Saturday, April 30, 2016

40% ...

... of the carriers that sold qualified health plans through public insurance exchanges for 2016 also sell Medicaid managed care coverage in the same state, according to an analysis from the Association for Community Affiliated Plans.

"I do see [short-term health insurance policies] as a serious threat ...

... threat to the stability of the market and am surprised that the big insurers are not more concerned about them."

— Tim Jost, a Washington and Lee University law professor who serves as a consumer advocate at the National Association of Insurance Commissioners, told AIS's Inside Health Insurance Exchanges.

Friday, April 29, 2016

$670 ...

... will be the 2017 dollar-per-month threshold for Medicare Part D specialty drug tier placement, up from a $600 threshold that has been in place since 2008, CMS said in its 2017 Rate Announcement and Call Letter.

The impact of CMS's recent final Medicare Advantage (MA) payment notice and Call Letter ...

... "depends on the composition of your membership. This is a hit of probably somewhere between 2.5% and 4% to plans that have a lot of group retirees [Employer Group Waiver Plans, or EGWPs]. Remember, 19% of MA is in group, and so the EGWP provision really is a big change and I think a lot of the folks in the [Obama] administration viewed that as some corporate welfare that they wanted to start whittling away at.... The risk adjustment piece could be a minor headwind as the plans shift to more encounter data, which is ultimately going to make the risk adjuster a lot more accurate. And by our read it's a big boost for plans with large populations of low-income subsidy and fully dual-eligible beneficiaries."

— John Gorman, founder and executive chairman of Gorman Health Group, told AIS's Health Plan Week.

Simplifying Choices in the Marketplace-Standardized Plan Options and Quality Star Ratings



April 29, 2016

By Kevin Counihan, CEO of & Dr. Patrick Conway, Principal Deputy Administrator of CMS 


Simplifying Choices in the Marketplace-Standardized Plan Options and Quality Star Ratings

It’s hard to believe the fourth year of Open Enrollment for the Health Insurance Marketplaces is just six months away. We’re continuing to learn how to make the consumer experience even better, and have been working hard to make improvements for this year. We’ve learned about what information consumers need to make decisions and how to improve the help and support we provide throughout the enrollment process. Because shopping is so important to make sure consumers have the plan that is right for them, we are making sure consumers have clear, easy-to-understand information. We’re excited to announce some new ways we’re doing that.  We want to layout two new innovations we plan to pilot with in the next year. 

Simple Choice Plans

This year for the first time, consumers will have the option to select “Simple Choice plans”. These are plans that have a uniform set of features – enabling consumers to compare plans on fewer important plan factors like monthly premiums and providers in the plan’s network with the confidence of knowing that the benefits won’t vary from plan to plan.  

We expect these plans will be a core part of the shopping experience on this year.  To improve decision making, Simple Choice plans will display prominently in Plan Compare, with clear visual cues that show consumers the plans that are easy to compare vs. the ones that should be researched for differences.  Consumers also will be able to choose to only see these types of plans, if they want to quickly compare them.  

We will make sure that consumers understand that these plans have a fixed deductible and out-of-pocket limits, and standard copayments within a metal tier (bronze, silver, gold, and platinum). And, for certain services, for instance a primary care appointment, a consumer would pay the same amount in any Simple Choice plan, regardless of the metal tier. These plans emphasize coverage of core services before the consumer has reached their deductible. 

We are testing with consumers display options and descriptions for these plans, so that consumers can best understand what they offer, a clear, easy-to-understand choice.  Importantly, our approach does not stifle innovation so health plans can continue to offer all kinds of benefit options that will also be easy for consumers to find. 

Many of our other consumer tools, such as the physician and prescription drug lookup, as well as the quality ratings discussed below will work together with these plans to help consumers make the most informed decisions they can.  Simple Choice plans will help consumers make apples-to-apples cost-sharing comparisons as they shop, enabling them to choose plans with features they find valuable, such as particular providers or a plan’s experience managing chronic conditions. 

Quality Ratings

In 2014, we began development of the Quality Rating System (QRS) to provide comparable and useful information to consumers about health plans offered through the Marketplace. The information provided through the rating system can inform consumers about the quality of health care services and enrollee experience, as well as assess the overall patient and consumer experience, for health plans offered on the Marketplaces.  

We designed the star rating system with input from health care quality experts and other interested parties to inform the consumer-decision making process.  Star ratings provide health plan quality information on important topics, such as how well physicians coordinate with enrollees and other physicians to provide the best care, whether the plan’s network providers give members health care that achieves the best results, and how other enrollees rate their doctors and the care they receive. 

In the 2017 Open Enrollment period, CMS will pilot the display of star ratings using a 5-star rating scale. The pilot will be in several selected states that use the platform. During this period, we’ll continue testing consumer use and experience and improve the display of quality rating information.  We also have provided the opportunity for state-based Marketplaces to choose to display quality rating information on their websites in the 2017 Open Enrollment period.   

The pilot will include plans in Michigan, Ohio, Pennsylvania, Virginia, and Wisconsin -- states that CMS selected because they have a large number of health plans participating.  As with all quality ratings, they simplify a lot of information and in some cases, consumers would be wise to go beyond what they see here. Piloting the display of QRS star ratings will provide CMS with key feedback to inform the best way to provide quality rating information to consumers nationwide. 
The introduction of Simple Choice plans and quality star ratings are just a few new features that will give consumers the information they may need to find a plan that is right for them and their families. We will continue to listen and learn as we get nearer to the next Open Enrollment period. 

May is National Mental Health Awareness Month



Texas Health and Human Services Commission


Chris Traylor
Executive Commissioner

Date: April 29, 2016

Contact: Bryan Black, 512-424-6951

May is National Mental Health Awareness Month

AUSTIN – The Texas Health and Human Services (HHS) system is working to raise awareness of mental health and the effect mental health has on the lives of all Texans.


May is National Mental Health Awareness Month and HHS agencies will take part in the 2016 Children's Mental Health Awareness Day Walk and Rally starting at 9 a.m., April 30 at the Texas State Capitol south steps, followed by a short march through downtown to Woolridge Square Park where local mental health providers and resources will be on hand to help connect attendees with available services. HHS agencies will also have booths set up in the Capitol throughout the month to provide mental health information to Texans.


"When you treat someone with a mental health condition, you improve the quality of their life and the quality of the lives of their family, friends and co-workers as well," HHS Executive Commissioner Chris Traylor said.


HHS has instituted Mental Health First Aid training for its employees and first responders across the HHS system. The training helps people recognize the signs of someone who needs help and provides guidance on what actions to take to assist.


The HHS system is also working with other state agencies to promote awareness of programs and make sure Texans who need help from different agencies get help.


"We are making great progress bridging the behavioral health gap between state agencies," said Sonja Gaines, associate commissioner for mental health coordination. "Through our efforts, we can expect to see improved awareness, access to care and more efficient, coordinated and effective behavioral services delivered through state funded agencies."


To get help or learn more about mental health symptoms and risks visit

According to a recent report from the CDC, life expectancy in the U.S. in 2014 was as follows:

  • 78.8 years for the total population
  • 76.4 years for males
  • 81.2 years for familes
  • 81.8 years for Hispanics
  • 78.8 years for non-Hispanic whites
  • 75.2 years for non-Hispanic blacks

Source: "Changes in Life Expectancy by Race and Hispanic Origin in the United States, 2013–2014," Centers for Disease Control and Prevention, NCHS Data Brief No. 244, April 2016,

TheStreet: 10 Best Managed-Healthcare Stocks For 2016

1.  United Healthcare Group Inc. - A+    

2.  Aetna Inc. - A+

3.  Cigna - A-

4.  Triple-S Management Corp. - B+

5.  Molina Healthcare Corp. - B+

6.  Magellan Health Inc. - B

7.  Anthem Inc. - B

8.  Centene Corp. - B

9.  Wellcare Health Plans Inc. - B

10. Humana Inc. - B-


Notes: Letter grades reflect TheStreet's value-focused stock rating model



Source: The Street

Thursday, April 28, 2016

3.2% of Children Under Age Five are Uninsured

The Urban Institute recently conducted an analysis of uninsurance rates in children under five years old. Here are some key findings from the report:

·         The share of young children (under 5) without health insurance fell from 13% in 1997 to 3.2% in 2015.

·         As of 2014, 1 million young children were uninsured, down from nearly 3 million in 1997.

·         91.6% of uninsured young children were in families with incomes below 400% FPL in 2014.

·         Young noncitizen children were more than 3 times as likely to be uninsured as citizen children.

·         6.4% of children with noncitizen family members were uninsured, compared to 3.5% with all-citizen families.

·         In 2014, 40.9% of uninsured young children were Hispanic, 41.5% were white, and 11.4% were black.

Source: The Urban Institute, April 19, 2016

Nearly 50% ...

... of providers in five specialties that have a lot of biologics use say they expect to increase their prescribing of biosimilars over the next three years as more of these drugs become available, according to an InCrowd survey.

"There are significant costs to throwing out a ...

...  [state insurance exchange] system that you've spent tens of millions — and in some cases hundreds of millions of dollars — developing. There are a lot of costs related to unwinding and dealing with health plans that are dependent on that old system. There is also a huge political risk. There could be egg on the face of people who propose throwing a $100 million IT system out the window for something better. You want to be able to prove the case that this will be less expensive in the long run. This strategy might be more appealing to a partnership or [federally facilitated exchange] state that is looking to build its own exchange from scratch. They wouldn't face the politics of switching IT systems."

— Jon Kingsdale, Ph.D., the founding executive director in 2006 of the Massachusetts Commonwealth Insurance Connector and now a director at Wakely Consulting in Boston, told AIS's Inside Health Insurance Exchanges.

Wednesday, April 27, 2016

Extending participation in the Bundled Payments for Care Improvement initiative




April 18, 2016

by Dr. Patrick Conway, Acting Principal Deputy Administrator and Chief Medical Officer


Extending participation in the Bundled Payments for Care Improvement initiative


The Centers for Medicare & Medicaid Services is pleased to offer the awardees in the Bundled Payments for Care Improvement (BPCI) initiative the opportunity to extend their participation in Models 2, 3 and 4 through September 30, 2018.


The first cohort of awardees in Models 2, 3, and 4 that began in October 2013 were scheduled to end their participation on September 30, 2016. This extension means that they, along with other organizations that joined later in 2014, have the opportunity to continue their participation in the Bundled Payments for Care Improvement initiative up until September 30, 2018. In addition, by extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending health care dollars more wisely. This would build on the first year evaluation.


As of April 1, 2016, the Bundled Payments for Care Improvement initiative has 1,522 participants, comprised of 321 Awardees and 1,201 Episode Initiators. In Models 2, 3 and 4 there are 48 clinical episodes from which participants are able to choose when considering their opportunities for care redesign, improving quality, and achieving savings.


Bundling payment for services that patients receive across a single episode of care – such as a heart bypass surgery or a hip replacement – is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients, both when they are in the hospital and after they are discharged. The initiative is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality and reduce costs.


We are excited to offer the opportunity for awardees in the Bundled Payments for Care Improvement initiative to continue their participation, and we look forward to further working with them in providing high quality, coordinated care to Medicare beneficiaries.


For more information about the Bundled Payments for Care Improvement initiative, please visit:



Proposed fiscal year 2017 payment and policy changes for Medicare Skilled Nursing




April 21, 2016


Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries



Proposed fiscal year 2017 payment and policy changes for Medicare Skilled Nursing



On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1645-P] outlining proposed Fiscal Year (FY) 2017 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). The FY 2017 proposals and other issues discussed in the proposed rule are summarized below.


The proposed policies in the proposed rule continue to shift Medicare payments from volume to value. The Administration has set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they provide to their patients. The Administration met the goal of tying 30 percent of Medicare payments to care provided in alternative payment models ahead of schedule and is continuing this momentum to reach the goal of tying 50 percent of payments to care provided in alternative payment models by the end of 2018. This proposed rule includes policies that advance that vision and support building a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people. CMS encourages comments, questions, or thoughts on this proposed rule by June 20, 2016.


Changes to Payment Rates under the SNF Prospective Payment System (PPS)

Based on proposed changes contained within this proposed rule, CMS projects that aggregate payments to SNFs will increase in FY 2017 by $800 million, or 2.1 percent, from payments in FY 2016. This estimated increase is attributable to a 2.6 percent market basket increase reduced by 0.5 percentage points, in accordance with the multifactor productivity adjustment required by law.


SNF Quality Reporting Program (QRP)

The Improving Medicare Post-Acute Care Transformation Act of 2014 (P.L. 113-185) (IMPACT Act), enacted on October 6, 2014, requires the implementation of a quality reporting program for SNFs beginning with FY 2018. SNFs that do not submit required quality data to CMS under the SNF Quality Reporting Program (QRP) will be subject to a 2.0 percentage point reduction to their annual updates.


The IMPACT Act requires the continued specification of quality measures for the SNF QRP, as well as resource use and other measures. In order to satisfy the requirements of the IMPACT Act, CMS is proposing one new assessment-based quality measure, and three claims-based measures for inclusion in the SNF QRP. These measures align with the measures proposed for inclusion in the Long Term Care Hospitals (LTCH) QRP and the Inpatient Rehabilitation (IRF) QRP.


Assessment-based measure for the FY 2020 payment determination and subsequent years:

Drug Regimen Review Conducted with Follow-Up for Identified Issues.


Claims-based measures for the FY 2018 payment determination and subsequent years:

  1. Discharge to Community – Post Acute Care (PAC) SNF QRP;
  2. Medicare Spending Per Beneficiary (MSPB) – PAC SNF QRP; and
  3. Potentially Preventable 30 Day Post-Discharge Readmission Measure for SNFs.


The proposed rule further defines the SNF QRP requirements. CMS proposes to use a Calendar Year (CY) schedule for measure and data submission requirements that includes a period for provider review and correction, with quarterly deadlines following each quarter of data submission beginning with data reporting for the FY 2019 payment determinations.  


The IMPACT Act requires that procedures for public reporting of quality and resource use and other measures include a process consistent with the Hospital Inpatient Quality Reporting (IQR) review and correction processes. CMS proposes the following for public display of quality measure data for the SNF QRP, including review and correction periods, and the pre- and public reporting preview period:

  • Align the SNF QRP quarterly reporting timeframes and quarterly review and correction periods for assessment-based measures with the approach followed in the IQR;
  • Align processes related to the review and correction of claims based measures with the approach followed in the IQR; and
  • Apply a 30-day preview period prior to publishing SNF quality data during which corrections to data cannot be made, but SNFs may ask for a correction to their measure calculations.

SNF Value-Based Purchasing Program (VBP)


Section 215 of the Protecting Access to Medicare Act of 2014 (PAMA) added new subsections (g) and (h) to section 1888 of the Social Security Act. The new section 1888(h) of the Social Security Act authorizes the establishment of a Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program beginning with FY 2019 under which value-based incentive payments are made to SNFs based on performance.





This rule proposes to specify the SNF 30-Day Potentially Preventable Readmission Measure, (SNFPPR), as the all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure to meet the requirements of section 1888(g)(2) of the Social Security Act. The SNFPPR assesses the facility-level risk-standardized rate of unplanned, potentially preventable hospital readmissions for SNF patients within 30 days of discharge from a prior admission to a hospital paid under the Inpatient Prospective Payment System, a critical access hospital, or a psychiatric hospital.



Other Policy Proposals


In this proposed rule, CMS is seeking public comments on additional proposals related to the SNF VBP requirements including:

  • Establishing performance standards;
  • Establishing baseline and performance periods;
  • Adopting a performance scoring methodology; and
  • Developing confidential feedback reports.


For More Information


The proposed rule went on display on April 21, 2016, at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at Public comments on the proposed rule will be accepted until June 20, 2016.


For further information, please see:



Helpful Weblinks:

FY 2017 SNF PPS (CMS-1645-P) (PDF) at Federal Register:

And on 04/25/2016 available online at

Seven years ago, Congress passed a law to spur the country ...



April 27, 2016

By: Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services
Dr. Karen DeSalvo, National Coordinator, Office of the National Coordinator for Health IT 

Seven years ago, Congress passed a law to spur the country to digitize the health care experience for Americans and connect doctors’ practices and hospitals, thereby modernizing patient care through the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.” Before this shift began, many providers did not have the capital to invest in health information technology and patient information was siloed in paper records. Since then, we have made incredible progress, with nearly all hospitals and three-quarters of doctors using EHRs. Through the use of health information technology, we are seeing some of the benefits from early applications like safe and accurate prescriptions sent electronically to pharmacies and lab results available from home. But, as many doctors and patients will tell you (and have told us), we remain a long way from fully realizing the potential of these important tools to improve care and health. 

That is why, as we mentioned earlier this year, we have conducted a review of the Meaningful Use Program for Medicare physicians as part of our implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), with the aim of reconsidering the program so we could move closer to achieving the full potential health IT offers.


Over the last several months, we have made an unprecedented commitment to listening to and learning from physicians and patients about their experience with health information technology – both the positive and negative. We spoke with over 6,000 stakeholders across the country, including clinicians and patients, in a variety of local communities. Today, based on that feedback, we are proposing to incorporate the program in to the Merit-based Payment System (MIPS) in a way that makes it more patient-centricpractice-driven and focused on connectivity. This new program within MIPS is named Advancing Care Information.


What We've Learned


In our extensive sessions and workshops with stakeholders, a near-universal vision of health information technology surfaced: Physicians, patients, and other clinicians collaborating on patient care by sharing and building on relevant information.


Three central priorities to address moving forward:

  1. Improved interoperability and the ability of physicians and patients to easily move and receive information from other physician's systems;
  2. Increased flexibility in the Meaningful Use program; and
  3. User-friendly technology designed around how a physician works and interacts with patients. 


This feedback created a blueprint for how we go forward to replace the Meaningful Use program for Medicare physicians with a more flexible, outcome-oriented and less burdensome proposal. 


How We’re Moving Forward

Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology. Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduces burden, and improves patient outcomes because it would:

    • Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice
    • Simplify the process for achievement and provide multiple paths for success
    • Align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria
    • Emphasize interoperability, information exchange, and security measures and require patients to access to their health information through of APIs
    • Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting


  • Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures
  • Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group 

A full list of the operational differences included in this new proposal is available here, along with more details on how it would work. 

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability. 


Under the new law, Advancing Care Information would affect only Medicare payments to physician offices, not Medicare hospitals or Medicaid programs. We are already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well. 

This proposal, if finalized, would replace the current Meaningful Use program and reporting would begin January 1, 2017, along with the other components of the Quality Payment Program. Over the next 60 days, the proposal will be available for public comment. It is summarized here  and the full text is available here . We will continually revise and improve the program as we gather feedback from patients and physicians providing and receiving care under the Advancing Care Information category – and the Quality Payment Program as a whole. We look forward to hearing from you and working together to continue making progress in the coming months and years. 

Where Do The Poor Have The Shortest Life Expectancy?

 1. Gary, Ind. - 74.2

 2. Indianapolis - 74.6

 3. Detroit - 74.8

 4. Louisville, Ky. - 74.9

 5. Tulsa, OK. - 74.9

 6. Toledo, OH - 74.9

 7. Oklahoma City - 75.0

 8. Dayton, OH - 75.1

 9. Knoxville, TN - 75.1

10. Las Vegas - 75.1     


Notes: Data expressed in years



According to a recent report, the average deductible for ...

... people with employer-provided health coverage increased from $303 in 2006 to $1,077 in 2015.

Source: Payments for cost sharing increasing rapidly over time," The Henry J. Kaiser Family Foundation, April 12, 2016,

CMS Adds New Quality Measures to Nursing Home Compare




April 27, 2016


Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries



CMS Adds New Quality Measures to Nursing Home Compare

Largest addition of quality measures to Nursing Home Compare since 2003


Today, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its consumer-based Nursing Home Compare website ( Three of these six new quality measures are based on Medicare-claims data submitted by hospitals, which is significant because this is the first time CMS is including quality measures that are not based solely on data that are self-reported by nursing homes. These three quality measures measure the rate of rehospitalization, emergency room use, and community discharge among nursing home residents. They include:


  1. Percentage of short-stay residents who were successfully discharged to the community (Medicare claims- and MDS-based)
  2. Percentage of short-stay residents who have had an outpatient emergency department visit (Medicare claims- and MDS-based)
  3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission (Medicare claims- and MDS-based)
  4. Percentage of short-stay residents who made improvements in function (MDS-based)
  5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
  6. Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based)


“These new quality measures broaden the set of quality measures already on the site so that patients, their family members, and caregivers have more meaningful information when they consider facilities,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., MSc.


With today’s quality measure updates, CMS is nearly doubling the number of short-stay measures, which reflect care provided to residents who are in the nursing home for 100 days or less, on Nursing Home Compare. CMS is also providing information about key short-stay outcomes, including the percentage of residents who are successfully discharged and the rate of activities of daily life (ADL) improvement among short-stay residents.


Beginning in July 2016, CMS will incorporate all of these measures, except for the antianxiety/hypnotic medication measure, into the calculation of the Nursing Home Five-Star Quality Ratings. CMS is not incorporating the antianxiety/hypnotic medication measure because it has been difficult to determine appropriate nursing home benchmarks for the acceptable use of these medications.


Nursing Home Compare is the agency’s public information website that provides information on how well Medicare- and Medicaid-certified nursing homes provide care to their residents. With today’s update, it now reports information on 24 quality measures for 15,655 nursing home providers on Nursing Home Compare.


For more information on today’s announcement, please visit here:

81% ...

... of diabetes apps for Android phones do not have privacy policies, according to a study published in a recent issue of the Journal of the American Medical Association.

"We're not suggesting the IRS start enrolling people ...

[on public exchanges] or providing assistance or outreach, but [since they can readily identify the uninsured] this seems like too good of an opportunity to pass up.... If a kid is receiving a subsidized school lunch, there should be someone available to reach out to that family and explain there is a high likelihood they are eligible not only for health coverage for that child, but also for adults in the family."

— According to Linda Blumberg, a senior fellow at the Urban Institute and co-author of a new institute report on the uninsured.

Tuesday, April 26, 2016

21% ...

... of the uninsured are eligible for premium subsidies for coverage on public insurance exchanges, according to a new report from the Urban Institute.

"Colonoscopy drives 75% of gastroenterologist revenue...

... and that procedure has a big target on it. The RVU [relative value unit] for colonoscopy was down for this year, and there are alternative screening tools in development. What can we pivot to when our major revenue stream is under pressure?"

— Lawrence Kosinski, M.D., managing partner, Illinois Gastroenterology Group and president of SonarMD LLC, told attendees at the recent National Value-Based Payment and Pay for Performance Summit in San Francisco, sponsored by Global Health Care, LLC.

Asian/Pacific Islanders and Whites More Likely to Have Blood Pressure Controlled than Blacks

Centers for Medicaid and Medicare Services recently released an analysis on racial disparities in healthcare. They compared care and accessability measures from 2014 data. Here are some key findings from the report:

·         82% of Asian/Pacific Islanders (API) got a flu shot, compared to 61.6% of Blacks and 76.4% of Whites.

·         3 in 4 Asian/Pacific Islanders got a colorectal cancer screening, vs. 67.8% of black enrollees.

·         Diabetic Asians/Pacific Islanders and Hispanics were more likely to have blood sugar tested than Whites.

·         79% of Asians/Pacific Islanders and 74% of Hispanics with diabetes had an eye exam in the past year.

·         APIs and Whites (65%) were more likely to have blood pressure controlled than Blacks (52.5%).

·         3 in 4 Asian/Pacific Islanders managed their high cholesterol, vs half of Blacks and 62.9% of Whites.

Source: CMS, April 19, 2016

According to a recent report, which analyzed data from over 300 data security incidents ...

... on which the firm BakerHostetler advised in 2015:

  • 23% of the incidents were from the healthcarre industry
  • Hacking/phishing caused 31% of the incidents
  • Employee mistakes causing 24% of the incidents
  • The average amount of time from incident to discovery for all industries was 69 days, but healthcare took nearly twice as long as other industries
Source: "BakerHostetler Data Security Incident Response Report Reveals Being “Compromise Ready” Better Positions Companies to Respond to Incidents," BakerHostetler Press Release, March 30, 2016,

Monday, April 25, 2016

7% of U.S. Counties Have One Insurer on the Exchange

Kaiser Family Foundation recently conducted an analysis of a UnitedHealthcare's participation in ACA health insurance marketplaces. Here are some key findings on current marketplace distribution from the report:

·         64% of U.S. counties have three more more insurers on the exchange in 2016.

·         Over a quarter (29%) of U.S. counties have two insurers.

·         7% of counties have one insurer on the exchange.

·         Most Americans (85%) are enrolled in counties with three or more insurers.

·         13% are enrolled in counties with two insurers.

·         Counties with one insurer are home to 2% of enrollees.

Source: Kaiser Family Foundation, April 18, 2016