This week: health care events and observations, along with an insightful take on what fintech leaves on the table if it neglects accessibility at its widest, and thoughts about leadership and how expertise decays.
Aditi Sen, Tradeoffs. A Look at New Health Care Cost Data (November 16, 2021)
Between 2015 and 2019, average annual health care spending for individuals with employer-sponsored insurance grew 21.8%, topping $6,000 per person for the first time in 2019. This includes the amount payers (either an insurance company or employer) and patients spent on both medical and prescription drug claims. It does not include insurance premiums. Our report’s most important takeaway is that this spending increase was driven largely by health care prices, rather than by how much care people are getting.
The updated HCCI dataset used in this report — and now available to academic, nonprofit, government and other researchers — includes claims data on one-third of the U.S. population with employer-sponsored insurance.
Teresa Torres, Product Talk. Discovery Hand-Offs Kill Momentum: Here’s What to Do Instead (November 17, 2021)
During sprint retrospectives, be sure to include your discovery work in the review. I encourage teams to ask these two questions in every retrospective:
- What did we learn in the past sprint that surprised us?
- How could we have learned that sooner?
Keeri Tramm, Accessible. Fintech & Accessibility: The need and market for interdependent technology (November 16, 2021)
I’ve been going on about financial interdependence a lot now, but it’s something I am incredibly passionate about. It is very overlooked by most people who provide support to the Neurodivergent community and by companies that create fintech (financial technology) products as well. This needs to change. Financial empowerment is for everyone, but a large portion of our population lacks access to it. I believe tech can help change that.
Andrew Gelman, Statistical Modeling, Causal Inference, and Social Science. Fake drug studies (November 18, 2021)
After a review of recent examples, Gelman concludes:
I’m concerned that bad drugs are being approved instead of good drugs. Indeed, if you can get treatments approved by cheating, this would reduce the incentives to develop effective treatments in the first place. Also, negative data—examples where the treatment fails to work as expected—provide valuable information, and by not doing real trials you’re depriving yourself of opportunities to get this feedback.
Morgan Housel, Collaborative Fund. Experts From A World That No Longer Exists (November 10, 2021)
Gaining experience takes time, effort, and often comes at the price of making painful mistakes. You don’t want to let those lessons go. You want them to mean something, to help you from making the same painful mistakes again. To help others from making the same mistakes you made. So it will always be the case that those with the most experience – and the good, smart, accurate wisdom that comes from it – will be the least willing to adapt their views as the world evolves.
In the rapidly iterating environment of modern digital technology one can earn experience in a relatively short timeline - and see it displaced by the evolving world. Housel points out that every generation cycles through the same process... no age has a monopoly on insight, and different levels of experience offer different kinds of lessons.
Hailey Mensik, Healthcare Dive. Congress, alongside provider and consumer groups, continues spat over surprise billing ban rules (November 17, 2021)
A key sticking point is the arbitration process, and how the qualifying payment amount (QPA) — determined by a plan's median in-network contracted rate for a geographic area — is used to arrive at rates for out-of-network providers.
Congress is also spatting over the rules, with 152 lawmakers penning a letter Nov. 5 stating the latest rules "do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes."
Eric Nehrlich, Unrepentant Generalist. Creating Alignment With Others (November 15, 2021)
In most situations where a leader is not doing the work themselves, they must communicate clear expectations, secure commitments from others, and hold them accountable to their commitments in order for their leadership to scale.
Ada Palmer, Before We Go Blog. Hopepunk, Optimism, Purity, and Futures of Hard Work (November 5, 2021)
Hopepunk narratives are genre stories which have depictions of human nature (teamwork, honesty, resilience) but which also counter purity narratives, by having space for partial victories, unfinished projects, compromise, and mundane not-character-defining failures and mistakes. Setbacks in hopepunk tend to be more about the outcome for the world, what now needs to be done to help or fix the problem, in contrast with stories where setbacks or failures are mainly beats in character development, the point where the hero must stand by his vow never to kill again, or prove her leadership skills to keep the team together.
We need all sorts of stories, but we have a special need for hopepunk right now, because, in many people’s lived experience, this is one of those false-utopias which seemed great but has had its unforgivable underbelly exposed, plural underbellies in fact—climate impact, structural inequality, global inequity, systemic racism, dystopian tech. We need better models for what to do now than just blowing up the overlord’s tower, since that doesn’t fix it.
Rebecca Pifer, Healthcare Dive. Insurtechs notched feverishly high MLRs in Q3. But it's not necessarily a mark of poor cost management (November 17, 2021)
Clover Health, Oscar Health and Bright Health Group reported eye-poppingly high medical loss ratios in the third quarter. High MLRs historically have been taken as a portent that payers are failing to adequately manage member spend.
But that wasn't the case, some analysts and company management say. Instead, the newly public insurtech startups are tethered mostly to one product or one geography, leaving them more vulnerable to regional influences. Combining that fact with higher-than-expected COVID-19 costs from the surging delta variant and the risk of new members in the individual exchanges gained during the special enrollment period left them with higher MLRs relative to larger, more diversified peers.
Under the Affordable Care Act, insurers have to shell out at least 85% of their premiums on patient care. They can keep the rest to cover other expenses and profit, so an MLR over 85% means payers are pocketing less for themselves.
In the third quarter, Minneapolis-based Bright's MLR reached 103%, up from 90% same time last year, while New York-based Oscar's MLR reached 99.7%, up from 90.5% same time last year.