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» Mark Cuban Drug Savings, Value-Based Care, Racial Bias, LGBTQ Provider Directory, and more!

June 21, 2022

Business Strategies, Digital Health, Direct Contracting, Employee Benefits, Health Equity, Health Insurance, Healthcare Innovation, Healthcare Spending, Human Resources, News, Prescription Drugs, Research


If you’re taking prescription drugs, please check out MCCPDC

Because “The Mark Cuban Cost Plus Drug Company” is way too long to say out loud.

And now onto the rest of the newsletter!

Value-Based Care in Employer Health Plans

If there was a hypebeast for health care, they’d be all over value-based care. But can VBC really deliver “better benefits at lower costs” like we all dream of? (Ok maybe I just have weird dreams)

The answer is a resounding ‘sort of’, based on a review of 59 (!) studies over the last few decades. Overall, VBC had numerous positive results for quality (did people get healthier?) and fewer but still positive results on spending and utilization.

Now recall, value-based payments in short means linking reimbursement to doctors and hospitals to measures of quality or spending. You might see them called pay-for-performance, bundled or episode-based payments, shared savings or shared risk, or population-based payments. The alternative is Fee-for-Service, which pays providers for every single thing they do, which might induce them to extra or unnecessary tests and procedures. Value-based care is ‘skin in the game,’ so to speak.

Key takeaways:

  • Benefit design can send people to high-quality providers as a way to control costs. We love this.
  • Success for VBC depends on the data and systems capabilities of a health system to support the model, not to mention the system’s openness to change. This makes sense and is why we like partnering with forward-thinking health systems like UCLA, Scripps, and MemorialCare.

While some of the spending results weren’t as strong in these studies, we do believe that for companies offering benefits over a long time horizon, healthier employees will cost less to insure. Remember, insurance carriers work with a 12-month perspective; you are paying for your employees’ healthcare for the foreseeable future.

More and more carriers and plans are adopting elements of VBC so if you want to know how this can help your organization with the dream of ‘Better benefits for lower costs’, let’s talk.

Cool Resource: LGBTQ Provider Directory

The GLMA is the world’s largest and oldest association of LGBTQ health professionals, founded back in 1981. It has a number of resources such as trans health resources, the Lesbian Health Fund, advocacy, and more. The resource I want to highlight though is the Provider Directory, a free resource to help you find primary care providers, specialists, therapists, dentists and more in your area.

Why is it important to help your LGBTQ population get access to competent care?

  • 25% of LGBTQ+ people report having to educate their clinicians
  • Over 50% of LGBTQ+ people report some form of healthcare discrimination
  • 20% of Gen Z identify as LGBTQ+

Stats via FOLX Health 

You’re probably hiring generations like Millenials and Gen Z who even if they don’t identify themselves with a particular group, they sure as heck are looking to see how inclusive and open your company is as a whole. 

Racial Bias in Cancer Clinical Trials

This article looked at the racial bias in patient enrollment in cancer clinical trials, which is a big deal for cancer research and drug development.  One survey found that 60 percent of Black respondents to a survey said they were never offered a clinical trial or even had a discussion about one with their provider.

Researchers make assumptions about the time involved, their perception that patients lack transportation, and all sorts of stories to not be inclusive. Another issue is researchers exclude certain races from a trial due to the incidence of comorbidities, which they believe can skew the data. But the data is typically skewed due to the non-diverse patient population in the trial to begin with!

KHN: 100 million people in America are saddled with healthcare debt

Kaiser Family Foundation reported on a recent study that looked at medical debt in the country. TL;DR: We’re not doing great!

Most damning of all in this article was a quote from the former CEO of Kaiser Permanente, “People are getting bankrupted when they get care even if they have insurance.”

If you make benefits decisions at your company, you have to consider the possibility that your plans are leading your employees to take on medical debt. 

But if you can offer benefits that save people from falling into a hole of medical debt and instead offer them affordable and accessible healthcare… what kind of edge would that be in your labor market?

Other News in Healthcare

Digital Twin: Companies and researchers use what’re called ‘Digital Twins’ to test real-life decisions in a virtual setting. This is pretty fascinating and applies to many industries, not just healthcare. 

Bias in ML for Health Insurers: Machine learning is one of the hottest trends in society and health insurers are no exception. They’re using machine learning to identify patients at risk for things like being noncompliant with medicine or falling below optimal adherence for resources. But like anything in emerging technology, there are systemic biases that affect how a question gets framed, how the algorithm is developed and implemented, and how intervention occurs. 

The Billionaire Fighting Hospital Monopolies: FTC pushback recently squashed two health system mergers, one between RWJBarnabas Health and Saint Peter’s in New Jersey and the other involving HCA Healthcare and Steward Health in Utah. This is important because research has found that decreased competition and increased concentration in markets tend to drive up prices but have no positive impact on quality. And interestingly, a legal campaign fighting consolidation has new backing from billionaire John Arnold. Let’s see where this goes!

That’s it for this week. As always, like and subscribe to this post on LinkedIn and schedule time with me if you want to directly chat about anything you read!

Posted by in Business Strategies, Digital Health, Direct Contracting, Employee Benefits, Health Equity, Health Insurance, Healthcare Innovation, Healthcare Spending, Human Resources, News, Prescription Drugs, Research