Thursday, July 31, 2014

Today's Datapoint

More than $65 billion a year is being spent by the nation’s 37 independent Blue Cross and Blue Shield plans (about $1 for every $5 spent on medical claims) in financial incentives aimed at improving patient outcomes while reducing waste in care delivery, according to the BCBS Association.

Wednesday, July 30, 2014

According to a recent survey,

...hospitals lost $45.9 Billion, or 6.1% of total costs, in uncompensated care in 2012. This includes both bad debt and charity care, but not underpayments by Medicare and Medicaid.

Source: "Hospitals Lose $45.9 Billion in Uncompensated Care in 2012," The Hospitalist, abstract only, July 2014,

Monday, July 28, 2014

Trustees Report shows continued reduced cost growth, longer Medicare solvency


FOR IMMEDIATE RELEASE                                             Contact: CMS Media Relations

July 28, 2014                                                                     (202) 690-6145 or




Trustees Report shows continued reduced cost growth, longer Medicare solvency


The Medicare Trustees today projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Due in part to cost controls implemented in the Affordable Care Act, per capita spending is projected to continue to grow slower than the overall economy for the next several years.


“The Medicare Hospital Insurance trust fund is projected to be solvent for longer, which is good news for beneficiaries and taxpayers,” said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS). “Thanks to the Affordable Care Act, we are taking important steps to improve the quality of care for Medicare beneficiaries, while improving Medicare’s long-term solvency. Specifically, we have made major progress in improving patient safety, decreasing hospital readmissions, and establishing new payment models such as accountable care organizations aimed at reducing costs and improving quality. These reforms slow the rise in health care spending while improving the quality of care for beneficiaries.”


A number of factors have contributed to the improved outlook, including lower-than-expected spending in 2013, and lower projected utilization in the types of health care needed by Medicare patients. Medicare spending per beneficiary has grown quite slowly over the past few years and is projected to continue to grow slowly over the next several years.  During the past four years, per capita Medicare spending growth has averaged 0.8 percent annually, much more slowly than the average 3.1 percent annual increase in per capita GDP and national health expenditures over the same period.


The benefits of this slower growth accrue to both taxpayers and beneficiaries. For example, although the Part B premium for 2015 will not be determined until later this year, the preliminary estimate in the Report indicates that it will remain unchanged from the 2013 premium for the second consecutive year.





In 2013, Medicare covered 52.3 million people: 43.5 million people aged 65 and older, and 8.8 million people with disabilities. About 28 percent of these beneficiaries have chosen to enroll in Part C private health plans that contract with Medicare to deliver Part A and Part B health services. Total expenditures in 2013 were $582.9 billion. Total income was $575.8 billion.


The Medicare Trustees are Health and Human Services Secretary Sylvia M. Burwell, Treasury Secretary and Managing Trustee Jacob Lew, Labor Secretary Thomas Perez, and Acting Social Security Commissioner Carolyn Colvin. Two other members are public representatives who are appointed by the President, subject to confirmation by the Senate. Charles Blahous III and Robert Reischauer began serving on Sept. 17, 2010. CMS Administrator Tavenner is designated as Secretary of the Board.


Today's Datapoint

36,000... was the price Pharmasset, Inc. was planning to charge for a three-month supply of the hepatitis C drug Sovaldi before the firm was acquired by Gilead Sciences Inc., which charges $84,000 for a three-month treatment cycle, according to information acquired by the Senate Finance Committee.

Quote of the Day

“Quite frankly, employers are trying to stay clear of the [Affordable Care Act’s] Cadillac tax as they look out to the future, and thus there has been more of a migration to account-based plans. And with account-based plans, I would say more companies are putting in [health savings accounts] than [health reimbursement accounts] as a way to partner with employees who have more of an active role in managing health care costs.”

— Brian Marcotte, president and CEO of the National Business Group on Health, told AIS’s Health Plan Week.

RS sets max fines for health coverage refusal

It’s official: if you make a quarter of a million bucks a year and decide not to pay for health insurance, you’re going to have to fork over $2,448 to the feds.

The Internal Revenue Service finally released its maximum fines for those who choose to go without health insurance. Under terms of the Patient Protection and Affordable Care Act, fines were included for those who decided not to have coverage as an incentive to get more folks to purchase coverage.

The maximum family penalty issued by the IRS was $12,240 for a five-member family. That’s five times $2,448, in case you wondered.

Most Americans who may have been on the fence about getting coverage under the act won’t get dinged too hard. For individuals earning more than $19,650, the fine is one percent of annual income.

For those making between $10,150 and $19,650,  it’s a flat fee of $95. For those earning less than $10,150, there’s no penalty.

The penalty is due when people file 2014 taxes.

Friday, July 25, 2014

Quote of the Day

UnitedHealth Group’s second-quarter financial report, which beat Wall Street expectations, “just shows that in the health care sector, because there are so many challenges, the larger, more well-diversified companies are just in better shape to handle these challenges.... [UnitedHealth] lost some individual membership overall in the first half of the year [from members moving to public exchanges], but they made up for it with strong Medicaid membership. And Optum is very, very strong. It fills in the gaps when they have a hiccup in one of the other health care operations.”

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

Both nurse practitioners and physician assistants reported

...seeing an average of 16 to 18 patients per day, according to a recent survey.

Source: "How Today’s Medical Practices Utilize Advanced Practice Professionals," Jackson Healthcare Press Release, July 8, 2014,

Thursday, July 24, 2014

Median Health Plan Costs by Product (PMPM)

The following 2013 are median Independent/Provider-Sponsored health plan costs by product per member per month according to Sherlock Company:

Commercial Insured: HMO - $38.86 POS - $39.05 Indemnity & PPO - $47.08 Commercial ASO - $21.63 Medicare Supplemental - $37.59

Medicare: Advantage - $75.40 SNP - $139.35 Cost - $43.73

Medicaid: HMO - $32.56 Child Buy-In - $23.29 Comprehensive Total - $38.59

*2013 Data, Per Member Per Month

Source: Sherlock Company

According to a recent U.S. survey:

  • 12% say companies should be allowed to refuse to hire people because they are significantly overweight
  • 14% say companies should be allowed to refuse to hire smokers
  • 58% say that setting higher health insurance rates for smokers would be justified
  • 39% say that setting higher health insurance rates for those who are significantly overweight would be justified

Source: "Hiring Discrimination for Smokers, Obese Rejected in U.S.," Gallup Press Release, July 22, 2014,

Today's Datapoint

12% ... has been the increase since 2013 in membership in health savings account (HSA)-eligible plans, an increase to 17.4 million people, according to a new survey from America’s Health Insurance Plans.

Quote of the Day

“It will be a challenge for [the federal marketplace] to move beyond a rigid one-size-fits-all approach. But [the federally run exchanges are] being built by the same private vendors that offer flexibility to the state-run exchanges, and that approach could be incorporated into the federal build as well. The first mission has to be getting the basic framework built out, but once that is accomplished, there is no reason [the federal platform can’t offer some options to the states].”

— Joel Ario, managing director at the consulting firm Manatt Health Solutions and former director of HHS’s Office of Health Insurance Exchanges, told AIS’s Inside Health Insurance Exchanges.

Wednesday, July 23, 2014

The typical Medicare beneficiary paid an average

of $4,734 out-of-pocket for their health care in 2010, up 44% from 2000, according to a new report.

Source: "How Much Is Enough? Out-of-Pocket Spending Among Medicare Beneficiaries: A Chartbook," The Henry J. Kaiser Family Foundation, July 21, 2014,

Today's Datapoint

34% lower medical costs were achieved under a three-year bundled payment pilot program by UnitedHealth Group’s UnitedHealthcare unit and five medical oncology groups that paid doctors upfront for treating cancer patients.

Quote of the Day

“There has been recognition by state exchanges and HHS that agents bring a lot to the table, but the process isn’t welcoming or efficient....Brokers don’t feel the love from HHS....HHS doesn’t want to be involved in the commissions carriers pay their brokers, and they shouldn’t be. But they do need to provide the carriers with information about the work the broker provided.”

— Wesley Bissett, senior counsel for government affairs at the Independent Insurance Agents & Brokers of America, told AIS’s Inside Health Insurance Exchanges.

Tuesday, July 22, 2014

Today's Datapoint

$100 million will be attempted to be recouped by four states from technology vendors who worked on flawed launches of public exchanges in Maryland, Massachusetts, Nevada and Oregon.

Median Health Plan Costs by Functional Area (PMPM)

The following 2013 are median Independent/Provider-Sponsored health plan costs per member per month (PMPM) according to Sherlock Company:

Sales and Marketing - $10.80

Provider and Medical Management - $6.38

Account and Membership Administration - $15.29

Corporate Services - $6.16

Total Expenses - $38.59

*2013 Data, Per Member Per Month

Source: Sherlock Company

According to a recent analysis of data from the e-prescription network Surescripts:

  • By April 2014, 70% of physicians were e-prescribing using an electronic health record (EHR)
  • Only 7% of physicians were e-prescribing using an EHR when the Medicare Improvements for Patients and Providers Act (MIPPA) was passed in December of 2008
  • 24% of physicians were e-prescribing using an EHR when the Medicare and Medicaid EHR Incentive Programs began in 2011

Source: "E-Prescribing Trends in the United States ," The Office of the National Coordinator for Health Information Technology (ONC), ONC Data Brief no. 18, July 2014,

Today's Datapoint

20 million people have gained health insurance coverage as a result of the ACA: 8 million via public exchanges and another 12 million through Medicaid expansion and by remaining on parental plans, among other methods, according to a new Commonwealth Fund study published in the July 2 New England Journal of Medicine.

Sunday, July 20, 2014

Affordable Care Act's 1st Open Enrollment Period

A survey was taken regarding the decline for the % of adults who are uninsured (after the end of open enrollment). This was done on a monthly basis and this is what they found:

  • July-Sept. 2013 (Ages 19-34) - 28%
  • April-June 2014 (Ages 19-34) - 18%
  • July-Sept. 2013 (Ages 35-49) - 18%
  • April-June 2014 (Ages 35-49) - 15%
  • July-Sept. 2013 (Ages 50-64) - 14%
  • April-June 2014 (Ages 50-64) - 11%
  • July-Sept. 2013 (Total) - 20%
  • April-June 2014 (Total) - 15%
Source: The Commonwealth Fund

CMS Fraud Prevention System Identification of Improper Medicare Payments

In its second year of operations, CMS' state-of-the-art Fraud Prevention System, that employs advanced predictive analytics, identified or prevented more than $210 million in improper Medicare fee-for-service payments, double the previous year. It also resulted in CMS taking action against 938 providers and suppliers. The Fraud Prevention System is used as part of an agency focus on home health services in South Florida. CMS identified this type of service in South Florida as an area of high risk to our programs. The Fraud Prevention System led to investigations and administrative actions, which ultimately led to the revocation of the billing privileges of home health agencies, with potential savings worth more than $26 million.

Source: Centers for Medicare & Medicaid Services

When Retirement Households are Simulated to Run Short of Money

Under a variety of simulated post-retirement expense scenarios, the lowest preretirement income quartile is the cohort where the vast majority of the retirement readiness shortfall occurs, and the soonest. When nursing home and home health-care expenses are factored in, the number of households in the lowest-income quartile that is projected to run short of money within 20 years of retirement is considerably larger than those in the other three income quartiles combined. Extending the results to a maximum of 35 years in retirement (age 100, assuming retirement at age 65), 83 percent of the lowest-income quartile households would run short of money and almost half (47 percent) of those in the second-income quartile would face a similar situation. Only 28 percent of those in the third-income quartile and 13 percent of those in the highest income quartile are simulated to run short of money eventually.

Source: Employee Benefit Research Institute

Increase in Adults Eligible for Coverage Who Had Visited a Marketplace

A Commonwealth Fund June tracking survey indicates the proportion of adults potentially eligible for health coverage that visited a marketplace increased to 2 out of 5 persons. The historical percentages from the tracking surveys are: 

  • % of Adults aged 19-64 who visited the marketplace (monthly):
  • Oct. 2013 - 17%
  • Dec. 2013 - 24%
  • April-June 2014 - 43%
Source: The Commonwealth Fund

Projection of Medicare Savings Attributable to GPOs

An analysis of the National Health Accounts by Dobson displays the projection of Medicare savings attributable to GPOs (Group Purchasing Organizations) at an 80% penetration rate ($ in billions). The numbers from the report are:

5 Year Savings (2013-2017)

  •  10% Savings ($49.7)
  • 15% Savings ($78.9)
  • 18% Savings ($98.1)

10 Year Savings (2013-2022)

  • 10% Savings ($116.0)
  • 15% Savings ($184.3)
  • 18% Savings ($229.3)
Source: Centers for Medicare and Medicaid Services (Dobson | DaVanzo)

10 States To Face The Largest Increases In Premiums For The Typical Family

1.    Delaware- 100 %

2.    New Hampshire- 90 %

3.    Indiana- 54 %

4.    California- 53 %

5.    Connecticut- 45 %

6.    Michigan- 36 %

7.    Florida- 37 %

8.    Georgia- 29 %

9.    Kentucky- 29 %

10.  Pennsylvania- 25 %

Source: Digital Journal

Distribution of Payer Rejection of Retail Prescriptions by Reasons

1.    Quantity Limits - 5.3 %

2.    Prior Authorization Required - 11.7 %

3.    Not Covered - 12.0 %

4.    Step Edits - 20.4 %

5.    Re fill Too Soon - 30.8 %

6.    All Other - 19.9 %

Source: IMS Institute for Healthcare Informatics

Average Premium After Tax Credits for Individuals Who Selected Plans with Tax Credits Through The 2014 Federally - Facilitated Marketplace

1.    Bronze - $68

2.    Silver - $69

3.    Gold - $208

4.    Platinum - $220

5.    All Metal Levels - $82

Source: ASPE Office of Health Policy

Best Practices to Reduce Costly Readmissions

1.    Involve Patient's Social Network, Family, and Friends

2.    Streamline the Discharge Process

3.    Get to Know the Patients

4.    Build a Comprehensive Discharge Team

Source: Fierce Healthcare

Top 10 Most Social Media Friendly Hospitals for 2013

1.    Mayo Clinic – Rochester, MN

2.    Cleveland Clinic – Cleveland, OH

3.    University of Texas M.D. Anderson Cancer Center – Houston, TX

4.    Mount Sinai Medical Center – New York, NY

5.    University of Michigan Hospitals and Health Centers – Ann Arbor, MI

6.    Dana-Farber Cancer Institute – Boston, MA

7.    City of Hope – Duarte, CA

8.    Oregon Health and Science University – Portland, OR

9.    University of Wisconsin Hospital and Clinics – Madison, WI

10.  Brigham and Women’s Hospital – Boston, MA

Source: MHA Degree

% of persons of all ages who had excellent or very good health: U.S., 1997–2013

1.    1997 - 68.5

2.    1998 - 69.1

3.    1999 - 68.7

4.    2000 - 68.3

5.    2001 - 68.4

6.    2002 - 67.4

7.    2003 - 67.5

8.    2004 - 66.5

9.    2005 - 66.5

10.  2006 - 65.9

11.  2007 - 66.0

12.  2008 - 66.0

13.  2009 - 66.3

14.  2010 - 65.7

15.  2011 - 65.6

16.  2012 - 65.8

17.  2013 - 66.3

Source: CDC/NCHS, National Health Interview Survey

10 Most Expensive Cities for Healthcare

1.    Sacramento, CA- The most expensive city for CT scans at $1,404 and MRIs at $2,635

2.    San Francisco, CA- With an average cost of $251, San Francisco is the most expensive place to find preventive primary care in the U.S.

3.    Dallas, TX- The fourth most expensive city for CT scans, fifth for MRIs, and eleventh for preventive primary care

4.    St. Louis, MO- The eighth costliest place for MRIs, tenth for CT scans and thirteenth in preventive care

5.    Kansas City, MO- The third most expensive city in the country for both CT scans and MRIs, it falls to eighteenth when it comes to preventive primary care at just $138

6.    Charlotte, NC- Seventh for MRIs at $1,813 and fifth for primary care at $199

7.    Denver, CO- Denver scores a pair of sixth place rankings for CT scans and MRIs, but falls to nineteenth in preventive care at $134

8.    Miami, FL- Ranks notably high for the cost of an MRI. It’s the fourth most expensive place for one at $1,968

9.    Boston, MA- The sixth most expensive city for preventive primary care, Boston is also number 10 when it comes to MRIs at $1,737

10.  Portland, OR- Portland is the third most expensive city for preventive primary care at $216, but drops to fourteenth for MRIs and seventeenth for CT scans

Source: Castlight Health

Percent Wireless Phone Only Households by Health Status

1.    Health status described as excellent or very good - 63.8%

2.    Experienced serious psychological distress in past 30 days - 4.4%

3.    Obese (adults aged 20 and over) - 29.0%

4.    Asthma episode in past year - 3.5%

5.    Ever diagnosed with diabetes - 6.2%

Source: CDC, National Center for Health Statistics