avoidable ED use.

As the chart shows, nearly 70% of “avoidable ED visits” happen between 8am and 8pm. This is probably not the typical idea that people have in their minds about when “avoidable ED” visits occur. So based on Massachusetts data showing the majority of avoidable ED visits happening during daytime hours, it seems more likely that the ACEP point of view is correct: Maybe these visits really do indicate access to care problems more than patient choice – which possibly could be changed simply by improved education.

The Health Commission chart is accompanied by some analysis from the 2014 Massachusetts Health Insurance Survey. In the survey, of the respondents who had been to the ED in the past year, “over half said they had done so because they could not get a timely appointment with their usual source of care.” Ideas to address this lack of access include encouraging patients to seek care at retail clinics or urgent care centers, encouraging providers to expand office hours, making hotlines and telehealth more available, and “granting Nurse Practitioners full practice authority.”

Reducing unnecessary health care costs is a common goal across individuals, families, employers, and governments. The Massachusetts Employer-Led Coalition to Reduce Health Care Costs zeroes in on “avoidable ED visits,” listing a focus on four levers for impact:

Employee engagement
Data and measurement
Multi-sector collaboration
Policy advocacy

We often focus on what works, and it seems notable that the Commonwealth has a range of data showing expanding access to a broader range of providers (by changing scope of practice laws and reimbursing more convenient types of care) seems highly likely to reduce “avoidable ED visits.” As more specificity is put forth by the coalition, time will tell whether their policy solutions match the problem.

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Check out my blog on PharmExec.com today!

By M2|2018-06-29T21:09:07+00:00June 29th, 2018|Uncategorized|

Check out my blog on PharmExec.com today!

Recently CMS announced two decisions on access to prescription drugs in Medicaid – an innovative approach (that states have been asking for) was approved in Oklahoma, but the media has focused on the denial of a less innovative Massachusetts approach. I think it’s fascinating that the media has focused on the Massachusetts decision, when in reality the Oklahoma decision is quite notable and exciting because it shows the way for manufacturers and states to work together. Read more at PharmExec.com.

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