october 1, 2012 monday memo health reform update€¦ · countless forms that repeatedly asked the...
TRANSCRIPT
Deloitte Center for Health Solutions
October 1, 2012
Monday memo
Health reform update
This week’s headlines: My take
Implementation update - HHS provides funding for mental health workforce expansion targeting at-risk populations
- CMS: new initiative to study avoidable hospitalizations for nursing home residents
- Health insurance exchange update: guidance for multi-state plans
- Report: safety net providers critical for ACA’s insurance coverage provisions
- Hospitals submit comments on IRS charitable hospital rule
Legislative update - House bill proposes CBO expand projections for prevention and wellness programs
- FDA receives approval from Congress to collect funding from the generic drug industry
State update - Health insurance exchange update
- State round-up
Industry news - mHealth task force releases recommendations for expanded use of mobile health - HHS, DOJ warn about fraud in hospitals
- Military leaders say junk food is a threat to national preparedness
Quotable
Fact file
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My take
From Paul Keckley, Executive Director, Deloitte Center for Health Solutions
I just finished the final accounting for my knee episode last November and subsequent
blood clot. The scorecard: total charges billed by doctors, hospitals, labs, pharmacies, and
over-the-counter “stuff” including bandages, etc.: $23,786. Of this, I paid $1,975 out-of-
pocket. Pretty good deal! I was a guest in four hospital emergency rooms, including three to
aspirate my knee so I could walk, and used 12 different labs in seven states for blood
testing to monitor my warfarin dosage. I saw my primary care physician and surgeon twice,
gratefully engaging with both via e-mail regularly through the process.
It took a while to figure this out, and along the way I learned a lot about the health care
system:
It’s hard to know how much anything costs. Prices are not readily available, and often
they bear no resemblance to what things cost or what’s actually paid by the
insurance company. Getting answers about costs is tough, too. Front desk folks
seem put-off if queried about costs, though quite effective in collecting insurance
information and co-payments up front.
The insurance company’s “explanation of benefits” sometimes bears resemblance to
what’s paid out-of-pocket, but not always.
Getting anything scheduled or a question answered by telephone requires a ten
minute wait to get to a living, breathing person. And for a physician’s office, unless
it’s an emergency, forget about it.
The system is archaic when it comes to information management: I filled out
countless forms that repeatedly asked the same questions, sometimes for the same
organization that did not have the capacity to share information across its multiple
sites.
But thankfully, all the “piece work” for me came together for a successful outcome: I am
walking without pain, except when going down stairs, jogging more frequently, and off
medication.
Since 2008, the Deloitte Center for Health Solutions has surveyed consumers in the U.S.
and other countries to assess their views about their own health and how they navigate their
systems of care. We use a sophisticated multivariate methodology to determine differences
between folks. Individuals navigate the system in several different ways—what patterns of
behaviors and attitudes portray consumers’ unique views of the health care market? The
result was a behavioral and attitudinal segmentation scheme we’ve monitored since. Our
2012 segmentation results will be released shortly.
In the U.S. market, we identified six segments: “content and compliant,” “sick and savvy,”
“casual and cautious,” “online and onboard,” “shop and save,” and “out and about.” The
“content and compliant” and “sick and savvy” tend to behave like “patients,” not particularly
inclined to challenge a professional’s recommendation and query clinicians. The “casual and
cautious” are simply not engaged because they don’t see the need. The other three
segments show characteristics of activism, certainly disruptive to a system more
comfortable with patients than consumers. “Out and about” actively seek and use
alternative, non-Western medicine, often without the knowledge of their clinicians; “online
and onboard” use online tools and mobile applications to assess providers and compare
treatment options and provider competence; and “shop and save” is simply the value
purchaser and is not content with paying more than necessary under any non-emergency
scenario.
2012 health care consumer segments:
Source : Deloitte Center for Health Solutions, “2012 Health Care Consumer Segments,”
October 2012
Amazingly, the composition of the U.S. consumer market has changed little across the half
decade that endured the second longest economic downturn in our history and an
unprecedented spotlight on the health care system via the Affordable Care Act (ACA). I am
struck by the 11% increase in the “casual and cautious”—perhaps health care is “fait
accompli” and beyond their control to change their plight or its trajectory. And the “shop and
save”: 4% who, then and now, comprise the cost-conscious, price-driven element of the
market. Go figure. Virtually every other industry in our economy has seen an uptick in price
sensitivity and value purchasing—cars, housing, furniture and clothing. Store brands have
gained market share vs. national brands, discount retailing has increased dramatically, and
the same is true in other industries as well. In most sectors, “premium brands” have been
resilient for the upscale cohort but increased price sensitivity has driven more purchasers to
seek better deals.
It’s easy to see why “shop and save” is such a small and seemingly stagnant segment. The
fact is it’s hard to be a “value shopper” in health care when all this “stuff” is so confusing and
outsiders have limited access to what things cost or how much they’ll spend. The market is
deluged with “Top 100” lists intended to help consumers cut through the noise, but with 700
“Top 100” hospitals, which list matters most? And every airline magazine now features “top
doctors” along with steakhouses to shortcut our shopping. But costs and pricing are rarely
provided.
Having gone through this knee ordeal, I have concluded the health system operates as if
we’re not consumers. We are “patients” to our hospitals, doctors think us incapable of
managing health on our own or are too lazy to engage, and drug manufacturers depend on
prescribers to sell their products. And we are “members” to health plans and employers who
choose insurance options for us and then monitor our use. It’s easier for providers to
manage patients than engage consumers; it’s a completely different business for health
insurers to plan to sell to individual consumers vs. employers and government contractors.
In my view, the most significant trend in the U.S. system not fully understood nor embraced
by its stakeholders is the impact of engaged consumers. Engaged consumers will test our
value propositions, require information technologies that eliminate redundant testing and
paperwork, and demand information about the evidence supporting a treatment
recommendation and its associated costs before the “transaction” is finished. This will
accelerate as employers embrace defined contributions in lieu of defined benefits and state
health insurance exchanges (HIXs) create a new market for individuals to purchase
coverage.
Millennials (18-29 years olds) are there now; the younger Generation X (40-45 years olds) is
just behind. It’s not a matter of if, but how soon. And for them, it can’t come soon enough.
I am thankful to have survived my knee episode without further complication, but it could
have been much easier and perhaps less costly—it’s hard to know. The secrets of the
system’s costs are still perhaps its most guarded.
PS – This Wednesday, the first of three Presidential debates will be aired at 9pm EDT from
Denver with PBS’ Jim Lehrer moderating. Health care is slated as one of the six topics for
the domestic issue focused agenda.
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Implementation update
HHS provides funding for mental health workforce expansion targeting at-risk
populations Last week, the U.S. Department of Health and Human Services (HHS) announced $9.8
million in funding for 24 graduate schools that offer social work and psychology degrees.
The three-year grants are intended to increase the mental health workforce to provide
services for at-risk individuals, including veterans and individuals with mental illnesses living
in rural areas.
Background: Section 5306 of ACA allocates funding for mental and behavioral health
education and training grants for higher education institutions.
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CMS: new initiative to study avoidable hospitalizations for nursing home
residents Last week, the Centers for Medicare and Medicaid Services (CMS) introduced the Initiative
to Reduce Avoidable Hospitalizations among Nursing Facility Residents program partnering
with seven organizations and 145 nursing facilities to study avoidable hospitalizations for
seniors living in nursing homes.
Background: Section 3201 of the ACA established the Center for Medicare and Medicaid
Innovation to implement innovative payment systems to improve quality of care and reduce
costs for plan participants and beneficiaries. Section 2602 of the ACA established the
Medicare-Medicaid Coordination Office to improve coverage and payment coordination for
dual eligibles.
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Health insurance exchange update: guidance for multi-state plans The U.S. Office of Personnel Management (OPM) released the draft 2014 Multi-State Plan
Program (MSPP) application for interested health insurance issuers this month. Per ACA
Section 10104, the OPM must contract with at least two multi-state plans (MSPs) that offer
coverage through HIXs in all geographic regions. The OPM proposes the following:
MSP issuers may phase in over four years. In the first year of the MSPP contract,
MSPs must be offered in 60% of states and 85% in the third year
MSPs would be able to participate in part rather than all of the states initially
OPM may enter into contract negotiations with any applicant who submits a
complete, responsive application that demonstrates to OPM’s satisfaction that the
applicant is able and willing to meet the requirements to become an MSPP issuer
MSPP issuers must accept enrollments beginning October 1, 2013 for coverage
beginning as early as January 1, 2014
(Source: OPM, “2014 Multi-State Plan Program Application DRAFT,” September 2012)
Comments will be accepted through October 22, 2012.
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Report: safety net providers critical for ACA’s insurance coverage provisions Last week, the National Academy of State Health Policy released a report about the role
safety net providers could play relative to the insurance coverage expansion provisions in
the ACA. The report highlighted areas where safety net provider involvement is critical:
Conducting outreach to uninsured or under-insured clients to help determine
eligibility for a state’s HIX or Medicaid program
Assisting individuals with enrollment, as many safety net providers already have
services in place
Safety net providers participating in Qualified Health Plans (QHPs) in a HIX can help
promote continuous insurance coverage for low-income individuals at-risk of churning
between Medicaid and the HIX
Background: Section 1311 of the ACA requires that QHPs include “essential community
providers, where available, that serve predominantly low-income, medically underserved
individuals.” Also, per Section 2201 of the ACA, states must coordinate enrollment efforts
between the state’s HIX and Medicaid program. According to guidance from HHS, the U.S.
Supreme Court’s June 2012 ruling allowing states to reject Medicaid expansion does not
exempt states from Section 2201 of the ACA.
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Hospitals submit comments on IRS charitable hospital rule Last week, the American Hospital Association (AHA) and the Catholic Health Association
(CHA) submitted comments to the U.S. Internal Revenue Service (IRS) about its Additional
Requirements for Charitable Hospitals proposed rule released in June 2012. Among others,
their recommendations include:
The effective date for final regulations be postponed to after January 1, 2014
The IRS allow hospitals to individually decide the most effective and efficient way to
meet financial assistance policy (FAP) requirements with full disclosure rather than
the adoption of the proposed uniform procedures
The U.S. Department of the Treasury establish an “intermediate sanctions” period to
allow hospitals with infractions to resolve them without losing tax exemption status
The IRS provide clarification that other procedures for publicizing FAP will be allowed
to ensure hospitals use the most effective way to inform their community
The removal of additional requirements for emergency medical care that go beyond
the scope of Emergency Medical Treatment and Labor Act (EMTALA) requirements
Issuing clarification to allow hospitals to continue to include insured patients who
struggle to pay deductibles and co-pays in their FAP, and limit the notice and
application period for financial assistance to no more than 180 days total
Background: per ACA Section 9007, IRS code was amended to include new requirements
hospitals must satisfy to maintain charitable organization status including: the information
that must be included in its FAP and emergency medical care policy, methods to widely
publicize its FAP, maximum amounts FAP-eligible individuals may be charged for
emergency care. The rule also describes hospital collections practices that are permitted
and prohibited in charitable hospitals, and all requirements would apply to taxable years
beginning after March 23, 2012.
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Legislative update
House bill proposes CBO expand projections for prevention and wellness
programs Before Congress went on its pre-election recess, Representative Michael Burgess (R-TX),
with 16 co-sponsors, introduced the Preventive Health Savings Act (H.R. 6482), which
would require the U.S. Congressional Budget Office (CBO) to look beyond the typical 10-
year forecasting period when determining cost savings related to disease prevention and
wellness programs. The bill was referred to the House Committee on the Budget on
September 21, 2012.
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FDA receives approval from Congress to collect funding from the generic
drug industry Before leaving for pre-election recess, Congress authorized the U.S. Food and Drug
Administration’s (FDA) collection of fees from the generic drug industry per the Generic
Drug User Fee Amendments (GDUFA) of 2012, which is part of the FDA Safety and
Innovation Act. GDUFA was passed in July of this year to increase availability of generic
drugs on the market and would allow the FDA to receive funding from the generic drug
industry to help expedite reviews of generic drug applications. The FDA has been unable to
review generic drug applications in a timely manner due to the high volume of applications
and its limited resources. According to the FDA, there are 2,500 applications for new
generic drugs waiting for FDA approval. The FDA is scheduled to begin the program today.
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State update
Health insurance exchange update Thursday, HHS announced that Arkansas, Colorado, Kentucky, Massachusetts,
Minnesota, and the District of Columbia (D.C.) were awarded grants to establish their
HIXs. To date, a total of 49 states, D.C., and four territories have received HIX planning
grants, and 34 states and D.C. have received HIX establishment grants. South Dakota
Governor Dennis Daugaard (R) announced Wednesday the state will not set up its own HIX,
and will allow the federal government to establish a Federally-Facilitated Exchange (FFE).
Senator Orrin Hatch (R-UT) sent a letter to HHS expressing concern over the “lack of
transparency” from the agency with regard to the implementation of the FFE. The Senator
remarked that with the November 16, 2012 exchange blueprint deadline quickly
approaching, states have yet to receive adequate information on how the FFE will operate
with state insurance law or cost estimates associated with selecting the FFE. Senator Hatch
requests a response to his inquiries from HHS by October 19, 2012.
Related: Friday, Representative Fred Upton (R-MI) and Senator Chuck Grassley (R-IA) sent
a letter to Secretary of HHS, Kathleen Sebelius, asking how HHS is tracking state spending
of federal funds disbursed to states for HIX implementation. The letter also asks HHS
whether effectiveness of grant use is being measured and whether HHS is providing
guidance to states on how to avoid fraud, waste, and abuse.
Background: per Section 1311 of the ACA, a state can choose to establish a state-operated
HIX, participate in a State Partnership Exchange (SPE), or allow the federal government to
run an FFE in the state. States seeking to operate a state-based exchange or participate in
a SPE must submit a blueprint of its plan and operational capabilities by November 16,
2012. States choosing to implement a HIX through the federal partnership with HHS will be
responsible for day-to-day management of plans and/or any consumer assistance functions,
but HHS will be the authority over the FFE selecting state partners through which plan
management and consumer assistance functions will be provided (i.e., infrastructure and
operational partnerships).
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State round-up Last week, Insurance Commissioner Michael Consedine of Pennsylvania sent a
letter to HHS Secretary Kathleen Sebelius seeking clarity on whether today’s
deadline for the essential health benefit (EHB) benchmark plan is a hard or soft
deadline. “HHS recently has directed states that they must identify their EHB
benchmark by September 30th. Some communications from your agency indicate
that this is a suggested response date while other indicates that it is a deadline of
some sort. We again are asking for clarity on the process and timing for decision
making at both the state and federal levels.” (Source: Insurance Commissioner
Michael Consedine, letter to HHS Secretary Kathleen Sebelius, September 23, 2012)
Background: per section 1302 of the ACA, states must define an EHB benchmark
plan that includes all ten statutorily required benefit categories. Each state must
model its plan after one of the following health insurance plans: one of the three
largest small group plans in the state by enrollment, one of the three largest state
employee health plans by enrollment, one of the three largest federal employee
health plan options by enrollment, or the largest HMO plan offered in the state’s
commercial market by enrollment. According to HHS, states that do not define an
EHB benchmark plan must use the small group plan with the largest enrollment in the
state.
Governor Jerry Brown (D) recently signed the California Birth Control Bill,
authorizing registered nurses in primary care clinics to dispense specified birth
control drugs or devices with an order issued by a physician, surgeon, certified
nurse-midwife, nurse practitioner, or physician assistant. The bill prohibits clinics from
employing nurses solely to perform drug dispensing duties. It also establishes
standardized procedure including training requirements regarding educating patients
on medical standards for ongoing women’s preventive health, and the extent of
physician and surgeon supervision required.
Nebraska issued a request for proposal for bidders to provide a Web portal to
support the state’s HIX, administered by the Department of Insurance. The state has
yet to adopt legislation or an executive order creating an HIX, but has received
almost $6.5 million from HHS in HIX planning and establishment grants.
A recent study of Arizona’s Medicaid program expansion found that the state would
receive close to $8 billion in federal funding, insure an additional 435,000 residents,
and create 21,000 jobs by 2017 with a $1.5 billion investment over the first four years
if it elects to expand its Medicaid eligibility to 133% federal poverty level (FPL).
Researchers also found that complying with ACA expansion to 133% FPL would
save the state $1.2 billion when compared to complying with the “Healthy Arizona”
proposition, which would expand eligibility to 100% FPL and offer more coverage to
children.
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Industry news
mHealth task force releases recommendations for expanded use of mobile
health Last week, the mHealth Task Force met with Federal Communications Commission (FCC)
Chairman Julius Genachowski to discuss its recommendations for successful adoption of
wireless health technologies. The goal of the task force is to guide the FCC and other
agencies in making wireless electronic health solutions routinely available as part of best
practices for medical care by 2017. Highlights:
Task Force Goals Recommendations of the Task Force
1. FCC should continue to play a
leadership role in advancing
mobile health adoption
FCC should appoint a Health Care Director, improve educational
outreach activities to health care organizations, launch a health
care website, and continue to seek public input and further its
engagement with the mHealth Task Force
2. Federal agencies should
increase collaboration to promote
innovation, protect patient safety,
and avoid regulatory duplication
The Secretary of HHS should convene a formal working group as permitted under the FDA Safety and Innovation Act of 2012
FCC should explore how to share specific health data between
federal agencies, standardize health technology nomenclature, and provide expertise and resources
3.The FCC should build on
existing programs and link
programs when possible in order to expand broadband access for
health care
FCC should update the Rural Health Care Program, and modernize the Lifeline Program for Broadband
4. The FCC should continue
efforts to increase capacity,
reliability, interoperability, and radio frequency (RF) safety of
mHealth technologies
FCC should make available more licensed spectrum for mobile broadband, work with international counterparts to allocate
spectrum for services, solicit input from the medical community to
assess 2 to 5 year needs to support technology, and evaluate and
make recommendations to address the issues of affordable
connectivity and compatibility in home environments
5. Industry should support continued investment, innovation,
and job creation in the growing
mobile health sector
Industry should adopt standard based technologies to transmit authenticated messages and encrypted health information provide
access and documentation for secure and trusted application
interfaces (API’s) for health data service, and seek collaborative
opportunities for informal and formal private public partnerships
with federal partners
Source: mHealth Task Force, “Findings and Recommendations: improving care delivery
through enhanced communications among providers, patients, and payers,” September
2012
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HHS, DOJ warn about fraud in hospitals Last week, HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder issued
a letter to five major hospital associations, calling attention to the use of electronic systems
to duplicate records for the sole purpose of increasing payments. The letter warned that
early reports have indicated that providers may be committing fraud by “upcoding” the
severity of patients’ conditions for their own profit. CMS is currently reviewing billing through
audits, and will use new tools authorized by the ACA to cease Medicare payments for those
suspected of fraud.
Response: the AHA quickly issued a response noting that on 11 occasions they have
requested CMS develop national guidelines for the reporting of hospital emergency
department (ED) and clinic visits since 2001. Despite these requests, CMS continues to
propose that, until national guidelines are established, hospitals should continue to report
visits according to their own internal hospital guidelines to determine the different levels of
clinic and ED visits. The letter also expressed hospitals’ concerns that without standardized
guidelines new auditing programs are causing redundant audits, unmanageable medical
record requests, and inappropriate payment denials that require time to appeal. AHA offered
to assist CMS in the development of such guidelines and recommends that investments are
made in provider education and payment system fixes to prevent payment mistakes.
Background: according to a recent New York Times analysis, hospitals have changed the
Medicare billing codes they are using and have received $1 billion more in reimbursements
in 2010 than in 2006 as a result. Hospital emergency rooms increased use of the two
highest-paying reimbursement categories in 2010: 54% vs. 40% in 2006. (Source: Reed
Abelson, New York Times “Medicare Bills Rise as Records Turn Electronic,” September 21,
2012)
My take: historically, when information systems are implemented in medical practices and
hospitals, coding accuracy is increased. Hospitals are understandably frustrated by the
warning and anticipate intensified anti-fraud efforts by government overseers.
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Military leaders say junk food is a threat to national preparedness Childhood obesity and junk food in schools poses a threat to national security, according to
a report by retired military leaders released last Tuesday. The report highlights that one in
four young adults are currently too overweight to join the military, and being overweight or
obese is the number one medical reason adults are unable enlist. The study suggests that
schools are a major contributor to the problem by offering poor food choices and lack of
education about proper nutrition. Other notable findings include:
U.S. Department of Defense spends an estimated $1 billion per year for medical care
associated with weight-related health problems
TRICARE—the military health insurance system serving active duty personnel, their
dependents, and veterans—spends over $1 billion a year treating weight-related
diseases including diabetes and heart disease
Overweight recruits were 47% more likely to experience a musculoskeletal injury (i.e.
sprain or stress fracture)
More overweight recruits had to recycle back through boot camp
(Source: Mission Readiness: Military Leaders for Kids, “Still Too Fat to Fight”, September
2012)
My take: many schools are trying to improve cafeteria offerings and increase educational
activities about nutrition; but demand from students for “junk” food and sugar-loaded
beverages is problematic, as is parental involvement, food choices at home, and adequate
exercise. Tackling obesity seems a matter of national urgency requiring an all-out war on its
causes. It’s not just schools.
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Quotable “We have to remember that 30% of our health care dollars are wasted according to recent
studies. And that’s about $750 billion dollars. Fraud, waste, and abuse represents a small
part of that, but in order to really make some headway on everything from inefficient care to
improper diagnoses and lack of coordinated care, we have to have electronic medical records as a foundation to move that forward.”—Harry Greenspun, M.D., Senior Advisor,
Deloitte Center for Health Solutions, Fox Business, “Electronic Medical Records Causing
Rise in Medicare Spending?” September 24, 2012
“Big employers are planning a radical change in the way they provide health benefits to their
workers, giving employees a fixed sum of money and allowing them to choose their medical
coverage and insurer from an online marketplace….The approach will be closely watched
by firms around the US. If it eventually takes hold widely, it might parallel the transition from
company provided pensions to 401(k) retirement savings plans controlled by workers and funded partly by employer contributions.” —Anna Wilde Matthews, Wall Street Journal, “Big
Firms Overhaul Health Coverage,” September 27, 2012
“Nearly 40% of consumers surveyed last year said they use hospital ratings to choose a
health care facility, but there’s little agreement among the lists, raising questions about their
value…At least 15 different groups rank health care organizations, but no two judge them
the same way, which leads to widely divergent results.” —Joyce O Donnell, USA Today, “A
Health Disagreement: Which Hospitals are best? Even the experts can’t agree,” September
28, 2012
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Fact file Life expectancy: 78 years in U.S.; 75.5 years for men and 80.5 years for women.
The U.S. ranks 41st in the world in life expectancy for women vs. 14th in 1985. (Source: U.S. Census Bureau and New York Times, “Life Spans Shrink for Least-
Educated Whites in the U.S.,” September 20, 2012)
Health care investments: in 2011, investments in health care increased to $368
million, up from $261 million in 2010. (Source: National Venture Capital Association)
Medicare costs: 3.25% of gross domestic product (GDP) and forecasted to be
4.25% in 2030 if left as is; both Representative Paul Ryan (R-WI) and President Obama would lock in Medicare at GDP plus .5%. (Source: CBO)
Organ donation: one of five donated kidneys is thrown away; over 115,000 on donor
wait list; country divided in 50 donor districts; in 2011, 2,644 of 14,784 discarded—
500 because a recipient could not be found. (Source: United Network for Organ
Sharing)
Employer sponsored health insurance: 9% of companies representing 2.58 million
workers (3% of the workforce) anticipate dropping coverage in the next one to three
years. (Source: Deloitte Center for Health Solution, 2012 Employer Survey, 2012)
Illicit drug use: among youth age 12 to 17, 2.8% reported current non-medical use
of prescription-type drugs in 2011—down from 4% in 2002. The rate of non-medical
pain reliever use also declined during this period from 3.2% to 2.3% in 2011. Fifty-
four percent obtained the pain relievers from a friend or relative or free, and 12%
purchased them from a friend of relative. Among young adults aged 18 to 25, the rate
of current nonmedical use of prescription drugs in 2011 was 5%. (Source: HHS, 2011
National Survey on Drug Use and Health, September 2012)
Consumer spending: consumers increased their annual spending 3.3% last year,
the fastest growth rate since 2006. The average level of spending in 2011, $49,705
—highest since 2008. Consumer prices rose 3.2% last year, offering one potential
explanation for increased spending. (Source: Wall Street Journal, “Consumers Back
to Feeling Flush,” September 2012)
Total knee arthroplasty (TKA) volume increase: the number of annual primary
TKAs increased 161.5% between 1991 and 2010 (93,230 to 243,802) while per
capita utilization increased 99.2% (from 31.2 procedures per 10,000 Medicare
enrollees in 1991 to 62.1 procedures per 10,000 in 2010). (Source: JAMA, “Total
Knee Arthroplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries,
1991-2010,” September 2012)
Variation in episode costs: episode costs for major medical procedures vary about
2.5-fold, and up to 15 for common chronic conditions. Costs were on average 14%
lower among physicians who met certain quality and efficiency benchmarks. “This
suggests a potential opportunity exists to improve the current efficiency of care
across the health care system.” (Source: Health Affairs, “Wide Variation In Episode
Costs Within A Commercially Insured Population Highlights Potential To Improve The
Efficiency Of Care,” September 2012)
Americans’ opinions of the ACA: 88% of Americans believe the ACA will be
implemented in full/part either with minor changes (41%), major changes (31%), or as
passed (11%). Twelve percent of respondents anticipate the ACA to be repealed
completely. (Source: Associated Press, “AP-GfK Poll: Health Care Reform,”
September 2012)
Election issues: top issues in Presidential campaign: the economy (49%), federal
budget deficit (41%), Medicare (36%). Among seniors, Medicare was more important,
with 46% indicating Medicare is extremely important to their vote compared with 51%
saying the economy is extremely important. Democrats (48%) are much more likely
than Republicans (28%) to say Medicare is an extremely important factor in their
presidential pick. Seniors (64%) and Democrats (62%) heavily favor keeping
Medicare as it is today while many Republicans (48%) and voters ages 18-54 (44%) support switching to a fixed-value voucher program. (Source: Kaiser Family
Foundation, “Kaiser Health Tracking Poll,” September 2012)
Poverty rates: in 2011, the U.S. poverty rate was 15%, which represents 46.2 million
people. (Source: U.S. Census Bureau)
Medicare fix: 50% think Obama will fix Medicare vs. 44% Romney. (Source:
Gallup/USA Today Poll of 1096 registered voters September 11-17, 2012)
Excessive alcohol consumption: 14 drinks per week for men, or no more than four
per day; seven per week for women, or no more than three per day. (Source:
National Institute on Alcohol Abuse and Alcoholism)
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Deloitte Center for Health Solutions research
Coming soon:
2012 Survey of U.S. Health Care Consumers – INFOBrief series and Five-year report
Impact of Health Care Reform on Insurance Coverage: Project Scenarios Over 10 Years—
Update
Currently available: State Medicaid Program Management: Update and considerations—September 2012.
Available online at www.deloitte.com/us/2012statemedicaid
Meeting the Challenge: Maximizing the value of employer-sponsored health care—
August 2012. Available online at www.deloitte.com/us/meetingthechallenge
2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. health care system
and plans for employee health benefits—July 2012. Available online at
www.deloitte.com/us/2012employersurvey
A look around the corner: Health care CEOs’ perspectives on the future—July 2012.
Available online at www.deloitte.com/us/healthcareceoperspectives
Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health
care system and health care reform—June 2012. Available online at
www.deloitte.com/us/2012consumerism
Health Care Reform: Center Stage 2012 Perspectives from consumers, physicians
and employers—June 2012. Available online at
www.deloitte.com/us/healthcarecenterstage2012
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Dbriefs – live webcasts that give you valuable insights on important developments affecting
your business.
October 9: State Health Insurance Exchanges: Where Are We and What Lies Ahead?
November 13: Market Forces at Work: Life Sciences Implications of Changes in Health Care
Delivery, Access, and Coverage
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Deloitte contacts
Jessica Blume, U.S. Public Sector National Industry Leader, Deloitte LLP
Bill Copeland, U.S. Life Sciences and Health Care National Industry Leader, Deloitte LLP
Jason Girzadas, National Managing Director, Life Sciences & Health Care, Deloitte
Consulting LLP ([email protected])
Harry Greenspun, M.D., Senior Advisor, Health Care Transformation and Technology,
Deloitte Center for Health Solutions ([email protected])
Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions
Mitch Morris, M.D., National Leader, Health Information Technology, Deloitte Consulting
LLP ([email protected])
George Serafin, Managing Director, Health Sciences Governance Regulatory & Risk
Strategies, Deloitte & Touche LLP ([email protected])
Rick Wald, Director, Human Capital, Deloitte Consulting LLP ([email protected])
To receive email alerts when new research is published by the Deloitte Center for Health Solutions, please register at www.deloitte.com/centerforhealthsolutions/subscribe.
To access Center research online, please visit
www.deloitte.com/centerforhealthsolutions.
To arrange a briefing for your team, contact Jennifer Bohn ([email protected]).
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