Author Archives: Bob Simison

Self-Insured Nonprofit Employer Credits HCMS in Health Plan’s Turnaround

Self-Insured Nonprofit Employer Credits HCMS in Health Plan’s Turnaround


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The Christian and Missionary Alliance’s health benefits program made a dramatic swing from red ink to black after consolidating plans and deploying clinical prevention service.

 Colorado Springs, Colorado (June 20, 2017) – The Christian and Missionary Alliance’s health benefits program swung from losing money in the first quarter of 2016 to posting a surplus in the 2017 first quarter, according to Ken Baldes, the church organization’s vice president of operations and treasurer. He credited the health information company HCMS Group and the consulting firm Benefit Dynamics Co.

The C&MA, a 2,000-church denomination which also sponsors missionaries abroad, engaged the services of HCMS in 2015 after a series of costly illnesses wiped out the benefit program’s financial reserves and caused a deficit.

“HCMS has been instrumental in the turnaround of the C&MA’s self-funded health plan,” Baldes said. “Their ability to bring data, analytics and clinical services together was key for us – and something we hadn’t seen in the market. Their approach to plan design and analytics was critical to our ability to interpret the story behind the numbers.

“The plan design HCMS proposed required consolidation of four plans into one – a high deductible with an employer funded Health Savings Account. Transitioning to this new plan helped our members understand the real cost of their health insurance which we believe will lead to better decisions and help contain annual premium increases. Having an employer funded HSA (50 percent of deducible) helps temper the cost of services while provides an incentive to save.

“The clinical intervention service of KnovaSolutions and the predictive modeling HCMS developed to identify those in need, helped improve the experience of our members with complex health issues. It has also been key to improving our situation with our high cost individuals and as a result, has begun to bend the cost curve.

“HCMS’s partnership and excellent working relationship with our health plan consultant, Benefit Dynamics, has leveraged the strengths of each organization and together we’re better!”


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Foster Teen Research Series – Part 1

Foster Teen Research Series – Part 1


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Foster Teen Research Blog Series

Why Are 18-Year-Olds in Foster Care 20 Times More Likely to Have a Child?

Research by HCMS and the Wyoming Department of Family Services shows sharply higher teen pregnancy rates among foster children than previously estimated.

In the year they turn 18, girls in foster care are 20 times more likely to have a child than teens living with their families.

Recently published, peer-reviewed research by HCMS Group and the Wyoming Department of Family Services explores the dimensions of the problem and identifies a surprising new correlation that may help explain it. The study will appear soon in Child Welfare, the research journal of the Child Welfare League of America.

HCMS first looked into this issue three years ago and found that teen pregnancy rates were significantly higher for girls in foster care than previous research suggested. Our initial analysis didn’t identify causes, though other experts have cited unstable living situations, adolescence, and exposure to sexual abuse.

Working with the state DFS, our data analysts Justin Schaneman and Pamela Pendleton subsequently designed a more rigorous study following 5,326 Wyoming girls from the time they were 15 until they turned 19. The analysis, covering more than 11 years, compared foster teens with two groups of girls living at home. One group’s healthcare was covered by Medicaid – as was that of the foster-care group – and a second group had private health insurance.

Here’s what the data showed year by year:

Why were the differences so stark, especially between the foster teens and girls with private health insurance? Based on published research, we suspected a correlation between the pregnancy rates and substantially higher prescribing rates of narcotic, psychotropic, and other drugs for foster children.

We’ll have more on what we discovered in our next post. But here’s a hint: Our research showed that foster teens were four to six times as likely to have a mental health diagnosis as girls living at home and covered by private medical insurance.


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Press Release – May 23, 2017


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Teen Pregnancies Linked to Multiple Drug Prescriptions

The more medications are given to teens, the greater the likelihood of pregnancies, study by Wyoming and HCMS Group shows.

Cheyenne, Wyo., May 23, 2017 /PR Newswire/ — Multiple drug prescriptions given to teenage girls correlate with more teen pregnancies, according to a study by the Wyoming Department of Family Services and HCMS Group, a health information company.

Researchers found that girls ages 15 through 18 in the foster care system were often prescribed more than a dozen medications, including powerful narcotics and psychotropics. The simultaneous use of multiple drugs is known as polypharmacy. For teens taking 20 medications or more, the pregnancy rates topped 20 percent, almost 10 times the rate for all girls of those ages, according to the Centers for Disease Control and Prevention.

The findings “for the first time suggest a correlation between the use of multiple prescription medications and the results of adolescent decision-making leading to underage pregnancies,” the researchers write. “There is ample research showing the life-altering effects of teen pregnancies for young mothers and their children, spanning multiple generations. This study suggests that polypharmacy increases the risks for foster teens.”

The study, soon to be published in Child Welfare, the research journal of the Child Welfare League of America, spotlights the risk of pregnancy associated with multiple prescription drugs for the almost 40,000 girls ages 15 to 18 in U.S. foster care, according to lead author Dr. Hank Gardner, the CEO and principal partner of HCMS Group. While teen pregnancy rates have declined in recent years, polypharmacy has climbed and opioid use has soared.

The researchers compared a group of girls in foster care covered by Medicaid with other girls over 11 years starting in 2003. The foster teens were prescribed many more medications than girls living with their families. Among the foster-care girls, more than 60% had mental-health diagnoses in the 15, 16, and 17 age groups, five times the rate for girls with private health care.

“The findings add to a growing body of evidence that polypharmacy intended to help manage troubled children can instead add a layer of abuse,” the authors conclude. Other investigators were Dr. Steve Corsi and Dr. Marty Nelson of the Wyoming Department of Family Services; and Justin Schaneman, Pamela Pendleton, and Bob Simison of HCMS.

For more information, contact Bob Simison at HCMS, bob_simison@hcmsgroup.com, or 202-210-7981.


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HCMS Unveils Purple Solution for Obamacare


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HCMS Group today unveiled our Purple Solution for the fight over Obamacare between Democrats and Republicans in Washington. We outlined it in a news release: http://www.prnewswire.com/news-releases/we-need-a-purple-solution-for-americas-healthcare-conundrum-300389869.html. Click here for research findings supporting our position, and here to see the elements of the plan.

Our point is that there is a simple, proven solution to the challenges created by the Affordable Care Act. We test-drove and refined it in the state of Wyoming, and we advocate it every day for self-insured employers. We’ve shown that it works to reduce healthcare waste while protecting health.

For more news from HCMS, click here.


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Connecting the Dots on STAT: Surging Health Care Costs, Stagnant Economy, Flat Wages


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Cheyenne, Wyo., Oct. 10, 2016 – Dr. Hank Gardner, CEO and managing partner of HCMS Group, pointed out the link from healthcare waste to flat wages to economic stagnation in an op-ed column published on the healthcare news website STATLink to downloadable PDF.

He defined healthcare waste as over-treatment by providers, in the form of excessive testing and prescribing, and over-consumption by patients, such as taking and often demanding too many tests and drugs.

The column cited a recent HCMS study of wages and healthcare costs based on 140,000 people in the company’s research reference database. The findings showed how healthcare costs rising at 10 percent or more a year help hold wage increases to 2 percent or less.

“Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy,” Gardner wrote.

Don’t count on a government fix, he argued. Instead, private, non-government employers can carry out do-it-yourself, market-based healthcare reform. Gardner outlined the HCMS approach involving integrated data, advanced data analytics, incentive alignment, and the 5|50 Solution.

To drive real health care reform, look to what employers are doing


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What’s Eating Up Your Paycheck? Healthcare Costs (Healthcare Waste)


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Healthcare waste helps keep wages flat, widening economic inequality and fueling voter anger and frustration.

healthcare waste causes wage stagnation

Tuan Azizi/Getty Images/Thinkstock

 

Everybody talks about how insanely expensive healthcare and health insurance are. And there’s lots of talk about how wages have barely kept up with inflation for at least eight years.

But nobody’s really talking about how those two things – surging healthcare costs and stagnant wages – are directly connected. New research by HCMS Group, a healthcare reform company based in Cheyenne, Wyo., dramatically shows the link.

For a substantial cross-section of private employers and the people they cover, healthcare costs rose more than 10% in 2014, the study showed. Worker pay climbed just 4.1%. For those making less than $30,000 – predominantly women – wages inched up 0.5% while their healthcare costs jumped almost 17%.

What’s the connection? Well, employers lump wages and benefits together in their budgets for worker compensation. As healthcare expenses drain progressively more money out of total compensation budgets, there’s less available to put in people’s paychecks. Many employers try to limit their healthcare costs by raising premiums, copays, out-of-network charges and deductibles. But that just takes even more money directly out of people’s pockets, without improving health.

The study spotlights one of the biggest but least discussed economic effects of runaway health benefit costs. Flat wages widen economic inequality – one of the things fueling voter anger and frustration this election year.

“The key to resolving wage stagnation is to reduce healthcare waste and funnel those dollars into wages,” said Dr. Hank Gardner, the CEO of HCMS Group.

Healthcare waste is at the center of the problem. Waste is overtreatment by medical providers and overconsumption by patients, with risky narcotics at the top of the list. Waste accounts for 30% of national healthcare spending. The current healthcare benefits system encourages waste and does little to improve health.

The HCMS study of wages and healthcare costs was based on the company’s unmatched Research Reference Database, which includes healthcare, compensation and paid time off data for almost 4 million Americans whose benefits are provided by more than 300 employers.

healthcare costs and wage study

In 2014, average wages in the healthcare costs study group of more than 140,000 people rose 4.1% to $81,371. Average health plan costs – including those paid by employers and directly out of employees’ pockets – jumped 10% to $10,263 a person. Among people earning less than $30,000, wages increased $124, or 0.5%, while their health plan costs surged $797, or 16.6%.

People in higher income brackets had higher raises – 4.3% for those making $30,000 to $80,000 and 4.2% for salaries higher than $80,000. Meanwhile, their healthcare costs rose substantially less than expenses for people in the under $30,000 group. The data show how the costs of healthcare waste fall disproportionately on those with lower incomes, contributing to economic inequality.

“This shows the power and importance of real healthcare reform,” Gardner said. “We need to put more money in people’s pockets. People with the lowest incomes – notably women and single mothers – wind up paying the most for healthcare waste in the form of forgone wages.”

 

For self-insured employers HCMS Group offers offer comprehensive, REAL healthcare reform solutions to reduce healthcare waste and costs while improving health. Please contact us at HCMSgroup.com or call (877) 883-5786.

— Bob Simison on behalf of HCMS Group data analytics.


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HCMS Group Introduces Waste-Reducing Healthcare Reform Solution


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CHEYENNE, Wyo., April 21, 2016 /PRNewswire/ — HCMS Group has introduced a new healthcare reform solution for employers and healthcare providers that is designed to address one of the biggest contributors to soaring medical costs: over-treatment by the health industry and risky over-consumption by patients.

Part of the problem with healthcare waste – over-treatment and over-utilization – is that it’s a $1 trillion elephant in the room that nobody wants to talk about. It’s a touchy subject, because who’s to say what waste is when we’re talking about someone’s health?

HCMS health analytics help answer that question. Focusing on waste is the best way to lower cost while improving health, as 30% of the nation’s $3.2 trillion in annual healthcare spending is wasted on over-consumption and over-treatment, with dangerous narcotic medications topping the list. Waste accounts for 30% to 40% of healthcare costs for many employers, based on HCMS research.

“Most healthcare providers know they over-treat people,” said Dr. Hank Gardner, CEO of HCMS Group, a health information services company based in Cheyenne. “They do it because that’s what patients expect – lots of tests and procedures and prescriptions – and the providers have to worry about customer satisfaction scores.”

Healthcare waste threatens business profitability and puts patients at risk, Dr. Gardner said. The HCMS healthcare reform solution targeting healthcare waste and has been proven effective in bending the healthcare cost curve, with reductions of 10% to 15%.

The 5|50 Solution, HCMS’s solution for healthcare reform, is built on a robust integrated data warehouse assembled for each employer. HCMS provides patent-pending predictive health analytics as an early alert system, health plan overhaul and high-touch clinical prevention focusing on the 5% of the population who account for more than half of medical costs.

Over the past five years, HCMS clients have recorded healthcare cost increases less than half as much as those of other companies in the same industries. HCMS is marketing its healthcare reform solution, and the centerpiece of the campaign is a “Know Your Numbers” explanation of healthcare waste:

  • 5 – The percentage of people who account for more than half of medical spending.
  • 50 – The percentage of healthcare cost that comes from business policy design incentives rather than from disease.
  • 30 – The percentage of spending that is waste and can be reduced while improving health.

http://www.prnewswire.com/news-releases/hcms-group-introduces-waste-reducing-healthcare-reform-solution-300255499.html?tc=eml_cleartime


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