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Mal Allison

With Change Coming, Aetna Targets Employers - NYTimes.com - 0 views

www.nytimes.com/...g-aetna-targets-employers.html

Aetna ACO ACA patient data

shared by Mal Allison on 03 Sep 13 - No Cached
  • Mr. Mead cited a report by the Institute of Medicine that tallied more than $760 billion in health care “waste” created annually as a result of consumer fraud, unnecessary procedures and excessive administrative costs.
  • r. Mead said the campaign also stressed the need for health care providers to shift to a model known as “accountable care,” which shifts their reimbursement models for health care professionals from being paid for the volume of services they perform to being paid based on the outcomes of patient care. Accountable care systems are usually linked to technologies that help health care providers measure performance and manage patient data. Aetna has 27 accountable health care agreements with hospitals and other health care providers around the country.
  • Bertolini said in the video. “If we fix just 20 percent of it, we could pay for the Affordable Care Act. We could insure everyone without increasing taxes.”
  • ...2 more annotations...
  • The fee-for-service model is broken,” Mr. Mead said. “The Affordable Care Act encourages the system to move to accountable care,” he added. “The challenge with that is that doctors and hospitals need technology and support to make that work.”
  • He noted how costs could vary widely depending on where a person lived and who their insurer was. “It shouldn’t vary that much,” Mr. Huckman said.
  • Mal Allison on 03 Sep 13
     
    Aetna, one of the largest of the companies, will introduce a new campaign on Tuesday aimed at those groups. It will highlight the company's goal of cutting billions of dollars of expenditures through so-called Big Data, electronic health records and other technologies as well as encouraging better coordination among health care providers. The campaign, called "Our Healthy," will run online, in print and on mobile devices through the end of 2013.
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

'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

Hospitals evolving to meet health care law demands : Health - 0 views

herald-review.com/...5a-11e3-823a-001a4bcf887a.html

hospitals health care law evolving

shared by Mal Allison on 02 Oct 13 - No Cached
  • Under the Affordable Care Act, health care providers may be rewarded if they demonstrate better health outcomes at lower costs.
  • “In the old world, doctors and hospitals were paid more if they did more,” Kannaday said. In the new model, doctors and hospitals that demonstrate they are providing quality care at a lower cost are rewarded financially, she said.
  • decline in charity care and bad debt with more patients
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  • “The health care system clearly was not sustainable,” she added. “By partnering with physicians and hospitals and payers, we can create a health care system to propel us the right way into the future.”
Mal Allison

Overcoming Fragmentation in Health Care - John Noseworthy - Harvard Business Review - 0 views

blogs.hbr.org/...tainable-model-for-health-care

health care Noseworthy Fragmentation

shared by Mal Allison on 15 Oct 13 - No Cached
  • But the ACA does little to address fragmentation, quality of care, and the sustainability of the financial model for U.S. health care — ho
  • At the foundation of our approach is a knowledge-management system — an electronic archive of Mayo Clinic-vetted knowledge containing evidence-based protocols, order sets, alerts and care process models
  • It is alarming to see more than a two-fold variation in health care quality across the country.
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  • One such resource is the work of Optum Labs, which we formed with Optum earlier this year. Optum Labs, an open R&D facility with a unique set of clinical and claims data, is being used to drive advances that will improve health care for patients and our country. We are now inviting others — providers, life science companies, research institutions, consumer organizations, and policy makers — to be part of Optum Labs. This opportunity to apply world-class analytical tools to both cost and quality will provide t
Mal Allison

Should Mental Health Be a Primary-Care Doctor's Job? : The New Yorker - 0 views

www.newyorker.com/...-primary-care-doctors-job.html

mental health primary care

shared by Mal Allison on 25 Oct 13 - No Cached
  • 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
Mal Allison

Data mining helps manage employer health care risks - Articles - Employee Benefit News - 0 views

ebn.benefitnews.com/...alth-care-risks-2734952-1.html

data mining population management

shared by Mal Allison on 21 Aug 13 - No Cached
  • And all of this translates to a healthier bottom line. According to the consulting firm Aon Hewitt, population health management can help employers save as much as $700 per employee per year when they focus on any three of these eight major health care behaviors, which contribute to 80% of the cases of chronic illness: poor diet, physical inactivity, smoking, lack of health screening, poor standard of care, insufficient sleep, excess alcohol intake and poor stress management.
  • Mal Allison on 21 Aug 13
     
    And all of this translates to a healthier bottom line. According to the consulting firm Aon Hewitt, population health management can help employers save as much as $700 per employee per year when they focus on any three of these eight major health care behaviors, which contribute to 80% of the cases of chronic illness: poor diet, physical inactivity, smoking, lack of health screening, poor standard of care, insufficient sleep, excess alcohol intake and poor stress management.
Mal Allison

States experimenting to lower health care costs - 0 views

bigstory.ap.org/...enting-lower-health-care-costs

states lower health care

shared by Mal Allison on 04 Sep 13 - No Cached
  • "Look at any of the long-term projections for the federal budget or for state budgets," said Alan Weil, executive director of the National Academy for State Health Policy. "If we don't bring down health care costs, we're either going to be paying a whole lot more in taxes or we're going to stop spending money on other things we care about."
  • "It has to end eventually," said Larry Levitt, senior vice president of the Kaiser Family Foundation, "because we can't have an economy driven entirely by health care."
Mal Allison

Government Mandates Don't Lower Health Care Costs - Forbes - 0 views

www.forbes.com/...s-dont-lower-health-care-costs

340B drugs hospitals health costs

shared by Mal Allison on 23 Jul 13 - No Cached
  • The costs of the 340B program exist of course.  They are initially imposed on insurance companies and pharmaceutical manufacturers.  But, the costs are not confined to just these industries.  The costs created by the 340B program are ultimately integrated into the overall health care system and are manifested through rising insurance premiums, declining insurance coverage, declining innovation and productivity (especially for pharmaceutical drugs), and higher medical costs in unrelated segments of the health care system.  Perhaps more troubling, the added noise created by the 340B cost shifting worsens the overall functionality of the U.S. health care system
Mal Allison

Health Care Policy and Marketplace Review: The Affordable Health Care Act's Launch On O... - 0 views

healthpolicyandmarket.blogspot.com/...e-health-care-acts-launch.html

health care Obamacare Exchanges sustainable Laszewski

shared by Mal Allison on 30 Sep 13 - No Cached
  • We often hear that the administration's first-year objective is to sign-up 7 million people––of which 2.4 million need to be aged 18-34, in order to get a sustainable mix.
  • But, buyer beware. Consumers need to be very thorough here. A Silver plan is not a Silver plan is not a Silver plan.
  • he 2015 exchange rates and health plans will have to be developed by the participating insurance companies in mid-2014 so they can go through the approval process and be put on the exchange in time for the next year's October 1 open enrollment
Mal Allison

5 Easy Ways to Reduce Your Health-Care Costs | Fox Business - 0 views

www.foxbusiness.com/...-reduce-your-health-care-costs

health care costs consumers tips Fox News

shared by Mal Allison on 03 Jul 13 - No Cached
  • The best way to reduce health-care and insurance costs is if the price of treatment declines.
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

Business Boondoggle: Shedding the Cost of Health Care | The Fiscal Times - 0 views

www.thefiscaltimes.com/...ggle-Shedding-Cost-Health-Care

business portability true cost of insurance

shared by Mal Allison on 19 Sep 13 - No Cached
  • he actions of these other employers don’t detract from the unique nature of Walgreens’ decision. Two months earlier, the retailer announced its partnership with the Department of Health and Human Services to extol the benefits of Obamacare to its employees and its customers. Their website still features the effort, and brochures continue to be distributed even while the corporation itself realizes that compliance must force it to abandon employer-provided health insurance for the people in the stores distributing the brochures to customers.
  • With the CBO predicting that rising health-care costs would increase at twice the rate of other federal spending, the same increase in costs will now be borne almost entirely by employees.  Finally, it appears that the private-exchange option will satisfy the employer mandate, which means that the employees cannot bail out of these private exchanges in order to qualify for federal subsidies, which prevents the employers from having to pay increasing fines for non-compliance.
  • limit the liability of the third-party payer.
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  • s opposed to the Independent Payment Advisory Board and its “death panel”-like power. 
  • nce, and now employees will get more than just one or two options at open enrollment, with twenty-five plans available in the Aon exchange.
  • This arrangement makes the consumer the customer of the exchanges from the very beginning.  A termination would only impact the subsidy, which the consumer/employee could negotiate as part of his compensation package with his next employer. 
  • is to restore price signals on health care back to the consumer through the elimination of third-party payers and middlemen. 
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

The Health Care Law Guru vs. the Conservative who Inspired It | The Business Desk with ... - 0 views

www.pbs.org/...uru-of-obamacare-vs-the-c.html

ACA individual Market Gruber

shared by Mal Allison on 02 Oct 13 - No Cached
  • "Fine. A big group, we can understand the overall risk. We can model that. We're happy. But individuals, we're not so sure, and that's why the individual insurance market, which is a market where Americans who don't get insurance from their employer or the government have to turn, that's why that market is so screwed up all around the country and why we needed the Affordable Care Act.
  • First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on "catastrophic" costs -- so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.
  • Mal Allison on 02 Oct 13
     
    We can model that. We're happy. But individuals, we're not so sure, and that's why the individual insurance market, which is a market where Americans who don't get insurance from their employer or the government have to turn, that's why that market is so screwed up all around the country and why we needed the Affordable Care Act.
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