HEALTHCARE NEWS FLASH December 02, 2013
Table of Contents Sales & Marketing ................................................................................................................. 3 Finance ............................................................................................................................... 13 Technology .......................................................................................................................... 18 Strategy .............................................................................................................................. 23
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Sales & Marketing It's not Obamacare, it's business November 25, 2013 | Politico http://www.politico.com/story/2013/11/health-insurance-industry-obamacare-affordable-careact-100356.html Insurance companies are ready to unleash an expensive PR blitz to get 7 million new customers once HealthCare.gov is fixed. But don’t expect them to sell “Obamacare.” Big insurers and the stock analysts that track them say that once the White House is sure its enrollment website is working, the companies will barrage the airwaves with messages encouraging people to join new health insurance exchanges, either by signing up directly with insurers or by giving the website another shot. The strategy makes sense: “Obamacare” polls terribly with Americans, but the idea of affordable insurance is a hit. And for the insurance industry, the new health care law isn’t about politics — it’s business. Already Kaiser Permanente has sent a letter to potential customers in the Washington area, touting the availability of federal subsidies and mentioning specific benefits and coverage options for “hassle-free coverage that won’t let you down.” But the letter makes no mention of Obamacare, the Affordable Care Act or President Barack Obama. “If you need help paying for health care, you may qualify for federal financial assistance when you enroll in a plan offered in the marketplace,” it says, giving a toll-free number. WellPoint, the largest insurer within the Blue Cross Blue Shield Association, has earmarked $150 million for “exchange-related activities” that include marketing to customers, a company spokeswoman said. The timetable for spending will depend on “the pace of overall exchange readiness — and tenor of consumer sentiment,” she said. The health care website is supposed to be working “smoothly” for most people by this weekend, White House officials say. The insurance companies could be critical in getting people to log on. “They’re not necessarily unbiased. They have a lot of skin in the game. They can help convince people that it’s working,” said former Senate Majority Leader Tom Daschle, a longtime champion of national health reform who now, as an adviser at DLA Piper, has close ties to insurers.
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White House ally Enroll America, which has Kaiser Permanente and Blue Shield of California on its board, says it’s preparing an early December “chase program” to re-engage people who were stymied early on by the flawed website. The “chase” will get under way only if HealthCare.gov is working by then. “Right now, there’s about 50,000 people that we’re going to be reaching back to at the door, on the phone, by email,” said Enroll spokesman Justin Nisly. “We’ll be following back up and pushing them toward the website. Hopefully the website will be working.” Nisly added that the effort is meant to ramp up enrollment until insurers step in and provide PR “air cover” early next year. But they have to be confident that HealthCare.gov is really working and that people have faith that they can get on and get results other than error messages and crashes. “What you don’t want to do is direct people to a nonworking website. That is not good business practice,” said Sheryl Skolnick, managing director of investment analysis firm CRT Capital. “I think that it’s fair to say that once it’s established that you can go from typing in the words HealthCare.gov to getting a confirming email saying ‘you’re covered’ with reasonable ease, then I think you’re going to see a huge marketing boost to get people enrolled.” An industry ad campaign could be a wild card in the Obama administration’s effort to get the president’s health program back on track — including drawing a robust number of young, healthy people into the new market. The calamitous rollout depressed enrollment in the first months and has led some analysts to predict far fewer sign-ups than the White House is seeking. “Even if those issues are resolved quickly, you still probably are not going to get as much enrollment,” said Matthew Borsch, vice president of Goldman Sachs, who predicted 5 million people would become covered in the first year. Insurers did increase their advertising after the federal website launched. Sixty-three percent of the industry’s television ad spending since July occurred after the Oct. 1 start of enrollment, according to an analysis by Kantar Media. But once the severity of the website problems became evident, they pulled back, analysts say. “We have a very different situation than we were expecting two months ago,” said Mike Killeen, marketing director for the Atlanta-based firm Lenz Marketing. “They’re pulling back and they’re not placing the media I think they planned on spending. What’s the point in doing that if you can’t even get people through the system?” In the limited messaging that is going on, insurers are either casting themselves as more trustworthy than the government — or pretty much ignoring the Affordable Care Act and the benighted website altogether. They don’t want to scare off customers from applying to a program that has provoked so much opposition and skepticism. Nearly all of the major insurers such as Cigna, Humana and United Healthcare are mostly ignoring the health law and its messy start. Only 18 percent of ads placed by health insurers since Oct. 1 have referenced the Affordable Care Act, according to Kantar Media.
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Treating the law as radioactive, at least for now, seems to be the safer path. “It seems pretty normal for insurers to play it safe for this first round, see how things go,” said Elizabeth Wilner, vice president of Kantar Media’s CMAG. “They didn’t know the website wasn’t going to work, so now they seem pretty prescient.” So far, Blue Cross Blue Shield is the only major network of insurers directly referencing the federal website over the airwaves — and it’s depicting itself as an alternative to the balky site. The message is that health plans can help — even when the government is stuck. They are touting the direct enrollment option. That’s been a path for consumers all along, but the HealthCare.gov repair team is still working on making that work for people who qualify for subsidies, not just those who self-pay. But Blue Cross’s subsidiaries have released a slew of ads that recognize the law in ways meant to reassure — and even amuse — consumers. Wellmark Blue Cross Blue Shield launched three ads last week in Iowa and South Dakota that mock HealthCare.gov’s woes. The message: The federal government might be a laughingstock, but we’re serious about getting you covered. “Things don’t always work like they’re supposed to,” the ads say. “Good thing the government exchange isn’t the only place to buy health insurance. … Just visit Wellmark.com/simple or call today.” “Clearly, they sat down and decided ‘we are going to reposition ourselves as the reassuring solution for people who are nervous about their health care situation,’” Wilner said. “I think what they’re selling is simplicity, certainty, confidence,” Killeen said. “It’s such a mess right now with the site. It’s a functional mess turned into an emotional mess.” Robert Blendon, a Harvard University health policy expert, said insurers would be wise to steer clear of the broader political debate when re-engaging consumers to enroll. “It really should be much more a consumer education campaign: We’re open for business, it’s easy to sign up, here are the kind of choices we’re offering — no mention of what happened before,” he said. “From the insurance industry’s point of view, they’re only interested in people who can come to the exchange and buy a product. They should not be involved in the broader issue.” Daschle said insurers would do well to highlight real people who stand to benefit from the law — “people that have no ax to grind one way or the other.” That would be a counterpoint to all the stories about people who face higher bills. It’s still unclear when HealthCare.gov will run as smoothly as the Obama administration wants — and how the insurers perceive whatever progress is achieved by Nov. 30. Skolnick of CRT Capital Group said it’s not a good sign if insurers don’t ramp up their marketing after Nov. 30, “since we know they’re prepared to do so.” Killeen said insurers would act when the public truly believes HealthCare.gov is working.
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State-run health insurance exchanges report November ‘enrollment surge’ November 23, 2013 | The Washington Post http://www.washingtonpost.com/politics/november-surge-seen-in-obamacare-sign-ups-instates/2013/11/22/4233cc50-539e-11e3-9fe0-fd2ca728e67c_story.html After anemic enrollment in the federal health insurance marketplace, several states running their own online exchanges are reporting a rapid increase in the number of people signing up for coverage, a trend officials say is encouraging for President Obama’s health-care law. By mid-November, the 14 state-based marketplaces reported data showing enrollment has nearly doubled from last month, jumping to about 150,000 from 79,000, according to state and federal statistics. The nonprofit Commonwealth Fund, which has been tracking the data, called the most recent numbers “a November enrollment surge.” The latest figures from the state-run exchanges, combined with totals on the federal exchange, bring the national number to at least 176,000. While the pace of enrollments increased this month, signups are still well below early projections. On Friday, the Obama administration announced that it is giving consumers an extra week in December to sign up for coverage that begins Jan. 1, in light of troubles with federal enrollment. Insurers worried that the change would not give them enough time to process applications. Health policy experts said the momentum from state exchanges is encouraging. California, which has had about 80,000 sign-ups, is now reporting about 2,000 enrollments per day. New York and Washington state reported enrollment numbers in the tens of thousands as of this week. A total of 27,000 enrollments were reported in October for the federal marketplace in which 36 states are relying on HealthCare.gov; the number has not been updated in November. “It’s not all doom and gloom,” Kaiser Family Foundation President Drew Altman said. “What this says is that the problems are system problems, not problems with demand or interest.” Health policy experts have always expected that enrollment would be slower in October because coverage doesn’t begin until January. What they did not expect was the array of technical issues that would make it difficult for even the most eager shoppers to purchase coverage. The state exchanges that have performed well “were just better equipped and ready to handle high capacity” of users, said Sara Collins, a vice president at the Commonwealth Fund, a health policy nonprofit group. They worked out some of their technical issues, testing early on in the summer, she said. Those states have also conducted stronger outreach, aggressively targeting young people, who generally have fewer health problems and are considered critical to the success of the exchanges.
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Some of the state exchanges are seeing the pace of enrollment pick up daily. California has been out in front; the state’s enrollments have grown steadily in November and now account for nearly half of all health law sign-ups. The state has had its strongest two weeks of enrollment this month. “We’re seeing much larger numbers than we expected,” Covered California Executive Director Peter Lee told reporters this week. Connecticut officials say they have seen about 14 percent of their expected enrollees sign up through mid-November. The state has had about 8,000 people enroll in private coverage. The latest figures from the state-run exchanges, combined with totals on the federal exchange, bring the national number to at least 176,000. While the pace of enrollments increased this month, signups are still well below early projections. On Friday, the Obama administration announced that it is giving consumers an extra week in December to sign up for coverage that begins Jan. 1, in light of troubles with federal enrollment. Insurers worried that the change would not give them enough time to process applications. Health policy experts said the momentum from state exchanges is encouraging. California, which has had about 80,000 sign-ups, is now reporting about 2,000 enrollments per day. New York and Washington state reported enrollment numbers in the tens of thousands as of this week. A total of 27,000 enrollments were reported in October for the federal marketplace in which 36 states are relying on HealthCare.gov; the number has not been updated in November. “It’s not all doom and gloom,” Kaiser Family Foundation President Drew Altman said. “What this says is that the problems are system problems, not problems with demand or interest.” Health policy experts have always expected that enrollment would be slower in October because coverage doesn’t begin until January. What they did not expect was the array of technical issues that would make it difficult for even the most eager shoppers to purchase coverage. The state exchanges that have performed well “were just better equipped and ready to handle high capacity” of users, said Sara Collins, a vice president at the Commonwealth Fund, a health policy nonprofit group. They worked out some of their technical issues, testing early on in the summer, she said. Those states have also conducted stronger outreach, aggressively targeting young people, who generally have fewer health problems and are considered critical to the success of the exchanges. Some of the state exchanges are seeing the pace of enrollment pick up daily. California has been out in front; the state’s enrollments have grown steadily in November and now account for nearly half of all health law sign-ups. The state has had its strongest two weeks of enrollment this month. “We’re seeing much larger numbers than we expected,” Covered California Executive Director Peter Lee told reporters this week.
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Connecticut officials say they have seen about 14 percent of their expected enrollees sign up through mid-November. The state has had about 8,000 people enroll in private coverage. And in Washington state, health law enrollment in private plans has jumped from 7,341 at the end of October to 11,742 through Nov. 14. “We’re definitely seeing interest continuing to build,” exchange spokesman Michael Marchand said. “I fully suspect we may have half our enrollment coming in in December.” Meanwhile, the federal government is giving consumers even more time, allowing them an extra week in December to sign up for coverage to begin Jan. 1. The previous Dec. 15 deadline has been pushed back to Dec. 23, said Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, the federal agency overseeing HealthCare.gov. She said that the date was changed in consultation with insurers and that the administration was confident carriers would have enough time to process applications. But industry officials raised concerns that the shortened period would not be enough time to complete the many tasks required after someone hits “submit” on an application and before a benefit card arrives in the mail. “It makes it more challenging to process enrollments in time for coverage to begin on January 1,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans. Insurers are worried that a flood of new applications at the last minute, combined with the inaccurate enrollment data they are receiving from HealthCare.gov, will leave them scrambling to verify information and receive payment. Health and Human Services officials also announced Friday that insurers in Florida, Texas and Ohio will launch a pilot program to allow consumers to directly enroll in coverage, bypassing HealthCare.gov. This type of enrollment was always supposed to be an option for consumers, but the online system has not worked properly. The administration also confirmed Friday that it is pushing back next year’s open enrollment by one month, so that it begins Nov. 15 instead of Oct. 15 and ends in early January instead of December. Republicans accused the administration of a blatantly political effort to shift the sign-up period until after the Nov. 4 election and delay bad news that might result from the next round of open enrollment. But from a policy perspective, the deadline change also gives insurers an extra month to set rates for 2015. Insurance companies would have until May 2014, instead of April, to file their rates. With the current open enrollment ending March 31, insurers have long complained that it would be difficult to know.
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White House Pushes Next Year's Health Plan Sign-Ups Later November 22, 2013 | NPR http://www.npr.org/blogs/health/2013/11/22/246779639/white-house-pushes-next-yearshealth-plan-sign-ups-later Another day brings another delay for the federal health law known as the Affordable Care Act. On Friday, the Obama administration announced that, starting next year, it is pushing back the start of the sign-up period for those buying individual and small business insurance until mid-November, rather than mid-October. That will give insurance companies some extra time to set their premiums, given this year's difficulties. And, as some analysts point out, the delay may also ease some political concerns for Democrats. The open enrollment period in 2014 will begin on Nov. 15 and last until January, White House spokesman Jay Carney said at a press briefing. "This gives [insurance companies] more time to assess the pool of people who are getting insurance through the marketplaces and then make decisions about what rates will look like in the coming year," Carney told reporters. The delay also gives the administration a bit of breathing space in case, as expected, it needs to extend the current enrollment period past the March 31 deadline, if ongoing problems with the website aren't fixed. Right now, the schedule has insurance companies tasked with filing next year's proposed rates in April. The change would give them until May. But some question whether the additional month actually gives insurers much more information. "They're going to have marginally a little more data," says Robert Laszewski, a health industry consultant. "But it's not really going to matter, in terms of their being able to calculate rates." So what is driving the change? Laszewski says that's easy: politics. Moving the start date of open enrollment to Nov. 15 means that if premiums for the next year are going to rise, as many fear, it won't be known until safely after Election Day. Still, there are downsides to changing the dates, at least for consumers. Brian Haile, who heads health policy at the tax preparation firm Jackson Hewitt, says it could hit people who lack health insurance particularly hard. Putting the Christmas holiday "smack dab in the middle" of the open enrollment period means that decisions about health insurance will compete head-to-head with holiday gift-buying, Haile points out. "And that's a real challenge," he says. "Because if you're trying to get someone to sign up for insurance, you don't want to be competing with their desire to put something under the tree."
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As long as the administration has decided it has the authority to move the dates for open enrollment around, Haile says, it ought to consider moving the decision point to the season when the uninsured have the most disposable income. That would be spring, when tax refunds arrive. The Obama administration on Friday also pushed back a date associated with 2013 sign-ups. Until now, in order to have coverage start on Jan. 1, 2014, you had to complete the enrollment process by Dec. 15. That date is now being moved to Dec. 23, to help accommodate the crowds expected to flood the federal and state websites in the coming weeks. The shift in dates may be a reprieve for consumers, but it prompted some concern among members of the insurance industry. "It makes it more challenging to process enrollments in time for coverage to begin on Jan. 1," says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an industry trade group. "Ultimately it will depend on how many people enroll in those last few days." Zirkelbach and officials from the Department of Health and Human Services also note that anyone signing up this year must pay their first month's premium before the end of December to have coverage take effect on Jan. 1, 2014.
California won't extend health plans November 21, 2013 | Los Angeles Times http://www.latimes.com/business/la-fi-health-exchange20131122,0,6358145.story#axzz2lNAHikq8 Spurning President Obama's call to let insurers extend canceled health policies, California won't allow 1 million policyholders to keep their health plan for another year. The board of the Covered California health exchange voted unanimously to break with the president and keep its requirement that insurers terminate most individual policies Dec. 31 because the policies don't meet all the requirements of the Affordable Care Act. Officials acknowledged that their decision won't satisfy angry consumers and will mean many of them will pay significantly more for new coverage come January. But they worried that allowing widespread renewals could cripple the rollout of the healthcare law in California just as enrollment is picking up steam. "We know this transition is difficult and some people will be hurt," Covered California board member Susan Kennedy said. "But delaying the transition won't solve a single problem. I think it will make a bad situation worse if we complicate it further." The state did offer some modest relief for consumers. The exchange will open a special hotline Monday to address policyholders' questions about cancellations and pushed back the deadline to sign up for January coverage to Dec. 23, about a week later.
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State officials pointed out that many policyholders who receive termination notices will get a better deal next year under the healthcare law — either through federal premium subsidies based on their income or new limits on out-of-pocket medical expenses. But the state estimates that nearly 600,000 customers getting cancellation notices may see higher rates next year. That's likely to be the case for Javier Lopez, a self-employed engineer in Huntington Beach. He pays $750 a month for an Anthem Blue Cross plan for his family of four. His premiums may rise nearly 20% next year for a new policy because his current plan is being phased out. "I'm extremely disappointed" with the state's decision, Lopez said. "I think the intent of the law was to allow people with insurance to keep it." California joined a handful of other Democrat-led states, such as Washington and Minnesota, that have rejected the president's proposal on cancellations. Obama's plan last week came in response to a public uproar over millions of consumers nationwide losing their coverage. Many consumers were surprised and upset because Obama had repeatedly said people could keep their health plan if they liked it despite the massive healthcare overhaul. "I think it was a very hard decision for California," said Timothy Jost, a health-policy expert and law professor at Washington and Lee University in Lexington, Va. "You'd like to make everyone a winner. It's unfortunately a situation where that can't happen." California Insurance Commissioner Dave Jones scolded the exchange for not heeding Obama's call and upholding the president's promise to people. "It is definitely a rebuke to the president," Jones said. "Covered California could have honored President Obama's request without causing damage to the implementation of the Affordable Care Act or the exchange." State Republican lawmakers said they will introduce legislation to allow consumers to keep their health plans in 2014. Most consumer advocates and insurance companies agreed with the exchange's decision. They expressed concern about further confusing people who are already struggling to understand how a complex law will affect them. It's also likely that insurers would have raised rates midyear on people renewing their coverage. But the increase could come when it's too late to buy new coverage because enrollment ends March 31. Exchange officials said consumers would be locked out from new coverage and unable to take advantage of premium subsidies they may qualify for.
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"A year extension posed more disruption to the market as a whole, and would be accompanied by a rate increase," said Anthony Wright, executive director of consumer group Health Access. "So the delay didn't provide the relief that these consumers sought." One of the biggest worries was that widespread renewals of existing policies could keep too many healthy customers out of the new market and lead to higher rates. Exchanges need a diverse mix of customers to spread out the costs incurred by sicker patients. To address that issue, Covered California had required its 11 participating insurers to terminate most of their existing individual policies Dec. 31. Covered California said that 79,891 people have enrolled in private health plans through Tuesday, an increase of about 20,000 in the last week. California's marketplace has outperformed the troubled federal exchange that serves 36 other states.
Blue Cross Kansas to Extend 10K Health Plans November 20, 2013 | Becker's Hospital Review http://www.beckershospitalreview.com/payer-issues/blue-cross-kansas-to-extend-10k-healthplans.html Health insurer Blue Cross and Blue Shield of Kansas announced yesterday it will give its members the option of extending health plans that were previously scheduled to be canceled next year for not meeting the reform law's requirements. The insurer will soon send letters to approximately 10,000 individual policyholders affected by the change to explain their options, according to a news release. The insurer will also reach out to small business owners about extending small group benefit plans that were previously marked for cancelation. Last week, President Barack Obama announced he would take executive action to make sure health insurers can continue offering individual market health plans for the next year. Originally, non-grandfathered policies — plans that went into effect or underwent certain changes after the PPACA became law in March 2010 — had to meet new coverage requirements in 2014. Under the PPACA, individual health plans must cover "essential benefits" such as prescription drugs, mental health services and maternity care. Insurers must also cap consumers' annual expenses. Many insurers sent out cancellation notices to people enrolled in non-grandfathered individual plans that didn't meet these requirements. The development spurred Republicans to criticize President Obama, saying he had failed to keep his promise that Americans could keep their old health plans if they wanted under the PPACA. Earlier this month, Anthem Blue Cross of California announced it would extend 104,000 canceled insurance policies. However, the insurer granted only a two-month extension because it didn't send out notification letters in time, and the extension came before the president's announcement.
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Finance HHS to boost risk payments to insurers due to reinstated policies November 26, 2013 | Fierce Health Payer http://www.fiercehealthpayer.com/story/hhs-boost-risk-payments-insurers-due-reinstatedpolicies/2013-11-26 Insurers offering exchange plans could receive higher risk payments under a proposed rule from the U.S. Department of Health & Human Services on Monday. After overestimating the total covered claims costs of individuals enrolled in reinsurance-eligible plans in 2014, HHS wants to lower the attachment point at which risk payments kick in for high-cost members from $60,000 down to $45,000 next year. In 2015, insurers will have a $70,000 attachment point, a $250,000 reinsurance cap and a 50 percent coinsurance rate. Federal health officials agreed to pay insurers certain risk payments for the first three years to compensate for uncertain exchange enrollment, Reuters reported. In the proposed rule, the Obama administration also admits its directive to reinstate canceled policies for one year could hurt the health insurance exchanges, according to The Hill's Healthwatch. HHS noted people who choose to stay on their existing plans likely have lower health risk than those enrolling in reform-compliant individual and small group plans."If lower health risk individuals remain in a separate risk pool, the transitional policy could increase an issuer's average expected claims cost for plans that comply with the 2014 market rules," the rule states. And since insurers set exchange premiums based on a risk pool of healthier applicants from the nongrandfathered plans, they could see higher expected claims costs and unexpected losses, according to HHS. The proposed rule also includes provisions for risk adjustment data validation that adhere to HHS goals of consistency and fairness by creating uniform audit requirements. HHS also aims to ease the burden on issuers by coordinating any audits of risk adjustment covered plans with related audits of exchange programs and reinsurance eligible-plans. The proposed rule, published on Monday in the Federal Register, has a 30-day comment period.
Insurers Cut Doctor Fees, Restricting Networks Under Obamacare November 22, 2013 | NewsMax http://www.newsmax.com/Newsfront/insurers-cut-doctors-fees/2013/11/22/id/538109 Healthcare insurers are cutting the fees they pay to doctors on many of the new plans offered through the Obamacare exchanges, which could cause more medical practices to shun those marketplaces.
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United Health Group, for example, sent physicians in New York City new contracts this month that included much lower rates than doctors normally get from private insurance, reports The Wall Street Journal, which obtained confidential documents. "We have heard from a lot of physicians the rates [insurers] are offering them are very low, and physicians are questioning whether they are going to participate," Sam Unterricht, a Brooklyn ophthalmologist and president of the Medical Society of the State of New York, told the newspaper. The documents show that some of the rates being offered by United are similar to those paid by people on Medicaid. The fees for some office visits are less than half of what New York City doctors get for treating patients on employer-sponsored plans. WellPoint's Anthem Unit in Connecticut also is slashing payments, offering one ear, nose, and throat specialist in Trumbull rates that he told the Journal "were not what a reasonable person would consider acceptable." He refused the contract. A WellPoint spokeswoman said the plans were "focused on affordability, to allow the maximum number of individuals to purchase coverage." But not all doctors are willing to accept the lower rates and have the ability to opt out, meaning consumers could choose a plan based on doctors who ultimately decide not to participate. "It is going to be very tough for consumers to have accurate information about which physicians they really have access to," Paul Ginsburg, president of the Center for Studying Health System Change, told the Journal. Meanwhile, some insurers are restricting consumers' choices of doctors and hospitals, excluding toprated facilities, in an attempt to keep costs down, reports The Washington Post. In Washington state, for instance, Premera Blue Cross did not include Seattle Children's Hospital as an in-network provider except in cases where the treatment could not be found elsewhere. "Children's non-unique services were too expensive, given the goal of providing affordable coverage for consumers," spokesman Eric Earling told the newspaper. For Seattle resident Jeffrey Blank, that means his daughter Zoe, who was diagnosed with a rare bone disorder, no longer will be able to go to Children's for routine checkups without it being billed as a much more expensive out-of-network visit. "It just stresses me," Blank, who is self-employed, told the Post. "I hope things continue wonderfully for my daughter and that she doesn't need the level of care she got after her diagnosis, but there's this unknown." Seattle Children's Hospital has sued Washington's insurance commissioner for being kept out of many of the state's provider networks.
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Many of the country's other leading hospitals — including the Mayo Clinic in Minnesota, CedarsSinai in Los Angeles, and children's hospitals in Houston and St. Louis — reportedly also have been excluded from most new plans in an attempt to keep down the cost of care. The result in many places, experts say, could be a two-tiered system of healthcare, with those on individual plans receiving coverage far inferior to that available to those covered by their employers' plans.
Public, safety-net hospitals hit hardest by value-based purchasing November 20, 2013 | Fierce Healthcare http://www.fiercehealthcare.com/story/public-safety-net-hospitals-hit-hardest-value-basedpurchasing/2013-11-20 The transition from traditional fee-for-service healthcare to the value-based model may be disproportionately hurting safety-net hospitals, according to an analysis by Ashish K. Jha, M.D., a professor at the Harvard School of Public Health. Based on the latest round of penalty and bonus data released by the Centers for Medicare & Medicaid Services, Jha found that a hospital's size and teaching status had a negligible effect. However, he said hospitals with the most low-income patients had their Medicare payments reduced by an average of 0.09 percent, while the hospitals with the lowest number of low-income patients received a bonus of 0.6 percent on average. Public hospitals fared especially poorly, with reductions of 0.10 percent, according to the analysis. Jha cautioned that it was too early to draw conclusions as to whether CMS' criteria are unfair to public, safety-net hospitals. "My suspicion is that much of the difference is driven by differences in patient experience scores. The challenge for all of us is to understand why safety-net hospitals generally have worse patient experience scores," he wrote. "Is it that poorer or minority patients are just less likely to give high scores on patient experience? Or are safety-net hospitals not doing as good of a job on patient-centered care?" The analysis also found a less significant regional difference in how well hospitals fared. Hospitals in the Northeast (which had an average penalty of 0.06 percent) and West (with an average penalty of 0.10 percent) generally did slightly worse than those in the Midwest, which saw an average gain of 0.01 percent, and the South, which was only penalized an average of 0.01 percent. These differences can become more significant, Jha added, when variables are added together. "A large urban public hospital in the Northeast with a high DSH [disproportionate share hospital] index gets an average penalty of about 0.30 percent of their Medicare payments," he wrote. "Is that a lot? No – but it's not irrelevant for a safety-net hospital that may be operating with razor thin financial margins."
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BCBSNC wants to hike rates on reinstated plans by as much as 23% November 20, 2013 | Fierce Health Payer http://www.fiercehealthpayer.com/story/bcbsnc-wants-hike-rates-reinstated-plans-much23/2013-11-20 Blue Cross and Blue Shield of North Carolina asked regulators Tuesday to approve reinstatement of canceled plans that don't meet Affordable Care Act requirements, but the move may come with a hefty price tag: BCBSNC is seeking 16 percent to 23 percent rate hikes on extended individual plans, according to WRAL.com. These increases are due to ACA-triggered taxes and fees, coupled with rising healthcare consumption by enrollees of these plans, the article noted. Proposed increases would take effect on January 1; but if the North Carolina Department of Insurance decides they're too high, the regulator may require BCBSNC to issue refunds, The News & Observer reported. These increases represent twice the price inflation for the same product offerings one year ago, News & Observer reported. Yet some customers are cheering nonetheless, possibly since ACAcompliant replacement plans may cost up to three times more than their dearly-departed counterparts, WRAL noted. "The key thing is--this is one more year," said BCBSNC spokesperson Michelle Douglas. "It's not saying you can keep this plan forever." More that 473,000 North Carolinians, including 227,400 Blue Cross members, were affected by the cancelations, according to insurance commissioner Wayne Goodwin. Responding to public outcry about cancelations after telling people they could keep their plans if they liked them, President Obama proposed a one-year reinstatement of canceled plans as a temporary fix. But not all states are implementing the President's proposal. And the possibility of rate shock rocking the financial stability of the health insurance system has surfaced before, in the buying behaviors of young adults. BCBSNC plans to send renewal notices to eligible customers by December 1, WRAL noted. And the extension only applies to those enrolled in individual plans on or before October 1. Customers who can't afford possible rate hikes may shop for other products on the federal exchange.
Reference pricing saves insurers, patients money November 19, 2013 | Fierce Health Payer http://www.fiercehealthpayer.com/story/reference-pricing-saves-insurers-patients-money/201311-19 Michael Belman, M.D., has witnessed firsthand the benefits of reference pricing. When he had cataract surgery in Los Angeles he found a variation in prices ranging from $3,500 to $11,000.
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By taking the time to learn about prices, Belman was able to save himself out-of-pocket costs and provide savings to his insurance provider. Those savings will mean members will spend less money in the future through the trickle-down effect. "This is a direct impact for all of us," said Belman, who also serves as the regional vice president and medical director for clinical programs and innovations at Anthem Blue Cross in California. He was one of the Alliance Health Reform's panelists (pictured above) on Monday who discussed reference pricing and whether price caps will help contain healthcare costs. Reference pricing, a relatively new model in the American healthcare industry, establishes a standard price for a drug, procedure, service or bundle service, and usually requires health plan members pay any charges beyond the set amount. Panelist shared information, first-hand knowledge and studies that showed reference pricing for routine procedures and prescriptions expanded the transparency of medical prices without reducing the quality of care. It also gives purchasers and members the opportunity to make choices that reduce costs, they said. Belman shared Anthem Blue Cross' valued-based purchasing design for hip and knee replacements, which showed the cost for the hospital portion ranged from $15,000-$110,000 with very little difference in quality in the California commercial preferred provider organization population. Anthem set a reference price of $30,000, which resulted in a shift of members to designated hospitals, a 17.9 percent decrease in total cost for a joint replacement, as well as a reduced rate of general infections in designated hospitals. A Center for Innovation at California Public Employees' Retirement System (CalPERS) study found its hip and knee replacement reference pricing program meant a $5.5 million savings over the first two years of its existence, with the average price charged for a joint replacement dropping 26 percent, more than $9,000 per procedure, said panelist David Cowling, chief of CalPERS. The Cincinnati-based retailer Kroger Co. experienced a $4.3 million in company savings in 2012 after implementing reference pricing for prescription medication, and has seen $1.7 million in savings so far this year, according to panelist Theresa Monti, vice president of corporate total rewards. The only concern the company experienced with reference pricing, she said, was monitoring members' adherence prescriptions to make sure people didn't stop buying medication because of cost. Panelists also addressed criticism that reference pricing too drastically effects the market a whole. The measure shines a spotlight on price variation, sending the message into the market that the practice is no longer tolerable. Shifts in volume will also result in behavior changes, panalists agreed. Reference pricing brings healthcare consumers into the equation and can exert pressure on highcost providers to lower their prices, FierceHealthcare previously reported.
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Technology Telehealth helps Arkansas meets healthcare challenges November 27, 2013 | Fierce Health IT http://www.fiercehealthit.com/story/telehealth-helps-arkansas-meets-healthcarechallenges/2013-11-27 With 73 of 75 counties in Arkansas designated as medically underserved, access to health services remains one of the major challenges in the state, according to David Miller, vice chancellor and CIO for University of Arkansas for Medical Sciences (UAMS). Telehealth is one way his organization is tackling that challenge, Miller said in an interview at iHT2. It offers pregnancy and neonatal telehealth services, a telestroke program, and telemedicine services in psychiatry, pediatrics, geriatrics, rehab medicine, cardiology, internal medicine, burn, trauma and genetic counseling. Miller will address lessons learned about telehealth on one of two panel discussions in which he will participate at the upcoming iHT2 Health IT Summit in Austin, Texas, in December. When asked to name the top challenges for hospitals in the next five to 10 years, Miller included: •
Bending the cost curve
•
Increasing quality
•
Enhancing patient safety
•
Improving outcomes
He says those are possible only if hospitals: •
Find ways to exchange patient data in real-time across multiple disparate organizations
•
Find ways to coordinate population health to respond to new payment models
•
Change treatment approaches to a team-based, patient- and family-centric delivery model
The federal IT mandates health organizations face will be difficult even for even "well-resourced" health institutions, John Halamka, CIO at Boston-based Beth Israel Deaconess Medical Center, wrote recently. He says the timelines are to short for Meaningful Use Stage 2 attestation, ICD-10 implementation, HIPAA Omnibus Rule readiness and Affordable Care Act implementation. He's suggesting a series of deadline extensions and pilot tests.
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Halamka previously wrote that hospital CIOs' priority for 2014 will have to be "institutional survival" and that many departmental needs will go unmet while ICD-10 consumes the lion's share of resources. The Healthcare.gov debacle illustrated how IT projects can go very, very wrong, prompting FierceHealthIT's Dan Bowman to warn organizations not to let ICD-10 be dĂŠjĂ vu all over again.
Online site to test health apps for usability, trustworthiness November 25, 2013 | Fierce Mobile Healthcare http://www.fiercemobilehealthcare.com/story/online-site-test-apps-usabilitytrustworthiness/2013-11-25 An international health app website has been launched to help patients and the public find the most suitable mobile health apps, according to an article posted by PMLiVE. My Health Apps, which aims to help bring health apps into mainstream healthcare, promises to test every app it features for usability and trustworthiness. The site features apps in 47 languages (from Albanian to Welsh), drawn from 146 health specialties, and includes disease-oriented apps for monitoring, tracking and supporting the management of symptoms. Featured apps are given a "heart" rating, based on the extent to which they meet five consumer/patient needs: give people more control over their condition (or keep them healthy); ease of use; can be used regularly; allow networking with other people like them (or with people who understand them); and are trustworthy. The launch of the new My Health Apps site comes just weeks after a report from the IMS Institute for Healthcare Informatics found that the overwhelming majority of healthcare apps in the iTunes store have limited functionality. According to the report, more than 90 percent of health apps reviewed by the IMS Institute scored less than 40 out of a possible 100 for functionality, based on 25 screening factors. Currently, My Health Apps showcases 307 apps, which have been selected by 456 patient groups, disability groups or consumers as their favorites and there are plans to involve several hundred more every six months. The site was launched by UK-based research firm PatientView in partnership with GSK, Janssen, Novo Nordisk and telecom companies O2/Telefonica Europe and Vodafone Foundation. PatientView also received assistance from NHS England's Library of Health Apps, UK government body KTN CONNECT and the European Commission's Directorate General for Communications Networks, Content and Technology (DG CONNECT). Last month, Partners HealthCare's Center for Connected Health in Boston announced the launch of Wellocracy, a similar online site designed to guide consumers in their use of health apps. Wellocracy is described as a "clinically-based source of impartial, easy-to-understand information on new personal 'self-health' technologies such as health and fitness trackers and mobile apps."
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Electronic health records may be used to measure patient-centeredness of primary care practices November 22, 2013 | News Medical http://www.news-medical.net/news/20131122/Electronic-health-records-may-be-used-tomeasure-patient-centeredness-of-primary-care-practices.aspx Although electronic health records (EHR) are primarily used to store patient clinical data, the nonclinical data they collect may be used to measure patient-centeredness of primary care practices, finds a new study in Health Services Research. In addition, two of the process of care measures collected via EHRs, volume of between clinician e-messages and frequency of in-person patient visits, were associated with better patient health outcomes. "We were looking for ways to leverage the amount of operational information in a practice's EHR and find measurements of the process of care," said Ming Tai-Seale, Ph.D., MPH, a senior staff scientist at the Palo Alto Medical Foundation Research Institute in Palo Alto, CA, and lead author on the study. "We were pleasantly surprised to see we could do that," she said. The study collected data on more than 15,000 people with diabetes and more than 49,500 patients with high blood pressure who were patients at a large group practice in Northern California during 2010. The clinical data collected included blood glucose and blood lipid levels and blood pressure readings. Then they examined the relationship between that clinical information and various nonclinical types of EHR information, including the volume of secure electronic communication (emessages) between physicians and patients, e-messages about patients within the practice, and the time to the third-next-available appointment, a measure of how easy it is to schedule non-urgent visits. The volume of e-messages, the number of days to the third-next-available appointment, and the volume of internal communications were found to be reliable measures of the processes of care within a patient-centered practice. In addition, , better blood lipid management and blood pressure control was associated with frequent e-messaging between doctors and patients with diabetes. Practices with more in-person visits had better blood pressure control in patients with high blood pressure. [These non-clinical] data are the type often evaluated by those looking at how well a large practice operates, but had not necessarily been linked to a clinical outcome, Tai-Seale noted. "The reason we also looked at process-of-care measures-emailing, e-messages with staff, and continuity of care-is because these have not been used to study their linkages with patient health outcomes before," she said. "It seems they are trying to solve a problem kind of backwards," said Jason Mitchell, M.D., director of the American Academy of Family Physicians Center for Health IT in Leawood, KS. The researchers are looking at operational activities and trying to correlate them with clinical outcomes, he commented. "Yes, there is an association, but there isn't any evidence of a cause and effect." There may be other variables that can change this association, he explained.
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Many health policy organizations are trying to measure the value of health care-and not just the cost; but, not every area of medicine has clinical outcomes as clear cut as blood glucose and blood pressure levels, commented Mitchell. Most organizations are frustrated that they are not able to get such direct information and are seeking proxies they can measure. "We really need to be looking at those outcomes and use EHRs to get that directly instead of [using] proxies," he noted.
Statewide medical database aims to improve care, lower costs November 21, 2013 | Fierce Health IT http://www.fiercehealthit.com/story/statewide-medical-database-aims-improve-care-lowercosts/2013-11-21 A consortium of universities and hospital systems in South Carolina have started using a database containing the medical information of millions of patients across the state with the intent of developing better, more cost-effective treatment plans. The State reports that this $15 million database--dubbed the Clinical Data Warehouse--is housed at Clemson University and operated by Health Sciences South Carolina in Columbia. The funds came from the Duke Endowment, a philanthropic organization benefiting the Carolinas. Doctors and university researchers hope to use this collection of data--3.2 million patients who have been through 25.3 medical diagnoses since 2011--to enhance preventative healthcare. "It's a complete shift," Tripp Jennings, systems vice president for Palmetto Health in Columbia, told The State. "Our history has been sick care. Now, we're really trying to get to healthcare." Researchers so far have been accessing records and using analytics to, for example, find ways to reduce surgical complications and study care for people who have heart attacks outside of hospitals, according to the article. Hospitals sending their information to the warehouse include: Palmetto Health in Columbia, Greenville Health System and MUSC Health in Charleston, according to the article. Additionally, Spartanburg Regional Healthcare System, AnMed Health in Anderson, Self Regional Healthcare in Greenwood and McLeod Health in Florence are not too far behind in taking advantage of the database. And they're paying attention to security--medical data is encrypted, and anyone using the data warehouse must receive approval and training first. The staff of 25 includes computer security and privacy officers, the article notes. This past summer, University of Pittsburgh Medical Center researchers were able to electronically integrate clinical and genomic information on 140 breast cancer patients through use of a data warehouse. "The integration of data, which is the goal of the enterprise data warehouse, allows us to ask questions that we just simply couldn't ask before," Adrian Lee, a professor in the Department of Pharmacology and Chemical Biology and director of the Women's Cancer Research Center, said of that endeavor.
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The American Society of Clinical Oncology, as well as Public Health England, also have massive databases in the works as they strive to better understand how cancer develops and the best ways to fight the disease.
Bill expands MU incentives to behavioral health providers November 18, 2013 | Fierce EMR http://www.fierceemr.com/story/legislation-expands-meaningful-use-incentives-behavioralhealth-providers/2013-11-18 Sen. Rob Portman (R-Ohio) has introduced legislation to encourage behavioral health providers such as psychiatric hospitals, substance abuse facilities and psychologists to adopt electronic health records by extending the Meaningful Use incentive program to them. The Behavioral Health Information Technology Coordination Act of 2013 (S. 1685), introduced in the Senate Nov. 12, would not only extend the Meaningful Use program to such providers, but also addresses the reporting of EHR-related adverse events to patient safety organizations, clarifies that EHRs are not devices subject to the Food, Drug and Cosmetics Act, limits electronic discovery in EHRs and increases legal protections for providers. Sen. Sheldon Whitehouse introduced similar legislation (S. 1751) in September, calling for an extension of the program to behavioral health providers, but his bill is less comprehensive. Portman's bill has been referred to the Committee on Finance. It is virtually the same as House bill 2957, introduced by Rep. Tim Murphy (R-Pa.) and others in August. Congress previously tweaked the Meaningful Use program to address participation gaps by adding rural health centers and Federally Qualified Health Centers to the program. These bills are not the only ones introduced this Congressional session to modify the Meaningful Use program. For instance, a bill introduced by Rep. Diane Black (R. Tenn.) in March would create two new exceptions for eligible professionals, soften other requirements and establish a formal appeals process that providers could utilize before penalties are imposed. And Sen. Jay Rockefeller (D-W.Va.) and others introduced a bill in July that would extend the Meaningful Use incentive program to safety net providers; a companion bill also was introduced in the House of Representatives.
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Strategy RegionalCare to Build Hospital in Haiti November 26, 2013 | Becker's Hospital Review http://www.beckershospitalreview.com/strategic-planning/regionalcare-to-build-hospital-inhaiti.html Brentwood, Tenn.-based RegionalCare Hospital Partners has partnered with Nashville, Tenn.-based nonprofit LiveBeyond to open a hospital in Thomazeau, Haiti. RegionalCare is set to break ground on the new facility after Jan. 1, according to a news release. The for-profit company has already sponsored four employee volunteer group trips to the region and plans to send 10 more groups in 2014. The company connected with LiveBeyond — which brings medical services to disaster areas and developing countries — after beginning a search for a volunteer program about 18 months ago, according to the release. While the new hospital is under construction, RegionalCare employee volunteer groups will work at makeshift clinics in the area, focusing on maternity care, wound care and dental care.
Crozer-Keystone Health System Joins New Pennsylvania Alliance November 22, 2013 | Becker's Hospital Review http://www.beckershospitalreview.com/accountable-care-organizations/crozer-keystone-healthsystem-joins-new-pennsylvania-alliance.html Crozer-Keystone Health System, a five-hospital system based in Springfield, Pa., has joined a new Pennsylvania-based health alliance that was formed earlier this summer. In July, three health systems — Abington (Pa.) Health and Aria Health and Einstein Healthcare Network, both based in Philadelphia — created a new initiative to focus on population health, care coordination, backend efficiencies and management of employee healthcare benefits. Abington, Aria and Einstein created a limited liability company for the venture, with each investing an equal amount into the partnership. Crozer-Keystone will be a full, equal partner with the other three health systems, and each organization will retain independence. The initiative has not yet been named. Fifteen hospitals and more than 4,600 physicians now encompass the alliance, which is similar to accountable care organizations.
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Michigan Blues shares claims data to help improve quality, lower costs November 21, 2013 | Fierce Health Payer http://www.fiercehealthpayer.com/story/michigan-blues-helps-hospitals-find-practices-bestoutcomes-lowest-costs/2013-11-21 Blue Cross Blue Shield of Michigan (BCBSM) recently launched a new initiative to help hospitals better understand their utilization patterns so they can know which practices result in the best outcomes and lowest costs. Under the Michigan Value Collaborative (MVC), which Blue Cross started last month, the insurer and the University of Michigan Health System will use claims data to determine cost and utilization patterns among 130 hospitals throughout the state. They will focus on 10 conditions, including congestive heart failure, and 10 surgeries, such as hip replacement, that frequently have wide cost variations, AIS Health reported. One problem right now is there's almost a $20,000 difference among cardiac bypass surgery costs for 27 Michigan hospitals. So with the MVC, "hopefully you'll see a narrower range of variation in cost ... with improved outcomes," says BCBSM Senior Vice President of Value Partnership David Share, M.D. Blue Cross will give hospitals real-time access to information on a dedicated website so they can "drill down their own experience in 20 areas in a real dynamic way," Share told AIS Health. The MVC program also will hold meetings three or four times a year with clinical and financial leaders to share results and improvement strategies. But launching MVC wasn't easy and took several years of development. One of the biggest challenges has been analyzing and sharing data with many hospitals "in an easy-access electronic format," Share added. BCBSM has been investing in several payment reform initiatives, including a medical home project that saved $155 million and boosted quality and a value-based reimbursement model with one hospital to reduce premiums while coordinating care, FierceHealthPayer previously reported.
University Hospitals, Cigna Ink Accountable Care Deal November 19, 2013 | Becker's Hospital Review http://www.beckershospitalreview.com/accountable-care-organizations/university-hospitalscigna-ink-accountable-care-deal.html Cleveland-based University Hospitals Accountable Care Organization and health insurer Cigna have launched a collaborative accountable care initiative, the payer's version of an ACO.
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University Hospitals' CAC initiative with Cigna will include about 10,000 people covered by a Cigna health plan who receive care from UH's roughly 1,500 employed physicians. UH first launched an ACO for its employees in 2011, and the system also has a pediatric ACO and Medicare ACO. As part of the deal, UHACO registered nurses and medical assistants will serve as clinical care coordinators and help chronic disease patients manage their care. The care coordinators will work with Cigna case managers to better coordinate care, according to the news release. Cigna will also provide the care coordinators with patient-specific data. No information on the agreement's reimbursement structure was released. Cigna has 75 CAC initiatives in 26 states.
Hospitals seek patient collection strategies: Cash upfront, payment plans November 18, 2013 | Fierce Health Finance http://www.fiercehealthfinance.com/story/hospitals-seek-patient-collection-strategies-cashupfront-payment-plans/2013-11-18 Hospitals and physician groups--expecting a rise in the number of patients with high-deductible health insurance plans--are coming up with strategies to ensure they receive payment for providing services for scheduled or elective surgeries. Among the most popular options: Collecting cash upfront and enrolling patients in payment plans, according to the Chicago Tribune. More patients will now have plans that require them to pay a larger portion of their bills for hospital care and physician services, in exchange for lower monthly premiums. But that puts hospitals and physician practices in the uncomfortable position of insisting on payment even though they have legal and ethical obligations to treat critically ill patients regardless of their ability to pay, the paper reports. "It's a dramatic change in collection practices," Andy Scianimanico, vice president of revenue cycle for Northwestern Memorial Healthcare, told the Tribune. "The biggest challenge for us is to move conversations (with prospective patients) as far up in the process as possible. It's not about strongarming patients to pay. It's about getting information into the hands of patients so they can make better-informed decisions." Hospitals expect more patients will have greater out-of-pocket costs under high-deductible plans offered through the new health insurance exchanges under the Affordable Care Act. In addition, 54 percent of employers report they are shifting workers to those types of coverage plans, according to a 2013 employer survey conducted by the Deloitte Center for Health Solutions.
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But collecting money from patients is an ongoing problem for hospitals, which historically have collected approximately 20 percent of a patient's portion of the charges within 120 days of sending the first bill, the Tribune reported. Those poor collection rates, combined with the patient's larger responsibility for medical bills, are contributing to mounting bad debt levels. "It's such a big deal because it makes [hospital] financial planning and revenue projections difficult," Kip Piper, a former state Medicaid official and White House budget officer, said in the article. As a result many Chicago hospitals are offering patients low- to no-interest payment plans. For example, the newspaper reports that Loyola University Health System is working with a firm to offer patients three- to five-year payback plans with a 4 percent interest rate. But Loyola is also asking more patients to pay for their costs upfront, prior to receiving treatment, according to the article. However, the hospital says it won't cancel or postpone a procedure if the patient is unable to pay the bill in advance. And Northwestern Memorial Hospital administrators are trying to better estimate a patient's portion of his or her medical bill, based on insurance information and projected hospital charges, the article said. They are calling patients in advance to discuss payment options so there are no surprises after discharge. The greater pricing transparency, the Tribune reports, will help patient's understand their financial responsibility in advance and put the hospital is a better position of collecting as much of the bill as possible. Pricing transparency is one of the Healthcare Financial Management Association's missions and earlier this year it set up a task force to address the issue for hospitals, physicians, employer groups and patients, FierceHealthFinance previously reported. The association has also released draft patient financial interaction guidelines for hospitals. The guidelines provide information on when and how to communicate information about patient insurance coverage, financial counselling, patient financial responsibility for service, and any existing balance the patient may have.
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