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In the News: August 23–30

Disrupters Top List of Health Care’s Most Influential People

Modern Healthcare recently released its 2018 list of the “100 Most Influential People in Healthcare,” which ranks and showcases the most significant players in health care as determined by their peers and the publication’s senior editors. Most striking about this year’s list is not the new “disrupter” category, as might be expected, but the significant shift in the types of organizations represented on the 2018 list compared to 2017.

From 2017 to 2018, the number of provider organizations represented decreased 15%, whereas health insurance organizations increased 140%. In addition, Amazon; Apple; and the unnamed Amazon, Berkshire Hathaway and JP Morgan Chase venture stood out as new additions. Looking more closely, 12 of the top 13 individuals in 2018 are considered disrupters. Of those, only 5 were ranked among the top 25 in 2017 and 4 did not appear on the list last year.

This shift reflects the industry transformation taking place, with traditional lines continually blurring. In this landscape, health care organizations must be willing to break some boundaries to adapt. For strategies on leveraging innovation to achieve success in a complex, disruptive environment, register for the upcoming Executive Summit 2018 Post-Conference interactive session, Innovation and Disruption: Innov8 Health Care 2018.


Cervical Cancer Screening Guidelines Allow for More Options

A recent JAMA article presents the latest update to cervical cancer screening recommendations from the US Preventive Services Task Force (USPSTF). The agency now recommends 3 cervical cancer screening options for women between 30 and 65 years of age: human papillomavirus (HPV) testing alone every 5 years, a Pap smear alone every 3 years or a combination of the 2 every 5 years. HPV is the main cause of cervical cancer.

USPSTF continues to recommend against screening for women under 21 years old and for the use of the HPV vaccine for women and men up to age 26.

The number of deaths from cervical cancer in the US is estimated to have decreased substantially due to widespread implementation of cervical cancer screening measures, resulting in a decline in fatality rates from 2.8 to 2.3 deaths per 100,000 women between 2000 and 2015.

Sg2 encourages its members to evaluate trends impacting women’s health care services, such as the declining national birth rate and the increased proportion of high-risk pregnancies, and consider best practice market segmentation strategies to add growth and value. To learn more about how to create opportunities in the rapidly changing women’s health landscape, watch Sg2’s Women’s Health Landscape 2018 webinar.


Patient Exposure to Out-of-Network Claims Is Gauged

A recent analysis by the Kaiser Family Foundation of 2016 medical claims data for nearly 20 million people in the large-group commercial insurance market found that nearly 1 in 5 inpatient admissions includes a claim from an out-of-network provider. Admissions with an emergency department claim were more likely to include a claim by an out-of-network provider, and enrollees with anesthesia or pathology claims, as well as those using mental health services, were more likely to include a claim from an out-of-network provider. Furthermore, even for enrollees who used in-network facilities, more than 15% of admissions included at least 1 out-of-network provider claim.

Out-of-network claims can expose patients to significant out-of-pocket costs due to higher cost-sharing requirements or providers requiring patients to pay the different between the charged amount and the reimbursed amount.

Given that overall cost-sharing in commercial plans is increasing and that many patients don’t know when they are treated by an out-of-network provider, Sg2 believes that health systems need to develop a consumer-informed strategy that addresses patient pain points. For more on developing a consumer-informed strategy, watch the webinar, A Consumerism Outlook and Update: Building a Consumer-Informed Access Strategy.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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