BETA
This is a BETA experience. You may opt-out by clicking here

More From Forbes

Edit Story

Text Shots From The World Healthcare Congress

This article is more than 8 years old.

Joe Caiati describes a text shot as “slightly more than a tweet, but not as long as a blog post.” Users put text shots into Twitter by attaching a photo of an iOS Note, or similar, to a tweet. And thus a medium is born. Plus, it's a nicely punchy idea.

Text shots seems like an ideal way to describe the big ideas I heard at last week’s 2015 World Healthcare Congress in DC: a quick paragraph for each. I will expand the more promising ideas in later posts.

Managed care is taking over government-funded healthcare. Medicaid executives from DC, Utah, and South Carolina talked about success of Managed Care Organizations and Accountable Care Organizations controlling cost growth and delivering quality care. In DC 70% of Medicaid clients are now under managed care. Medicare Advantage (i.e., managed) plans now cover 32% of Medicare beneficiaries, growing 10% per year. Medicare Advantage has not yet shown savings in aggregate cost comparisons, but panelists believe it has the potential to do so. Forbes editor Avik Roy argued that, looking back from 2030, we will see ObamaCare as a Trojan Horse for privatizing the U.S. healthcare entitlement system.

Providers are driven to consolidate. Several said: “we know we have to charge less per person, so we have to see more people each year.” Since the population grows very slowly, gaining volume means absorbing competitors. Let’s hope the government is wise enough to limit this trend before it creates local monopolies. That will encourage providers to find lower cost ways to serve customers, which is a good way to prosper in a world of declining prices.

Providers & payers talk about becoming consumer centric, but it’s early days. They spoke of about treating patients as long-term clients by offering price transparency, 24x7 access to care, increased attention from nurses, user-friendly electronic records access, and patient centered medical homes. But, when a listener asked, “Have you fixed your billing to make it understandable and show what the real price is?”, the answer was “No, we’re working on it, but it’s very difficult, and Medicare is no better”. Today providers charge some customers far more than others. Transparency will tend to equalize prices at the low levels set by the largest buyers and the most efficient providers. This drug addiction will prove hard to kick.

Medical consumers now have skin in the game, but they don’t know what to do. The main way plan sponsors are controlling cost growth is high deductibles. Silver plans on the public exchanges leave consumers exposed to 30% of expected cost. Consumers are ill-equipped to manage their exposure: information resources are still thin, and consumers often can’t shop for healthcare when they are seriously ill. The primary care doctor needs to take the role of smart buyer on behalf of his/her client.

Virtual medicine is coming of age. Millennials want healthcare on their smart phones, just like everything else. TeleDoc, a start-up that has become the leading virtual medicine company, says that 80% of customers went to the emergency room because primary care was not available; a virtual medicine encounter costs <10% of the alternative on average; and, 47% of health plan sponsors will have a virtual medicine benefit by the end of 2015. TeleDoc has grown 90%/year to 300k encounters last year and raised $75 million. Big health systems are using mobile tech to monitor customers post-discharge. The value proposition is firming up: mobile monitoring and feedback yields a 45% drop in readmission of congestive heart failure customers at Duke, and more benefit than drug therapy to A1C levels for diabetes customers at Partners Healthcare.

Primary care is undergoing a revolution. Healthcare leaders are reaching a consensus that retainer based primary care docs produce impressive benefits to both cost and health by intervening early, keeping customers out of advanced care, and coaching customers on how to manage the system. The leading retainer-based medicine companies are start-ups.  Chet Burrell of CareFirst BC/BS commented: “When we look at risk-adjusted total cost of care, the top quartile is heavy with independent practices that are smart about managing patients and the medical system, and the bottom quartile is heavy with big academic medical centers.” At the same time primary care is becoming distributed and significantly virtual: delivered on the phone/video, in Wal-Mart/CVS, and urgent care centers. How medical home providers coordinate this for the benefit of the customer will be a challenge.

Notes:

  1. I use the word “customer” or "client" in lieu of “patient” wherever possible.