The Role of Social Media in the Healthcare Industry

We can all agree that social media has become a part of everyday, mainstream life. As with many new technologies, some industries are slower to adapt than others. In this case, the healthcare industry has been a little on the slow side of social media adaptation.

However, a recent report found that,

"In a survey of more than a thousand consumers, more than two-fifths of individuals said social media did affect their choice of a provider or organization. Forty-five percent said it would affect their decision to get a second opinion; 34 percent said it would influence their decision about taking a certain medication and 32 percent said it would affect their choice of a health insurance plan."

These findings are not implying that social media is the deciding factor for choosing a healthcare providor, but they do provide very valuable information. 

The most important of this information can be summed up in a quote from Farris Timimi, medical director for the Mayo Clinic Center for Social Media:

"Our patients are there. Our moral obligation is to meet them where they're at and give them the information they need so they can seek recovery," Timimi said. "This is not marketing; this is the right thing to do."

Banner Health Considers Pioneer ACO Contract

Arizona may be the home of the first pioneer ACO, if the state’s Banner Health accepts a contract presented by CMS this week. The largest health system in the state, Banner has a lot to gain from the early adopter ‘pioneer’ program.

In a statement describing massive funding cuts, Banner CEO Peter Fine explained the thought behind the move to ACO.

The traditional model of fee-for-service is gradually giving way to a collaborative model in which reimbursement is shared by hospitals, physicians and other providers based on the health management of defined populations…Doubtless, there will be those who will decry ACOs as a by-product of health-care reform and therefore unworthy of consideration. However, ACOs and similar collaborative models are moving forward whether health-care reform is implemented or not.

For Banner, the only point of concern was timing. “The issue before us now is that of timing. How fast can we bring new models of collaboration into existence?” Fine asked in his statement. As it turns out, it’s a question that many people are asking.

In a white paper available from the Robert Wood Johnson Foundation, authors Berenson RA and Burton RA explain that “…so far, the reception to CMS’ final regulations has been positive, but how many organizations will actually apply to CMS to be ACOs is another question.” The paper attempted to explain CMS’s motives for the ACO Pioneer program, and to establish a prediction on the widespread success of the program. FierceHealthcare summarizes:

How many and how fast will ACOs spread? CMS estimates 50 to 270 ACOs will sign up to participate, generating a net savings of $940 million during the first four years through Shared Savings, according to a recent report by the Urban Institute and the Robert Wood Johnson Foundation…

…According to the report, it's unclear if the Shared Savings Program and the earlier Pioneer ACO model are intended to test the ACO concept for large-scale implementation, to see whether it generates sustainable governmental savings, or to move as many providers as possible to ACOs to curb Medicare spending.

A few years will probably pass before we can come to any definitive conclusions on the program, but the Banner exercise at least demonstrates how much is at stake.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Final Rule Addresses ACO Criticism

At their first announcement, the Centers for Medicare and Medicaid Services’ rules for ACOs caused an uproar. Accountable Care Organizations will reward medical providers that meet certain quality of care requirements, but health professionals found the rules to be needlessly complicated, hard to follow, and unrealistic. CMS responded quickly, committing to rework and improve the rule set.

On October 20^th, the proposed changes, collectively called the final rule, released to public acclaim. CMS Administrator Dr. Donald Berwick told Kaiser Health News, “We have been able to fine tune and improve the rules for a range of stakeholders, providers and patients.” Across the board, health industry officials are praising CMS for the new rule changes, and it seems that these requirements will finally move toward improving the country’s health care.

FierceHealthCare.com put together a table outlining the changes CMS made. We have an excerpt below, or you can view the full table here.

Topic	Proposed rule	Final rule
Transition to risk in Track 1	ACOs offer two tracks. Track 1 would entail two years of one-sided shared savings; then participants would have to transition in third year to a performance-based risk, two-sided model of savings and losses.	ACOs still offer two tracks. Track 1 now removes two-sided risk.
Prospective vs. retrospective	Retrospective assignment based on primary care service use, with prospective identification of benchmark population	Preliminary prospective-assignment with beneficiaries identified quarterly, with final reconciliation after each performance year
Quality measures	65 measures in 5 domains	33 measures in 4 domains
Shared savings	One-sided risk model: Sharing begins at savings of 2 percent Two-sided risk model: Sharing on first dollar	Share on first dollar for all ACOs in both models once min. savings rate is achieved

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Medicare Annual Open Enrollment Begins Early

This year, CMS has announced an early launch for Open Enrollment, which will begin October 15^th, instead of the usual date of November 15^th. The enrollment will end on December 7^th. CMS made this change under hopes that it would improve the enrollment process for Medicare beneficiaries, according to the official press release.

This gives people with Medicare a full seven weeks to compare and make decisions, and ensures that they will have essential plan materials and membership cards in hand on January 1, 2012 when new coverage starts.

In the press release, CMS also made efforts to stress the importance of investigating and exploring plan options.

There'll be a wide range of health and drug plan options available across the country, including Original Medicare. Most people with Medicare can choose a "Part D" plan to help them pay for prescription drugs. And people who have chosen to enroll in a "Part C" Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program. Plans can change from year to year, so these are important choices that should be made with care.

As usual, the organization is making a big push to promote information sources such as 1-800-MEDICARE and http://www.medicare.gov. We saw many efforts being made around this time last year to promote those educational channels, and it is certainly good to see them remaining a large part of CMS’s enrollment initiative.

 

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Medical Marketers Make the Most of Small Windows

Curious about the best way to handle the complicated framework of marketing periods for health plans? As it turns out, Windsor Health Group came up with an intriguing loophole. This DMNews article does a great job of spelling out the details, but the whole process can be summed up in a few steps.

Windsor began their strategy by sending out copies of the most recent SSA Medicare guide to 200,000 of their best prospects:

"We wanted to make sure that everyone was aware of new regulations," says John Sowell, VP of marketing at Windsor Health Plan, Inc. "Because there were many changes with Medicare, the election period and new published social security guide, we wanted to make sure all eligibles in our service area were fully aware of the changes that were coming their way."

This allowed Windsor to make initial contact with prospects without violating compliance regulations that prevent benefit-oriented marketing before October 1.

Once that deadline arrived, Windsor sent out 400,000 packages detailing their Medicare Advantage health plan. Half went to the previously-contacted high level prospects, and half went to the second tier of potentials. This plan garnered a 1.64% response rate, and 20,000 direct mail leads. Continuing competition in the health care industry will likely provoke more creative techniques, but Windsor should be commended for taking advantage of every possible edge they had.

For other creative methods for marketing healthcare, click here.

Cignet Fined for HIPAA Violation.

The first civil money penalty of $4.3 million has been imposed by HHS on Cignet Health of Prince George’s County, Maryland. HHS and CMS have been very firm that violations will no longer be tolerated. With the enactment of HITECH, this type of penalty seemed inevitable.  An individual’s rights to the privacy of their personal information and access to their own medical records is of utmost importance and while beneficiary protection is a main theme of CMS, it appears HHS is a strong advocate of this as well.

OCR has issued a Notice of Final Determination finding that Cignet violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.  The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Ensuring that Americans’ health information privacy is protected is vital to our health care system and a priority of this Administration. The U.S. Department of Health and Human Services is serious about enforcing individual rights guaranteed by the HIPAA Privacy Rule,” said HHS Secretary Kathleen Sebelius.

In a Notice of Proposed Determination issued Oct. 20, 2010, OCR found that Cignet violated 41 patients’ rights by denying them access to their medical records when requested between September 2008 and October 2009. These patients individually filed complaints with OCR, initiating investigations of each complaint. The HIPAA Privacy Rule requires that a covered entity provide a patient with a copy of their medical records within 30 (and no later than 60) days of the patient’s request. The CMP for these violations is $1.3 million.  

During the investigations, Cignet refused to respond to OCR’s demands to produce the records. Additionally, Cignet failed to cooperate with OCR’s investigations of the complaints and produce the records in response to OCR’s subpoena. OCR filed a petition to enforce its subpoena in United States District Court and obtained a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet produced the medical records to OCR, but otherwise made no efforts to resolve the complaints through informal means.

OCR also found that Cignet failed to cooperate with OCR’s investigations on a continuing daily basis from March 17, 2009, to April 7, 2010, and that the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule. Covered entities are required under law to cooperate with the Department’s investigations. The CMP for these violations is $3 million.

“Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA’s requirements,” said OCR Director Georgina Verdugo.  “The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

State Medicaid Cutbacks?

Medicaid is a rapidly growing sector of the health care arena.  Today, 50 million low income people receive health benefits from their State Medicaid program.  The 50 million individuals are comprised of adults, large numbers of seniors and disabled patients in nursing homes, and 1 in 4 children in America.

Image Courtesy Of savemedicaid.org

Medicaid costs are the top expense of most state’s budget. With this in mind, states have asked HHS, Kathleen Sebelius for help. The states have requested to reduce enrollment within their respective states and raise eligibility criteria to foster this reduction. Another aspect of this request is their revenue shortfall of $175 billion. With the current administrations stimulus bill drying up at the end of this year all states are scrambling to find ways to survive.  The easy state budget cuts have been made and now hard realities must be reviewed. To make up this difference the states have asked to cut Medicaid enrollment and reduce eligibility. Currently each state much maintain a Medicaid enrollment level.

Secretary Sebelius urged states to find savings through other approaches, including charging higher co-payments for some services, limiting certain benefits, managing high-cost patients more efficiently, squeezing drugs costs, and cracking down on improper payments.

"We are committed to responsiveness and flexibility, and will expedite review of state proposals," Sebelius wrote. "My team stands ready to come to your state to discuss your priorities and how we can help achieve them."

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. Pam can be contacted at Pamela.Argeris@merrillcorp.com.

Mandated Member Communications in Healthcare: An Introduction

Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process. The enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process. Worse, failure to comply with strict service level agreements and deadlines can result in penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

Today, this blog is commencing a series on the topic of mandated member communications, including the different types that currently (and potentially) could exist, as well as new methods for companies to improve their process for staying compliant.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact her at Pamela.Argeris@merrillcorp.com.