Friday, February 24, 2017

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.
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Jacksonville, Fla. has the lowest cost per doctor's visit at $68.
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San Francisco has the lowest share of adults not eating fruits daily at 32.5%.
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Portland, Ore. has the most gluten-free restaurants at 12.3/100,000 residents.
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Durham, N.C., has the most nutritionists at 46.8 per 100,000 residents.
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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:

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


FOR IMMEDIATE RELEASE
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


FOR IMMEDIATE RELEASE
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

DOJ joins Medicare Advantage fraud lawsuit against UnitedHealth


By Shelby Livingston  | February 16, 2017

The U.S. Justice Department has joined a whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were.

The lawsuit, initially brought in 2011 and unsealed Thursday after a five year-long investigation by the Justice Department, alleges that Minnetonka, Minn.-based UnitedHealth has inflated its plan members' risk scores since at least 2006 in order to boost payments under Medicare Advantage's risk adjustment program.

UnitedHealth, the nation's largest Medicare Advantage insurer, allegedly collected payments from false claims that it treated patients for conditions they didn't have, for more severe conditions than they had, conditions that had already been treated, or diagnoses that didn't meet the requirements for risk adjustment, according to the complaint.

The lawsuit claims that in 2010, UnitedHealth planned to increase operating income by $100 million through "Project 7," which was the company's codeword for initiatives to increase risk adjustment payments.

“We reject these more than five-year-old claims and will contest them vigorously,” UnitedHealth spokesman Matthew Burns said in a statement Thursday. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with the program rules.”

Payment rates in Medicare Advantage are based on regional trends and utilization in traditional fee-for-service Medicare as well as adjustments to plan members' risk scores, among other variables. Under the Medicare Advantage program, the government pays private health plans monthly amounts for every member they cover, and those taxpayer-funded payments are adjusted based on how sick someone is.

Members with more chronic conditions have higher risk scores, and plans that cover them receive higher payments. These risk scores were created to incentivize plans to cover all seniors regardless of their health status, but there have been several whistleblower lawsuits in recent years that allege foul play by health plans to inflate the scores and collect more funds.

On average, the CMS pays a Medicare Advantage plan close to $3,000 per year, per condition that a member has that requires a risk adjustment payment, according to the complaint.

The lawsuit makes similar allegations against Health Net, Arcadian Management Services, Tufts Associated Health Plans, Aetna, Blue Cross and Blue Shield plans in Florida and Michigan, Emblem Health, Humana, Wellcare Health Plans and others.

 

Thursday, February 16, 2017

4 Broken Obamacare Promises Town Hall Protesters Should Remember


February 16, 2017 By D

While the House and Senate plan to repeal and replace Obamacare, members of Congress are hosting town hall meetings with their constituents and have been greeted by hostile crowds.

These folks seem to have amnesia about Obamacare’s glaring failures.

Here’s a quick refresher on Obamacare’s top four broken promises.

1. Costs are exploding.

President Barack Obama promised that his reform proposal would cut typical family costs by $2,500 annually. That, of course, never materialized.

The typical family today pays about 35 percent of their income for health care.

The small group and individual insurance markets were hit hard by big premium increases. An eHealth report concluded that from 2013 to 2017, the average individual market premium increases were 99 percent for individuals and a jaw-dropping 140 percent for families.

Costs have also increased for those with employer-sponsored insurance, according to the Kaiser Family Foundation, from 2010 to 2016, average family premiums for employer-sponsored plans nearly increased 32 percent.

Higher premiums are not the only shock. Out-of-pocket costs in the Obamacare exchanges, particularly deductibles, have been stunning. HealthPocket analyzed that for the lowest tier bronze plans in 2017, the average deductible for an individual is $6,092 and $12,383 for a family.

2. Competition and choice are declining.

Obama told America his proposal would increase competition in the health insurance markets but that hasn’t happened either.

On Tuesday, news broke that Humana will be leaving the Obamacare exchange markets next year. This was just the latest in a growing list of insurers who are jumping ship from this massive public policy failure.

Town hall audiences should take a good look at county-level data. A new Heritage Foundation analysis found that Obamacare’s exchanges, in their fourth year of operation, offer Americans little health insurer choice.

The downward slide in competition means that in 2017, consumers in 70 percent of U.S. counties are left with just one or two insurer options on the exchanges. The 70 percent figure is way up from 36 percent in 2016.

3. Forget about keeping your plan.

Perhaps the most famous health care promise of all, Obama’s promise: “If you like your health care plan, you’ll be able to keep your health care plan.” In fact, there were 37 instances where Obama or a high-ranking administration official repeated that infamous promise to keep you plan and your doctor.

Rarely has there been such a disconnect between rhetoric and reality. In 2014, the first year that Obamacare was fully implemented, the Associated Press reported that there were at least 4.7 million canceled policies across 30 states. The law’s insurance rules and mandates forced many insurers to cancel plans that people liked and wanted.

Sadly, the disruption only continued from there. For example, hundreds of thousands of people signed up for plans offered by insurers under Obamacare’s co-op program.

But 18 out of 23 of these federally-funded insurers have already collapsed, meaning taxpayers are highly unlikely to be repaid the more than $1.9 billion in loans they received—not to mention the thousands of co-op enrollees that lost their health care plans, some in the middle of the year.

Not exactly a proud moment in public policy.

4. No, you can’t necessarily keep your doctor.

Obama promised patients that they would be able to keep their doctors. For many patients, that also turned out to be untrue.

Obamacare’s rising costs, and its limited flexibility in federally fixed benefit designs, resulted in plans resorting to narrow provider networks. Narrow networks limit access to doctors and other medical professionals as a way to contain costs.

Enough is enough. For seven years, Obamacare has proved to be one giant bundle of broken promises and policy failures. Congress needs to get serious—quickly—and repeal Obamacare.

This is a crucial first step in moving America toward the patient-centered health care system our country deserves.

Commentary by The Heritage Foundation’s Jean Morrow.  Originally published at The Daily Signal.
http://senioramericansassociation.com/2017/02/16/4-broken-obamacare-promises-town-hall-protesters-remember/?utm_source=170216SAAMRSPOTNUTRITION2&utm_medium=email&utm_campaign=170216SAAMRSPOTNUTRITION2

U.S. Drug Spending Increased 3.8% in 2016


Express Scripts recently released their annual report on prescription drug spending. Here are some key findings from the report:

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U.S. drug spending increased 3.8% in 2016, 27% less than in 2015.
•
Drug spending decreased for one third of plans in 2016.
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The average out-of-pocket cost for a 30-day prescription was $11.34 in 2016.
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Member OOP cost share was 14.6% of the total costs per adjusted Rx in 2016.
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Average drug unit costs rose 2.5% in 2016, 22% less than in 2015.
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Specialty drug costs rose 6.2% in 2016, down from the 11.0% increase in 2015.

Source: Express Scripts, February 2017