The merger would create a 25-hospital integrated health system serving Wisconsin, Minnesota, Michigan and North Dakota.
Essentia Health and Marshfield Clinic Health System are in merger talks to create a four-state integrated health system in the upper Midwest, the two systems announced Wednesday.
The merger would create a 25-hospital system serving Wisconsin, Minnesota, Michigan and North Dakota, with more than 150 care venues, 3,500 providers, and a patient base of more than two million people.
The two mid-sized systems have signed a memorandum of understanding and note that they "have complementary geographies and capabilities, which provides an opportunity to collectively enhance the level of care" in the four-state region.
No firm date was given for completion of the talks. The systems call the memorandum "the first step toward a potential merger. More information will be shared as discussions progress."
It's not clear what, if any, state or federal regulatory hurdles the merger would have to clear.
However, despite the claims made by the hospital lobby that mergers improve efficiencies and care coordination, there is a growing body of academic studies – and increased sentiment among payers, patient advocates and government watchdogs -- that larger systems don't necessarily deliver better care, and that mergers allow larger systems to leverage more money from insurers, who pass that increased cost on to consumers.
David Herman, MD, CEO of Duluth-based Essentia, says he's been a longtime fan of his potential partner and has "admired the work of Marshfield Clinic for more than 30 years."
"I have always appreciated their ability to advance the well-being of the communities they serve. I am truly excited to work together for the benefit of our patients and our colleagues," Herman says.
He says the two health systems share common values and embrace a mission-driven approach to healthcare that extends beyond our facilities. "Through a new partnership, we can support the care models, services, research and technologies to ensure sustainable and thriving rural health care," he says.
Susan Turney, MD, CEO of Marshfield, WI-based Marshfield Clinic, called the potential merger "an exciting opportunity for both our organizations and those we serve."
"These are two of the premier health systems in the country, looking to come together to serve rural communities and beyond," Turney says. "When I look at Essentia, I see an organization with world-class expertise that complements our own. And I see their long, rich history of serving communities with a mission very similar to ours at Marshfield Clinic Health System."
Civil penalties for illegal denial of coverage were increased from $2,500 to $25,000 per violation.
Advocates are cheering a new law that raises by tenfold the fines imposed against California payers for illegal denial of health insurance coverage.
The new law -- signed by Gov. Gavin Newsom in late September, and which takes effect on January 1, 2024 -- updates the antiquated fine structure in California under the Knox-Keene Act that had been in place since the 1970s, and which critics say left health insurers with a financial incentive to pay fines rather than provide care.
By increasing civil penalties from $2,500 to $25,000 per violation, the Health Plan Accountability Act (SB 858) will give regulators the necessary tools to make health plans deliver the care their patients are legally required to receive, says the bill's sponsor, state Sen. Scott Wiener, D-San Francisco.
"Californians rely on their health insurance to cover critical, even life-saving, care, and we must hold health plans accountable for following the rules and providing timely and adequate coverage," Wiener says. "California's low, outdated fine levels allow health plans to view these fines as a mere cost of doing business. SB 858 makes clear that when we pass a law requiring coverage, we mean it."
Diana Douglas, Health Access California director of policy and legislative advocacy, notes that health insurance premiums have quadrupled in the past 20 years, while fines haven't kept pace.
"For years health care corporations have been skirting consumer protection laws with minimal consequences. This new law will change the behavior of these health plans and ensure access to needed care for Californians," Douglas says.
The amended law notes that "other provisions of the Knox-Keene Act that include penalty amounts have not been updated since 1999 or 2000."
"Since then, health plan premiums in California for employer-sponsored coverage have quadrupled from one hundred sixty three dollars ($163) per month in 2000 to six hundred sixty-one dollars ($661) per month in 2020, according to the California Employer Health Benefits Survey," the amendment reads.
To avoid another decades-long delay in increasing the fines, starting in January 2028 and every five years after that the penalties will be adjusted "based on the average rate of change in premium rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment," the law reads.
This amended law comes amid a nearly two-month-long walk out by mental health workers at Kaiser Permanente who claim that the massive health system has failed to fix chronic understaffing that is illegally delaying patient access.
The California's Department of Managed Health Care is reviewing Kaiser Permanente's mental healthcare access for potential violations of a law that went into effect in July ensuring that patients undergoing treatment for mental health or substance use disorders are getting follow-up within 10 business days of their prior appointment.
National Union of Healthcare Workers President Sal Rosselli, whose union represents 16,000 caregivers in California, says the union strongly supports the bill "because our 4,000 members who provide mental health care at Kaiser Permanente have seen firsthand how the lack of an effective fine structure harms patients."
Rosselli says the state in 2013 fined Kaiser $4 million for failing to provide timely access to mental health care, but the HMO, which reported a $8.1 billion net profit last year, has continued to understaff its mental health clinics and flout state timely access laws.
The average life expectancy of Black Californians is six years shorter (75) than the statewide average (81).
Despite their efforts to embrace a healthy lifestyle, Black Californians say they're discouraged by the systemic racism and bias plaguing the state's healthcare delivery system, a new poll shows.
"What we found in this study is of no surprise to any Black person who has navigated our health care system," says Katherine Haynes, senior program officer for CHCF's People-Centered Care team. "The study demonstrates exactly how much Black Californians are doing in pursuit of good health and the clear vision they have for addressing racism in health care and health systems. However, we need those who hold power within these systems to be partners in this vision."
The study, conducted by the Black-owned public opinion research firm EVITARUS, surveyed 3,325 Black California adults, and included interviews with 100 Black Californians, and 18 statewide focus groups, and is one of the largest studies focused on the health care experiences of Black Californians to date.
According to the survey:
Nearly one in three Black Californians has been treated unfairly by a provider because of their race or ethnicity.
Most Black Californians report putting a great deal or quite a bit of effort into getting appropriate screenings or preventive care (77%) and focusing on their mental health (79%).
Two-thirds (66%) of Black Californians report researching a health condition or concern before meeting with a provider, and 35% say they have tailored their speech and/or behavior to make a provider feel at ease.
Black Californians who identify as women, LGBTQIA+, or who have a physical disability or mental illness are more likely to report experiencing racism and inadequate pain treatment.
Survey participants offered several ways to improve healthcare for Black Californians, including increasing Black representation in healthcare, expanding education on navigating the system, establishing accountability for equitable care, and developing more holistic approaches to health care.
CHCF says a "common thread" of the report demonstrates the importance of buy-in and action from the decision makers inside and outside of healthcare who can address root causes.
"Helping patients navigate the current health care system is a short-term solution," explained Dr. Venise C. Curry, Consultant and Western Director for the Medical Consortium on Climate and Health's Climate Health and Equity Fellowship. "You can't just have people advocating for themselves at an individual level, we need a better care system, and for that there has to be accountability. We need to address the root cause to improve quality care."
Paul C. Hiltz, president and CEO of Naples-based NCH discusses the health system's response to the cataclysm.
Hurricane Ian ripped into Southwestern Florida as a Category 4 buzz saw on Setember 28, bringing with it 150 mph winds, unprecendented 18-foot tidal surges, and claiming 119 lives so far, with early estimates putting the cost of the damages at $63 billion.
Naples, Florida sat about 50 miles south of the eyewall, but providers there were quick to assess the extent of the emergency for the region.
NCH Healthcare System President and CEO Paul C. Hiltz details the system's response to Ian, its role in the transfer of more than 400 patients from nearby hospitals, what worked, and what was learned, in this email exchange with HealthLeaders.
HealthLeaders: When did you start making hurricane preparations?
Paul Hiltz: NCH Healthcare System sprang into action when we first learned that we were on the edge of the long-range forecast cone, even though then, models were suggesting that the storm could perhaps make landfall 300 miles to our north.
HL: Were your facilities damaged by the storm?
Hiltz: Comparative to many other facilities closer to our coasts and just 30 miles north of us, NCH was largely spared from major damage. We did see flooding on our campuses and storm surge waters damaged some equipment chillers that are outdoors as well as some cars in our first-floor garages and parking lots at both of our hospital campuses in Naples, but water never intruded into the hospitals themselves, save for a couple of leaks in the roof that made themselves apparent during the storm.
It is hard to gage total cost imparted by the storm because we continue to assess our properties and physician group practices for damage.
HL: Did you have a disaster preparedness plan in place?
Hiltz: NCH has had a hurricane preparedness plan in place for years, and each time our plans are enacted, we learn something more and figure out better ways to refine our processes. Each storm and their effects to our region are different, however, and that’s what can make planning for these things so challenging. For example, the storm surge we saw with hurricane Ian has never-before been documented in our area. Like many, however, we plan for the worse and hope for the best.
HL: How difficult is it to prepare when the healthcare sector has so many supply issues?
Hiltz: Certainly, the supply chain issues our entire nation is facing served to make attaining needed supplies in advance of the storm challenging. However, NCH Healthcare System has strong supply chain partners who made sure we had what we needed to be as prepared as possible for whatever impacts were to come our way.
HL: What was your biggest challenge in preparing for Ian?
Hiltz: The biggest challenge for planning for any hurricane is the relative unknown of ultimately where the storm is going to end up. The forecasters do what they can with the information they have, but as we saw with Ian, the cone shifted from the west coast of Florida to the panhandle four days before appearing to swing back west to the Big Bend region, then Tampa Bay, Sarasota, and ultimately making landfall in northern Lee county – southern Charlotte county just to our north a day before landfall. But again, because we planned for the worst, NCH was as ready as it could be for whatever impacts Ian was going to throw at us.
HL: Once it was clear that the Naples area would be spared a direct hit from Ian, how did you pivot into a resource for other hospitals?
Hiltz: As the largest healthcare system in Collier County, we didn’t have to pivot much because NCH is always ready to be a resource for the patients of our region. We were happy to be able to offer some available beds to our neighboring healthcare systems to the north who suffered greater impacts than we did, and we know if the situation were reversed, they would do the same for residents of Collier County.
HL: What challenges did you face in relocating more than 400 patients into your hospital?
Hiltz: Throughout the process of receiving patients from the impacted healthcare systems to the north, we have seen a rise in emergency department usage by our own community who have sustained injuries in the wake of the clean-up. Likewise, mothers from as far away as Cape Coral are coming to NCH to give birth to their babies. In response to this, NCH reached out to the state, and they sent us 50 RNs between our two hospitals. We have asked the state for additional pediatric nurses to help us handle the influx of peds, NICU, and birthing mothers we have seen at our facilities as well.
HL: What lessons have you learned from Ian?
Hiltz: As was mentioned earlier, each storm is different, so there are different lessons to be learned from each storm. From Ian, the greatest take-away will be the power and might of the storm surge, which all Florida residents hear about with an approaching storm, but most have never experienced in our state to the degree our region did just several days ago. As a result, we will most likely be giving more attention to storm surge preventative measures as we move forward.
HL: What weaknesses did you observe in the local-state-federal preparation and response? How could they improve their prep/response?
Hiltz: State and local government response could not have been better! Florida is used to storms, so power repair trucks were already in the area before the storm hit, national guard troops were here as well. We also had NCH liaisons stationed at the county Emergency Operations Center so we could hear firsthand the information coming from our local government as it was being discussed. Additionally, the state sent us 50 nurses between our two hospitals to help us care for the influx of patients we got from our neighboring healthcare centers to the north.
HL: How long of a recovery time do you anticipate for NCH and other providers?
Hiltz: As of this interview, NCH Healthcare System is just about back to business-as-usual as our teams and colleagues quickly rose to the challenges and hurdles presented by this catastrophic storm. Staff came forward in droves to come to work caring for our patients, setting aside their own personal impacts endured from the storm, to focus on our patients.
It will be a long road to recovery for many of our coastal communities, and as we always do, NCH Healthcare System will continue to be there with open doors that have never closed since we took our first patient back in 1956. We continue to learn about and share new resources available for our community and our staff who are dealing with the greatest impacts from Ian, and NCH will continue to be there to support our community and our staff as we take this journey to recovery together.
The health system says the initiative demonstrates its commitment to 'building a more climate resilient infrastructure.'
UPMC says it will reduce its greenhouse gas emissions by 50% across the Pittsburgh-based mega-system over the next eight years as part of its commitment to the Health Care Sector Climate Pledge.
Sixty-one of the nation's largest health systems, including UPMC, in June signed the Biden administration initiative to cut greenhouse emissions in half.
To meet those goals laid out in the Health Care Sector Climate Pledge, UPMC has named as co-chief sustainability officers John Krolicki, vice president, Facilities and Support Services, UPMC Presbyterian Shadyside and UPMC Children's Hospital, and Michael Boninger, MD, president, UPMC Innovative Homecare Solutions.
"UPMC will lead by example to develop approaches to health care that rapidly reduce our contributions to greenhouse gas emissions," Boninger says in a media release. "We are making these pledges on behalf of the health and well-being of people today and for future generations."
The U.S. Department of Energy in a 2009 analysis found that hospitals use 836 trillion BTUs of energy annually and emit more than 2.5 times the energy intensity and carbon dioxide emissions of office buildings, producing more than 30 pounds of CO2 emissions per square foot.
"Reducing the energy intensity of this sector will decrease its carbon footprint and also alleviate stress on America's electric power infrastructure," DOE said in 2009. "Additionally, new energy efficiency strategies hold the promise of reduced costs for the sector, as U.S. hospitals spend over $5 billion annually on energy, often equaling 1% to 3% of a typical hospital's operating budget or 15% of profits."
In 2014, UPMC joined the Green Building Alliance 2030 challenge and has reduced its carbon footprint by more than 10% in the Pittsburgh area, despite significant growth by the health system.
In addition, UPMC venues have eliminated plastic foam packaging from cafeterias, and more than 40 tons of appliances and equipment have been recycled over the past five years. UPMC venues have received accolades from the Arbor Day Foundation for tree planting. The health system is also transitioning to geothermal technology and building green venues.
"As we work to continue to reduce our environmental impact, UPMC looks forward to implementing additional cutting-edge solutions that will secure our place as a healthcare leader in sustainability," Krolicki says. "We are eager to join the cause in the communities we serve to make a difference for our environment for the long term, which in the end helps the patients we serve."
HumanaChoice says it 'strongly disagreed' with the audit, which found that 76% of claims 'were not supported in the medical records.'
Federal auditors are calling for Humana Inc. to refund $34.4 million in alleged overpayments made to the payer's HumanaChoice Medicare Advantage plan in 2016 and 2017.
The Department of Health and Human Services Office of the Inspector General, in an audit release this week, examined "nine high-risk groups" billed by HumanaChoice in 2016 and 2017 and found that 207 out of 270 (76%) randomly selected diagnosis codes with charges totaling 744,438 "were not supported in the medical records and resulted in $574,430 of overpayments for the 270 enrollee-years."
"These errors occurred because the policies and procedures that HumanaChoice had to prevent, detect, and correct noncompliance with CMS's program requirements as mandated by Federal regulations could be improved," OIG says. "On the basis of our sample results, we estimated that HumanaChoice received at least $34.4 million of overpayments for these high-risk diagnosis codes in 2016 and 2017."
The nine high-risk diagnosis codes are: acute stroke; acute heart attack; embolism; vascular claudication; major depressive disorder; lung cancer; breast cancer; prostate cancer; and colon cancer.
The audit recommends that Humana refund the $34.4 million, identify similar instances of noncompliance for high-risk diagnoses before and after the audit period and refund any overpayments they find, and review existing compliance procedures to identify areas where improvements can be made.
Humana Rebuttal
Humana issued a statement saying it "strongly disagreed" with OIG's findings.
"Humana takes its compliance responsibilities seriously and remains committed to working with CMS and policymakers to find ways to preserve affordable coverage and effective healthcare services for older Americans," the payer says.
"Humana's response to the Office of the Inspector General of Health and Humana Services audit of R5826 is reflected in the published report, including how we strongly disagreed with the OIG's methodology and findings and that we have repeatedly shared our concerns about the methodology with CMS. As the OIG acknowledges, its findings and recommendations do not represent final determinations."
On Monday, OIG released a similar audit of Highmark Senior Health Company, and identified $6.2 million in overpayments. Highmark also disagreed with the findings.
Illumina's partners say they believe the company will continue to improve the speed and continue to lower the price.
San Diego-based Illumina, Inc., has launched a "production scale” sequencer that it claims can process human genomes in half a day for $200.
Illumina CEO Francis deSouza says the company's new NovaSeq™ X Series (NovaSeq X and NovaSeq X Plus) have the power to more-accurately sequence more than 20,000 genomes each year – which is twice the capacity of earlier sequencers -- and will "push the limits of what is possible with genomic medicine, enabling faster, more powerful, and more sustainable sequencing.”
"Today, we are forging a new path forward to advance more breakthroughs in cancer and genetic disease treatments, precision therapies, and pandemic preparedness," deSouza says.
"Innovations like NovaSeq X are at the heart of how we will transform patient lives, and this groundbreaking technology will empower researchers, scientists, and clinicians in the fight to diagnose, treat – and eventually cure – disease while making genomics more sustainable and accessible to millions more people around the world."
Along with speed and cost, Illumina – which controls about 80% of the global genome sequencing market -- says the NovaSeq X also reduces packaging waste and weight by 90% and cuts plastic use in half when compared to NovaSeq 6000. Ambient-temperature shipping of reagents will also eliminate the need for nearly 500 tons of dry ice each year and waste for customers. Illumina will begin to distribute the NovaSeq™ X Series machines in 2023
Illumina's partners say they believe the company will continue to improve the speed and continue to lower the price.
"We're very excited to be a launching partner for NovaSeq X Series. Macrogen always strives to become the champion of personal whole genome sequencing," said Professor Jeongsun Seo, Chairman of Macrogen, a Korean international sequencing services provider that uses Illumina technology.
"I strongly believe NovaSeq X Series will accelerate our path towards the $100 genome. This will enable us to deliver a genetic blueprint to everyone in the world to unlock individual potential and increase life quality."
The payer disputes an audit finding that 70% of the diagnosis codes submitted for 'high risk groups' in 2016 and 2016 'did not comply with Federal requirements.'
Highmark Senior Health Company overcharged the federal government by an estimated $6.2 million in 2015-16, federal watchdogs say, and they want a refund.
The Department of Health and Human Services Office of the Inspector General, in an audit made public Monday, examined "six high-risk groups" billed by Highmark's Medicare Advantage plan in 2015-16 and found that 160 out of 226 randomly selected diagnosis codes with charges totaling $801,166 "were not supported in the medical records." Based on that sample, OIG estimates that "Highmark received at least $6.2 million of net overpayments for 2015 and 2016."
The six high-risk diagnosis codes are: acute stroke; acute heart attack; embolism; vascular claudication' major depressive disorder; and potentially mis-keyed diagnosis codes.
"With respect to the six high-risk groups covered by our audit, most of the selected diagnosis codes that Highmark submitted to the Centers for Medicare & Medicaid Services for use in CMS's risk adjustment program did not comply with Federal requirements," the audit says.
"These errors occurred because the policies and procedures that Highmark had to prevent, detect, and correct noncompliance with CMS's program requirements, as mandated by Federal regulations, could be improved," the audit says. "As a result, the Hierarchical Condition Categories (diagnosis code groupings based on similarity of clinical characteristics, severity, and cost implications) for these high-risk diagnosis codes were not validated."
The audit recommends that Highmark refund the $6.2 million, identify similar instances of noncompliance for high-risk diagnoses before and after the audit period and refund any overpayments they find, and review existing compliance procedures to identify areas where improvements can be made.
Highmark Rebuttal
Highmark issued a statement saying it "disagreed with OIG's findings on a number of grounds and requested that it withdraw its recommendation."
"Additionally, Highmark's review and analysis demonstrated that the audit only targeted records that supported an over payment, and that if the audit targeted records that supported underpayments as well the results would have been materially different," the statement said.
Centene allegedly used its subsidiary PBM to overcharge the Bay State's Medicaid program.
Centene Corp. will pay Massachusetts $14 million to settle allegations that managed care insurer overcharged the MassHealth Medicaid plan.
It's the latest in a series of settlements with at least 12 states for St. Louis-based Centene, the nation's largest Medicaid managed care provider, with 15.4 million enrollees nationwide. Centene agreed to pay Texas $165 million in July for overcharges in a deal that wasn't make public until earlier this month.
Massachusetts Attorney General Maura Healey says her office looked into Centene's operations in her state, including its pharmacy benefits manager, Envolve Pharmacy Solutions, Inc., after other states discovered irregularities in pricing and reporting to MassHealth by Centene subsidiaries.
Healey's office alleges that Envolve and Centene failed to disclose or pass on some retail discount fees to MassHealth, which inflated fees and drug costs reported to the Commonwealth.
"This settlement is a significant result in our work to protect taxpayer dollars and the integrity of our MassHealth program," Healey says. "We are pleased to secure these funds to help control Medicaid costs and ensure that state resources are directed to the best possible uses in our health care system."
Centene issued a statement admitting no wrong-doing and suggesting that the overcharges were unintentional.
"We respect the deep and critically important relationships we have with our state partners," the insurer says. "This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members."
More than two-thirds (67%) of respondents say they've used telehealth in the past year, up from 37% in 2019.
Consumers are embracing the convenience and accessibility of telehealth for "routine" medical care and mental health services in nearly twice the numbers seen in pre-pandemic 2019, a new survey shows.
The J.D. Power 2022 U.S. Telehealth Satisfaction Study, released Thursday, found that 67% of 4,306 consumers surveyed in June and July reported using telehealth within the past year, up from 37% in 2019.
And the vast majority (94%) of consumers who used telehealth in the past 12 months say they "definitely will" or "probably will" use telehealth to receive medical services in the future.
"Telehealth and digital technologies are transforming how patients seek and receive healthcare," says Christopher Lis, Troy, MI-based J.D. Power's managing director of global healthcare intelligence.
"Telehealth has the potential to increase access, convenience, care coordination and continuity, improve outcomes, and fill in gaps in provider coverage, particularly in underserved areas," Lis says.
"As technology adoption and consumer demand continue to increase, it will be important to keep evaluating what's working well and which areas need improvement, with the aim being to improve equitable access, quality of care and patient outcomes that complement in-person care."
A strong majority of consumers say they prefer telehealth for "routine care", such as prescription refills (80%), medication review (72%), test result consultations (71%), and mental health visits (57%).
Nearly two-thirds of consumers (61%) say that convenience is the top reason why they use telehealth, along with faster access to care (49%) and ease of access to health information (28%).
While the use of telehealth is gaining ground, the survey found that consumers still demand digital face time with clinicians, both to ensure care quality and to resolve medical concerns.
Among telehealth providers, LiveHealth Online ranks highest in telehealth satisfaction among direct-to-consumer brands, with a score of 869, followed by Doctor on Demand (864) ranks and eVisit (862). Among payers that provide telehealth services, Humana ranks highest with a score of
862, followed by Aetna (855). The segment average is 852.
The J.D. Power survey, now in its fourth year, measures customer satisfaction with telehealth service experience based on customer service (42%); consultation (28%); enrollment (19%); and billing and payment (11%).
