Wednesday, September 30, 2015

As Flu Season Returns, so Does the Need for Flu Vaccine

Texas Influenza Awareness Day is Oct. 1

Flu vaccine is now available in Texas, and the Texas Department of State Health Services reminds people that there is no reason to wait to be vaccinated. The number of flu cases will soon be increasing, so people should protect themselves and their families with flu shots now.

Everyone 6 months old and older should get vaccinated. People age 65 and older, pregnant women, young children and those with chronic health conditions such as asthma, diabetes, heart disease, lung disease or kidney and liver disorders are more susceptible to serious influenza complications, so flu vaccine is especially important for them.

“People in these higher risk groups should also see their health care provider promptly if they do get the flu,” said Dr. Lisa Cornelius, DSHS Infectious Diseases Medical Officer. “A doctor can prescribe antiviral medications that can make the illness shorter and less severe and help prevent complications. Treatment works best if it is started within 48 hours of the onset of symptoms.”

Influenza is an illness caused by one of a number of related viruses. Symptoms usually start abruptly and include fever, body aches, chills, a dry cough, sore throat, runny nose, headaches and extreme fatigue and can last a week or longer.

The flu vaccine is formulated every year to match the flu viruses researchers think will be circulating. Last year, changes in the flu virus caused the vaccine to be less effective. The strain that caused most of the illness last year is incorporated into this season’s vaccine, and researchers expect it to be much more effective.

All flu vaccines this season are made to protect against viruses similar to the strains A/California/7/2009 (H1N1), A/Switzerland/9715293/2013 (H3N2) and B/Phuket/3073/2013. Some vaccines will again provide protection against a fourth strain, B/Brisbane/60/2008.

While getting vaccinated is the best way to prevent the flu, people should also

  • Wash their hands frequently or use alcohol-based hand sanitizers.
  • Cover coughs and sneezes with a tissue or their arm or sleeve.
  • Avoid touching their eyes, nose or mouth.
  • Keep a distance from people who are sick.
  • Stay home if sick.

People can contact their health care provider, local health department or local pharmacy or dial 2-1-1 to find out where flu shots are available. Flu information and tips for protecting against the flu are at


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

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According to a recent global survey, 70% of young

...Millennials (aged 18-24) choose a primary care physician based on recommendations from family and friends, while only 41% of patients over the age of 65 do so.

Source: "The Millennial Patient: New Data Highlights Key Differences Between Millennial and Baby Boomer Healthcare Consumers," Nuance Press Release, August 31, 2015,

Tuesday, September 29, 2015

40% Spend 7 or More Hours Evaluating Health Insurance Options

Valence Health recently released its second 'U.S. Attitudes Toward Health Insurance and Healthcare Reform' study. Here are some key findings from the report:

·         38% of respondents currently receive insurance through an employer, versus 59% in 2013.

·         Nearly 3 in 4 respondents report being very or somewhat satisfied with their current health insurer.

·         40% of consumers spend seven or more hours evaluating their health insurance options.

·         The number of respondents seeking Medicare coverage in 2015 doubled from 12% in 2013 to 24%.

·         21% have an interest in purchasing insurance through a local hospital or health plan.

·         Over 2 in 5 say they've paid less than $100 in out-of-pocket healthcare costs in the last 12 months.

Source: Valence Health, August 25, 2015

68.2% of Physician Owned Hospital Admissions Come from Referrals

The BMJ recently published a comparative analysis on physician owned hospitals. Here are some key findings from the report:

·         More than 250 hospitals in the United States are partly or completely owned by physicians (POH).

·         6.3% of Medicare admissions in each region are at POHs.

·         POHs are more likely than non-POH's to have less than 100 beds.

·         Patients admitted to POHs were 1 year younger than those admitted to non-POHs (77.4 vs 78.4).

·         POHs had more admissions through physician or clinic referral (68.2%) than non-POHs (62.3%).

·         1.8% of POH patients are discharged to hospice care, versus 2.8% of patients at non-POHs.

Source: BMJ, September 2, 2015

Mergers Would Exceed Antitrust Guidelines in 17 States

The American Medical Association recently published an analysis on implications of the potential Anthem-Cigna and Aetna-Humana mergers. Here are some key findings from the report:

·         The mergers would exceed antitrust guidelines in 97 metropolitan areas in 17 states.

·         A significant absence of health insurer competition was found in 70% of metropolitan areas studied.

·         In almost 40% of metropolitan areas, a single health insurer had at least a 50% share of the market.

·         Both mergers would diminish competition in up to 154 metropolitan areas within 23 states.

·         46 states had two health insurers with at least a 50% share of the commercial health insurance market.

·         Alabama has the least competitive insurance market and Louisiana saw the biggest drop in competition.

Source: AMA, September 8, 2015

An Estimated 37,800 Cancer Deaths Will Occur in 2015 Among Hispanics

The American Cancer Society recently released a research article on cancer statistics for Hispanics/Latinos. Here are some key findings from the report:

·         Among Hispanics in 2015, there will be an estimated 125,900 cancer cases diagnosed and 37,800 deaths.

·         For all cancers combined, Hispanics have 30% lower death rates compared with non-Hispanic whites.

·         Cancer is the leading cause of death among Hispanics/Latinos, accounting for 17.4% of the US population.

·         The most common cancers in Hispanic men are prostate (22%), colorectum (11%) and lung (9%).

·         Liver cancer incidence rates in Hispanic men doubled from 1992 to 2012.

·         The most common cancers in Hispanic women are breast (29%), thyroid (9%), and colorectum (8%).

Source: American Cancer Society, September 16, 2015

Space Children 2-5 Years Apart to Decrease Autism Risk

Kaiser Permanente recently conducted a study regarding Autism risk and time between pregnancies (IPIs). Here are some key findings from the report:

·         1 in 68 children have Autism Spectrum Disorder (ASD).

·         Autism was diagnosed in 0.81% of second children following interpregnancy intervals (IPIs) of 3-4 years.

·         For IPIs of six to eight months, autism prevalence was 1.74%.

·         The rate of autism was 1.84% for interpregnancy intervals of six years or more.

·         These findings support the WHO's recommendation of spacing pregnancies a minimum of two years apart.

Source: Kaiser Permanente, September 14, 2015

59% of Medicare Advantage Enrollees Will Face No Premium Increase in 2016

CMS recently announced their 2016 projections for Medicare Advantage rates. Here are some key facts from the report:

·         59% of Medicare Advantage enrollees will face no premium increase in 2016.

·         The average Medicare Advantage premium will decrease by $0.31 in 2016, from $32.91 to $32.60.

·         65% of Medicare Advantage enrollees are enrolled in plans with four or more stars for 2016.

·         From 2010 to 2016, Medicare Advantageenrollment is projected to increase by over 50%.

·         The 17.4 million Medicare Advantage enrollees for 2016 represent 32% of the Medicare population.

·         The basic Medicare prescription drug plan premium in 2016 is projected to remain stable at $32.50/month.

Source: Centers for Medicare & Medicaid Services, September 21, 2015

Monday, September 28, 2015

In the first half of 2015

...the healthcare sector accounted for 21.1% of all data breaches worldwide, down from 29% last year.

Source: "Gemalto Releases Findings of First Half 2015 Breach Level Index," Gemalto Press Release, September 9, 2015,    

Eight Factors That Are Keeping Today's Doctors Stressed, Depressed, and Disengaged

1.    Coping with "big picture changes" is incredibly stressful

2.    Physicians are overworked and sleep deprived

3.    Physicians face downward pressure in compensation, coupled with heavy debt

4.    Many physicians need additional skills beyond great clinical expertise

5.    Patient needs and expectations are changing

6.    Consistently high quality operations are now a must

7.    Physicians want to receive consistent performance feedback

8.    Many feel they spend too little time with patients…too much time doing everything else

Source: Fire Starter Publishing

Premiums for Employer-Sponsored Health Insurance Rose 4% This Year

Kaiser Family Foundation recently released their 2015 Employer Health Benefits Survey. Here are some key findings from the report:

·         Premiums for employer-sponsored health insurance rose an average of 4% this year.

·         Since 2005, premiums have grown an average of 5% per year, compared to 11% annually from 1999-2005.

·         The average annual premium for single coverage is $6,251, of which workers on average pay $1,071.

·         Workers contribute an average $4,955 to the average family premium of $17,545.

·         81% have plans with general annual deductibles, which average $1,318 for single coverage.

·         Since 2010, there has been a 67% increase in health insurance deductibles.

Source: Kaiser Family Foundation, September 22, 2015

CMS announces Part D Enhanced Medication Therapy Management Model




September 28, 2015                                                                                                                          


Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

CMS announces Part D Enhanced Medication Therapy Management Model

Model’s goal is to improve care, reduce costs in Medicare

Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced a model to test strategies to improve medication use among Medicare beneficiaries enrolled in Part D. Medication therapy management, when implemented effectively, can improve health care and outcomes for patients and has the potential to lower overall health care costs. 

The Part D Enhanced Medication Therapy Management (Enhanced MTM) model will assess whether providing selected Medicare Prescription Drug Plans (PDPs) with additional incentives and flexibilities to design and implement innovative programs will better achieve the overall goals for MTM programs, including:

  • improving compliance with medication protocols, including high-cost drugs, ensuring that beneficiaries get the medications they need, and they are used properly;
  • reducing medication-related problems, such as duplicative or harmful prescription drugs, or suboptimal treatments;
  • increasing patients’ knowledge of their medications to better achieve their or their prescribers’ goals of therapy; and
  • improving communication among prescribers, pharmacists, caregivers and patients.


“As part of our approach to building a health care delivery system that results in better care, smarter, spending and healthier people, CMS will test changes to the Part D program to give prescription drug plans stronger incentives and flexibility to improve prescription drug safety and efficacy,” said Patrick Conway, M.D., MSc, CMS acting principal deputy administrator and chief medical officer. “Through this model, we are hopeful that Part D plans will invest in medication therapy management and identify new, effective strategies to optimize medication use and improve care coordination in Medicare.”


The Enhanced MTM model test will begin January 1, 2017 with a five-year performance period.   CMS will test the model in 5 Part D regions:

  • Region 7 (Virginia)
  • Region 11 (Florida),
  • Region 21 (Louisiana),
  • Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and
  • Region 28 (Arizona).


Eligible stand-alone PDPs in these regions can apply to vary the intensity and types of MTM interventions they offer based on beneficiary risk level and seek out a range of strategies to individualize beneficiary outreach and engagement. CMS will waive current MTM program requirements for participating plans in the test regions during the performance period. Participating plans, which are limited to plans offering a basic benefit, are expected to work closely with their network pharmacy providers and local prescribers to accurately identify enrollees whose medication usage has caused, or is likely to cause, adverse outcomes and/or significant non-drug program costs. Beneficiaries who are identified will be contacted by their drug plans, pharmacists, or prescribers and offered targeted assistance in order to optimize medication use and avoid any medication-related problems.



More information about the Enhanced MTM model test can be found in the model announcement, available at Please also save the date for a webinar on the Enhanced MTM model test, to be held on October 21, 2015. Registration information will be available on the same site.


CMS will accept applications for the Enhanced MTM via a Request for Applications (RFA), to be released shortly. Once released, application materials will be available at:

Wednesday, September 23, 2015

"The mistake I see exchange sponsors making in trying to customize the benefit portfolio for each employer that joins the exchange rather than truly creating a storefront. This industry needs to get over the need to customize benefits. Too much customization is a mistake...particularly among employers with fewer than 1,000 lives."

— Scott Carver, president of PlanSource, a provider of cloud-based health exchange and benefits administration software, told AIS's Inside Health Insurance Exchanges.

More than 80%

... of health care executives reported their organizations were compromised by a cyberattack in the past two years, and just 50% felt their organizations were equipped to handle security threats effectively, according to a new study released by KPMG LLP.

According to a recent survey

...the average buyer of an EHR (Electronic Health Record) system spends $117,672 per year on EHR software

Source: "EHR Software Industry Report," Capterra, September 15, 2015,

Monday, September 21, 2015

According to a recent study that matched occupational illness and injury shift scheduling for emergency medical services (EMS) workers, the risk of injury was 60% greater for employees that worked shifts greater than 16 hours and less than or equal to 24 hours in duration, compared to shifts greater than 8 hours and less than or equal to 12 hours in duration.

Source: "An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services," Occupational & Environmental Medicine, abstract only, September 14, 2015,   

Half of 10-17 Year Olds Are Misusing Their Prescription Medications

Quest Diagnostics recently released their Health Trends[R] study, Prescription Drug Misuse in America: Diagnostic Insights in the Continuing Drug Epidemic Battle. Here are some key findings from the report:

·         1 in 2 patients between the ages of 10 and 17 years are not using their medications appropriately.

·         In 2011, 70% of adolescents showed evidence of prescription drug misuse.

·         The overall rate of prescription drug misuse for all ages was 53% in 2014, compared to 63% in 2011.

·         In adults aged 30 and older, the two drug groups most likely to be misused were oxycodone and opiates.

·         Patients who did not take their medications consistently increased from 40% in 2011 to 44% in 2014.

·         35% of patients in 2014 combined drugs without a clinician's oversight, compared to 32% in 2011.

Source: Quest Diagnostics, September 10, 2015

Medicare Advantage premiums remain stable; enrollment at all-time high



September 21, 2015

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries



Medicare Advantage premiums remain stable; enrollment at all-time high

Seniors and people with disabilities will have continued access to a wide range of Medicare health and drug plans in 2016


Today, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare Advantage premiums will remain stable and more enrollees will have access to higher quality plans while, for a sixth straight year, enrollment is projected to increase to a new all-time high. In addition, CMS released today new information that shows that millions of seniors and people with disabilities with Medicare continue to enjoy prescription drug discounts and affordable benefits as a result of the Affordable Care Act. Today’s announcement comes as CMS releases the premiums and costs for Medicare health and drug plans for the 2016 calendar year.


CMS estimates that the average Medicare Advantage premium will decrease by $0.31 next year, from $32.91 on average in 2015 to $32.60 in 2016. The majority of Medicare Advantage enrollees (59 percent) will face no premium increase. 

“Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans while benefiting from a transparent and competitive marketplace,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare Advantage and prescription drug plans remain affordable and provide high quality care.”  

Access to the Medicare Advantage program will remain strong, with 99 percent of beneficiaries having access to a plan. In addition, in 2016, more Medicare Advantage plans will offer supplemental benefits for enrollees, such as dental, vision and hearing benefits. Between 2010, when the Affordable Care Act was enacted, and 2016, premiums are expected to decrease by nearly 10 percent and enrollment is projected to increase by more than 50 percent to approximately 17.4 million enrollees, which represents about 32 percent of the Medicare population. At the same time, beneficiaries are receiving higher quality care. About 65 percent of Medicare Advantage enrollees are currently enrolled in plans with four or more stars for 2016, a significant increase from an estimated 17 percent of enrollees in such plans in 2009.  

Premiums in the Medicare Prescription Drug Program (Part D) will also be stable next year. Earlier this year, CMS announced that the average basic Medicare prescription drug plan premium in 2016 is projected to remain stable at $32.50 per month. Because of the Affordable Care Act, people with Medicare are seeing reduced costs through both savings on covered brand-name and generic drugs and access to certain preventive services at no cost sharing. Since the passage of the Affordable Care Act, which closes the prescription drug “donut hole” over time, more than 9.8 million people with Medicare have saved over $17.6 billion on prescription drugs through July 2015 as a result of the discounts in the donut hole and rebates in 2010, for an average of $1,796 per beneficiary.  

Quality in Part D continues to be robust, with close to 50 percent of prescription drug plans receiving four or more stars. These plans serve about one-third of prescription drug plan enrollees, compared to 27 percent of enrollees in plans with four or more stars in 2009. CMS calculates star ratings from one to five (with five being the best) based on quality and performance for Medicare health and drug plans to help beneficiaries, their families, and caregivers compare plans.  

The Annual Election Period for Medicare health and drug plans begins on October 15, 2015 and ends December 7, 2015. Plan costs and covered benefits can change from year-to-year. Medicare beneficiaries should look at their coverage choices and decide what options best meet their needs. Beneficiaries who need assistance can visit, call 1-800-MEDICARE, or contact their State health Insurance Assistance Program (SHIP). Beneficiaries who are satisfied with their current coverage do not need to do anything.  

For more information on the premiums and costs of 2016 Medicare Advantage and Part D plans, please visit:  

For more information on Medicare Open Enrollment, including state-by-state fact sheets, please visit:  

For a fact sheet on Medicare Advantage and Part D, please visit:  

For state-by-state information on discounts in the donut hole, please visit:

For state-by-state information on utilization of preventive services at no cost sharing to beneficiaries in Medicare, please visit:


... is the projected increase in specialty pharmacy costs for 2015, with overall pharmacy costs rising 10%, according to a recent survey of health care vendors by Aon Hewitt.

Friday, September 18, 2015

$1.6 million

... will be repaid to BCBS of Vermont by the state's exchange, Vermont Health Connect, in connection with claims made on retroactively cancelled plans, the two sides agreed recently.

9.9 Million Consumers Have Health Insurance Marketplace Coverage

CMS recently released their snapshot of effectuated enrollment as of June 30, 2015. Here are some key findings from the report:

·         On June 30, 9.9 million consumers had effectuated Health Insurance Marketplace coverage.

·         84% were receiving an advanced premium tax credit (APTC) to make premiums more affordable.

·         The average APTC for those enrollees who qualified for the financial assistance was $270 per month.

·         1% enrolled in Catastrophic, 21% in Bronze, 68% in Silver, 7% in Gold, and 3% in Platinum plans.

·         7.2 million consumers enrolled through the 37 Federally-Facilitated Marketplaces.

·         The remaining 2.7 million enrolled through State-based Marketplaces.

Source: CMS, September 8, 2015

Wednesday, September 16, 2015


... of the commercial individual market, including coverage sold via public exchanges, is served by Blue Cross and Blue Shield plans, according to AIS's Directory of Health Plans

More than 16,000

... Medicaid beneficiaries (of the 5.4 million studied) potentially engaged in "doctor shopping" in 2011 to obtain prescriptions for antipsychotic and respiratory medications worth about $33 million, according to a recent U.S. Government Accountability Office review of Medicaid drug claims in four high-spending states, which concluded that increased reporting on lock-in programs may help strengthen CMS's efforts to monitor potentially wasteful or abusive practices.

$83 million

... is owed to consumers by Blue Shield of California under the ACA's medical loss ratio provisions, as the insurer spent just 77% of premium revenue on claims rather than 80%, the San Francisco Business Times reported.