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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.
  • ...17 more annotations...
  • 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

OptumInsight CEO talks about the big data insights analytical tools are producing for h... - 0 views

medcitynews.com/...alks-power-harnessing-big-data

data

shared by Mal Allison on 04 Mar 14 - No Cached
  • 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.
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  • “We’re not at the point where we’re building new technologies, but I think we’re at the point of discovering things in the combined data that would tell us how dramatically health systems could improve the way they deliver care and intervene with patients.”
Mal Allison

Fact vs. Fiction: Arkansas' Game-Changing Medicaid Expansion Plan - 0 views

www.governing.com/...g-medicaid-expansion-plan.html

arkansas medicaid expansion facts

shared by Mal Allison on 16 Jul 13 - No Cached
  • A: That’s true. Or that’s a prediction that I believe will be proven true, I should say. Here’s the explanation. The standard theory on making insurance markets is that you want its competition to be continuous. The way to do that is to see that the risk pool of covered lives is a large, stable and ideally relatively health population. I cannot think of a larger, more stable and relatively healthy population, in proportion to the rest of the exchange population, than the Medicaid expansion population. They are systemically younger than the rest of the population. That’s one of the reasons that they're poorer. Our program design is also going to pull out the highest-risk people from the private option and treat them in the traditional Medicaid program because we would have had to supplement for many of their services. (Editor's note: Federal law requires Medicaid premium assistance to 'wraparound' to make sure recipients get the same amount of coverage through private insurance as they would in Medicaid). That’s very hard to do. It’s both care and administratively burdensome. Those individuals, the highest five to 10 percent costly individuals, would be better served in a single program, and by definition that would have to be the traditional Medicaid program.
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

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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