Two days at DRG's Managed Markets Summit last week made me smarter about many topics, but a couple stand out: CO-OPs in the exchanges and electronic health records. (Full disclosure: I also presented at MMS.) Below is a summary:
CO-OPs: While a number of the 23 Consumer Operated and Oriented plans offered in the federal and state exchanges will likely be gone a year from now, some are going great guns, including the Kentucky Cooperative. It has captured more than 25,000 61 percent -- of the state's exchange enrollment, according to Rick Schultz, vice president of clinical care integration at Kentucky Healthcare Cooperative. These nonprofit organizations received low-interest loans from the federal government to offer health plans in exchanges, but many in the industry have been skeptical, pointing out that starting a health plan is no small endeavor.
The good news is that the Kentucky CO-OP has already blown past its original projections for enrollment. The more challenging news is that many of its enrollees will be expensive, since they transferred from the state's high risk pool, whose enrollees must now get their benefits through the exchange. The CO-OP was the only plan in Kentucky to offer a Platinum choice, which 30 percent of its members chose. Platinum plans provide richer benefits, making them more attractive to the chronically ill.
The Kentucky CO-OP plans to sell in West Virginia next year, and the CO-OPs in Montana and Massachusetts are also expanding into neighboring states. Across the country, CO-OPs are offering 37% of the lowest priced plans in the states they operate, according to co-presenter Steven Treff, president of ProCare Rx, and in states where they are not the lowest, they are quite competitive. With a total enrollment nationwide approaching 300,000, the CO-OPs should definitely be on biopharma's radar.
Information revolution: I'm so accustomed to reading and hearing about how far the United States has to go on electronic health records, that it was a surprise to hear keynote speaker Farzad Mostashari's optimistic view. Mostashari is a physician and former National Coordinator for Health Information Technology at the Department of Health and Human Services. He discussed systems such as Geisinger, where patients can easily access their records and see physicians notes, lab tests, medication, and other information, and pointed out that anyone in Medicare can access three years worth of claims records.
Mostashari mentioned the web site PatientsLikeMe.com, where thousands of patients share information on their treatments. All of this points to an explosion of democratization for patients, and Mostashari expects that within the next 12 months the U.S. will see a big improvement in interoperability among EHR systems. We've shot past many countries in interoperability and decision support, he said, compared to being far behind 10 years ago. On the other hand, we're a good ways away from doctors being able to use all that information for population health management, since they typically can't provide practice-wide information such as the percentage of patients whose blood pressure is under control. But if we are really that close to EHR interoperability, being able to use and analyze all of that data across populations ranks right up there with the discovery of antibiotics and the polio vaccine.
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