Insider News

This week in health care and insurance news: we're bringing you articles on potential changes to Affordable Care Act taxes and how that could affect insurance premiums, a discussion on access to prediabetes treatment in Massachusetts, and some insights on social media, mobile apps, and the role they play in health care.

IRS expects reinstatement of ACA health insurance tax to cost insurers $15.5B in 2020

The Internal Revenue Service (IRS) published a notice that health insurance companies will have to pay $15.5 billion in 2020 if the Affordable Care Act (ACA) health insurance tax resumes as planned. The tax was created to fund implementation of the ACA's marketplace exchanges, based on premiums and a payer's market share. It was suspended in 2019 due to concerns the tax would increase insurance premiums and out-of-pocket costs for consumers.

An analysis commissioned by UnitedHealth Group found insurance premiums are likely to rise by more than 2% in 2020 if the IRS implements the tax, which could also increase costs for Medicare Advantage and Medicare Part D beneficiaries, small employers and states. Congress is considering bipartisan legislation that could extend the moratorium on the tax through 2021.

Mass. residents with prediabetes struggle to access help managing condition

In Massachusetts, nearly 1.8 million adults have prediabetes. The Center for Disease Control's National Diabetes Prevention Program helps people get the disease under control before it becomes Type 2 diabetes. Those who complete the program can lower the risk of developing Type 2 diabetes by as much as 58%, or 71% if they’re over age 60. Some health experts say the program, and others like it, aren't available to all due to cost.

To increase community participation, the YMCA is working with Medicare to reimburse for program costs. Only two YMCAs in the state receive the reimbursement, however - North Attleborough and New Bedford. MetroWest Medical Center has a diabetes prevention program recognized by the American Diabetes Association that qualifies for Medicare reimbursement. However, there’s no Medicare reimbursement for those with prediabetes.

One possible solution, experts say, is developing partnerships with businesses to fund programs for their workers and families whom Medicare doesn’t cover.

Healthcare consumers look to social media when choosing providers

Binary Fountain’s Healthcare Consumer Insight & Digital  Engagement survey identifies trends in how patients choose a provider:

• 75% of respondents are influenced by online rating and review sites when selecting a provider;
• 60% check the ratings and reviews of a provider, even when referred by another provider, up 44% since 2018;
• Only 9% of respondents in 2019 selected say they “do not use any websites or online platforms” when selecting a provider. By comparison, 48% of respondents selected this answer in 2017, representing an 80% increase in Americans using some form of online website or platform to choose a provider;
• Of the respondents that used ratings and review sites when searching for a provider, 53% selected Google as a primary source, followed by a hospital and/or facility’s website (48%), Facebook (45%), Healthgrades (42%) and Instagram (28%);
• 27% of healthcare consumers list “wait times to see a provider” as their biggest pain point, while 20% list “scheduling an appointment."
  
  
  

Digital Health should stay away from 'one app' model and embrace specialization

Chris Hogg, COO of Propeller Health, says digital health won't move to a “One app to rule them all” model where patients flock to one comprehensive user experience for all their healthcare needs, from insurance and scheduling to lab results and disease management.

He argues such a model disregards the complexity and specificity of individual diseases and patient profiles. He claims it’s very difficult to build an engaging and useful user experience in one disease state, let alone across multiple disease states within one experience. Further, enrolling users and keeping them engaged is hard.

Hogg says making a great product requires focusing on a specific user and problem space. He believes a “best of breed” ecosystem approach is best. In this scenario, patients use a core clinical app, likely provided by their health system or primary care provider, that takes care of clinical interactions. Beyond that, patients use a set of specific apps that specialize in particular health issues.