May 17, 2020

3 Ways Hospital CEOs Can Prepare for Rising Insurance Premiums in 2015

Health Insurance
Hospital Finance
M&A
Health Insurance
Admin
3 min
According to a May 2014 news release from the Washington State Office of the Insurance Commissioner, 17 health insurers are filing plans for 2015 with a proposed average rate increase of 8 percent.
With the first full year of the Affordable Care Act winding down, already-taxed hospitals are bracing for a rise in insurance premiums in 2015.

There i...

With the first full year of the Affordable Care Act winding down, already-taxed hospitals are bracing for a rise in insurance premiums in 2015.

There is no single source that can accurately gauge how much costs will rise, or if they'll rise at all, but hospital managers and CEOs are already wondering how it will affect them and what tools they have to help them cope.

1. Know the Facts

The Wall Street Journal reported that health care premiums are likely to increase in 2015, although not as much as they have on average since 2010.

Although the article was sourced by the White House, all parties involved conceded that it was difficult to predict how much rates would jump, and if they would rise across all categories and demographics because this is the first year that insurers have had to calculate earnings and projections since the Affordable Care Act took effect.

But no matter what the increase, hospitals will have to adjust – and that adjustment will have to begin at the leadership level.

The article "Health insurance premiums likely to rise in 2015" predicted that cost containment will rest on two variables that are largely beyond the control of any hospital: the government and the level of competition between insurance companies.

The author makes the point that all increases must be approved by the government because it is the government that doles out subsidies.

When it comes to competition, the states with the fewest insurers competing (such as Colorado and Missouri) are also the states with the highest premiums. 

2. Consider Merging

Other than waiting for new government standards or hoping for increases in competition, what can hospital CEOs and managers do to fend off rising costs?

One solution has been to merge. Both private and non-profit hospitals and health systems have seen a dramatic increase in mergers over the last two decades, especially in recent years.

The establishment of enormous mega-hospitals enables smaller hospitals to compete by allowing them to pool resources with each other through strategic alliances.

3. Invest in Technology

For those hospitals that can't or won't merge, relatively modest, up-front investments in software and systems can help them save enough to prevent the need to reduce staff or close offices and labs. Using technology to rein in costs associated with administrative necessities is one step almost every hospital can take.

Most credible sources predict that insurance premiums will rise in 2015. The ripple effect from that will impact hospitals across the country. More and more CEOs are eyeing mutually beneficial mergers.

If that isn't in the cards, investments in technology that could streamline the costs of things like billing, records and data management may just be enough to see them through.

About the author: Andrew Lisa is a freelance business writer. He covers insurance within the health care industry.

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Jun 15, 2021

 NHS trials test that predicts sepsis 3 days in advance 

sepsis
MachineLearning
clinicaltrial
blooddisorder
2 min
Queen Alexandra Hospital is trialling a new sepsis test by Presymptom Health that uses machine learning to detect the onset of the disease

A new test that can predict sepsis before the patient develops symptoms is being trialled at a National Health Service (NHS) hospital in the south of England. 

Clinicians at Portsmouth’s Queen Alexandra Hospital are leading medical trials of the blood test, which they hope will help them save thousands of lives a year. 

The test is being developed by government spin-out company Presymptom Health, but the research began over 10 years ago at the Defence Science and Technology Laboratory (Dstl). This included a study of 4,385 patients and more than 70,000 samples, the largest study of its kind at the time. 

From the samples taken, a clinical biobank and database were generated and then mined using machine learning to identify biomarker signatures that could predict the onset of sepsis. The researchers found they were able to provide an early warning of sepsis up to three days ahead of illness with an accuracy of up to 90%.

Unlike most other tests, Presymptom Health identifies the patient’s response to the disease as opposed to detecting the pathogen. This is an important differentiator, as sepsis occurs as a result of the patient's immune system’s overreaction to an infection or injury, which can then cause life-threatening organ dysfunction. 

Worldwide, an estimated 49 million people a year contract sepsis, while in the UK almost two million patients admitted to hospital each year are thought to be at risk of developing the condition. If Presymptom's test is effective, it could save billions of pounds globally and improve clinical outcomes for millions of sepsis patients.

The initial trials at Queen Alexandra Hospital will last 12 months, with two other sites planned to go live this summer. Up to 600 patients admitted to hospital with respiratory tract infections will be given the option to participate in the trial. The data collected will be independently assessed and used to refine and validate the test, which could be available for broader NHS use within two years. 

If successful, this test could also identify sepsis arising from other infections before symptoms appear, which could potentially include future waves of COVID-19 and other pandemics.

Dr Roman Lukaszewski, the lead Dstl scientist behind the innovation, said: “It is incredible to see this test, which we had originally begun to develop to help service personnel survive injury and infection on the front line, is now being used for the wider UK population, including those fighting COVID-19.”

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