Today's Datapoint

$1 billion … could be saved by the state of Michigan over 10 years by participating in the health reform law’s Medicaid expansion, according to a recent report by the Center for Healthcare Research and Transformation, a Michigan research group.

Quote of the Day

“If a state participates in Medicaid expansion, a lot of people who are [now] uninsured would get Medicaid, and hospitals would bill Medicaid for this care. A lot of these folks are newly eligible, so states would get a much higher [level of federal support for them],” since the reform law calls for the federal government to pay 100% for newly eligible Medicaid enrollees from 2014 to 2016.
— January Angeles, a senior policy analyst at the left-leaning Center on Budget and Policy Priorities, told AIS’s Health Reform Week.

The Downside of MA Star Ratings: Big Problems for SNPs

By James Gutman - October 26, 2012

Somewhat lost in the good news about Medicare Advantage plans overall having improved their CMS star quality ratings for 2013 is the continuing tough stars road faced by MA Special Needs Plans (SNPs). Their average rating for 2013 remained about three stars, notes consultant Nathan Goldstein, CEO of Gorman Health Group, LLC, largely because the disadvantaged population they serve has characteristics that do not fit well with the stars rating system.

“I think SNPs are tremendously challenged here,” says Goldstein, citing such problems as beneficiaries who are medically illiterate and face difficulties in even having the transportation to get to providers. That means, he says, SNPs “really struggle” to have an active relationship with beneficiaries, a key to doing well in the star scores. Moreover, they are rated on the same categories as are other MA plans, plus on separate star measures for SNPs. There is also the problem that many of them operate in rural areas in the South and Southeast, where it is difficult to find appropriate providers who will conduct home visits with the beneficiaries.

What do you think is the answer for SNPs looking to improve their star scores, which will be a necessity after the current CMS demonstration program that allows even three-star plans to get a quality bonus ends in 2014? When the remaining program is the one in the health reform law that gives bonuses just for ratings of four stars and above, how will SNPs cope with the MA payment reductions under that same law? Just about everyone thinks SNPs perform a vital role, but how can they stay financially viable?

Datapoint

$425 million … are the projected savings in 2012 for the New York Medicaid program as a result of its switch from a fee-for-service system to managed care approach that carves in the pharmacy benefit, according to a new study from the Pharmaceutical Care Management Assn.

Today's Datapoint

$1.7 trillion … would be saved by the federal government from 2013 through 2022 under a House Republican budget plan that would convert Medicaid into a block-grant program to states, but 38 million fewer people would receive Medicaid benefits, according to a new report from the Kaiser Family Foundation.

People with Medicare save $4.8 billion on prescription drugs because of the health care law

Over 20.7 million with Medicare also receive free preventive services in the first nine months of 2012    

As a result of the Affordable Care Act, 5.6 million seniors and people with disabilities have saved $4.8 billion on prescription drugs since the law was enacted, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today. This year alone, 2.3 million people in the Medicare prescription drug coverage gap known as the “donut hole” have saved an average of $657. During the first nine months of 2012, over 20.7 million people with original Medicare got at least one preventive service at no cost to them.

This news comes after last month’s estimates that the health care law will save the typical person with original Medicare $5,000 from 2010 to 2022.

“I am pleased that the health care law is helping so many seniors save money on their prescription drug costs,” Secretary Sebelius said. “Medicare is stronger thanks to the health care law, offering new benefits at no cost to seniors.”

The health care law includes benefits to make Medicare prescription drug coverage more affordable. In 2010, anyone with Medicare who hit the prescription drug donut hole received a $250 rebate. In 2011, people with Medicare who hit the donut hole began receiving discounts on covered brand-name drugs and savings for generic drugs. For 2013, people with Medicare in the donut hole will receive about 53 percent on the cost of brand name drugs and a 21 percent savings for the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

The health care law also makes it easier for people with Medicare to stay healthy. Prior to 2011, people with Medicare had to pay part of the cost for many preventive health services. These costs made it difficult for people to get the health care they needed. For example, before the health care law passed, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Because of the health care law, many preventive services are now offered free to beneficiaries (with no deductible or co-pay) so the cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

 In 2012 alone, over 20.7 million people with original Medicare have received at least one preventive service at no cost to them. This includes 2.13 million who have taken advantage of the Annual wellness Visit provided by the health care law – almost 650,000 more than had used this service by this point in the year in 2011. In 2011, an estimated 32.5 million people with original Medicare or Medicare Advantage received one or more preventive benefits free of charge.

For state-by-state information on savings in the donut hole, please visit: http://downloads.cms.gov/files/Donut Hole Savings Summary - September 2012.pdf

For state-by-state information on utilization of free preventive services for people with original Medicare, please visit: http://downloads.cms.gov/files/Preventive Services Utilization by State - September 2012.pdf

For more information on the estimate that the average Medicare beneficiary will save $5,000 from 2010 to 2022 as a result of the health care law, please visit: http://aspe.hhs.gov/health/reports/2012/beneficiarysavings/ib.shtml 

Health care law delivers higher payments to primary care physicians

FOR IMMEDIATE RELEASE

Thursday, November 01, 2012

Health care law delivers higher payments to primary care physicians

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the final rule implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries.  The new rule raises rates to ensure doctors are paid the same for treating Medicare and Medicaid patients and does not raise costs for states.

“The health care law will help physicians serve millions of Americans across the country,” Secretary Sebelius said.  “By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”

The final rule implements the Affordable Care Act’s requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in Calendar Years 2013 and 2014.

This payment increase goes into effect in January of 2013.

In addition to payment improvements, the health care law includes numerous initiatives designed to bolster primary care and strengthen the primary care workforce, including an expansion of medical residency positions for primary care physicians, new investments in physician assistant and nurse practitioner training, and an unprecedented expansion of the National Health Service Corps, which provides scholarships and loan repayments to primary care providers who practice in underserved areas.

 For more information about today’s final rule visit:http://www.cms.gov/apps/media/fact_sheets.asp

To view a copy of today’s final rule visit: www.ofr.gov/inspection.aspx