Navvis Right Now: Issue 23 – May 11, 2019

May 11, 2019

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Kaiser Permanente Rolls out EHR-Integrated Program to Tackle Social Determinants of Health (SDoH)

Kaiser has launched Thrive Local, a social health network aimed at reducing homelessness, food insecurity and other critical needs that affect the health and wellbeing of communities.  The new network — a partnership with population health platform Unite US — will begin rolling out this summer and should be available by 2022 to all 12.3 million Kaiser Permanente members as well as 68 million people in communities the integrated health system serves. Thrive Local integrates into Kaiser’s EHR which is important as it will allows providers to track referrals and service outcomes to assess how well patients’ needs are being met.  Kaiser Permanente said up to 29% of its members with the greatest medical challenges struggle with food insecurity and up to 23% live with housing instability.

Takeaway: Kaiser places great emphasis on treating the whole person and has addressed SDoH in markets for years but this appears to be the first social health network to roll out at this scale to all members of plan. Last year Intermountain invested $12 million to address SDoH. England implementedsocial prescribingthis year to improve people’s health and wellbeing and reduce workload for healthcare professionals and CMS has created new toolsincluding “Z-codes” in ICD-10. Z-codes allow providers to create structured information about the SDoH, further the ability to analyze patterns and design impactful interventions. The American Medical Association and UnitedHealthcare and working to expand the number of available Z-codes.

Tennessee Will Test CMS’ Willingness to Block-Grant Medicaid

The Republican-led Legislature passed a bill last week ordering the governor to submit a Section 1115Medicaid Waiver request making Tennessee the first state to convert its Medicaid program to a block grant. The waiver would seek federal approval to transform TennCare, the $12 billion Medicaid program covering 1.3 million Tennesseans, from an open-ended entitlement program to one where the federal government makes fixed payments. Supporters of the block grant approach argue it will enable states to design more efficient Medicaid programs that provide better benefits, cover more people and save money. “If we can remove some of the red tape and regulation Medicaid has, we’d be able to free up more of our federal dollars to provide more services for individuals,” said Sen. Paul Bailey, a Republican sponsor of the bill. But opponents, including providers and patient advocacy groups, warn that capped models like block grants or per capita caps would lead to reduced Medicaid funding over time and require states to cut enrollment, benefits and payment rates.

Takeaway: Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law. However, this is a dramatic shift moving from an open-ended Federal government funded program into a fixed payment. The real question is can the state manage the costs more efficiently under the fixed per capita budget with rising or unforeseen healthcare costs and the number of people on Medicaid, which typically increase during recessions. If the state’s Medicaid costs become greater than the Federal per capita payments, the state must pay the additional costs or cut benefits or enrollment.

Home Care Industry Turnover Reaches All-Time High of 82%

Staffing is already cited as the No. 1 challenge, and the median caregiver turnover rate increased 15% over the previous year to 82% in 2018, according to this year’s Home Care Benchmarking Study. Nearly 700 home care providers operating across 1,148 locations participated in the 2019 Benchmarking Study. The home care industry has exploded over the past decade, partly thanks to private equity interest and older adults’ overwhelming preference to age in place. But it’s not just new entrants struggling with turnover. The bulk of providers that participated in the 2019 Benchmarking Study had been in the industry for 10 or more years. In general, experts say, specialized training programs help with turnover because they offer caregivers a career ladder and, in theory, opportunities to make more money. Different hours, better management and new clients are among the top reasons caregivers leave their agencies, according to Home Care Pulse. More money is also a top reason, with an increasingly larger share of caregivers shifting into retail and food service positions that offer higher pay. For example, online retailer Amazon raised its minimum wage to $15 for all full-time, part-time, temporary and seasonal employees, regardless of where they work or what their position is. Up to 12% of caregivers say they have interviewed or worked for Amazon over the past year, research from online job board myCNAjobs suggests.

Takeaway: Nationally, home health aides and personal care aides rank third and fourth as the fastest growing occupations, according to the U.S. Bureau of Labor Statistics. To meet consumer demand, an estimated 778,000 personal care aides and 431,000 home health aides will need to enter the workforce by 2026. There is more competition for caregivers, more demand with the increase in seniors and more focus on caregiver services when Medicare Advantage expanded supplemental benefits to include benefits such as in-home care and retail jobs offering higher hourly wages for oftentimes, easier work.  This is why the articles focus on providing specialized training and career ladder opportunities is an important consideration to retain caregivers.

Employer Health Plans Pay Hospitals 241% of Medicare

Private employer-sponsored health plans paid hospitals 241% of Medicare prices, on average, for the same services at the same hospitals in 2017, according to a RAND Health study. The study also found that relative prices in 2017 for outpatient care far exceeded prices for inpatient services. And while prices paid by employer health plans—which is how most Americans get their health coverage—increased gradually (4%) as a whole, prices varied widely by state and hospital system. Hospital systems’ prices for employer plans ranged from 150% of Medicare to more than 400%, according to the study. “If you ask hospitals, they will pretty commonly say that ‘our prices are high because we lose money on Medicaid patients and barely break even on Medicare.’ But if you kind of look at the data, that story doesn’t hold up that well empirically,” said Christopher Whaley, one of the study’s authors.  At the high end, Brentwood, Tenn.-based Quorum Health’s relative price for inpatient and outpatient services combined was 438% of the Medicare rate between 2015 and 2017. That includes outpatient prices of 590% of Medicare and inpatient prices of 249% of Medicare. Among the 25 states analyzed, prices paid by private plans in Indiana were the highest at 311% of Medicare, while prices paid in Michigan were the lowest on average at 156% of Medicare prices.

Takeaway: The report brings transparency into how widely the costs range among the 70 hospital systems and 25 states studied. This transparency can help employers improve their negotiated rates with health plans and third-party administrators. The article also includes examples where states are hoping the data will help employers to create new value-based payment models and benefit designs to help lower costs. The article also includes a good graphiccomparing the hospital system costs. RAND’s report is one of the few reports that shows relative prices at both the individual hospital level and the system level, which is why this study is so valuable.

Apple’s Rumored to Launch a Number of Hearing Related Technologies

Apple is taking one more step into helping consumers manage their health.  Hearing accessibility and wellbeing appear to be at the center of these health-related rumors. The tech giant is reportedly planning to include hearing aid support and e a new section for hearing health, which will inform users about music and environmental volume. The latest smartwatch is also going to have a function that displays the battery life of hearing aids, as well as external noise and rain data, Bloomberg reported. The Apple Watch will also have a new app, named Cycles, that will help women track their periods, and another, called Dose for pill reminders, according to the report.

Takeaway:  It matters because with boomers aging, hearing aids and services are becoming increasingly hot topics. Hearing loss is particularly prevalent in older adults impacting around one in three people between the ages of 65 and 74 and close to half of adults over 75, according to the National Institute on Aging. Dr. Charlotte Yeh, chief medical officer at AARP, named hearing loss as one of the top health issues that technology could address.

Disclaimer: This blog includes content gathered from other published sources, not authored by Navvis, and is presented as information only. As with any news story, this information may have changed since its publication date. Commentary included with the information is the opinion of its authors, and is not indented to provide legal or regulatory advice or guidance to the reader. Navvis does not represent the accuracy of or assume liability for the content presented herein.