Today's Datapoint

52% of 1,000 companies surveyed recently by Buck Consultants offer wellness-related insurance premium reductions, while 65% believe wellness-related programs are extremely or very important to attract and retain workers, according to the consulting firm’s new report “Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies.”

Quote of the Day

“We found that even with awareness of some of the provisions [of the Affordable Care Act] like the [individual mandate] penalty and the deadline, [young adults signing up for coverage on exchanges] didn’t understand that the government was prepared to help pay the premium. Maybe the word subsidies isn’t the right word....If a barrier to coverage is affordability...it is essential to get that word out.”



— Sarah Thomas, research director at Deloitte’s Center for Health Solutions, which recently released a “2014 Survey of Young Adults and Health Insurance,” told AIS’s Health Plan Week.

Primary care practices with 1 to 2 physicians

...had 33% fewer preventable hospital admissions than practices with 10 to 19 physicians, according to a recent study.

Source: "Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions," Health Affairs, abstract only, August 2014,


http://content.healthaffairs.org/content/early/2014/08/08/hlthaff.2014.0434

Today's Datapoint

99.7% ... of the information provided to insurance exchanges by the IRS to determine eligibility for subsidies was accurate, according to a glowing audit released Aug. 5 by the Treasury Inspector General for Tax Administration.

Quote of the Day

“I would characterize [talk in the industry about private exchanges] as more about hyper-interest and staggered growth [as opposed to “hyper growth”]. There is no doubt employers are interested in private exchange solutions, but they want to know more about what they are and what they entail.”


— Jonathan Har-Even, a manager in PwC’s Global Human Resource Services practice, told the audience at a recent AIS webinar.

Study: Facebook pages focused on chronic illnesses significantly for marketing purposes

According to a January 2014 study by the Journal of Medicine Internet Research:

• 32.2% of such pages are for marketing and promotion.
• 20.7% of Facebook pages dedicated to disease seek to raise awareness.
• 15.5% offer Wikipedia-type information.
• 9.4% of Facebook pages about chronic diseases are used for actual support.

Note: The study was carried out by researchers from Harvard Medical School, Stanford University.


Source: Journal of Medicine Internet Research

According to a recent study,

46% of respondents use up to four telemedicine solutions within their healthcare organizations, with two-way video/webcam being the most prevalent telemedicine solution (57.8%).

Source: "HIMSS Analytics Launches New Line of Reports with 2014 Telemedicine Study," HIMSS Analytics Press Release, August 13, 2014, http://www.himssanalytics.org/about/NewsDetail.aspx?nid=82171

Today's Datapoint

$7.8 million ... will be returned to policyholders in Missouri by two units of WellPoint’s Anthem BCBS of Missouri under a new settlement agreement, according to the Missouri Department of Insurance.

Quote of the Day

“You will frequently underpay or overpay doctors by not considering other factors [such as local reimbursement rates and overhead]. That probably is what causes a lot of consternation when they look at fair-market value compensation for rock-star doctors. They live on a flat earth based on only surveys and simplistic valuation methods.”



— Timothy Smith, national director of healthcare valuation services for American Appraisal in
Dallas, told AIS’s Report on Medicare Compliance.

Department of Health and Human Services outlines leading data breaches

According to a report from the Department of Health and Human Services:

• Breaches due to providers (63% - 68%)
• Breaches due to health information theft (50%)
• Breaches due to business associates (25% - 27%)
• Breaches due to hacking incidents (8% - 27%)
• Breaches due to unauthorized access (18 - 19%)
• Breaches due to loss of health information (12% - 17%)
• Breaches due to health plans (7% - 10%)

Note: Data from 2011-2012.


Source: United States Department of Health and Human Services

10 Questions To Ask Aging Parents About End-of-Life Care

1.    Thinking about your death, what do you value most about your life?

2.    If you were diagnosed with a terminal illness, would you want to pursue every possible cure?

3.    Do you imagine wanting to stop curative efforts if they were unsuccessful?

4.    What kinds of aggressive treatments would you want (or not want)?

5.    Do you want to die at home?

6.    How do you feel about an extended hospitalization?

7.    How much pain is acceptable to you?

8.    Do you want to be with your family when you die?

9.    What decisions regarding care do you want to entrust to others?

10.  What do you hope for most regarding your death?

Source: Hospice Foundation of America

10 health care benefits covered in the Health Insurance Marketplace

1.    Outpatient care—the kind you get without being admitted to a hospital

2.    Trips to the emergency room

3.    Treatment in the hospital for inpatient care

4.    Care before and after your baby is born

5.    Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

6.    Your prescription drugs

7.    Services & devices to help you recover if you are injured, or have a disability or chronic condition. Includes physical & occupational therapy, speech-language pathology, psychiatric rehab & more

8.    Your lab tests

9.    Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease

10.  Pediatric services: This includes dental care and vision care for kids

Source: Healthcare.gov, August 20, 2013

CMS Fraud Prevention System Identified Savings from (First/Second) Year (millions)

1.    Amount denied by pre payment edits 11.5/16.8

2.    Billed amount denied by auto-denial edits 4.7/1.6

3.    Payment suspensions 1.6/2.3

4.    Amount of overpayments referred for recovery 4.4/35.6

5.    Value of law enforcement referrals 68.2/73.2

6.    Cost avoidance due to changes in behaviour 11.1/NA

7.    Cost avoidance from revoking provider billing privileges 13.9/81.2

8.    Total 115.4/210.7

Source: Centers for Medicare & Medicaid Services

Top 15 Hospitals in the Country for Heart Surgery Earning Highest Marks

1.    Baystate Medical Center, Springfield, Mass.

2.    Borgess Medical Center, Kalamazoo, Mich.

3.    Cleveland Clinic, Cleveland

4.    Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.

5.    Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.

6.    Mother Frances Hospital-Tyler, Tyler, Texas

7.    Sequoia Hospital, Redwood City, Calif.

8.    Spectrum Health-Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.

9.    St. Joseph Mercy Hospital, Ypsilanti, Mich.

10.  St. Joseph’s Hospital Health Center, Syracuse, N.Y.

11.  St. Vincent Heart Center of Indiana, Indianapolis

12.  Swedish Medical Center-Cherry Hill Campus, Seattle

13.  The Heart Hospital Baylor Plano, Plano, Texas

14.  UMass Memorial Medical Center, Worcester, Mass.

15.  Valley Hospital, Ridgewood, N.J.

Source: mlive

Life Changes to Report if you have Marketplace Coverage

1.    Get married or divorced

2.    Have a child, adopt a child, or place a child for adoption

3.    Have a change in income

4.    Get health coverage through a job or a program like Medicare or Medicaid

5.    Change your place of residence

6.    Have a change in disability status

7.    Gain or lose a dependent

8.    Become pregnant

9.    Experience other changes that may affect your income and household size

10.  Change in tax filing status

11.  Change of citizenship or immigration status

12.  Incarceration or release from incarceration

13.  Change in status as an American Indian/Alaska Native or tribal status

14.  Correction to name, date of birth, or Social Security number

Source: HealthCare.gov

According to an international survey of smartphone users:

• 80% would like the option to use their smartphones to interact with health care providers
• 76% would like to be reminded of their medical appointments by mobile device
• 69% would like to receive mobile device reminders to arrange appointments or to prompt them to take their medication
• 56% trust health care organizations with personal data
• Almost 66% want to receive medical advice through digital channels instead of visiting a doctor

Source: "FICO Global Survey: 80% of Smartphone Users Interested in Health Care Alerts," FICO Press Release, June 18, 2014, http://www.fico.com/en/about-us/newsroom/news-releases/fico-global-survey-80-smartphone-users-interested-health-care-alerts/

Today's Datapoint

$1... will be the increase in the average premium for a basic Medicare Part D Prescription Drug Plan in 2015, for an estimated $32 per month, CMS announced recently.

5 LTCI (Long Term Care Insurance) Selling Points For Medicare Enrollees

1.    The cost of LTCI programs have gone up but so has the out of pocket cost of most major insurance expenses

2.    Long-term care facility costs accounted for more of the Medicare enrollee out-of-pocket spending in 2010 than any other type of out-of-pocket spending

3.    Higher-income Medicare enrollees spent considerably more out of pocket on dental care than lower-income and sicker enrollees did

4.    People who have $20,000 to $30,000 in annual income may have an above-average need for LTCI and other insurance products

5.    The current gaps in what Medicare covers are unlikely to shrink any time soon

Source: Life Health Pro

10 states are critical to health care plan enrollment

1.    California

2.    Texas

3.    Florida

4.    New York

5.    Georgia

6.    Illinois

7.    North Carolina

8.    Ohio

9.    Pennsylvania

10.  New Jersey

Source: USA Today

The Best Jobs In Health Care In 2014

1.    Biomedical engineer

2.    Dental hygienist

3.    Occupational therapist

4.    Optometrist

5.    Physical therapist

6.    Chiropractor

7.    Speech pathologist

8.    Pharmacist

9.    Podiatrist

10.  Respiratory therapist

11.  Medical records technician

12.  Physician assistant

Source: Forbes

Risk-adjusted in-hospital mortality

...was 13% higher in heart attack patients who arrived at the emergency department off-hours (weeknights, weekends and holidays), according to a recent study.

Source: "Impact of Time of Presentation on Process Performance and Outcomes in ST-Segment–Elevation Myocardial Infarction," Circulation: Cardiovascular Quality and Outcomes, abstract only, July 2014, http://circoutcomes.ahajournals.org/content/early/2014/07/29/CIRCOUTCOMES.113.000740.abstract.

Special Needs Plans with Highest Enrollment (Contract Name, Plan Name, Enrollment)

1.    MMM Healthcare, Inc., Medicare y Mucho Mas - Diamante Choice (HMO SNP), 98,255

2.    Managed Health, Inc., Healthfirst Life Improvement Plan (HMO SNP), 57,146

3.    MCS Advantage Inc., MCS Classicare Platino Ideal (HMO SNP), 39,753

4.    Care Improvement Plus South Central Insurance CO, Care Improvement Plus Gold Rx (Regional PPO SNP), 35,477

5.    Kaiser Foundation HP, Inc., Senior Advantage Medicare Medi-Cal Plan South (HMO SNP), 33,613

6.    Gateway Health Plan, Inc., Gateway Health Plan Medicare Assured (HMO SNP), 31,245

7.    American Health, Inc., AHM_Platino Plus (HMO SNP), 31,220

8.    Unitedhealthcare Plan Of The River Valley, Inc., UnitedHealthcare Dual Complete (HMO SNP), 31,080

9.    Kaiser Foundation Hp, Inc., Senior Advantage Medicare Medi-Cal Plan North (HMO SNP), 29,726

10.  Preferred Medicare Choice, Inc., Premier Preferred (HMO SNP), 29,676

Source: Centers for Medicare & Medicaid Services

Accountable Care Organizations

...are expected to generate almost $1 billion in care management revenues this year.

Source: "Parks Associates: U.S. patients of Accountable Care Organizations (ACOs) to exceed 130 million by 2017," Parks Associates Press Release, July 23, 2014, http://www.parksassociates.com/blog/article/chs-2014-pr4

Survey: Work-related Injury Impact on Quality Patient Care

According to a survey by Ergotron, 10% of the nursing workforce is injured on the job annually. The following are effects resulting from such injuries:



*22% of nurses are less friendly or engaging with their patients. * 22% of nurses have to modify or limit their activity/movement on the job. *17% of nurses are distracted. * 14% of nurses needed more assistance from other staff.



Note: Ergotron Nursing survey was fielded by GMI Research from 250 full-time nurses during 3/21/14-3/28/14.


Source: Ergotron

What Is the Result of States Not Expanding Medicaid?

• August 2014
• Publisher: Urban Institute
• Publication: Quick Strike Series
• Author(s): Dorn S, McGrath M, and Holahan J

A report by Urban Institute researchers illustrates the economic impact in states where Medicaid is not expanding.

In the 24 states that have not expanded Medicaid, 6.7 million residents are projected to remain uninsured in 2016 as a result.

These states are forgoing $423.6 billion in federal Medicaid funds from 2013 to 2022, which will lessen economic activity and job growth.

Hospitals in these 24 states are also slated to lose a $167.8 billion (31%) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.

The authors note that opting to expand Medicaid would generate state savings and revenues exceeding the cost of expansion.

 Key Findings

• States that have not expanded Medicaid will miss out on $423.6 billion in federal funding between 2013 and 2022.
• The decision of state leaders not to expand Medicaid also means their local hospitals will collectively forgo $167.8 billion in Medicaid reimbursement payments over the same timeframe.
• Based on analyses of state budgets, for every $1 a state spends expanding Medicaid, $13.41 in federal funding flows into the state.
• In total, hospitals in states not expanding stand to forgo $167.8 billion in reimbursement funding from 2013 to 2022.