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Mal Allison

'Wildfire' Growth Of Freestanding ERs Raises Concerns About Cost - Kaiser Health News - 0 views

www.kaiserhealthnews.org/...and-alone-emergency-rooms.aspx

wildfire growth ERs urgent care convenience cost

shared by Mal Allison on 16 Jul 13 - No Cached
  • Several hospital chains are driving the boom – including HCA Inc., which will open its seventh ER later this year in Florida, and Wake Med Health and Hospitals, which will add its fourth next month in the Raleigh, N.C., metro area. They regard the facilities as a way to expand into new markets, generate admissions to their hospital and reduce crowding at their hospital-based ERs.
  • reater Houston has 150 emergency rooms — twice the number as greater Miami -- even though its population is only slightly bigger, according to a KHN analysis.
  • While the ERs charge insurers double or triple the amount per patient as an urgent care center or doctor's office, patients use them for routine care that could be provided in less costly settings, Ho says. That is the case with standard ERs as well. Yet, insured patients have little incentive to drive past the more expensive, freestanding ERs because their co-payment is only $50 or $100, just modestly more than what it might cost for a visit to an urgent care center or doctor’s office. Their insurers pay the balance generally.
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  • The main reason they are more costly than urgent care is that they charge a "facility fee" on top of a fee for the physician's time—just like traditional ERs. The facility fee was originally intended as a way to help hospitals recoup overhead costs
  • In an effort to protect consumers, Texas in 2009 passed a law to license freestanding ERs that are not owned by hospitals. The law requires facilities be open 24 hours, always have doctors on site and give everyone a medical screening regardless of their ability to pay – all requirements that apply to hospital-based ERs. Many of the clinics, though, don’t accept Medicaid or Medicare and the law did not change that.
  • orried that insurers will eventually cut payments to those unaffiliated with hospitals, Emerus has started converting its facilities into "micro hospitals," with a few beds that treat patients such as those needing drug detox or hospice. The company has also recently partnered with Baylor Health System to jointly operate eight such "micro hospitals" in the Dallas area.
  • Mal Allison on 16 Jul 13
     
    "You can never have too much care for patients," says Rhonda Sandel, CEO of Texas Emergency Care Center.
Mal Allison

HEALTH REFORM: Expect Pluses, Minuses for Those With Job-Based Coverage - iVillage - 0 views

www.ivillage.com/...4-a-547763

ACA employer-based insurance

shared by Mal Allison on 01 Oct 13 - No Cached
  • Beginning in 2014, for instance, the reform package prohibits employer-sponsored health plans from excluding people from coverage based on pre-existing health conditions
  • It also makes larger employers responsible for offering medical coverage. Beginning Jan. 1, 2015, businesses with more than 50 workers must offer health insurance to full-time workers and dependents or pay penalties.
  • annual limits will be banned completely in 2014.
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  • Also, if you have an adult child under age 26 and your employer health plan offers coverage for dependents, the plan must allow your son or daughter to enroll. Spiro called th
  • The law also requires most employer health plans to offer certain preventive services at no cost to the employee.
  • Effective Jan. 1, 2014, the law allows employers to boost rewards and penalties (such as premium discounts or surcharges) to 30 percent of the total plan premium, up from 20 percent.
  • ne in five employers has boosted employees' share of health plan premiums,
  • HealthCare Advocates, which helps consumers resolve health insurance problems. "I think at the end of the day, everybody's going to be paying more," he said.
  • e IFEBP survey also estimates that about 16 percent of employers are trimming worker hours to part-time status so fewer employees will qualify for health-plan benefits.
  • Beginning in 2015, large employers -- those with at least 50 full-time workers -- must provide health insurance to employees who log an average of 30 or more hours a week or pay penalties.
  • A study published earlier this year by the University of California, Berkeley Center for Labor Research and Education found that 2.3 million workers nationwide -- particularly retail and restaurant workers -- are at risk of losing hours as a result of the new law.
  • A growing number of midsize and large employers -- 25 percent in 2014 and 44 percent in 2015 -- are also saying they're likely to discontinue health coverage for Medicare-eligible retirees, a new Towers Watson & Co. survey found.
  • Starting in 2018, the law imposes a steep tax on employer plans with premiums exceeding $10,200 for an individual and $27,500 for a family -- plans that are typically offered to high-wage earner
  • About 17 percent of employers are redesigning their high-cost plans to avoid this so-called "Cadillac tax," while 40 percent are considering i
  • The percentage of Americans receiving health insurance on the job or through a family member's job slipped from 69.7 percent in 2000 to 59.5 percent in 2011,
  • Staggering increases in health insurance premiums also contributed to the decline, resulting in fewer employers offering coverage and fewer employees accepting it.
  • Congressional Budget Office estimates suggest that as many as 7 million people will lose job-based coverage by 2017 a
  • But just 26 percent are confident that they will be offering health-care benefits a decade from no
  • r Center, has summarized provisions of the Affordable Care Act affecting employer-sponsored insurance.
  • To read part one of the series, how to navigate the new health insurance exchanges, click here.
  • Mal Allison on 01 Oct 13
     
    Experts say smaller companies that employ 50 or more workers and currently provide health insurance may drop coverage because it would be cheaper to pay fines than maintain coverage for all of their workers. Most large employers (with more than 1,000 employees) remain committed to providing health benefits for the next five years, according to an employer survey by Towers Watson/National Business Group on Health. But just 26 percent are confident that they will be offering health-care benefits a decade from now. Meanwhile, a number of large employers are eyeing private health insurance exchanges as a way to continue providing job-based coverage while controlling spending on health benefits. Much like the public exchanges under the Affordable Care Act, private exchanges represent a new way for employees and families to shop for group health coverage and other benefits. Instead of offering a limited number of health plans, the employer would give workers a set amount of money to buy their own coverage. Kaiser, who works in Gallagher Benefit Services' Mount Laurel, N.J., office, anticipates a slow migration toward private exchanges. "I don't think it's going to be a mass disruption of employer-sponsored plans where they all go, 'I'm out of the game,'" he said. More information The University of California, Berkeley Labor Center, has summarized provisions of the Affordable Care Act affecting employer-sponsored insurance.
Mal Allison

Employers Turn to Private Health Exchanges to Cut Costs - Bloomberg - 0 views

www.bloomberg.com/...lth-exchange-to-cut-costs.html

employers exchanges private

shared by Mal Allison on 19 Feb 14 - No Cached
  • One-third of U.S. employers plan to move their workers’ health-care coverage to a private exchange in the next few years, a survey found, following the le
  • Health spending in the U.S. is expected to increase more than 6 percent this year and 6.2 percent annually from 2015-2022 as the Patient Protection and Affordable Care Act takes full effect and millions of Americans gain insurance, according to the Centers for Medicare and Medicaid Services.
  • Under Obamacare, companies that don’t offer coverage for their employees will be fined $2,000 per employee. Employers spend $6,000 per employee on average, so d
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  • They found that 5 percent of the companies surveyed may drop employee health-care coverage in the next three to five years, an increase from 1 percent now
  • About 38 percent of the companies surveyed by Aon said they would offer no benefits to part-time workers within the next three to five years.
  • Only 25 percent of large employers offer subsidized retiree health benefits, Aon said, down from about 50 percent in 2004.
Mal Allison

Arkansas' Unprecedented Use of Performance Pay to Contain Health-Care Costs - 0 views

www.governing.com/...lth-care-cost-containment.html

health care costs Medicaid Arkansas GHI

shared by Mal Allison on 16 Jul 13 - No Cached
  • rkansas has been at the center of the ACA conversation with its game-changing plan for a privatized Medicaid expansion that several Republican-led states considered.
Mal Allison

Hospital, providers to develop state's only member-owned health plan - Health & wellnes... - 0 views

www.bostonglobe.com/...story.html

member-owned insurance Tufts Medical Center minuteman Health Initiative

shared by Mal Allison on 15 Jul 13 - No Cached
  • The Minuteman plan would streamline billing processes to save on administrative costs and allow providers to work more closely with employers, organizers said. Information about smoking cessation or workers’ weight collected through employer wellness programs is not typically shared with doctors. “Imagine working closely with an employer who can help us gather data and, with employees’ permission, to be able to share that data with their primary care providers,” said Dr. Jeff Lasker, chief executive of the Tufts physician group, New England Quality Care Alliance.
  • Partners HealthCare last year announced plans to acquire Neighborhood Health Plan, which mostly serves low-income people. Steward Health Care has worked with Fallon Community Health Plan to develop plans offered at reduced prices through a small business cooperative created by the Retailers Association of Massachusetts.
Mal Allison

Detroit wants to unload 19,389 retirees into Obamacare's marketplaces - 0 views

www.washingtonpost.com/...s-into-obamacares-marketplaces

Detroit retirees health costs ACA obamacare healthcare

shared by Mal Allison on 20 Jul 13 - No Cached
  • A good chunk of Detroit’s debt problem is a health-costs problem. The Detroit Free Press notes that the city has $5.7 billion in unfunded retiree health-care liabilities, nearly a third of the city’s debt.
  • . It plans to transition its 19,389 retirees into the health law’s new marketplaces, saving the city somewhere between $27.5 million and $40 million annually.
  • . One report from the Pew Center for the States looked at 61 cities across the country and found that, taken together, they had $126.2 billion in health benefits promised to retirees. Only 6 percent of that amount – $8 billion – currently has funding.
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  • econd, health-care costs have grown more rapidly than the rest of the economy (although they have slowed a bit in the past few years). That means some cities, such as Detroit, have an especially large bill to pay for retirees’ health-care benefits.
  • hicago announced plans in May to phase out retiree coverage, either moving workers into the exchanges or, if they’re old enough, having them rely entirely on the Medicare program. Detroit
Mal Allison

PwC's Health Research Institute projects historic slowdown in healthcare spending growt... - 0 views

www.pwc.com/...ojects-historic-slowdown.jhtml

Healthcare spending slowdown 2014 consumers

shared by Mal Allison on 09 Jul 13 - No Cached
  • Consumers, meanwhile, who are paying a greater share of the cost, are making spending adjustments.  Many are delaying care, using fewer services and choosing less expensive options such as retail clinics, urgent care centers and mobile health devices.
  • “Healthcare cost increases continue to exceed overall growth in wages, but the gap appears to be shrinking.  The long-term trends suggest that as the economy improves, the cycle of runaway cost increases will be broken,” said Michael Thompson, principal with PwC’s human resource services practice.  “This is critical as employers strategically reevaluate the role of healthcare benefits to their organizations and step up efforts to engage employees more directly in value-based healthcare decision making.”
Mal Allison

Health Insurance Within Reach - NYTimes.com - 0 views

well.blogs.nytimes.com/...health-insurance-within-reach

health insurance ACA changes

shared by Mal Allison on 16 Jul 13 - No Cached
  • All health plans offered on a state exchange must provide comprehensive coverage that includes doctors’ visits, lab work, hospital stays, emergency room services, maternity care, prescriptions, mental health services and children’s dental and vision care.
  • Policies with the most generous benefits will be “platinum” plans; they will have the highest monthly premiums but fewer out-of-pocket costs and lower deductibles. The “gold” and “silver” plans will be somewhat less generous, while those in the “bronze” category will have the cheapest premiums but may require high out-of-pocket costs and deductibles.
  • Be aware that the plans may have narrow provider networks — your favorite doctor or the hospital down the street may not be a participant. You’ll need to check to see if a certain provider is in the network, advised Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform.
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  • Be prepared for sticker shock. A 40-year-old nonsmoker may be able to buy a plan for about $4,000 annually or less; someone in his or her 50s may pay double. “Health insurance is an incredibly expensive product,” Ms. Corlette warned.
  • People who earn up to four times the federal poverty level — roughly $45,960 a year for a single person and $94,200 for a family of four — can receive subsidies to help pay for the new coverage. Those earning 250 percent of the poverty level are eligible for additional cost-sharing subsidies.
  • Americans who work at minimum wage jobs, earning less than 138 percent of the federal poverty level, which is $15,856 for a household of one and $32,499 for a household of four, will qualify for free government coverage under Medicaid — but only if they live in a state that is expanding its Medicaid program.
  • Open enrollment on the new exchanges will run from October 1 through March 31. Y
Mal Allison

Unions chafing at Obamacare provisions | Center for Public Integrity - 0 views

www.publicintegrity.org/...s-chafing-obamacare-provisions

unions obamacare Potter

shared by Mal Allison on 17 Sep 13 - No Cached
  • I’ve talked to union members who have not had a raise in years because of rising health care costs. They’ve been willing to forego wage increases at the bargaining table in exchange for keeping decent health insurance
Mal Allison

Online Health Exchanges for Small Businesses Hit Snag - WSJ.com - 0 views

online.wsj.com/...3796404579099310270573146.html

online health exchanges small biz

shared by Mal Allison on 27 Sep 13 - No Cached
  • The Obama administration said in April it was scaling back the complexity of the small-business marketplace by delaying by one year a feature to allow employees of such businesses to pick from a range of plans, instead of the company selecting one on workers' behalf.
  • Business owners will be allowed to submit a paper application using a PDF form starting Tuesday, but they won't be able to complete an electronic application until a few weeks later, the official said. A call center for businesses will open Tuesday for employers who want help completing the paper application.
  • Mal Allison on 27 Sep 13
     
    The Obama administration said in April it was scaling back the complexity of the small-business marketplace by delaying by one year a feature to allow employees of such businesses to pick from a range of plans, instead of the company selecting one on workers' behalf.
Mal Allison

Analysis: Tenet stands out by experimenting with core model of Obamacare | Reuters - 0 views

www.reuters.com/...analysis-idUSBRE99119620131002

analysis tenet ACO pay for performance

shared by Mal Allison on 04 Oct 13 - No Cached
  • Most in the Pioneer group achieved quality improvements, but only 18 produced cost savings.
  • It remains to be seen whether it functions profitably or not," said Alan Miller, chief executive of Universal Health Services, which operates more than 200 hospitals, behavioral health facilities and outpatient centers."There has been a lot of discussion of moving away from fee- for-service to something like this, but we are a long way from there," Miller said.
  • The big opportunity for cost savings lies in getting preventive care for people before they land in the hospital with illnesses such as heart disease, diabetes and asthma,
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  • If it became necessary to do something to be competitive, we might change our mind, but right now we think we can continue to grow our business without spending the capital dollars and replacing what managed care companies can do well, just by contracting,"
  • which $14 million was returned to Montefiore."The way you make this work is not by denying care. The way you save money is by giving the right care to the right patients in the right setting,"
Mal Allison

On the Threshold of Obamacare, Warily - NYTimes.com - 0 views

www.nytimes.com/...shold-of-obamacare-warily.html

Obamacare employees

shared by Mal Allison on 01 Oct 13 - No Cached
  • She eventually went to the M. D. Anderson Cancer Center in Houston, where she has been treated for more than two months. The bill at the end of August was $650,000. The hospital, he said, called them to ask for a payment for $500,000.
  • But while Mr. Cantu expects to enroll for coverage for next year, the law won’t help him with his wife’s medical bills, which he estimates now approach $1 million, if not more. “Where am I going to get that kind of money?” he said. “In 20 years, I wouldn’t be able to pay it off.”
Mal Allison

Targeted Therapies Offer Promise, But Are They Affordable? - 0 views

www.medscape.com/...810147

targeted therapies health costs

shared by Mal Allison on 29 Aug 13 - No Cached
  • Medicare patients, however, are at a disadvantage because there is no cap for out-of-pocket expenses. They "are paying copayments or coinsurance forever," Dr. Newcomer explained.
  • "What we are already seeing is that patients who are on Medicare are coming to hospital settings; they are not being treated at their doctor's office or their infusion center because the doctors can't afford to do it," said Dr. Swain. The doctors would actually lose money on this, so the patients are coming to a higher-priced facility — a hospital — to get their infusion, she explained. "I think it is really going to have an effect, not on the patients but on the economy in general," she added.
  • The decline in Medicaid budgets has added challenges to medication access for recipients of this program.
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