Tuesday, February 28, 2017

Cardiovascular Disease Will Cost $1.1 Trillion by 2035

The American Heart Association recently released a study on the nation-wide impact of cardiovascular disease. Here are some key findings from the report:

The US spent $555 billion on cardiovascular disease (CVD) in 2016.
Costs from CVD are expected to reach $1.1 trillion by 2035.
The number of Americans with CVD will rise to 131.2 million by 2035.
By 2035, there will be 123.2 million Americans with high blood pressure.
Cardiovascular disease risk is 50% at age 45 and 80% at age 65.
11.2 million Americans are projected to suffer from stroke in 2035.

Source: American Heart Association, February 14, 2017

Monday, February 27, 2017

How to protect your client and business data

One key step: Stick with trusted IT vendors to implement encryption

Feb 27, 2017 | By Ed McCarthy

How safe is your data?

It’s a question that financial services regulators are asking advisors more frequently, and it’s not just a compliance issue. If your clients’ data files are breached, they could become identify theft victims, as could your employees if their personnel records are hacked. A significant data theft can damage your business’s reputation, as well.

An effective cybersecurity program requires constant diligence. Two steps you should consider are encrypting your data, and managing user permissions more actively. These actions can help improve your cybersecurity quickly and inexpensively.

When it comes to technology implementation, independent insurance agencies lag behind the financial services industry.

Cracking the code?

Many financial services firms use a hybrid data storage model in which data are stored both in the cloud and on-site, depending on the application and the data. Even with the growing shift to cloud-based storage and software as a service (SaaS), however, it’s likely that some sensitive data still resides locally in your office network. These records could include clients’ health records, financial information, or Social Security numbers and you may be storing employees’ personnel records locally, as well. There’s also other confidential information about your business: financial and tax information, client lists, correspondence and marketing plans, for instance.

Local data are at risk from internal sources — think disgruntled employee who wants to start his own firm — and external sources who are trying to penetrate your network. Encrypting your local data adds a layer of protection, says Ryan Castle, executive vice president with Trace Security in Baton Rouge, Louisiana. “Even if they are able to steal the data, they aren’t going to be able to read it unless they can decrypt it.”

The mathematics behind encryption technology is complex, but the result is straightforward. Encryption uses a formula to scramble (encrypt) data so they look like random characters. Unscrambling (decrypting) the data requires the use of an alphanumeric key; without the key, unauthorized persons can’t decrypt the underlying files.

Encryption strategies

You can take multiple approaches to encryption. At the hard disk level, users must enter a password or key to decrypt the device before they can use it. This method protects the disk’s data in case the hard drive is stolen, says Castle, and he typically recommends this method for organizations with laptops or other take-home devices. David Damiani, CFA, chief financial officer with wealth managers Balentine LLC in Atlanta, Georgia, says that his firm generally avoids storing data locally. As a safeguard, though, the firm’s laptops use BitLocker encryption software that is included in Microsoft Windows 10.

Another protective measure is to additionally protect specific files, a method known as encryption at rest, says Castle. This provides two layers of protection: Users must first decrypt the hard disk when logging in and then provide the file-specific password or key to open the file. “If you left your computer on and unlocked and someone walked into your office and said, ‘I want to open up this file that has customer information,’ it would prompt them for a password or some way to have to decrypt it,” Castle explains. “Or if someone was to hack your system and get remote access and the hard disk was unlocked, they still couldn’t read that specific file.”

Running through the complicated mathematics to provide encryption does decrease a computer’s performance, but the impact usually isn’t significant with today’s processors, Castle notes. For example, when an encrypted laptop drive is unlocked, it functions as an unencrypted drive.

Don’t get permissive

A second good practice is to actively track user permissions on your network. This involves deciding which staff members should have access to which files and then monitoring and reviewing their usage. Castle recommends adopting the principle of least privilege. If a user needs access to data or some other elevated privilege, what is the minimum level of privilege required to do the tasks and how long will they need that privilege?

Castle cites the example a network administrator or other IT staff member who requires permissions to modify routers, firewalls or other networking equipment. But that person probably doesn’t need the ability to install software on a user’s workstation or access details in the human resources database, for instance. Applying that approach to each staff member’s access permissions for local and cloud-based data can help block attempts — both internal and external — to steal sensitive data.

This approach integrates well with encryption. Even if an unauthorized user gains access to sensitive data files at the system level, if the files are encrypted, that access will be worthless unless the user also has the decryption key. For example, network administrators can need the ability to move files around the system but they don’t need to decrypt those files.

One school of thought on integrating encryption and permissions is to limit privileged users’ access to only encrypted data. That tactic isn’t intended as a judgement on the user’s integrity — it’s a recognition that hackers regularly target privileged accounts because they are the golden ticket for undetected network access. Should an unauthorized user gain access to a privileged user’s account, an encrypted-file-only access policy can mitigate the breach damage.

The second part of permissions management is to regularly monitor and audit user accounts to determine who is accessing privileged accounts and how they are using them. If an employee changes jobs within the organization, does she still need the same level of permissions or can it be scaled back? Firms should regularly “conduct these audits of these privileged accounts to make sure that not only are they only providing the least amount of privilege necessary, but that they’re actually assigned to people who actually have a need for that access,” says Castle.

Balentine LLC implements the least privilege approach through compartmentalization, says Damiani. Employees’ network access is limited to what they need and the firm uses software to monitor usage. If an employee downloads an amount of data significantly greater than her normal volume, for instance, management receives an automated alert.

If an employee “has been here three years and has never once downloaded more than six megabytes of data in a given day to do her work, (and) all of a sudden there’s 17 gigs going out overnight, we’re going to be alerted… there’s an outlier,” Damiani explains.

Doing it right

Castle shares two other suggestions for better encryption and privileged account management. The first is to ensure that all users, and especially privileged accounts, maintain strong passwords and change them regularly. He also cautions against do-it-yourself encryption programs, maintaining that it is “really hard to do right.” Stick with trusted IT vendors to implement encryption, he suggests, otherwise its use can convey a false sense of security.

Health insurers optimistic after meeting with Trump

By Shelby Livingston  | February 27, 2017


After meeting with President Donald Trump at the White House early Monday, the CEOs of several large health insurers were optimistic about the future of the health insurance industry if the Affordable Care Act is repealed and replaced. The executives discussed plans to stabilize the individual insurance market.

CEOs of Aetna, Anthem, Cigna Corp., Humana, UnitedHealth, Kaiser Permanente and several Blue Cross Blue Shield companies attended the meeting. Industry lobbying group America's Health Insurance Plans, was also in attendance.

A Molina Healthcare spokeswoman said the Long Beach, Calif.-based insurer, which provided marketplace coverage to 526,000 people in 2016, was not invited to attend and did not know why. Molina lost $110 million from the plans it sold on the marketplaces in 2016.

WellCare, which does not sell plans on the exchanges but has benefited from the Medicaid expansion under the ACA, also didn't attend. The handful of health insurance co-ops established by the ACA that have not yet folded were also not in attendance.

The meeting offered health insurers a chance to discuss their concerns surrounding the future of the ACA and its replacement plan. Many insurers, including Anthem, Aetna and Molina, have said they can't commit to participating in the ACA exchanges in 2017 until they know what regulation will look like after the health care law is dismantled.

During the meeting, Trump called the ACA's health insurance exchanges “disastrous,” adding that the market is “going to absolutely implode.” He said this would be a “catastrophic” year for the ACA, which has extended health insurance coverage to 20 million Americans.

But, he assured them that a "fantastic" replacement plan is on the way that will lower costs and improve healthcare.

The rest of the talk with insurers took place behind closed doors, but after the meeting, insurers said they were optimistic about the future of the healthcare landscape.

“Everyone who took part in today's meeting shares a common goal—ensuring every American has access to affordable health care,” Aetna CEO Mark Bertolini said in a statement. “We look forward to continuing to work with the administration and both parties in Congress on a broader range of solutions that Americans will find valuable in managing their health care needs.”

"We're very glad to be with (Trump) today to hear that message and certainly willing and wanting to witness how this all will transition to a workable plan for the United States," Anthem CEO Joe Swedish told reporters after the meeting, CNN reported.

“The Administration has taken several recent steps to demonstrate its commitment to a stable, effective transition that works for consumers, and we look forward to Congress taking additional, much-needed action soon,” AHIP said in a statement. The lobbying group said it discussed at the meeting ways to deliver short-term stability and long-term improvement in the insurance market.

Consumer advocacy groups weren't convinced. Families USA, which represents health care customers, said Trump's plan to dismantle the ACA without an adequate replacement would leave Americans “once again to the mercies of the insurance executives the President chose to meet with.”

Insurers have been vocal about changes they hope to see to balance out and strengthen the individual market, which is dominated by members that are older, sicker and use more healthcare than insurers initially expected. The young, healthy members needed to stabilize the pool haven't shown up. So insurers—saddled with high medical claims— have raised insurance premiums to compensate.

Some insurers, like Centene and Molina, have fared much better on the exchanges and are poised to break even. Even so, many of the major players in the marketplaces who have sustained millions in losses from those plans have warned that if they don't soon get the details they need to set 2018 premiums, they may reevaluate whether they will play ball.

Others have already called it quits. Humana earlier this month announced it would no longer sell exchange plans next year. Aetna last month said it has no intention of re-entering the exchanges in any of the 11 states it exited earlier this year. UnitedHealth this year is selling exchange plans in just a handful of states, down from 34 states in 2016.

Initially, insurers had until May 3 to file 2018 exchange plan applications and rates. But in a move to ease insurers' anxiety over the deadlines and prevent more from exiting the marketplace, the Trump administration last week moved that deadline back to June 21. The extension is a small gesture that doesn't do anything to resolve uncertainty in the long-term stability of the market, insurers said.

The administration has also released a proposed rule meant to help stabilize the insurance market, but its small, short-term fixes failed to address most of the insurers' most pressing concerns.

Insurers are asking for assurances that the GOP-controlled Congress will keep the individual mandate and premium subsidies in place. Molina's CEO told Modern Healthcare earlier this month that scrapping the ACA's cost-sharing reductions and premium subsidies that help people afford their health insurance plans would be a deal breaker for the insurer.

They also want the administration to pay the more than $8 billion it owes them in risk corridor payments. The absence of those funds, meant to protect insurers from major losses during the first few years of the exchanges, has led to the failure of the co-ops and prompted several insurers to sue for payment.


2016-2025 Projections of National Health Expenditures Data Released

CMS News

February 15, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

2016-2025 Projections of National Health Expenditures Data Released

National health expenditure growth is expected to average 5.6 percent annually over 2016-2025, according to a report published today as a ‘Web First’ by Health Affairs and authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT). These projections are constructed using a current-law framework and do not assume potential legislative changes over the projection period.

National health spending growth is projected to outpace projected growth in Gross Domestic Product (GDP) by 1.2 percentage points. As a result, the report also projects the health share of GDP to rise from 17.8 percent in 2015 to 19.9 percent by 2025. Growth in national health expenditures over this period is largely influenced by projected faster growth in medical prices compared to recent historically low growth. This faster expected growth in prices is projected to be partially offset by slowing growth in the use and intensity of medical goods and services.

According to the report, for 2016, total health spending is projected to have reached nearly $3.4 trillion, a 4.8-percent increase from 2015. The report also found that by 2025, federal, state and local governments are projected to finance 47 percent of national health spending, a slight increase from 46 percent in 2015.

“After an anticipated slowdown in health spending growth for 2016, we expect health spending growth to gradually increase as a result of faster projected growth in medical prices that is only partially offset by slower projected growth in the use and intensity of medical goods and services,” says Sean Keehan, the study’s first author. “Irrespective of any changes in law, it is expected that because of continued cost pressures associated with paying for health care, employers, insurers, and other payers will continue to pursue strategies that seek to effectively manage the use and cost of health care goods and services.”  

Additional findings from the report:

  • Total national health spending growth: Growth is projected to have been 4.8 percent in 2016, slower than the 5.8 percent growth in 2015, as a result of slower Medicaid and prescription drug spending growth. In 2017, total health spending is projected to grow by 5.4 percent, led by increases in private health insurance spending. National health expenditure growth is projected to be faster and average 5.8 percent for 2018-2025 largely due to expected faster spending growth in both Medicare and Medicaid. 

  • Medicare: Medicare spending growth is projected to have been 5.0 percent in 2016 and is expected to average 7.1 percent over the full projection period 2016-2025. Faster expected growth after 2016 primarily reflects utilization of Medicare covered services increasing to approach rates closer to Medicare’s longer historical experience. This results in Medicare spending per beneficiary growth of 4.1 percent over 2016-2025 (compared to 1.6 percent growth for 2010-2015). 

  • Private health insurance: Spending growth is projected to have slowed from 7.2 percent in 2015 to 5.9 percent in 2016, a trend that is related to slower growth in private health insurance enrollment. Spending growth is projected to increase to 6.5 percent in 2017, due in part to faster premium growth in Marketplace plans related to previous underpricing of premiums and the end of the temporary risk corridors.

  • Medicaid: Projected spending growth slowed significantly in 2016 to 3.7 percent, down from 9.7 percent in 2015, largely reflecting slower growth in Medicaid enrollment. Spending growth is expected to accelerate and average 5.7 percent for 2017-2025 as projected per-enrollee spending growth rises over that timeframe. Underlying the faster per enrollee growth is the increasingly larger share of the Medicaid population who are aged and disabled and who tend to use more intensive services.

  • Medical price inflation: Medical prices are expected to increase more rapidly after historically low growth in 2015 of 0.8 percent to nearly 3 percent by 2025. This faster projected growth in prices is influenced by an acceleration in both economy-wide prices and medical specific prices and is projected to be partially offset by slowing growth in the use and intensity of medical goods and services.

  • Prescription drug spending:  Drug spending growth is projected to have been 5.0 percent in 2016, following growth of 9.0 percent in 2015, mainly due to slowing use of expensive drugs that treat Hepatitis C. Growth is projected to average 6.4 percent per year for 2017-2025, influenced by higher spending on expensive specialty drugs.

  • Insured Share of the Population: The proportion of the population with health insurance is projected to increase from 90.9 percent in 2015 to 91.5 percent in 2025.

An article about the study also being published by Health Affairs here: http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2016.1627

39.1% of Adults Had A High-Deductible Health Plan in 2016

The National Center for Health Statistics recently released estimates from their 2016 National Health Interview Survey on health insurance coverage. Here are some key findings from the report:

In 2016, 28.2 million (8.8%) persons of all ages were uninsured.
20.4 million fewer persons were uninsured in 2016 than in 2010.
20.3% of adults had public coverage and 69% had private coverage in 2016.
In 2016, 43.4% of children had public coverage and 53.5% had private coverage.
4.9% of adults had coverage through the Marketplace or state exchanges.
Those with high-deductible health plans increased from 36.7% in 2015 to 39.1%.

Friday, February 24, 2017

68% of Employers Believe Health Benefit Plans Affect Their Reputations

A study by the Healthcare Trends Institute found that 68% of employers believe health benefit plans affect their reputations and can raise employee morale and satisfaction. Three-quarters of respondents said that attracting and retaining quality talent was a desired outcome, and a majority (67%) said improvements to employee health were a major consideration.

HR Dive

Market Saturation and Utilization Data Tool

CMS News

February 23, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool, formerly called the Moratoria Provider Services and Utilization Data Tool, that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of the beneficiaries receiving that service in the area.

The fourth release of the data tool includes a quarterly update of the data to the eight health services areas from release 3, and also includes Physical and Occupational Therapy and Clinical Laboratory (Billing Independently) data. Release 4 will therefore include four, twelve-month reference periods and the following health service areas: Home Health, Ambulance (Emergency, Non-Emergency, Emergency & Non-Emergency), Independent Diagnostic Testing Facilities (Part A and Part B), Skilled Nursing Facilities, Hospice, Physical and Occupational Therapy, and Clinical Laboratory (Billing Independently).

The Market Saturation and Utilization Data Tool can be used by CMS to monitor and manage market saturation as a means to prevent fraud, waste, and abuse.  The data can also be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region. Provider services and utilization data by geographic regions are easily compared using an interactive map. There are a number of research uses for these data, but one objective of making these data public is to assist health care providers in making informed decisions about their service locations and the beneficiary population they serve. The tool is available through the CMS website at: https://data.cms.gov/market-saturation. Future releases may include comparable information on additional health service areas.


The analysis is based on paid Medicare claims data from the CMS Integrated Data Repository (IDR). The IDR contains Medicare and Medicaid claims, beneficiary data, provider data, and plan data. Claims data are analyzed for a 12-month reference period, and results are updated quarterly to reflect a more recent 12-month reference period.

The Market Saturation and Utilization methodology is different from other public use data with respect to determining the geographic location of a provider. In this analysis, claims are used to define the geographic area(s) served by a provider rather than the provider’s practice address. Further, a provider is defined as “serving a county” if, during the 12-month reference period, the provider had paid claims for more than ten beneficiaries located in a county. A provider is defined as “serving a state” if that provider serves any county in the state.

The Market Saturation and Utilization methodology is also different from other public use data with respect to determining the number of Medicare beneficiaries who are enrolled in a fee-for-service (FFS) program. In this analysis, a FFS beneficiary is defined as being enrolled in Part A and/or Part B with a coverage type code equal to “9” (FFS coverage) for at least one month of the 12-month reference period. There must not be a death date for that month or a missing zip code for the beneficiary so that the beneficiary can be assigned to a county. Other public use data may define a FFS beneficiary using different criteria, such as requiring the beneficiary to be enrolled in the FFS program every month during the reference period.

The Market Saturation and Utilization Data Tool includes an interactive map that is color-coded based on an analysis that separates the distribution into the following categories of states/counties for the selected metric: lowest 25 percent, second lowest 25 percent, third lowest 25 percent, top 25 percent excluding extreme values, and extreme values.  An extreme value is one that greatly differs from other values in its field (e.g., Number of Providers). For those interested in states and counties affected by CMS’ temporary provider enrollment moratoria during the reference periods for which data are available, the interactive map permits a visualization that identifies those states and counties. In this visualization, ambulance and home health service areas for moratoria versus non-moratoria states/counties are also identified based on color scheme. Counties that are excluded from the analysis are colored gray in the interactive map.

The examples below utilize the Ambulance (Emergency & Non-Emergency) service area data (selected for illustration purposes only). Similar maps can be created through the Data Tool for all of the health service areas included in the fourth release and for the four, twelve-month reference periods: 2014-10-01 to 2015-09-30, 2015-01-01 to 2015-12-31, 2015-04-01 to 2016-03-31, and 2015-07-01 to 2016-06-30.

Map 1 displays the distribution of providers by state for the Ambulance (Emergency & Non-Emergency) service area for the October 1, 2014 through September 30, 2015 reference period. This map utilizes a single color scale, which does not distinguish between moratoria and non-moratoria states.

Map 1. Ambulance (Emergency & Non-Emergency):
National Distribution of Number of Providers
October 1, 2014 – September 30, 2015
Single Color Scale

Figure 1

Map 2 displays the distribution of providers by state for the October 1, 2014 through September 30, 2015 reference period. This map utilizes a dual color scale, which distinguishes between moratoria and non-moratoria states.

Map 2. Ambulance (Emergency & Non-Emergency):
National Distribution of Number of Providers
October 1, 2014 – September 30, 2015
Color by Moratoria Status

Figure 2

Map 3 drills down to the county level and displays the distribution of providers by county within the State of Texas for the October 1, 2014 through September 30, 2015 reference period. This map utilizes a single color scale, which does not distinguish between moratoria and non-moratoria counties. 

Map 3. Ambulance (Emergency & Non-Emergency):
County Distribution of Number of Providers
October 1, 2014 – September 30, 2015
Single Color Scale

Figure 3

Map 4 drills down to the county level and displays the distribution of providers by county within the State of Texas for the October 1, 2014 through September 30, 2015 reference period. This map utilizes a dual color scale, which distinguishes between moratoria and non-moratoria counties.

Map 4. Ambulance (Emergency & Non-Emergency):

County Distribution of Number of Providers
October 1, 2014 – September 30, 2015
Color by Moratoria Status

Figure 4

Similar maps can be created at the national- and state-level for the other metrics included in the Data Tool: Number of FFS Beneficiaries, Average Number of Users per Provider, Percentage of Users out of FFS Beneficiaries, and Average Number of Providers per County.

Richmond, VA Has 221.5 Mental Health Counselors Per 100,000 Residents

WalletHub recently conducted an analysis on the healthiest cities in America. Here are some key findings from the report:

Richmond, Va. has the most mental-health counselors at 221.5/100,000 residents.
Jacksonville, Fla. has the lowest cost per doctor's visit at $68.
San Francisco has the lowest share of adults not eating fruits daily at 32.5%.
Portland, Ore. has the most gluten-free restaurants at 12.3/100,000 residents.
Durham, N.C., has the most nutritionists at 46.8 per 100,000 residents.
Tallahassee, Fla., has the most walking trails at 80.2 per 1,000 residents.

Source: WalletHub, February 13, 2017

Tuesday, February 21, 2017

Avoidable Admissions are 4x Higher for Lowest-Wage Employees

Health Affairs recently published an article on employee health spending relative to income level. Here are some key findings from the report:

Annual healthcare spending per patient was $4,835 for the lowest-wage group.
19% in the lowest-wage group used preventive care, versus 38% in the highest.
Lowest-wage employees had 31 hospital admissions per 1,000 versus 17/1,000.
Low earners had 4x the rate of avoidable admissions (4.3/1,000 vs. 0.9/1,000).
ER visits were 3x higher for lowest-wage employees (370/1,000 vs. 120/1,000).
Annual healthcare spending per patient was $5,074 for the highest-wage group.

Source: Health Affairs, February 2017

Friday, February 17, 2017

CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

CMS News

February 15, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services.  “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

The rule proposes a variety of policy and operational changes to stabilize the Marketplace, including:

  • Special Enrollment Period Pre-Enrollment Verification: The rule proposes to expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods in Marketplaces using the HealthCare.gov platform. This proposed change would help make sure that special enrollment periods are available to all who are eligible for them, but will require individuals to submit supporting documentation, a common practice in the employer health insurance market. This will help place downward pressure on premiums, curb abuses, and encourage year-round enrollment.
  • Guaranteed Availability: The rule proposes to address potential abuses by allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer. This will incentivize patients to avoid coverage lapses.
  • Determining the Level of Coverage: The rule proposes to make adjustments to the de minimis range used for determining the level of coverage by providing greater flexibility to issuers to provide patients with more coverage options.
  • Network Adequacy: The proposed rule takes an important step in reaffirming the traditional role of states to serve their populations. In the review of qualified health plans, CMS proposes to defer to the states’ reviews in states with the authority and means to assess issuer network adequacy. States are best positioned to ensure their residents have access to high quality care networks.
  • Qualified Health Plan (QHP) Certification Calendar: In the rule, CMS announces its intention to release a revised proposed timeline for the QHP certification and rate review process for plan year 2018. The revised timeline would provide issuers with additional time to implement proposed changes that are finalized prior to the 2018 coverage year. These changes will give issuers flexibility to incorporate benefit changes and maximize the number of coverage options available to patients.
  • Open Enrollment Period: The rule also proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, we propose an open enrollment period of November 1, 2017, to December 15, 2017.  This proposed change will align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare, and help lower prices for Americans by reducing adverse selection. 

CMS awards approximately $100 million to help small practices succeed in the Quality Payment Program

CMS News

February 17, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

CMS awards approximately $100 million to help small practices succeed in the Quality Payment Program
New helpline launched to provide additional support

Today, the Centers for Medicare & Medicaid Services (CMS) awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. CMS intends to invest up to an additional $80 million over the remaining four years.

These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available immediately, nationwide, and will be provided at no cost to eligible clinicians and practices.

“Clinicians in small and rural practices are critical to serving the millions of Americans across the nation who rely on Medicare for their health care,” said Dr. Kate Goodrich, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality. “Congress, through the bipartisan Medicare Access and CHIP Reauthorization Act, recognized the importance of small practices and rural practices and provided the funding for this assistance, so clinicians in these practices can navigate the new program, while being able to focus on what matters most -- the needs of their patients.” 

The selected organizations will provide customized technical assistance to clinicians and practices to help them be successful in the Quality Payment Program. For example, clinicians will receive help choosing and reporting on quality measures, as well as guidance with all aspects of the program, including supporting change management and strategic planning and assessing and optimizing health information technology.

This funding is one part of a multi-level outreach effort to help clinicians understand and provide feedback about the new Quality Payment Program. Through webinars and in-person presentations, thousands have received free training and education from CMS staff since the Quality Payment Program Final Rule was released last October. In addition, through the established Quality Innovation Networks, the Transforming Clinical Practice Initiatives, and the Alternative Payment Model Learning Systems, every clinician in the Quality Payment Program can receive in-person training, including information about the Merit-based Incentive Payment System, as well as the Alternative Payment Model track.

As part of that outreach effort, CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program. Clinicians may contact the Quality Payment Program by calling 1-866-288-8292 from 8AM – 8PM EST or emailing qpp@cms.hhs.gov.

CMS awarded contracts to the following organizations to provide the on-the-ground training and education to small practices:

  • Altarum
  • Georgia Medical Care Foundation (GMCF)
  • HealthCentric
  • Health Services Advisory Group (HSAG)
  • IPRO
  • Network for Regional Healthcare Improvement (NRHI)
  • QSource
  • Qualis
  • Quality Insights (West Virginia Medical Institute)
  • Telligen
  • TMF Health Quality Institute

For more information on the Quality Payment Program, please visit: qpp.cms.gov