Some direct-to-consumer telehealth companies shared personal data
Healthcare costs are the highest they’ve been in over a decade. Driving the trend is the combination of:
We expect costs to increase further over the next two years, as many health plan multiyear contracts are renegotiated. Lowering health insurance plan costs will be challenging for employers, which are already buffeted by other rising costs and the threat of an economic downturn.
There are three ways employers can lower healthcare costs:
Employer characteristics determine which employers can benefit from certain programs or initiatives. For instance, smaller employers that face high costs of contracting for programs with multiple vendors may benefit from programs offered through their health plan carrier or pharmacy benefit manager.
The demographics of a population matter too:
There is a huge difference in provider unit price, which is usually unrelated to quality or outcomes. Therefore, centers of excellence (COE) or high-performance network programs that direct members to the highest value providers can provide large cost savings. Some COEs also offer bundled prices. These programs are most effective with large financial incentives, which should be carefully developed to balance member and company cost impacts.
Site of care matters too. Programs to steer patients to ambulatory care centers for infusions and surgery can also decrease costs compared to care at hospitals.
Costs for newly approved, brand-name pharmaceutical products continue to increase rapidly, even as costs for generic drugs decline. Utilization management programs help ensure these drugs are used prudently and can lower costs. Manufacturer coupons that lower employer costs have been controversial but can lead to short-term cost savings.
New biosimilars for some expensive biologic brand-name anti-inflammatory drugs are expected in 2023 and beyond. Biosimilars should lead to some cost savings, but not as large as discounts for generic “small molecule” drugs, since the cost of production for most biologics is substantially higher.
Many look to preventive care to lower total healthcare costs, but only childhood vaccinations and birth control save substantial medical claim costs. Most other preventive care provides longer or better-quality life at a reasonable cost (but no net cost savings). Tobacco cessation programs can decrease costs modestly, and encouraging lower cost colorectal cancer screening (fecal immunochemical tests rather than colonoscopy) could lower costs and increase the acceptability of screening.
Most medical costs are incurred by a small number of plan members:
Diligent nurse care management of this group can decrease complications and lower healthcare costs.
For some employers, reviewing and putting health plan or pharmacy benefit managers out for rebid can be a source of savings, although this is a process that usually takes over a year.
Implications for employers:
StatNews reported last month that all but one of 50 direct-to-consumer telehealth companies they evaluated were passing along highly sensitive personal data to big technology companies. The telehealth companies generally consider themselves “platforms” and not healthcare providers and contend that they are not technically obligated to abide by the Health Information Privacy and Accountability Act (HIPAA), even though many of them claim to be HIPAA-compliant.
Telehealth companies sent health information including such sensitive items as suicidality, illegal drug use and drugs prescribed. This data was often associated with individual identifiers such as name, address, email address, phone number and IP address. While most telehealth companies in this report provide services directly to members of the public, some of them also sell services to employers, and more of them intend to do so.
This comes just weeks after The Wall Street Journal reported that some healthcare delivery systems were transmitting sensitive personal data to big tech companies including Microsoft, IBM and Amazon. This included data associated with virtual visits with clinicians. Many of these providers reported that they were changing their systems to prevent such data transmission.
The Health and Human Services Office of Civil Rights issued a bulletin last week stating that HIPAA regulated entities are “not permitted to use tracking technologies in a manner that would result in impermissible disclosures of protected health information to tracking technology vendors.” Vendors providing health services to employer-sponsored healthcare members are clearly HIPAA regulated entities and should abide by this bulletin.
There is a growing body of evidence that psychedelics are effective for some people who have depression who have not been successfully treated by other means.
Ketamine, an intravenous antidepressant, has been used off-label for this for many years. A component of ketamine, esketamine (Spravato) nasal spray was approved for treatment-resistant depression in 2019. It has not been used widely because it requires observed administration one to two times a week for eight weeks. A course of therapy costs over $7,000. This therapy is approved for those who have major depression and are acutely suicidal and is generally reserved for those who would otherwise be treated with electroconvulsive therapy, which is effective but sometimes has serious side effects.
National carriers generally provide coverage for Spravato with prior authorization, but some private clinics don’t accept insurance and charge patients $8,000 to $10,000 out-of-pocket for a course of therapy. A new third-party administrator, Enthea, recently received $2 million in seed funding and has announced intentions to provide a set of credentialed providers for this service, positioning this as a perk for progressive employers.
Clinical trials are underway to determine effectiveness of other psychedelics:
Implications for employers:
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
