Health Care News You Need to Know
The Orthopedic & Sports Institute (OSI) achieved Advanced Orthopaedic Certification in Total Joint Replacements by the Accreditation Association for Ambulatory Health Care (AAAHC).
Earning this certification means OSI, one of the founding providers in NOVO Health, met the highest level of nationally recognized standards for quality health care set by AAAHC. OSI previously achieved AAAHC accreditation; this certification builds upon that designation. It assesses OSI’s use of evidence-based clinical practice guidelines, ongoing performance improvement strategies and infrastructure that promotes excellence.
OSI’s Appleton surgery center is the first in Wisconsin to achieve this certification.
Common Ground stands firm
Wisconsin’s Common Ground Healthcare Cooperative is a survivor.
Launched on the Affordable Care Act insurance exchanges to boost competition and drive down costs, Common Ground is one of the last three health insurance cooperatives standing. At one time, 23 such co-ops existed insuring more than 1 million lives.
By 2018, Common Ground was the only health plan in seven northeastern Wisconsin counties. Today, the co-op has about 54,000 members and faces competition from two to five carriers in the 20 counties where it operates.
After struggling early on — the co-op was on the verge of ending operations in 2016 when it received a lifesaving $30 million loan — Common Ground recorded a $73 million profit last year and expects to receive about $95 million from the Supreme Court ruling that said the federal government improperly withheld payments designed to cushion losses.
Those payments were considered vital to the co-ops, which do not have the financial resources of the big insurers.
Insurance instability
In the first half of 2020, 43 percent of working-age adults did not have stable health insurance coverage, according to results from the Commonwealth Fund’s latest Biennial Health Insurance Survey.
The reasons for the instability varied: some were uninsured at the time of the survey (12.5%), some experienced a coverage gap (9.5%), and some were insured for the full year but had such high out-of- pocket costs or deductibles relative to their income that they were effectively “underinsured” (21%), according to results from the Commonwealth’s Fund’s latest Biennial Health Insurance Survey.
The Commonwealth Fund’s measure of underinsurance includes how much people spent out-of-pocket in the past year and the size of their deductible, both calculated as a share of their income. Over the past decade, deductibles have grown both in prevalence and size. The share of the adult population in private health plans with deductibles of $1,000 or more doubled between 2010 and 2020.
On the road to better care
The city of Superior, Wis. will reimburse its employees up to $1,000 if they travel to specified orthopedic providers as part of the city’s self-funded health plan, according to the Superior Telegram.
Under its self-funded health plan, Superior, Wis., will reimburse employees for travel expenses up to $1,000. Employees will also receive $500 in their health savings account to incentivize receiving care locally. Medical travel will only be authorized and encouraged for procedures such as shoulder and knee arthroscopy, back surgery, carpal tunnel treatment, rotator cuff surgery and knee and hip replacements.
Savings from medical travel for orthopedic procedures are expected to far surpass the cost of incentives.
All eyes on Walmart
Walmart continues to show an interest in growing its operations in the health care space. As the retail giant rolls out new clinics and services, industry watchers anticipate there could be major shakeups in the way care is delivered:
In July, Walmart announced it would add at least six more health clinics in Atlanta, giving the retailer 12 operational clinics by the end of 2020. The clinics include primary care, imaging, lab, dental and behavioral health services.
Walmart has also expanded in the pharmacy space, partnering with pharmacy benefit manager startup Capital Rx in July to adopt its drug pricing framework for specialty and mail-order prescriptions.
Walmart bought technology from CareZone, a startup that makes apps to help people manage multiple medications. The acquisition could help it compete with Amazon, which acquired PillPack in 2018.
In March, it was rumored that Walmart may add 5G to its stores with health clinics, which could allow for better telehealth visits, self-registration, prescription notifications and more.
New opportunities in health care
As the health care industry undergoes systematic changes driven by trends such as an aging demographic, the explosion in health care data, and increasingly complex administrative infrastructure, the COVID-19 outbreak exposed a greater urgency to all these challenges, according to a recent report by CBInsights.
Facebook, Amazon, Microsoft, Google, & Apple were already leveraging their scale, user base, technology and brand to modernize the consumer and enterprise health care experience:
Facebook: The social media giant aims to leverage its diverse user base and the unique user behavior data collected. Its health care effort primarily focuses on distributing health care information and organizing users with common health interests.
Amazon: Amazon attacks health care with its experience building back-end infrastructure and 110M+ loyal Prime members. Amazon counts drug supply chain, telehealth, and cloud computing among its health care endeavors today.
Microsoft: The company owns the world’s most popular workplace apps. Paired with a commercial focus, Microsoft is poised to drive quick adoption of these in health care. Teams and Azure products have already gained traction.
Google/Alphabet: Search, using advanced technologies like AI, is in Google’s DNA. The company is bringing this expertise to health care by building better search experiences for providers, patients and researchers.
Apple: Apple is focused on helping its users securely manage and organize their health care data. On top of that, Apple will build a health care-focused app store for developers and researchers.
Fallen on the frontlines
The Guardian and Kaiser Health News have launched a sobering memorial to the health care workers who have died while providing care to those suffering from COVID-19.
Entitled Lost on the Front Line, the memorial is a database of stories of those workers who lost their lives on the frontline of the pandemic. As of February, the count was 3,470 health care workers lost. The joint project has independently confirmed each of those deaths.
Of the workers added to the Lost on the Frontline database so far:
- Nurses and support staff account for the most deaths.
- The majority who died were younger than 60.
- A majority (66%) were identified as people of color.
- Nearly 700 worked in New York and New Jersey.
- The majority of deaths were early in the pandemic.
