Health Insights by HealthMine

  • The Number: 16

    Just sixteen percent (16%) of Medicare plan members with chronic conditions said they had a follow-up on quality of care after a provider visit, as reported to HealthMine in a recent study.  Only ten percent (10%) of plan members surveyed said their health plan offers guidance about these chronic conditions.

    Rob Wyse 2018-08-03
  • The Number: 317 Billion

    Chronic disease is prevalent in a huge portion of  the Medicare Advantage population, reportedly 70% of members have at least one chronic condition.  Topping the list is cadiovascular diseases estimated to cost $317 billion per year.

    Rob Wyse 2018-07-27
  • The Number: 23%

    Medicare Advantage beneficiaries had twenty-three (23%) percent fewer inpatient stays than those enrolled in Traditional Fee-for-Service (FFS) Medicare, found a report released this week by Avalere Health.

    Rob Wyse 2018-07-18
  • The Number: 54%

    Fifty-four (54) percent of beneficiaries of Medicare Advantage believe their health plan is working with them to limit out-of-pocket spending, according to a new JD Power consumer survey. This survey was the focus of a recent HealthPayerIntelligence article on customer satisfaction with Medicare Advantage plans.

    Rob Wyse 2018-07-09
  • The Number: 23 Million

    Beyond the estimated 30 million people who have diabetes is another 23 million estimated to have prediabetes – defined as elevated blood sugar levels putting them at heightened risk of developing type 2 diabetes.

    Rob Wyse 2018-06-30
  • The Number: 3%


    Just 3 percent of Medicare beneficiaries represent 25 percent of Medicare expenditures.

    According to a Bloomberg BNA report on June 18, even with this sizable share of funds, the three percent, made up of the advanced illness population, isn’t properly cared for by the current health care system. Now a proposal has been made for a new payment model just for this group with the most serious illnesses.

    Rob Wyse 2018-06-22
  • Data Tsunami

    Medicare Advantage Plans at Start of Data Tsunami

    CMS Administrator Seema Verma announced in April that the agency has released Medicare Advantage encounter data to researchers. (Encounter data are records of the health care services for which managed care organizations pay.)  It was reported that she said at the 2018 Datpalooza conference, “We recognize that the MA data is not perfect, but we have determined that the quality of the available MA data is adequate enough to support research.”

    Rob Wyse 2018-06-06
  • 1/100th of a Star Rating Point Could Mean Survival

    Some Medicare Advantage plans scored a 3.74 and were rounded to the “nearest half Star” based on Centers for Medicare & Medicaid Services (CMS) rules, so the plan was rated a 3.5.  Conversely, other plans were scored 3.75 and were rounded to the nearest half Star of 4.0. 

    Brennan Collins 2018-05-23
  • The Medicare Advantage VBID Plan Administrative Challenge

    CMS started its VBID (value-based insurance design) innovation model for Medicare Advantage on January 1, 2017 to run for five years.  
    Eligible Medicare Advantage plans can offer “varied plan benefit design” for enrollees based on specified clinical categories identified and defined by CMS. In 2017, diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of thereof were the defined categories.

    Brennan Collins 2018-05-11
  • Medicare Advantage

    CMS Expands Medicare Diabetes Program

    The Centers for Medicare and Medicaid (CMS) has expanded its Medicare Diabetes Prevention Program (MDPP) to now enroll traditional healthcare providers and community-based organizations as Medicare suppliers of health behavior change services.

    Brennan Collins 2018-05-09
  • Uber & Lyft Next in Medicare Plan Choice

    CMS announced that it “finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.” 

    Rob Wyse 2018-05-07
  • Health Plans: Are You Collecting Data or Insight?

    A new Premier survey with 63 healthcare executives found that healthcare systems are now shifting their focus from recording data in EHRs to integrating and combining this data to aid in decision making. This is a welcome development for providers and a nudge for health plans to move themselves in the direction of a single, integrated technology platform.

    Rob Wyse 2017-04-18
  • Member Centric Health Requires Intelligence

    Your members may feel that taking charge of their own health is like swimming upstream. Overwhelmed by an increasingly complex sea of medical choices and data, Americans can easily get lost, and carried away by the inertia of leaving their healthcare to providers. The consequences are grave, particularly for those with health risks and chronic conditions. In healthcare, being an engaged consumer is essential to promoting positive outcomes and lowering costs.

    Rob Wyse 2017-03-06
  • Are You Shifting Health Intelligence to Your Members?

    Your members may feel that taking charge of their own health is like swimming upstream. Overwhelmed by an increasingly complex sea of medical choices and data, Americans can easily get lost, and carried away by the inertia of leaving their healthcare to providers. The consequences are grave, particularly for those with health risks and chronic conditions. In healthcare, being an engaged consumer is essential to promoting positive outcomes and lowering costs.

    Rob Wyse 2017-03-06
  • Digital Intelligence Will Transform Your Business

    What if an intelligent application could diagnose a health condition as quickly and precisely as a human doctor? A Financial Times story features a digital diagnostic app called Babylon that crunches through billions of data points collected from thousands of test consultations to help pinpoint an ailment. This is just one example of how machine learning, also known as artificial intelligence, is transforming healthcare.

    Rob Wyse 2017-02-08
  • A Prescription to Combat Rising Drug Costs

    The prognosis for prescription drug costs in 2017 is not good. Prescription prices are projected to jump 11.6 percent in 2017 for Americans under 65 years old, and increase 9.9% for older Americans. This growth outpaces both the cost of living and wages, which are expected to rise just 2.5 percent this year, in contrast. The data comes from a new report by Segal Consulting.

    Rob Wyse 2017-01-13
  • Plan Sponsors Can Buck the Trend

    We spent nearly $10,000 per person on healthcare last year. That’s a higher healthcare bill than Americans have ever paid, and it accelerated at the fastest rate ever since the Great Recession in 2007.

    Rob Wyse 2016-12-13
  • Who is the Captain of Your Members’ Health?

    Patients are increasingly influencing the direction of medical research, according to a recent story by NPR. This is exciting and promising news.

    Rob Wyse 2016-11-29
  • Are Your Members Skipping Their Medicine?

    More than 30 percent of patients with hypertension aren’t taking their prescribed medicine, according to a new study published in the Journal of Evaluation in Clinical Practice.

    Rob Wyse 2016-11-21
  • The Gap In Smoking Cessation Support

    The American Cancer Society released new data spotlighting smoking’s leading role in cancer-related deaths. According to the study, cigarettes are to blame for nearly 3 in 10 cancer deaths in the U.S.

    Rob Wyse 2016-10-31
  • Looking Behind the Curtain at Breast Cancer Screenings

    A new argument for not participating in health screenings involves a theater analogy. Two researchers, Dr.

    Rob Wyse 2016-10-17
  • The Best Thing You Can Do For Members with Chronic Disease

    People with chronic conditions spend 99% of their time outside of the doctor’s office. What they do in that time determines the quality of their health—and the cost of their healthcare.

    Rob Wyse 2016-09-21
  • Big Pharma, Bigger Gaps in Healthcare

    Prescription drugs now account for almost 17% of personal healthcare expenditures – up from about 7% in the 1990s – according to the federal Health and Human Services Department.

    Rob Wyse 2016-09-07
  • E-Cigarettes In The FDA Spotlight

    A new Food and Drug Administration (FDA) rule in effect this month could have big implications for e-cigarettes. Questions have swirled around e-cigarettes recently: are they the same as regular cigarettes? Should they be allowed or banned in the workplace? Are they helpful in smoking cessation efforts or harmful?

    Rob Wyse 2016-08-31
  • A Dose of Technology for Population Health

    Providers are increasingly applying technology to improve the health of large populations--and plan sponsors can take a chapter from their playbook.

    Rob Wyse 2016-08-17
  • Small Portion Of Consumers Make Up Big Portion of Healthcare Costs

    Just 1.2 percent of all health plan members account for nearly a third (31%) of all healthcare spending for large employers. This data comes from a new study by the American Health Policy Institute.
    Over half (53%) of that disproportionately distributed spending is tied to treatment for chronic conditions. Conditions that were the most costly included cancer and heart disease.

    Rob Wyse 2016-07-27
  • Cancer May Be Preventable, But Screenings Are Needed

    Exciting new research revealed that cancer may not be unavoidable, as was previously thought.

    Rob Wyse 2016-07-21
  • Diabetes Patients Spend 4X More on Healthcare Each Year

    According to a recent report from the Health Care Cost Institute (HCCI), health care spending per capita for people with diabetes was a whopping $16,021 per year, compared to $4,396 for people without diabetes. Diabetes patients, in other words, pay nearly four times as much for healthcare as those not suffering from the disease.

    Rob Wyse 2016-07-12
  • Wellness Programs Lack Digital and Real Time Components Needed To Engage Users

    A recent article in Forbes pinpointed ten reasons a wellness program may not be meeting goals, both in terms of health outcomes and cost savings targets.
    1. You use scare tactics.
    2. You incentivize poorly.
    3. You don’t offer biometric screenings.
    4. You only offer biometric screenings.
    5. You don’t consult experts.
    6. You communicate poorly, if at all.
    7. You chose the wrong provider.

    Rob Wyse 2016-06-29
  • Wellness Program Participation Makes Sense (And Cents)

    Is it worth it? That seems to be the lingering question in plan sponsors’ minds when they decide between various wellness program offerings. There’s strong evidence that these programs aid employee attraction and retention. But do wellness programs deliver measurable return on investment (ROI)?
    The answer to that question, according to recent data from Priority Health, is yes.

    Rob Wyse 2016-06-20