May 21, 2015
Precision medicine made it onto the public’s radar on January 20th of this year when President Obama announced during his State of the Union address that he intended to make it a priority in the coming year. Ten days later, he formally unveiled the “Precision Medicine Initiative,” putting $215 million in federal funding towards a variety of strategies intended to get away from what the Administration calls a “one size fits all” style of medicine.
The National Academy of Sciences defines “precision medicine” as “the use of genomic, epigenomic, exposure, and other data to define individual patterns of disease, potentially leading to better individual treatment.” Also known as personalized medicine, precision medicine now is used primarily for the treatment of cancer.
While cancer treatments have long varied based on the type of cancer a person has – breast, lung, colon and so on – precision medicine enables physicians to take into consideration the molecular and genetic makeup of an individual patient’s tumor. This has spawned new medications such as Herceptin trastuzumab (Herceptin) for breast cancer. Having this information also can make a profound difference in treatment decisions physicians make.
Emily Whitehead, who is featured on the whitehouse.gov website, is a great example of an individual who has benefited from precision medicine. Emily was diagnosed with leukemia at age 6, yet was declared cancer-free just 28 days later. Her treatment included a procedure in which Emily’s own white blood cells, which play a key role in immunity, were collected from her blood and altered to recognize a protein found only on the surface of leukemia cells. The cells were then infused back into Emily’s blood, where they circulated throughout her body finding and destroying her leukemia. Science magazine declared this procedure a 2013 Breakthrough of the Year.
In the future, precision medicine also will be used to treat other types of illnesses, not just cancer. In fact, any condition that has a genetic or hereditary component – including mental illnesses – could benefit from this approach.
Some experts suggest that the buzz around precision medicine is getting ahead of the science, but that remains to be seen.
Precision medicine may be the medicine of the future, but not necessarily the distant future.
Inquiring Minds: Towers Watson Reveals Top 10 Questions Employees Asked When Enrolling in Health Plans on OneExchange
February 26, 2015
Every year Towers Watson customer support staff receives thousands of calls from people using OneExchange to find and enroll in health plans. The questions they ask us — and their employers –tell us a lot about what’s important to them and the information and guidance they need to make the best decisions they can.
With a growing number of full-time employees using OneExchange to find health coverage, we decided to compile the top 10 questions asked during the recent fall enrollment period for the plan year 2015. The questions underscore the obligation that employers and exchange providers have to help employees become more informed consumers and more active participants in their own health care.
Earlier this month, we issued a press release with a list of the top 10 questions and what they reveal about employees’ concerns.
Click here to read the full release.
Towers Watson released survey results showing that nearly one in four employers believe that private insurance exchanges could provide a viable alternative for their full-time, active employees as soon as 2016. So far, 28 percent have “extensively evaluated” the viability of private exchanges.
These results are from the 2014 Towers Watson Health Care Changes Ahead Survey, which was completed in July 2014 by 379 employee benefit professionals of midsize to large companies across a variety of industries.
Results from the survey also revealed the three primary reasons employers would adopt a private exchange: 1) if it was a better value than current self-managed model, 2) if other large companies in their industry adopted one, and 3) if the employer’s company was unable to get under the ACA’s excise tax ceiling coming in 2018.
Though employers are starting to consider the viability of private exchanges, they are not inclined to send active employees and their families to the public exchanges. Of the employers surveyed, 99.5 percent said they have no plan to exit health benefits for their active employees and send them to public exchanges.
This position is not likely to shift soon – 77 percent of employers were not confident the public exchanges would be a viable alternative for actives in either 2015 or 2016.
For additional details on these topics and others, click here.
February 7, 2014
>> Stay tuned later this week when the Extend Health blog gets a new name and look. <<
The recent expansion of our Exchange Solutions business segment is a good opportunity to look back at the news from our private Medicare exchange over the past few years. Here are highlights from our early days to today.
It’s a new year and employers are making some resolutions of their own to improve health and wellness — not for themselves, but for their employees.
New Year, New Goals
According to the 2013/2014 Staying@Work report from Towers Watson, nearly half (49%) of U.S. employers surveyed said health and productivity programs are essential to their overall organizational health strategy and 42% said they play at least a “moderate role.” In the survey, health and productivity was defined to include “physical, psychological and emotional aspects of health.”
Meanwhile, 94% of U.S. employers surveyed said that they plan to have “an articulated health and productivity strategy” in the next three years. According to Towers Watson, programs without a cohesive, articulated strategy run the risk of inadvertently offering program elements that are not coordinated with each other, have low return on investment or do not adequately engage employees. When implemented correctly, these programs have been tied to improved employee health AND company savings.
November 6, 2013
With the amount of money being spent on health care in America — and our general enthusiasm for all things mobile — you’d think there would be a huge and successful market for mobile apps that empower consumers to take control of their health and wellness.
But according to a report by the IMS Institute for Healthcare Informatics, of the 40,000+ health care apps now available for download on the U.S. Apple App Store, over 50% of them get downloaded fewer than 500 times.
The report is based on an analysis of these apps and an assessment of the potential value they provide at various stages of a patient’s journey to better health. The study was conducted in June 2013.
So what’s the problem?
According to the IMS report, the following issues are holding us back.
1. There are just too many apps!
Forty thousand apps are available on the App Store alone — with reports of at least another 60,000 available from other sources. Seriously? How can we possibly sort through them and decide which ones might meet our needs… let alone which ones are any good.
The sheer number of apps available suggests that app developers are well aware that if they can strike the right chord with consumers, the potential rewards are great. But so far, few seem to have found that magic formula.
Maybe developers should try asking consumers what we want. And perhaps they should also do a better job working with health care providers to determine what we need.
The payday developers are seeking — and the results consumers and their health care providers are looking for — might very well lie at that intersection.
2. For all of the health apps out there, just 54% have a legitimate health-related function, and therefore have the potential to help us stay healthy or manage existing conditions.
Of the 43,689 apps identified as falling into either the “health and fitness” or “medical” categories in the IMS study, 20,007 were excluded early on from additional analysis because they were not really related to health care. According to the study, examples of those include apps related to beauty or fashion or “apps that use gimmicks with no real health benefits.”
Of the remaining 23,682 apps, 16,275 were for consumers and 7,407 were for health care professionals. Of those for consumers, the majority focus on diet and exercise.
The analysis further showed that two-thirds of the apps available for consumers simply provide information. Smaller subsets give instructions, capture data entered by consumers or have an alert/reminder feature.
In other words, the majority of apps for consumers simply move general information from websites and/or printed materials to our mobile phones — and do little else.
3. We have no way to tell the good apps from the bad apps.
The report notes that another issue is that consumers have few options for guidance on the quality of the various apps available. While physicians see the potential benefits of these, they are wary of recommending them to their patients. They too need information about which ones are helpful and which ones aren’t.
With so many apps available, it’s a sure bet that many, many of them are not very good. The report quotes Dr. Israel Green-Hopkins of Boston Children’s Hospital, saying “…40,000 apps within any store is the definition of poor design, because you know that 90% of them are terrible designs.”
Other reports show that some doctors have recommended apps as helpful tools for their patients – to track pollen counts in allergy season, brush teeth for the recommended amount of time or resist urges when quitting smoking. But physicians warn that these apps are supplements and not replacements for in-office care, with most of their benefit coming from encouraging good behavior, not actually improving health.
For the apps evaluated in this study, the App Stores’s popularity rankings do provide one small measure, but it is ultimately insufficient.
4. The vast majority of these apps are completely disconnected from the rest of our health care providers and systems.
The report notes that over time, health care apps will mature from being self-selected by consumers or physician-recommended on an ad hoc basis to being used systematically in health care delivery as an integrated component of our system. But they are not there yet.
What’s working now
Still, amidst this mass of underperforming apps, it is interesting to note that just five of the 40,000+ apps in the App Store make up a whopping 15% of all downloads.
One of these, Calorie Counter by MyFitnessPal, was the second most popular app in the App Store at the time this analysis was conducted and is the most popular free calorie counter and fitness tracker on Google Play. What does it do? And why is it breaking through?
Positive reviews of the app suggest that its primary strength is its community aspect, which allows users to share their progress, weight-loss goals and calorie counts with friends via social media channels like Facebook and Twitter.
While this might not be appealing to everyone, it has been a powerful differentiator in a sea of competitors. An attractive and intuitive interface also allows it to stand out from the crowd.
Despite these distinctions, the Calorie Counter app simply counts calories and nothing more! And counting calories alone has not been proven to improve overall health.
Bottom line, developers need to build better apps and consumers need better ways to find the good ones.
And the health care community needs to fully embrace mobile apps and integrate them into our health care system — empowering consumers to take charge of their own health.
In the meantime, if you’re using apps to get fit, it’s all about finding what works for you – whether it’s tweeting your latest weight loss milestone or tracking your speed on your morning jog.
August 9, 2013
Reports from the Wall Street Journal last month indicated that doctors are increasingly opting out of the Medicare program. But new numbers from CMS indicate that doctor’s biggest issue may not lie with Medicare, but instead with Medicaid.
The Wall Street Journal article reported that the number of doctors leaving the Medicare program has risen from 3,700 in 2009 to 9,539 in 2012. We wrote about this issue a few weeks ago.
While more doctors are leaving the program, there are also many more joining it. CMS reported that, “the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.” In just the past year, 30,000 doctors entered Medicare, vastly outweighing the 6,000 that opted out over the past 3 years.
While Medicare payments may continue to be an issue for doctors, Medicare patients remain a vital part of many doctors’ practices. Reid Blackwelder, president-elect of the American Academy of Family Physicians, stated that Medicare patients make up 24% of the patient population for AAFP members.
So Medicare isn’t perfect, reimbursement rates and the annual doc-fix are still a point of contention for doctors, but the importance of Medicare patients keeps the majority of doctors in the program.
Medicaid participation tells a different story.
Reports show that less than 70% of the nation’s doctors accepted Medicaid in 2012. And the numbers aren’t getting any better. In a new Health Affairs Study, it was found that about 33% of primary care physicians didn’t accept new Medicaid patients last year.
Reimbursement rates for Medicaid patients are low; payments for procedures are much higher through private insurance than the same procedure for a Medicaid patient. The Affordable Care Act provides a 30% pay hike to primary care physicians who treat Medicaid patients, but the growing number of Medicaid recipients is also a concern. As many as 16 million Americans are expected to gain coverage through Medicaid in the coming years, and doctors may be faced with more patients than they can manage.
The good news is that the availability of doctors who accept Medicare patients appears to be adequate, and will continue to be so. Instead, perhaps the focus needs to be placed on helping doctors continue to accept, and prepare for the increasing numbers of Medicaid patients.
July 26, 2013
The bigger the organization, the greater the chance they are providing employee benefits. In last week’s Labor Department annual report on employee benefits, both size and ownership impact whether companies provide health care benefits, retirement plans, paid vacation and sick leave.
The study found that in 2012, 88% of private sector companies with 500 workers or more provided their employees with health care benefits. The percentage dropped with workforce size. For companies with 100-499 employees, the number fell to 82%. For companies with 50-99 employees, the number further dropped to 69%. And for the smallest companies, with 1-49 employees, only 53% of workers had access to employer-sponsored benefits. The trend was very similar in the public sector, with 90% of organizations with 500 or more employees providing coverage.
Access to company health care in both the public and private sectors rarely changes by more than one percentage point from year to year. In 2011, 90% of the largest companies provided health care benefits and 53% of the smallest companies provided access. In 2002, 82% of companies with 100 workers or more workers provided health care benefits and 58% of companies with 1-99 workers provided the same benefits. The 2013 report continues a long-standing trend of larger employers providing benefits.
Payroll and hours data were also examined in the report and analysts concluded that the numbers did not indicate any extreme increase in the part time work force. While the part time work force can fluctuate by thousands, its percentage of the total workforce has stayed level, between 18.5%-20%, since 2009.
The Labor Department’s report indicates that trends in employer sponsorship of health care benefits are continuing as they have over the last few years. Benefits continue to depend on the size of the company, and the small bump in the part time workforce may mean more part time workers, but as a percentage of the total workforce, it remains constant.
Read more about the report here:
July 25, 2013
In a new survey from Health Pocket released this week, 65 percent of respondents said they would prefer to choose their own insurance carriers rather than have their employer choose for them. But the majority of Americans don’t have the ability to choose their own insurance company. Sixty-six percent of insured Americans receive coverage through their employer, where health care options are limited to the insurers selected by the company.
Private exchanges emerging into the market today from a number of companies, including Towers Watson, offer the kind of choice that the survey indicates people want. A report by Accenture predicts that private exchanges will surpass enrollment in public exchanges by 2018.
Read the Health Pocket survey here: http://www.healthpocket.com/healthcare-research/surveys/group-health-insurance-plans-americans-prefer-to-choose-provider
July 23, 2013
The UCLA Fielding School of Public Health released a study last week examining the constitutional right to health care in countries around the globe. Although all members of the United Nations acknowledge the universal right to health, the study shows that not all counties include health care as a constitutional right.
The study found that 73 U.N. member countries (38 percent) guaranteed the right to medical care services, while 27 (14 percent) aspired to protect this right in 2011.
But the numbers don’t tell the whole story. Countries with older constitutions often don’t include the right to health care, but such countries often have excellent national health care systems. In contrast, there are counties that have constitutional protections for health care, but have trouble implementing their health care systems on the ground.
There is a clear global trend towards adopting national health care systems. Only 1 of 33 constitutions adopted between 2000 and 2011 did not protect at least one health right. America is following the global trend as the Affordable Care Act moves the country closer to the goal of health care coverage for every United States citizen.
Read more about the study here: http://newsroom.ucla.edu/portal/ucla/a-constitutional-right-to-health-247449.aspx