Musings on the Way to a Bids Deadline: Does It Only Seem Quieter This Time Around?

By James Gutman - May 27, 2015

If there is one time of year when Medicare Advantage (MA) and Part D executives are sure to be burning the midnight oil, it is now: a few days before the deadline for submission to CMS of their bids for the following year. But while the pre-bid period this time around still is hectic, the impression I’m getting from some industry actuaries and consultants is that it’s a little less so than in the past few years despite an unusually short period between the final 2016 pay-rate notice (April 6) and the bids deadline (June 1).

There may be a few reasons for the relative tranquility this time. One is that the phase-in of the new MA rate methodology to that called for in the Affordable Care Act is virtually done, meaning those plans that can keep their year-to-year spending growth a little below the national Medicare fee-for-service trends can achieve higher profit margins in the future, notes consultant Bill MacBain, senior vice president, strategy at Gorman Health Group, LLC. A second is that the overall pay-rate change for many MA plans next year is slightly positive, compared with considerably negative the past couple of years. And perhaps a third may be that MA sponsors are getting accustomed to working with CMS’s new yardsticks, such as the continued $32 per-member per-month limit in most situations on the increase in enrollee cost from year to year.

To be sure, there are lots of countervailing factors that make MA bid preparation for 2016 less than a walk in the park. The complete phase-in of the new CMS risk-adjustment methodology, for instance, figures to cost many MA insurers plenty in 2016, and they are looking for ways to offset this. Moreover, the Part D standard benefit is getting richer next year as the Initial Coverage Limit goes up, and this has to be figured into the bids. So do the many new risk-sharing arrangements that plan sponsors are working out with providers for next year.

How has the bid period so far gone for you? How will the size industrywide of premium hikes and benefit cuts (including for ancillary benefits such as dental) compare with those changes a year ago? What about the prevalence of service-area expansions and contractions? Are we indeed entering a quieter era for MA bids, or is this just the calm before the storm?

http://aishealth.com/blog/medicare-advantage-and-part-d/musings-way-bids-deadline-does-it-only-seem-quieter-time-around?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=75731105

Most Top Health Plans Saw Enrollment Increases in 2014

Here are some key findings from the latest Mark Farrah Associates Healthcare Business Strategy report:

·         Aetna, Cigna, HCSC, Humana, Kaiser, UnitedHealth and Anthem insure 54% of the insured US population.

·         Membership for these plans increased 5.7% from 139.1 million in 2013 to 144.7 million in 2014.

·         In December 2014 Anthem lead in membership with 37.5 million members and annual increase of 1.9%.

·         UnitedHealth enrollment decreased from 37.2 mil members in 2013 to 36.8 mil in 2014.

·         Kaiser reported an income of $3.1 billion on revenues of $57.6 billion for 2014 with a profit margin of 5.34%.

·         UnitedHealth's profit margin decreased from 6.3% in 2013 to 5.8% in 2014.

Source: Mark Farrah Associates, May 20, 2015

https://www.virtualpressoffice.com/publicsiteContentFileAccess/2009445/2009445.html/?fileContentId=2009445&fileName=2009445.html&fromOtherPageToDisableHistory=Y

According to a recent report,

70.3% of adults with medical debt said that all of it was accrued during periods with insurance:

• 9.2% reported medical debt incurred during periods with insurance from services that were not covered by their health plan
• 14.5% reported medical debt from cost sharing under their health plan
• 11.0% reported medical debt from co-payments and coinsurance
• 11.1% reported medical debt from a deductible

Source: "Most Adults with Medical Debt Had Health Insurance at the Time the Debt Was Incurred," The Urban Institute, May 21, 2015, http://hrms.urban.org/briefs/Most-Adults-with-Medical-Debt-Had-Health-Insurance-at-the-Time-the-Debt-Was-Incurred.html

90% of payers

...cited "reducing drug costs" as their top oncology management goal, but only 17% felt they were controlling drug costs effectively, according to the latest EMD Serono Specialty Digest, which includes data from 70 commercial health plans representing more than 100 million covered lives.

"We're not even through the second

...year [of insurance exchanges] and people are already writing the eulogy for [state-based] exchanges based on sustainability....I think we are going to see a lot of innovation coming from the marketplaces in the next six to 12 months."

— Dan Schuyler, a director at the Salt Lake City consulting firm Leavitt Partners, told AIS's Inside Health Insurance Exchanges.

"A flourishing pharmaceutical industry

...provides invaluable benefit to society by developing new drugs to combat disease and alleviate suffering. The success of the pharmaceutical industry in bringing new therapies to market for the treatment of MS has improved the care of people with MS. However, the unbridled rise in the cost of MS drugs has resulted in large profit margins and the creation of an industry 'too big to fail.' It is time for neurologists to begin a national conversation about unsustainable and suffocating drug costs for people with MS — otherwise we are failing our patients and society."

— Oregon State researchers who published the article "The Cost of Multiple Sclerosis Drugs in the U.S. and the Pharmaceutical Industry," which appeared in the April 24 issue of Neurology.

$11.9 billion

...was the reduction in U.S. spending on prescription drugs in 2014 as a result of patent expirations, the lowest impact of expirations in five years, according to a new report, Medicines Use and Spending Shifts, from the IMS Institute for Healthcare Informatics.

Overall patient satisfaction has fallen

...3.2% since last year, to a score of 75.1 on a scale of 0 to 100, according to a recent annual survey.

Source: "ACSI: Customers Less Satisfied with Energy Utilities, Shipping and Health Care," the American customer Satisfaction Index (ASCI) Press Release, May 12, 2015, http://www.theacsi.org/news-and-resources/press-releases/press-2015/press-release-utilities-shipping-and-health-care-2015

Commercial health insurers transact only 15% of

...payments and 27% of payment remittance advice electronically, while the rest of U.S. businesses transact an average of 43% of payments electronically, according to a recent report.

Source: "Healthcare industry’s payment system needs structural change to meet demands of consumers, new PwC Health Research Institute report finds," PricewaterhouseCoopers LLP Press Release, May 7, 2015, http://www.pwc.com/us/en/press-releases/2015/hri-money-matters-payments-press-release.jhtml

Healthcare Jobs and Spending Growth Trends

Altarum Institute recently released a Health Sector Economic Indicators brief highlighting the growth surge in the health services sector. Here are some key findings from the report:

·         Over the past 6 months, healthcare has added 226,000 jobs, the largest increase in 25 years.

·         Health job growth now exceeds nonhealth job growth at 2.7% annual growth versus 2.1% annual growth.

·         Health care prices in March 2015 were 1.3% higher than in March 2014 and hospital prices rose 0.4%.

·         Physician and clinical services prices fell 0.6% and prescription drug prices rose 5.7% last year.

·         National health spending in March 2015 was 6.8% higher than in March 2014.

·         At $3.2 trillion, health spending now represents 18.1% of gross domestic product.

Source: Altarum Institute, May 13, 2015

CMS proposes rule to strengthen managed care for Medicaid and CHIP Enrollees

CMS NEWS

FOR IMMEDIATE RELEASE

May 26, 2015                                                                                                                          

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

CMS proposes rule to strengthen managed care for Medicaid and CHIP Enrollees

Proposal will modernize and improve quality of care for Medicaid and CHIP managed care plans

 

Today, the Centers for Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries. This proposed rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage. Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.

 

“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade. This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage,” said Andy Slavitt, Acting Administrator of CMS.

 

Since CMS last issued managed care regulations in 2002 and 2003, the health care delivery landscape has changed and grown substantially. States have expanded managed care to several new populations including seniors and persons with disabilities. The growth of managed care in the Marketplace and Medicare Advantage further highlights the importance of policy alignment when appropriate across programs in order to ease the transition for consumers whose circumstances change during the year.

 

CMS proposes to modernize Medicaid managed care regulations in the following ways:

 

·         Supporting states’ efforts to encourage delivery system reform initiatives within managed care programs that aim to improve health care outcomes and beneficiary experience while controlling costs; and

·         Strengthening the quality of care provided to beneficiaries by strengthening transparency and measurement, establishing a quality rating system, and broadening state quality strategies and consumer and stakeholder engagement;

·         Improving consumer experience in the areas of enrollment, communications, care coordination, and the availability and accessibility of covered services;

·         Implementing best practices identified in existing managed long term services and supports programs;

·         Aligning Medicaid managed care policies to a much greater extent with those of Medicare Advantage and the private market;

·         Strengthening the fiscal and programmatic integrity of Medicaid managed care programs and rate setting;

·         Aligning the CHIP managed care regulations with many of the proposed revisions to the Medicaid managed care rules strengthen quality and access in CHIP managed care programs.  

 

The proposed rule is available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-12965.pdf or https://www.federalregister.gov/public-inspection and can be viewed at https://www.federalregister.gov/articles/2015/06/01/2015-12965/medicaid-and-childrens-health-insurance-program-chip-programs-medicaid-managed-care-chip-delivered

starting June 1. The deadline to submit comments is July 27, 2015.

 

For more information, visit http://medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.  

 

CMS Fact Sheet: http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-05-26.html

585 accountable care organizations

...now operate in the U.S., up from 522 in 2014 and 258 in 2013, according to the consulting firm Oliver Wyman.

"We had the 3Rs to protect the carriers

[from a disproportionate share of high-cost enrollees on public exchanges], but two of the main protections go away in 2017. The uncertainty has been prolonged by the [extension of] transitional policies, and it's not exactly clear when those members will move over and what their health status is compared to the rest. It creates a lot of anxiety for carriers operating in transitional states."

— Hans Leida, principal and consulting actuary at Milliman, Inc., told AIS's Inside Health Insurance Exchanges.

Want More Small Business Clients?

Complete Your SHOP Profile Today!

The Small Business Health Options Program (SHOP) Marketplace makes it easier and more affordable for small businesses to provide insurance to their employees.

Once you’re registered to sell in the SHOP Marketplace, you must establish your profile on the SHOP Agent Broker Portal. Once you’ve established your profile, small employers will be able to authorize you to assist them with their SHOP enrollment.

Agents and brokers in the SHOP Marketplace have access to the SHOP Agent Broker Portal where they can assist with client applications, manage their coverage, and handle other SHOP Marketplace tasks.

Need help? The SHOP Call Center, 1-800-706-7893 (TTY: 711) is available to assist you Monday - Friday 9:00am – 7:00pm ET.   

According to a recent report:

• 10.6% of adults with non-group insurance had zero deductible in 2014, up from 3.6% in 2013
•  For adults with non-group insurance, high deductibles of $1,500 or more per person were reported by 42.8% of those insured in the marketplace,
  compared to 58.3% insured outside the marketplace
•  For adults with non-group insurance, very high deductibles of $3,000 or more per person were reported by 22.5% of those insured in the
  marketplace, compared to 37.5% insured outside the marketplace
•  29.8% of adults with deductibles of $1,500 or more per person, who were insured for a full year, went without needed medical care
  because they could not afford it
• 19.6% of adults with deductibles under $1,500 per person went without needed medical care because they could not afford it

Source: "Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care," Families USA, May 2015, http://familiesusa.org/sites/default/files/product_documents/ACA_HRMSurvey%20Urban-Report_final_web.pdf 

Health Care Spending on Diabetes: 2009-2013

The Health Care Cost Institute recently released an issue brief regarding the financial impact of diabetes from 2009-2013. Here are some key findings from the report:

·         In 2012 diabetes cost $245 billion in direct medical costs in the United States.

·         $14,999 was spent per capita on healthcare for people with diabetes in 2013.

·         Per capita spending for children with diabetes rose 7% from 2011-2012 and 9.6% from 2012-2013.

·         Between 2011 and 2013, children with diabetes had the fastest per capita spending growth

·         People with diabetes spent on average 2.5 times more out of pocket than people without diabetes.

·         The average per capita spending difference between people with and without diabetes was $10,310.

Source: Health Care Cost Institute, May 2015

Texas Reports Year’s First West Nile Case

The Texas Department of State Health Services is reporting the state’s first case of West Nile illness this year and reminding people how to protect themselves from the mosquito-borne virus that causes it.

A patient in Harris County has been diagnosed with West Nile neuroinvasive disease, the more serious form of illness. DSHS won’t release additional personal details in order to protect the patient’s identity. To reduce the chances of a mosquito bite that can transmit West Nile virus, people should

• Use an approved insect repellent every time they go outside and follow the instructions on the label. Among the EPA-approved repellents are those that contain DEET, picaridin, IR3535 and oil of lemon eucalyptus/para-menthane-diol.
• Regularly drain standing water, including water collecting in empty cans, tires, buckets, clogged rain gutters and saucers under potted plants. Mosquitoes that spread West Nile virus breed in stagnant water.
• Wear long sleeves and pants at dawn and dusk when mosquitoes are most active.
• Use air conditioning or make sure there are screens on all doors and windows to keep mosquitoes from entering the home.

“Up to 80 percent of people who contract the virus don’t get symptoms and won’t even know they have it,” said Dr. Tom Sidwa, state public health veterinarian and manager of DSHS’s zoonosis control branch. “But those who do get sick can experience very serious effects ranging from fever to substantial neurological symptoms and even death.”

Symptoms of the milder form of illness, West Nile fever, can include headache, fever, muscle and joint aches, nausea and fatigue. People with West Nile fever typically recover on their own, although symptoms may last for weeks to months. Symptoms of West Nile neuroinvasive disease can include those of West Nile fever plus neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis.

There are no medications to treat or vaccines to prevent West Nile virus infection. People over 50 years old and those with other health issues are at a higher risk of becoming seriously ill or dying when they become infected with the virus. If people have symptoms and suspect West Nile virus infection, they should contact their healthcare provider.

Health officials are also monitoring cases of another mosquito-borne virus, chikungunya. Seven Texas residents have been diagnosed with chikungunya this year. So far, all Texas cases have been acquired by people travelling abroad in areas where the virus is more common, particularly Central and South America. The same precautions apply, and DSHS encourages travelers to take steps to avoid mosquito bites.

Last year, there were 379 human cases of West Nile illness in Texas, including six deaths. DSHS will regularly update case counts at www.dshs.state.tx.us/news/updates.shtm.

-30-

(News Media Contact: Chris Van Deusen, DSHS Press Officer, 512-776-7753)

DSHS on Twitter

This service is provided to you at no charge by the Texas Department of State Health Services.

Visit us on the web at http://www.dshs.state.tx.us/.

U.S. Nursing Home Quality Star Ratings

Kaiser Family Foundation recently released an analysis regarding nursing home ratings under CMS's Five-star Quality Rating System. Here are some key findings from the report:

• Over 1 in 3 nursing homes have low star ratings (1 or 2), accounting for 39% of nursing home residents.
• 45% of nursing homes have overall ratings of 4 or 5 stars, accounting for 41% of all nursing home residents.
• One-third of non-profit homes earn 5 stars compared to 18% of for-profit homes.
• 39% of homes with fewer than 60 beds got 5-stars compared 14% of homes with more than 120 beds.
• States with the most low-rated nursing homes are Texas, Louisiana, Georgia, Oklahoma and West Virginia.
• Two-thirds of all counties in the U.S. have at least one nursing home with a 4 or 5-star rating.

Source: Kaiser Family Foundation, May 14, 2015

According to a recent analysis of 153 clinical registries that collect data on patient outcomes:

• Only 16.2% of the 117 specialty societies of the American Medical Association were affiliated with a registry
• 26.1% of the registries were associated with government funding
• 18.3% of the registries audited data
• 23.5% of the registries risk adjusted outcomes
• Just 2% of registries were associated with mandatory public reporting of hospital outcomes for all participating hospitals

Source: "Prevalence and Data Transparency of National Clinical Registries in the United States." Journal for Healthcare Quality, abstract only, April 24, 2015, http://journals.lww.com/jhqonline/Abstract/publishahead/Prevalence_and_Data_Transparency_of_National.99939.aspx

70% of the HIPAA covered entities

...surveyed by the Ponemon Institute indicated that "employee negligence" is the security threat they worry about the most, followed by "cyber attackers" at 40% and "use of public cloud services" at 33%, according to the institute's Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data. (Up to three responses were permitted.)

The marriage penalty

Tales from PPACA World

May 15, 2015 | By Patrick Brennan

Like a new planet, with metal levels.

Eddie works in a thrift store, and earns just enough to put him a little above the federal poverty limit for a single taxpayer.

One of the people for whom the Patient Protection and Affordable Care Act (PPACA) was intended, he signed up early in 2014, and received a $680 per month “silver” plan for which he paid only $45 out of pocket.

On Dec. 27, Eddie married Jan, a disabled widow he met at work.

Jan is a few years older than Eddie, collects Social Security, and is covered by Medicare. As part of the process of starting his new life, and encouraged by the sense of economic security provided by affordable health insurance, late in November Eddie negotiated the settlement of an outstanding credit obligation. He started 2015 a very happy man.

Then he tried to file his taxes.

First, he discovered that the “write-off” portion of his credit settlement was counted as “income,” although he had actually received none. According to PPACA, Eddie's increased adjusted gross income (AGI) meant he would have to pay “back” (a term Eddie could not understand, since he had never received that money, either) $1,100 of premium tax credits advanced on his behalf.

The issue that hurt the most, however, was Jan's Social Security benefit, which totaled more than $18,000. Although that money is not subject to federal income tax, PPACA counts it as income in calculating premium tax credit eligibility. Added to everything else, it just about eliminated all of Eddie's credits.

It took several trips through the instructions for Form 8962 and IRS Publication 974 to discover and implement the “Alternative Calculation for Year of Marriage,” which effectively nullified the penalty for 2014.

However, Eddie still had to return $1,100 of his 2014 advance premium tax credit, and now pays and additional $100 per month for his insurance plan.

That's the penalty for marrying a Social Security beneficiary on Medicare.

http://www.lifehealthpro.com/2015/05/15/the-marriage-penalty?eNL=555a382b160ba00f739435ee&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=105824905

 

According to a recent survey of registered nurses who use Electronic Health Record systems (EHRs):

• 71% would not consider going back to paper-based medical records
• 72% agreed that EHRs improve patient safety and avoid medication errors
• 43% agreed that EHRs eliminate duplicate work
• 33% agreed that EHRs give nurses more time with patients

Source: "Nurses Agree EHRs Improve Patient Safety," Allscripts News Release, May 6, 2015, http://investor.allscripts.com/phoenix.zhtml?c=112727&p=irol-newsArticle&ID=2044642

According to a recent analysis

Medicare and its beneficiaries spent $103 billion on prescription drugs in 2013; the drug with the greatest total cost was the brand drug Nexium, at $2.5 billion for 1.5 million Medicare patients, who filled 8 million prescriptions and refills.

Source: "Medicare Itemizes Its $103 Billion Drug Bill," Kaiser Health News, April 30, 2015, http://kaiserhealthnews.org/news/medicare-itemizes-its-103-billion-drug-bill/

Texas Outlines Requirements for Blue Bell

May 14, 2015
NEWS RELEASE
Texas Department of State Health Services

 

Texas Outlines Requirements for Blue Bell

Texas health officials today finalized with Blue Bell Creameries the steps the company must take before selling ice cream from its Brenham plant. The company temporarily shut down its operation following the discovery of Listeria monocytogenes in certain ice cream products.

Texas health officials outlined requirements and milestones the company must reach before releasing ice cream into the marketplace. The company agreed to the terms with the state early today.

Blue Bell must notify the Texas Department of State Health Services at least two weeks before its intent to start producing ice cream for sale so health officials can conduct a full assessment of the company’s progress and test results. The company must conduct trial production runs of ice cream that will be tested separately by DSHS and the company for Listeria monocytogenes. The products must consistently test negative before they can be distributed to  the public. A trial run with negative test results must occur for each production line before the line can begin making ice cream for sale.

State health inspectors will be on site at the Brenham plant regularly to evaluate test results and monitor the trial runs. The company will be testing ice cream, ingredients, food surfaces, machinery and other equipment in its Brenham plant for Listeria monocytogenes and allow state health inspectors to review all results.

For at least two years after resuming production, Blue Bell must report any presumptive positive test result for Listeria monocytogenes in a product or ingredient to DSHS within 24 hours. For at least one year after resuming production, Blue Bell must implement “test and hold” procedures for all finished product, meaning products made at the Brenham plant must have negative test results before they can be distributed for sale to the public.

State health officials also are reviewing deep-cleaning procedures, ongoing sanitation processes and training activities at the Brenham plant. Blue Bell has retained an independent expert to oversee sanitation efforts and, as part of the agreement, will conduct root cause analyses to try to determine the sources of contamination.

Texas is working with state and national experts to examine frozen dessert manufacturing and identify changes that may be needed to strengthen regulations to protect public health.

Here is the agreement: http://www.dshs.state.tx.us/news/releases/bluebell.pdf

91% of HIPAA covered entities

that were surveyed suffered a data breach in the last two years, according to the Ponemon Institute's Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data.

Insurers and Wearable Technologies: Trends, Attitudes, and Projections

Accenture recently released their annual Technology Vision for Insurance report. Here are some key findings from the survey:

• 63% of respondents believe that wearable technologies will be adopted broadly by the insurance industry
• Almost one-third said they are already using wearables to engage customers, employees or partners.
• 73% of insurers said that providing a personalized customer experience is one of their top three priorities
• Half claim to already see a positive return from their investment in personalized technologies
• 75% believe the next generation of platforms will be led by insurance players, not technology companies
• Half (51%) said they plan to partner with major digital technology and cloud platform leaders

Source: Accenture, May 5, 2015

Employer Health Care Costs

Employers predict that in 2015, health benefit cost per employee will rise by 4.6 percent on average.
Average total health benefit cost per employee rose 3.9 percent last year to $11,204, an increase from 2.1 percent in 2013.

Source: Mercer

Unless it receives a sudden and substantial cash infusion

Hawaii's insurance exchange will need to shut down and transfer its functions to the state legislature, which recently approved $2 million for the Hawaii Health Connector. That amount is far short of the $10 million the exchange's leaders requested to ensure the entity's sustainability, Pacific Business News reported May 11. The Connector has prepared a contingency plan to close operations by the end of the third quarter. The plan calls for halting new enrollments on Friday, May 15, transferring the technology to the state on Sept. 30 and eliminating the exchange's more than 60 full- and part-time workers, as well as a dozen contractors, by Feb. 28, 2016.

"What we have seen

... [in surveys of health care organizations], in general, is a lot of people who do security are not expert in security."



— Larry Ponemon, chairman and founder of the Ponemon Institute, which conducts an annual Benchmark Study on Privacy & Security of Healthcare Data, told AIS's Report on Patient Privacy.

Today's Datapoint

$103 billion was spent by Medicare on pharmaceuticals in 2013, with the heartburn drug Nexium leading the way at $2.5 billion, CMS showed in its first-ever release of prescriber-level data on April 30.

63% of generic drugs

...declined in cost for the year that ended April 1, 2015, compared with the previous year, while more than a third rose in cost, with a median increase of 15.5%, compared with a median increase of 5.3% for the first calendar quarter of 2015, according to Adam Fein, Ph.D., president of Pembroke Consulting, Inc., who has been tracking generic prices on his Drug Channels blog.

"...compliance officers are not trained

... in human behavior. I was trained as a lawyer — that laws and rules are important. And the reality is, they are important, but compliance programs are really about impacting human behavior and how you get people to do the things you want them to do and to adhere to your definition of right and wrong."

— Daniel Roach, general counsel and chief compliance officer at Optum360, speaking at the Health Care Compliance Association's recent Compliance Institute in Orlando.

According to a recent Gallup poll:

• 43% of Americans say they are satisfied with the work the federal government is doing in healthcare
• In 2013, only 29% said they were satisfied with the government's work in heatlhcare
• In the current poll, 65% of Democrats, 39% of independents and 15% of Republicans indicated they were satisfied with the government's work in healthcare

Source: "Americans' Views of Gov't Handling of Healthcare Up Sharply," Gallup, Inc., May 6, 2015, http://www.gallup.com/poll/183014/americans-views-gov-handling-healthcare-sharply.aspx?utm_source=CATEGORY_HEALTHCARE&utm_medium=topic&utm_campaign=tiles

According to a recent study

there has been a 125% growth healthcare breaches from criminal attacks over the last five years.

Source: "Criminal Attacks: The New Leading Cause of Data Breach in Healthcare, Ponemon Institute Press Release, May 7, 2015, http://www.ponemon.org/blog/criminal-attacks-the-new-leading-cause-of-data-breach-in-healthcare

Healthcare CEO Attitudes Toward Value-Based Care

Modern Healthcare's first quarterly CEO Power Panel survey reveals the opinions of 55 CEOs regarding reimbursement models. Here are some key findings from the report:

• 78% of respondents support moves toward value-based reimbursement models
• One-fifth said that fee-for-service should end entirely
• 2% believe FFS medicine should continue to play the dominant role in healthcare reimbursement
• One-third of respondents said value-based reimbursement models will shrink their margins
• 27% believe value-based reimbursement will shrink their top-line revenue

Source: Modern Healthcare, May 4, 2015

"I think [the SGR fix law that emphasizes quality and value] is a major moment

as far as the push towards value. It's a doubling down of government to say we are moving towards value — yes, fee-for-service is going to go away."



— Dennis Butts, director of value transformation with Navigant Consulting Inc.'s health care practice, told AIS's Value-Based Care News.

86% of employers

... surveyed by the Pharmacy Benefit Management Institute, who cover an estimated 23.5 million enrollees, use prior authorization as their No. 1 strategy for managing specialty drugs in the pharmacy benefit, with clinical care management coming in second at 76%.

Today's Datapoint

22.8 million people in the U.S. gained health insurance coverage between September 2013 and February 2015 and 5.9 million lost coverage, for a net gain of 16.9 million, according to the results of a study released May 6 in Health Affairs.