Friday, May 30, 2014

Journalists Sue Obama Admin Over Medicare Advantage Transparency

Posted 05/29/2014 | In The News0
by Sarah Hurtubise –

A Pulitzer-prize winning investigative journalism organization filed a lawsuit against the Obama administration Tuesday for refusing to disclose Medicare Advantage documents.

The Center for Public Integrity (CPI), a left-leaning nonprofit research outlet, is suing the Department of Health and Human Services over public documents available through the Freedom of Information Act that the administration will not disclose.

CPI has struggled for a year to obtain documents that concern an HHS subagency, the Centers for Medicare and Medicare Services’, oversight of the Medicare Advantage program — a privately-run and often lower-cost alternative to Medicare. The federal government is required by law to respond to public records requests within 20 business days; but while CPI received an acknowledgment of their request in May 2013, they’ve yet to receive any documents.

Fred Schulte, a senior reporter at CPI, requested that CMS provide program audits, billing data and the names of health insurance plans that the administration suspected had overcharged the federal government for Medicare Advantage patients. Medicare Advantage costs taxpayers $150 billion annually.

“The information about Medicare Advantage that we are asking for should be readily available to the taxpaying public,” CPI Executive Director Bill Buzenberg said in a statement. “There’s no excuse for ignoring our request.”

CPI and The Wall Street Journal successfully sued the Medicare administrator in 2009 over a failure to disclose Medicare billing records.
The center promised to publish the results of the investigation next month.

It’s the latest of several recent lawsuits against the Obama administration for its lack of transparency. Judicial Watch, a right-leaning nonprofit government watchdog, filed two lawsuits against the Obama administration’s CMS last month for refusing to release documents relating to Obamacare.

Judicial Watch is seeking documents about files that communicate enrollment in Obamacare exchanges between the federal government and private insurers, as well as records relating to the administration’s oversight and requirements for Obamacare navigators.

Today's Datapoint

$3,138 ... is the annual drug cost threshold for 2015 that was recently set by CMS, up slightly from 2014’s threshold of $3,017.

Quote of the Day

“I think that [lacking scale] is a concern when you are looking at smaller [insurers] throughout the country. There is a lot of pressure on them as they meet a lot of regulatory requirements, IT requirements, either with the ACA changes or other things that are going on in the industry like with ICD-10, and all the requirements to really be competitive and maintain a low administrative expense base. Combining resources [like the recent alliance between CDPHP and Independent Health in New York] just makes a lot of sense.”

— Steve Zaharuk, senior vice president at Moody’s Investors Service, told AIS’s Health Plan Week.

Thursday, May 29, 2014

Biologic's and Generic's Share of Pharmaceutical Market

Biologics share of total pharmaceutical sales worldwide:
2014 2015 2016 2017
11% 15% 18% 19-20%

Generics market share:
Developed Markets Emerging Markets Rest of World World
2012 16% 58% 27% 27%
2017 21 63 31 36
Publication Source: Managed Care, May 2014

Data Source: IMS Institute for Healthcare Informatics

According to a recent report,

...the percentage of workers who had employment-based health coverage from their own job in 2012 was: • 12.8% of workers who were employed less than 30 hours per week • 33.6% of workers who were employed between 30–39 hours per week • 60.5% of workers who were employed at least 40 hours per week Source: "Trends in Health Coverage for Part-time Workers," Employee Benefit Research Institute Press Release, May 22, 2014,

Doctors Found Sanctioned for Negligence by the New York State Department of Health Allowed to Continue to Practice

According to The New York Public Interest Research Group, over three-quarters of doctors found sanctioned for negligence by the New York State Department of Health are allowed to continue to practice. Nearly 60% of New York State actions against doctors were based on sanctions taken by other states, the federal government, or the courts, not directly as the result of an Office of Professional Medical Conduct (OPMC)-initiated investigation. One of the arguments as to why New York State does not revoke questionable doctors' licenses is that they are an important resource. However, over the past ten years, New York's population has grown by about 2%. Its doctor population has swelled by 36%. Source: The New York Public Interest Research Group

Friday, May 23, 2014

According to a recent survey of large employers with a median employee population of 23,000:

• 91% believe they have a ‘good to excellent’ understanding of the complexities involved in moving to a private exchange • 60% said they would want to remain self-insured if they moved to a private exchange • 37% have no plans to evaluate private exchanges • 13% have done an evaluation and decided not to proceed with replacing their current medical benefit plan with an exchange • 35% said that they have started to evaluate private exchanges as a potential benefits strategy for active employees • 11% are interested in evaluating exchanges • 3% are currently in an exchange Source: Large Employers ‘Fully Committed” to Company-Sponsored Benefits, Express Mixed Reaction to Private Health Insurance Exchanges." Pacific Resources Press Release, April 29, 2014,


Researchers evaluated the prevalence in Medicare of 26 tests and procedures that have been found to offer little or no clinical benefit, and calculated: • There were 21.9 million instances of the 26 low-value treatments during 2009 • 42% of beneficiaries received at least one such service • This cost Medicare $8.5 billion, or 2.7% of overall spending Using more specific definitions of inappropriate treatments, the researchers calculated: • 9.1 million low-value services were provided in 2009 • 25% of beneficiaries received at least one such service • This cost Medicare $1.9 billion, or 0.6%of overall spending Source: "Harvard: Overused Medical Services Cost Medicare Billions," Kaiser Health News/Capsules, May 12, 2014,

The all-cause 30-day hospital readmission rate among Medicare fee-for-service beneficiaries

...fell to 17.5% in 2013 from 18.5% in 2012; this rate had held constant from 2007 to 2011 at around 19% to 19.5%. Source: "New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings," U.S. Department of Health & Human Services, May 7, 2014,

Diabetes Among Hospitalized Patients in California

According to a study by the UCLA Center for Health Policy Research, found that among all hospitalized California patients aged 35 or older - the age group that accounts for most hospitalizations - 31 percent had diabetes. Diabetes is one of the nation's fastest-growing diseases and one of the most costly. It adds an extra $1.6 billion dollars every year to hospitalization costs in California, with hospital stays for patients with diabetes costing nearly $2,200 more than stays for non-diabetic patients. Three-quarters of that care is paid through Medicare and Medi-Cal, including $254 million in costs that are paid by Medi-Cal alone. Imperial County, with 41 percent of its hospitalized patients suffering from diabetes, leads the state, followed by Solano (36.2 percent), Yuba (35.7 percent), Merced (35.7 percent), Fresno (35.1 percent) and Sacramento (34.5 percent) counties. Source: UCLA Center for Health Policy Research

Today's Datapoint

$10,000 … is the average cost per month for a branded oncology drug in the U.S., according to the new report “Innovation in Cancer Care and Implications for Health Systems.”

Quote of the Day

“I think that Aetna has made a lot of investments over the last five to seven years to try to be a better collaborator with providers. But still, at the end of the day they are an insurance plan and that relationship is inherently antagonistic.” — Erik Johnson, senior vice president at Avalere Health LLC, told AIS’s Health Plan Week.

Respondent-reported prevalence of heart disease, cancer, and stroke among adults aged 18 and over

Year Heart disease Cancer Stroke 1997-1998 12.0% 4.9% 2.3% 1999-2000 11.1% 5.1% 2.2% 2000-2001 11.5% 5.1% 2.3% 2001-2002 11.5% 5.3% 2.4% 2003-2004 11.3% 5.2% 2.5% 2005-2006 11.2% 5.7% 2.5% 2007-2008 11.3% 5.6% 2.6% 2008-2009 11.5% 5.9% 2.7% 2009-2010 11.4% 6.0% 2.6% 2010-2011 11.1% 6.0% 2.6% 2011-2012 10.8% 5.9% 2.5% Source: CDC/National Center for Health Statistics

93% of adults surveyed said

...they would be likely to choose a doctor that offers email communication, and among that 93%, 1 in 4 said they would still choose that doctor even if it cost $25 per episode. Source: "Catalyst Healthcare Research finds that nine out of ten (93%) adults want email communication with their doctor," Catalyst Healthcare Press Release, May 13, 2014,

Physician Specialists’ Usage of Digital Technology in Medical Practice

1. Emergency Room physicians – 40 percent 2. Cardiologists – 33 percent 3. Urologists – 31 percent 4. Nephrologists – 31 percent 5. Dermatologists – 30 percent 6. Gastroenterologists – 30 percent 7. Psychiatrists – 28 percent 8. Radiologists – 24 percent 9. Rheumatologists – 22 percent 10. Endocrinologists – 21 percent 11. Oncologists – 20 percent 12. Clinical Pathologists –16 percent Source: Smartphones, medical apps used by 80 percent of docs

Percent With Private Health Insurance Where Source of Payment for Healthcare is Out of Pocket, by Year

1. 1987 - 29.0% 2. 1997 - 21.6% 3. 2000 - 21.2% 4. 2010 - 17.5% Source: CDC/National Center for Health Statistics

Premiums for the Second Lowest Cost Silver Plan (Before Subsidies) in Selected Cities, by Age

Statewide Pre-ACA Small Group Average 27-Year Old 50-Year Old Denver $440.50 $212.96 $365.36 Baltimore $451.50 $197.00 $335.00 Minneapolis $445.83 $135.99 $231.75 New York County $525.33 $365.28 $365.28 Jefferson County (Birmingham) $439.08 $135.99 $231.75 Wayne County (Detroit) $464.17 $183.75 $313.14 Source: Robert Wood Johnson Foundation/The Urban Institute

Thursday, May 22, 2014

Percent Distribution of Office-Based Physicians by Age: United States, 2007-2012

2007 2008 2009 2010 2011 2012 Under 35 Years 8.2% 28.1% 3.3% 3.1% 2.6% 2.5% 35-44 Years 28.1% 26.9% 23.7% 22.8% 23.0% 22.7% 45-54 Years 35.0% 34.6% 31.9% 32.4% 28.3% 31.5% 55-64 Years 20.0% 24.2% 29.7% 28.7% 32.1% 30.0% 65 Years and Over 8.5% 11.2% 11.2% 12.9% 14.0% 13.2% Source: Centers for Disease Control and Prevention, National Center for Health Statistics

Wednesday, May 21, 2014

Star Ratings Conundrum: CMS Stresses Care Quality, but Beneficiaries Stress Cost

By James Gutman - May 16, 2014 There is a kind of Catch 22 for Medicare Advantage (MA) plans and even more so for stand-alone Prescription Drug Plans (PDPs) in the findings of Kaiser Family Foundation (KFF) focus groups during last fall’s Annual Election Period about how seniors choose private Medicare plans. While CMS is pushing to make quality of care the focus of those decisions via its star-rating system, “overall it seems the star ratings are not affecting seniors’ plan choices,” Gretchen Jacobson, Ph.D., associate director, program on Medicare policy at KFF, said at a KFF briefing on the focus-group results May 13. The findings have got to be frustrating to CMS — and even to the insurers who expend huge amounts of financial and human resources to improve on the criteria the agency measures for the annual star quality ratings. This is probably especially the case for the PDPs, which do not get bonus payments from CMS for achieving high stars results the way MA plans do. While CMS has focused on the star ratings as a means by which Medicare beneficiaries can compare plans, the focus groups suggest that the seniors rely instead more on insurance agents and friends. “I’ve never used [star ratings] because I presume that they are doing some weighting of these factors to get to the stars, and my only factor that I care about is cost,” one focus-group participant told KFF. Another, referring to stars, said “I haven’t seen that, and I’m online every day and I never paid attention to that.” “Stars…have meant absolutely nothing for seniors,” asserted Barclays Capital securities analyst Joshua Raskin, who also spoke at the KFF briefing. He cited as evidence that while MA plans overall grew 8% in enrollment in the past year, top-rated (i.e., five-star) plans gained just 6.5% while three-star plans grew 12%. Rather than stars, “it’s the lowest [cost] structure that wins,” Raskin said. Why do you think the CMS star-ratings system has been so slow in catching on with seniors, and what can be done about it? Since the focus groups also showed that seniors — perhaps with good reason — find the agency’s Medicare Plan Finder difficult for comparing plan options, what can be done to help seniors choose the MA plan or PDP that objectively best meets their needs? How can seniors be persuaded to change plans as their needs change, when they seem to get more resistant to change as they get older? Is the fault in the stars — or in ourselves?

Aetna backs Medicare plan end-of-life care changes

By Allison Bell MAY 21, 2014 The U.S. health care system often puts dying patients and their families through a maze of care services and settings without providing much financial or emotional support. Carmella Bocchino, an executive vice president at America's Health Insurance Plans (AHIP), and Dr. Randall Krakauer, a vice president at Aetna (NYSE:AET), were two of the witnesses who talked about the bureaucracy and confusion that face dying patients today at a hearing on advanced care planning organized by the Senate Special Committee on Aging. Krakauer urged senators to improve end-of-life benefits for patients in Medicare Advantage plans by changing the rules that govern use of hospice benefits. Medicare managers should let enrollees who seem to have as many as 12 months to live use hospice benefits, Krakauer said. Today, the cut-off is six months. Your clients should start planning for the end long before they expect it to happen. Medicare also should let more patients get the emotional support hospice programs provide by letting patients get hospice treatment along with hospice, Krakauer said. Aetna already provides those program rules for commercial health plan enrollees who appear to have fewer than 12 months to live, and, for those patients, it also provides coverage for an unlimited number of hospice inpatient days and eliminate outpatient hospice dollar limits, Krakauer said. Family members get 15 days of respite care and bereavement services. The program increases the percentage of patients who use hospice, improves their level of satisfaction, and reduces use of acute medical care services, Krakauer said. Krakauer said Aetna also supports the idea of including measures of the quality of end-of-life care in Medicare plan quality ratings. "We believe that measuring health plans' progress in caring for members with advanced illness helps ensure that individuals and their families receive the compassion and support that is critically important at the end of life," Krakauer said, according to a written version of his testimony. Bocchino testified that AHIP is working with a wide range of stakeholders, including employers and health care providers, to develop proposals for improving management of care for people with advanced illness. The members of the team will try to develop proposals for eliminating unreasonable program eligibility criteria and artificial benefits boundaries that affect where patients can get certain types of care, Bocchino said.

The percentage of 18-to-64-year-olds having health insurance through Medicaid

...rose from 6.8% in the fourth quarter of 2013, to 9.0% in April 2014. Source: "More in U.S. Have Self-Funded Health Coverage, Medicaid," Press Release, May 9, 2014,

Today's Datapoint

$365 million … in restitution is being sought by WellCare Health Plans, Inc. from its former top managers who were convicted in 2013 of Medicaid fraud.

Thursday, May 15, 2014

Today's Datapoint

$23.5 million … was spent by Blue Shield of California ($9.5 million) and Kaiser Permanente ($14 million) to lobby against a November ballot initiative that would allow California’s insurance commissioner to deny health premium increases seen as excessive, according to a blog in The San Francisco Business Times.

9 Obamacare Predictions That Have Come True

Robert Moffit May 5, 2014 at 6:30 am It directly affects the personal life of every American, and it controls or regulates a complex sector of the American economy that is slightly larger than the entire economy of France. If you guessed Obamacare, you’ve been paying attention for the past four years. Four years ago, many health policy analysts, including those at The Heritage Foundation, predicted some of the effects this law would have on Americans. These are all coming true. Here are nine of our predictions that have come to pass—and it’s not over yet. 1. The individual mandate is an enforcement nightmare. As a candidate, President Obama worried that an individual mandate to buy insurance would be unenforceable. He changed his mind once he became president. This year—the first year that the mandate penalties are to be imposed—he has already started backtracking on the enforcement of the provision he signed into law. 2. The law will create new disincentives to work. Between Obamacare’s higher taxes and its subsidies that drop off if you raise your income, there’s not a lot of incentive here to work harder and better your situation. 3. The law, particularly the employer mandate, will impose new costs on businesses that undercut jobs and wages. The employer mandate has been delayed until 2015, but the uncertainty Obamacare has created—and its 18 new tax hikes—have put a huge dent in job creation. 4. The law undermines competition and further consolidates health insurance markets. Heritage Foundation analysis of federal and state exchanges shows that the law has, in general, reduced competition and consolidated health insurance markets. Between 2013 and 2014, the number of insurers offering coverage on the individual markets in all 50 states has declined nationwide by 29 percent. 5. The law guarantees major premium increases. As Heritage predicted, the average annual premiums for single and family coverage in 2014 are rising in the state and federal health insurance exchanges all around the country. In 11 states, premiums for 27-year-olds have more than doubled since 2013; in 13 states, premiums for 50-year-olds have increased more than 50 percent. 6. The law discourages insurance enrollment among the young. The law’s insurance rules and new benefit mandates will make it cheaper for many younger Americans simply to remain uninsured and pay the penalty fine. It’s not surprising that young people have been staying away. 7. The law’s Medicare savings would not financially strengthen Medicare. The law’s proponents originally promised that “savings” from Medicare changes would be spent simultaneously in two places: helping Medicare and expanding Obamacare. But money can be spent only once, so that didn’t work. 8. The law’s Medicare changes will result in reduced benefits and threaten seniors’ access to care. The law’s impact is fairly straightforward: Fewer Medicare providers, reimbursed at rates progressively reduced over time, will create access problems for patients. Medicare cuts have been underway for several years now. 9. The law compels taxpayers to fund abortion and weakens protections of the right of conscience. Obamacare mandates health plans that include coverage of abortion. It also spawned the Health and Human Services regulatory mandate that forces American employers to provide coverage for abortion-inducing drugs. It is safe to say that four years ago, millions of Americans did not expect that the national health care law would become a vehicle for an aggressive government infringement of personal liberty or coerce Americans to fund medical procedures and drugs in direct violation of their ethical and religious convictions. Is it any wonder public opinion is against this debacle? It’s unfair, unworkable, and unaffordable. We need real health reform that puts patients back at the center and increases choice for Americans. Read the Morning Bell and more en espaƱol every day at Heritage Libertad.

Quote of the Day

“It’s baffling. I sat there with my jaw on the table." — Lisa Banker, M.D., physician adviser for CarolinaEast Health System in New Bern, N.C., telling AIS’s Report on Medicare Compliance of her reaction when, for the “education” part of her system’s Medicare administration contractor’s “probe and educate” program under the new two-midnight rule, Palmetto GBA (the MAC) referred her to the entire Medicare Program Integrity Manual for guidance.

Tuesday, May 13, 2014

CMS imposed more than $500,000 in CMPs against Aetna Inc.

From Medicare Advantage News - CMS on April 24 imposed more than $500,000 in civil monetary penalties (CMPs) against Aetna Inc. for violations of Medicare Part D plan requirements concerning beneficiary access to pharmaceuticals. Specifically, the agency imposed a CMP of $407,800 against Aetna’s Coventry Health Care, Inc. subsidiary and $101,500 against the parent company. In enforcement letters sent to Aetna, CMS said its auditors found that the insurer failed to comply with Medicare requirements.

Sky High Initial Duals Opt-Out Rates: Is the Sky Falling or Just Not Clearing Yet?

By James Gutman - May 9, 2014 We knew the initial opt-out rates for beneficiaries auto-assigned to new plans to integrate care for Medicare-Medicaid dual eligibles would be high given the nature of the extremely vulnerable population targeted and the big changes envisioned for it. But this high? So high that a tabulation in Massachusetts shows as of April 1 a 1.54 ratio of opt-outs to enrollments? And so high that, as of the same date, 28.9% of the passively enrolled duals beneficiaries in the only California county (San Mateo) that has conducted large-scale passive enrollment so far have opted out? The opt-out rates are important not just because they will reduce the already scaled-down demos and thus their potential for large cost savings and improved clinical outcomes. They also are significant since they could alter the composition of the pool of beneficiaries to be managed, although opinions differ on whether those left in the demo will be sicker or less sick than those exercising their right not to participate. Perhaps equally significant is that the high opt-out rate could indicate provider problems either in the form, as Fallon Total Care head Richard Burke put it, of a poor “provider network match” between duals and the specialists they need and want, or deliberate efforts by providers to discourage their duals patients from enrolling in the demo. But it’s vital to keep in mind that there could be other less nefarious explanations for the high opt-out rates at the start. In Massachusetts, for instance, the initial notice of auto-assignment that eligible duals got came from the state, not the plans themselves, 60 days before the effective date and spelled out prominently what those beneficiaries needed to do if they didn’t want to participate. Duals anxious about changes in their health care may be likely to pull the plug right away, even though they also can opt out later, thus skewing the initial figures. There certainly, though, are reasons for concern regardless. Some patient-advocate groups in Massachusetts have been “agitated” about the demo there since many primary care physicians and the state’s largest hospital system are not in the networks, probably largely because of relatively low payment rates, noted Fallon Total Care Medical Director Dan Rome, M.D. The number of voluntary signups preceding auto-assignment has been way below expectations in that state, perhaps partly reflecting difficulties in contacting the duals population on a regular basis. What do you think are the main reasons for the high opt-out rates? How much of a reason for concern are they? Is CMS right in saying that this is a less significant cause for concern than if duals decided to leave the plans after they initially accepted enrollment? Are these figures mainly a result of state and federal regulators making sure duals preserved their rights not to participate, or are they more a clear sign of the difficulties ahead in applying managed care principles to a population unaccustomed to it?

Monday, May 12, 2014

Deloitte: The Four Dimensions of Effective mHealth

1. People: Demographics. A nuanced understanding of demographics such as age, gender & income can point to technology preferences and help drive customization and targeting of users’ mHealth experiences 2. Places: Local Infrastructure. The convergence of infrastructure needs and rapid technological development may be a tipping point for mHealth adoption. 3. Payment: Reimbursement & Regulatory. Addressing privacy & security concerns, reimbursement approaches & regulatory consistency across jurisdictions, should remove several barriers to adoption. 4. Purpose: Disease Dynamics. Fitness, wellness, care provision, disease management and complex case management can be supported by mHealth functionality, but the approach has to fit the condition. Source: Deloitte

9 Personal Health Record Tools

1. Microsoft HealthVault 2. Dossia Health Manager 3. Cerner Patient Portal 4. Epic MyChart 5. GE Centricity Patient Online 6. MedSeek 7. RelayHealth 8. ClinicalWorks Patient Portal 9. AllScripts Source: InformationWeek

Improvement in Select Hospital-Acquired Conditions from 2010 baseline through 4th Quarter 2013

1. Ventilator - Associated Pneumonia (VAP) - 53.2% ↓ 2. Early Elective Delivery (EED) - 64.5% ↓ 3. Obstetric Trauma Rate (OB) - 15.8% ↓ 4. Venous thromboembolic complications (VTE) - 12.9% ↓ 5. Falls and Trauma - 14.7% ↓ 6. Pressure Ulcers - 25.2% ↓ Source: U.S. Department of Health & Human Services

The uninsured rate for U.S. adults

...dropped from 15.0% in March to 13.4% in April, the lowest monthly uninsured rate since Gallup and Healthways began tracking it in January 2008. Source: "U.S. Uninsured Rate Drops to 13.4%," Gallup Press Release, May 5, 2014,

Friday, May 9, 2014

According to a recent study,

...patients living in high-poverty neighborhoods were 24% more likely than others to be readmitted to a hospital, after adjusting for demographic characteristics and clinical conditions. Source: "Socioeconomic status and readmissions: Evidence from an urban teaching hospital," Health Affairs, abstract only, May 2014,

Quote of the Day

“All of my marketplace sources are telling me that the feds are far from done building the back end of, particularly the carrier premium payment system and the enrollment reconciliation system.” — Robert Laszewski, president of Health Policy and Strategy Associates, LLC, told AIS’s Inside Health Insurance Exchanges.

Today's Datapoint

$105 million ... in savings were generated by a four-year-old accountable care organization formed by Blue Shield of California along with a physician group and hospital system to treat members of the California Public Employees Retirement System.

Thursday, May 8, 2014

According to a recent survey of U.S. consumers:

• 69% of those with chronic health conditions believe patients should have the right to access all of their healthcare information • 51% believe that accessing their medical records online outweighs the privacy risks • Consumers with chronic conditions had greater privacy concerns regarding online banking (70%), in-store credit card use (69%) and online shopping (68%), than their concern over privacy of their electronic medical record (65%) • 87% of U.S. consumers say they want to control their health data, but 55% believe they currently do not have very much control Source: "Majority of U.S. Consumers with Chronic Conditions Believe Accessing Medical Records Online Outweighs Privacy Risks, According to Accenture Survey," Accenture Press Release, May 5, 2014,

Quote of the Day

“The issue for us as regulators is that when you weigh all of the tax increases and the cost of doing business to meet the requirements of the [Affordable Care Act] there is no way that you can stand up and say we are going to have lower premiums than we had before....We as regulators can’t artificially hold rates.” — Miss. Insurance Commissioner Mike Chaney (R), at an April 17 White House meeting between President Obama and 44 state insurance commissioners.

Today's Datapoint

28% … of the 8 million people who signed up for insurance on federal and state exchanges are between 18 and 34 years old, virtually the same youth percentage that signed up in Massachusetts in the first year of that state’s landmark health reform, according to the White House.

Wednesday, May 7, 2014

Quote of the Day

“The opponents of the ACA are just sputtering, ‘I know it’s a failure, and if the data show it’s a success, then the data must be wrong. Let’s try to figure out how they’re wrong.’ ….We’ve offered tax subsidies for health insurance in the employer market since the 1950s, and it’s been very, very popular. So if we extend those to people outside the employer market, or to people who can’t get health insurance through their employer, why should we be surprised that people want that?” — Tim Jost, a Washington and Lee University law professor who serves as a consumer rep for NAIC, told AIS’s Health Reform Week.

Today's Datapoint

67% … of the members of the National Assn. of ACOs were either “very unlikely” or “somewhat unlikely” to sign a second three-year contract in the Medicare Shared Savings Program (MSSP) if the only option were a two-sided risk model.

Tuesday, May 6, 2014

According to a recent survey:

• 35.3% of U.S. adults have not visited a dentist in the past year • 69.6% of Asians, 68.4% of whites, 55.2% of Hispanics and 55% of blacks have visited a dentist in the last year • 82.3% of those with incomes of $120,000+ have visited a dentist in the last year • 42.7% of those with incomes of $12,000 or less have visited a dentist in the last year Source: "One-Third of Americans Haven't Visited Dentist in Past Year," Press Release, April 28, 2014,

Quote of the Day

ACA initiatives and pilot programs designed to “bend the cost curve,” such as accountable care organizations, “will only affect premiums in the longer run. In the short run, it will be all about the mix of health risks and, specifically, the mix in each state. There is a lot of focus on age, but that’s really only a proxy for health risk. I think that mix is what will be driving premiums in the short run, and it could differ a lot by state.” — Anne Royalty, Ph.D., an economics professor and director of the Center for Health Economics Research at Indiana University-Purdue University, Indianapolis, told AIS’s Health Reform Week.

Today's Datapoint

Approximately 5 million people have fallen into the ACA’s coverage gap, making too much money to qualify for Medicaid yet not enough to qualify for federal subsidies on the exchanges, according to the Kaiser Family Foundation.

Monday, May 5, 2014

Primary Reasons For Remaining Uninsured (Ages 16-64)

1. Tried to get insurance but it is to expensive- 36% 2. Don't think the requirement applies- 14% 3. Didn't know about the requirement to have health insurance- 13% 4. Tried to get coverage but were unable- 12% 5. Would rather pay the fine than pay for insurance- 7% Source: Kaiser Family Foundation

Electronic Health Records as a Predictor of Physician's Electronic Exchange Capability

1. 55 percent of all physicians had computerized capability to send prescriptions electronically vs. 78 percent of physicians with an EHR 2. 67 percent of all physicians could view electronic lab results vs. 87 percent of physicians with an EHR 3. 42 percent could incorporate lab results into their EHR vs. 73 percent of physicians with an EHR 4. 35 percent could send an electronic order to a lab vs. 54 percent of physicians with an EHR 5. 38 percent could provide clinical summaries to patients vs. 61 percent of physicians with an EHR 6. 31 percent exchanged patient clinical summaries with another provider vs. 49 percent of physicians with an EHR Source: U.S. Department of Health & Human Services

Breakdown Of The More Than 8 Million People Selected Marketplace

from October 1, 2013, Through March 31, 2014 1. 54 percent are female and 46 percent are male 2. 34 percent are under age 35 3. 28 percent are between the ages of 18 and 34 35% of employer premium contributions, and can access the credit as a refund. 4. 65 percent selected a Silver plan, while 20 percent selected a Bronze plan 5. 85 percent selected a plan with financial assistance Source: U.S. Department of Health & Human Services

The number of patient office visits to primary care physicians

fell by 0.7% in 2013, while visits to specialists increased by 4.9% overall and by 9.5% for seniors. Source: "IMS Health Study: Spending Growth Returns For U.S. Medicines," IMS Institute for Health Informatics Press Release, April 15, 2014,

Thursday, May 1, 2014

Percent of Enrollees in Federal Marketplace That Paid First Month's Premium

Data provided by every insurance provider in the health care law's Federally Facilitated Marketplace (FFM) shows that, as of April 15, 2014, only 67 percent of individuals and families that had selected a health plan in the federally facilitated marketplace had paid their first month's premium and therefore completed the enrollment process. Of those who had paid their first month's premium: -Under 18: six percent; -Ages 18 to 25: 10 percent; -26 to 34: 15 percent; -35 to 44: 16 percent; -45 to 54: 23 percent; -55 to 64: 29 percent; -65 and older: 1 percent Source: United States House of Representatives Committee on Energy and Commerce

American's Perspective on Health Insurance Situation After ACA

Nearly two-thirds (68%) of Americans are okay with a business adding a nominal surcharge to each bill in order to help pay for employees' health insurance, according to a new report. Support for this practice is highest among 18-29 year olds (64%) and lowest among Americans ages 65 and older (39%). Overall, few Americans feel their health insurance situation has gotten better with the advent of Obamacare. In fact, only 13% of Americans say their health insurance situation has improved compared to one year ago. Americans reporting higher monthly healthcare spending outnumber those reporting lower spending by a ratio of greater than four-to-one. Americans who want to repeal Obamacare edge out those who want to keep it in place by a slight margin (45% vs. 44%). Fifty-one percent of 50-64 year olds (more than any other age group) say they would keep Obamacare rather than repeal it. This is an 11-point increase from the last time Bankrate asked this question in December 2013. Source:

Rural and Urban Hospitals' Role in Providing Inpatient Care

In 2010, 12% of the 35 million U.S. hospitalizations were in rural hospitals. A higher percentage of inpatients in rural hospitals were aged 65 and over (51%) compared with inpatients in urban hospitals (37%). The average number of diagnoses for rural and urban inpatients was similar, as was the average length of stay. Sixty-four percent of rural hospital inpatients, compared with 38% of urban hospital inpatients, had no procedures performed while in the hospital. Following their hospitalization, a higher percentage of rural inpatients (7%) than urban inpatients (3%) were transferred to other short-term hospitals, and a higher percentage of rural (14%) than urban (11%) inpatients were discharged to long-term care institutions. Source: CDC/National Center for Health Statistics

Lengths of Stay for Patients Receiving Hospice Care in The U.S. in 2012

<7 Days - 35.5% 8-29 Days -27.0% 30-89 Days - 17.4% 90-179 Days - 8.8% 180+ Days -11.5% Source: Managed Care, March 2014 Data Source: National Hospice and Palliative Care Organization: NHPCO's Facts and Figures, 2013

Top 25 Most Expensive Markets for Long-Term Care Coverage

Market Nursing Home Private Room Annual Rate Bridgeport-Stamford-Norwalk, CT $159,359 Anchorage, AK $156,950 New York-Northern New Jersey-Long Island, NY-NJ $155,180 Poughkeepsie-Newburgh-Middletown, NY $155,180 Hartford, CT $154,118 Boston-Worcester-Lawrence, MA $146,372 Rochester, NY $141,244 San Diego, CA $135,554 Seattle-Tacoma-Bremerton, WA $131,750 San Francisco-Oakland-San Jose, CA $130,283 Philadelphia-Wilmington-Atlantic City, PA-NJ-DE $129,239 San Jose-Sunnyvale-Santa Clara, CA $127,130 Albany-Schenectady-Troy, NY $126,932 Portland, ME $121,910 Honolulu, HI $121,154 Washington-Baltimore, DC-MD $120,709 Sacramento-Yolo, CA $120,322 Boise, ID $118,475 Milwaukee-Racine, WI $118,005 Manchester-Nashua, NH $117,264 Miami-Fort Lauderdale, FL $116,931 Buffalo-Niagara Falls, NY $116,577 Los Angeles-Riverside-Orange County, CA $115,165 Detroit-Ann Arbor-Flint, MI $114,716 Portland-Salem, OR $111,909 Source: New York Life Insurance Company

The Cost of the Affordable Care Act

Survey found the top three ACA provisions that increased costs in 2013 were the Patient-Centered Outcomes Research (PCORI) fee, general ACA administrative costs, and explaining ACA provisions to participants. The survey also found the most common ways employers plan to deal with the increased costs due to the ACA are shifting costs to employees and increasing wellness and value-based health care initiatives. Source: American Health Policy Institute