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Thirty percent of companies that provide coverage to Medicare-eligible retirees (age 65 and over) already have moved to exchanges, according to an Aon Hewitt survey of more than 1,230 employers released last month.

For Medicare-eligible retirees, employer benefits are supplemental. Retirees who use traditional fee-for-service Medicare might be offered a Part D (prescription drug) benefit, and a subsidized Medigap plan, which plugs coverage gaps in fee-for-service Medicare. Retirees using Medicare Advantage (all-in-one managed care plans) receive a subsidy toward buying those plans.

oving to exchanges also can help employers avoid the looming risk of the so-called Cadillac tax on rich-benefit insurance plans.

The law provided the ONC with $2 billion to support development of a nationwide electronic health information system. Th

On the positive side, providers are clearly aware of and responding to the availability of incentives. Internal CMS surveys show that as of April 2011, 78% of physicians and 96% of hospital executives were aware of the meaningful-use program (Trudel K: personal communication). As Figure 1Figure 1Provider Registrations for Meaningful-Use Payments. shows, more than 114,000 eligible providers, or 21%, had registered for meaningful-use payments by the end of September 2011.11

it was the first company we had seen that flattened out clinical data and matched it with administrative data.”

But one example he gives would be around transparency in hospital practices, identifying trends that would be used compare the costs of one hospital caring for a particular patient with another system in the context of the clinical stream to see what each one is doing differently.

Every health system is in the business of protecting their doctors,” said Miller.

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.”

It’s estimated that seventy per cent of a primary-care doctor’s practice now involves management of psychosocial issues ranging from marriage counselling to treatment of anxiety and depression.

Fewer medical students are going into psychiatry, partly because psychiatrists, like primary-care doctors, earn among the lowest salaries of all physicians. Those who do choose psychi

But insurers underestimated how fast medical costs would rise, and how many seniors would actually use the benefits. And they underpriced the insurance premiums. Making matters worse, some insurers that were "hungry for market share" charged too little at first and planned to increase premiums later, says Joseph M. Belth, editor of the Insurance Forum newsletter and professor emeritus of insurance at Indiana University.

These small group requirements are expected to increase the cost of small group coverage by an average of 15%––with wide variation by state and the average age of the group.

Why not do the same for small employers as well? And while they are at it, use the time to reconsider the impact many of these regulations are likely to have on the number of small employers continuing to offer coverage