Retiree Health Care: Biggest Retirement Bill Coming Due

According to a report from Pew Center on the States on pension and retiree health care funding in 61 cities-the most populous one in each state plus all others with populations over 500,000, the cities had set aside just 6 percent of $126.2 billion in projected costs for what are known as Other Post-Employment Benefits, primarily retiree health care, leaving $118.2 billion in unfunded liabilities in fiscal year 2009.

Los Angeles led the 61 cities with 55 percent of its retiree health care promises pre-funded in fiscal year 2009. Next were Denver (51 percent); Washington, D.C. (49 percent); Louisville (40 percent); Sioux Falls (37 percent); and San Antonio (31 percent).

Some cities have begun tackling their retiree health care liabilities by pre-funding a portion of their expenses. Of the 27 cities with some assets set aside, five contributed more than 90 percent of the annual sums recommended by their actuaries in both fiscal years 2009 and 2010: Anchorage, Charlotte, Los Angeles, Sioux Falls, and Virginia Beach. Eight contributed more than half of their full annual payments in both years, and 14 contributed less than half.

Source: Pew Center on the States
http://www.pewstates.org/research/reports/a-widening-gap-in-cities-85899442341?p=1 

African Americans in Alabama get help to fight cardiovascular disease and stroke

CMS NEWS

FOR IMMEDIATE RELEASE                                                Contact: CMS Media Relations

January 31, 2013                                                                                       (202) 690-6145 or

                                                                                                                                                                                        

                                                                                                HHS Office of Minority Health

Division of Information & Education

                        (240) 453-8833

African Americans in Alabama get help to fight cardiovascular disease and stroke 

 

African Americans living in parts of Alabama will get improved access to community-based health services to prevent heart attacks and strokes through a new public, private partnership led by the U.S. Department of Health and Human Services (HHS).
The Morehouse School of Medicine and HHS awarded $900,000 to the National Baptist Convention, USA, Inc. to target three counties in Alabama where African Americans face significantly high rates of cardiovascular disease. The National Baptist Convention will build on the strengths of faith-based organizations to connect communities to vital health care resources like hypertension management services, including blood pressure monitoring, free or low-cost medication, and patient counseling and education.

The Million Hearts Stroke Belt Project is being funded jointly through the HHS Office of Minority Health (OMH) and the Centers for Medicare & Medicaid Services Office of Minority Health (CMS/OMH).

“Partnerships that help reduce health disparities and save lives is our priority at HHS,” said J. Nadine Gracia, M.D., M.S.C.E., deputy assistant secretary for minority health. “This project helps educate and empower people to reduce their risk of heart disease and stroke.”

“The Affordable Care Act has made preventive services more accessible to Americans, including those at higher risk of heart disease and stroke,” said Cara V. James Ph.D., CMS/ OMH director.

African Americans are 30 percent more likely to die from heart disease, according to 2009 data from the Centers for Disease Control and Prevention. African Americans living in Alabama – one of the states that comprises an area referred to as the “Stroke Belt” – lack access to health care. Fifty-four of the 67 counties in Alabama have a shortage of primary medical care, dental or mental health providers.

The Million Hearts Stroke Belt Project seeks to reverse this trend.  The project supports the Million Hearts initiative, which counts on public, private partnerships to help prevent one million heart attacks and strokes by 2017. The project is a key part of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Prevention Strategy to reduce health disparities among racial and ethnic minorities.

Together, OMH and CMS/OMH operations are dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities. To learn more, visit:  http://minorityhealth.hhs.gov/.

Medicaid: Cut Cost Not Benefits

By David Pittman, Washington Correspondent, MedPage Today

Published: January 31, 2013

WASHINGTON -- Reducing overall healthcare costs -- and not cutting benefits -- is the way to address rising spending on entitlement programs, a senior White House adviser said Thursday.

Gene Sperling, director of the National Economic Council and assistant to the president for economic policy, slammed efforts to change Medicaid, addressing advocates at a conference here sponsored by Families USA, a liberal health policy group.

"The right answer and the best answer for reducing entitlement savings is to reduce the cost of healthcare in a way that does not compromise quality," Sperling said.

The economic adviser specifically mentioned Republican efforts to transform Medicaid into a block grant program -- a move the GOP says would cut Medicaid spending by about a third -- as one effort to attack Medicaid.

Instead, efforts currently under way through the Affordable Care Act and private sector have the ability to reduce costs, he said, citing accountable care organizations and bundled payments.

"The more that we win the battle of lowering overall healthcare costs, the less you will have to do in terms of more difficult budget choices," Sperling said.

But if the White House chooses to protect Medicaid, policymakers will make to make tough decisions elsewhere, Sterling admitted, noting the need for a balanced budget.

Sperling left the door open for Medicare changes, but didn't mention what those could be. A common call has been to increase the eligibility age to 67 or force more wealthy beneficiaries to pay higher premiums.

"But we're going to [make changes] in a sensible way, and when we do it, we are going to make sure we're not just shifting costs in ways that make no sense or put the burden on the most vulnerable," he said.

Making changes that simply shift costs to beneficiaries doesn't address the true problem in either Medicare or Medicaid because then money is still leaving the economy by forcing them to pay more, Sperling said.

He tried to reassure governors who might be struggling with the decision to expand Medicaid programs in their states. A common complaint has been that they would expand only to have federal support slashed and then be left to cover beneficiaries themselves.

"They will not make this step and then find later Medicaid is the first place or even the last place people are going for serious deficit reduction," Sperling said. "Medicaid savings and Medicaid cuts for this president are not on the table."

The Obama administration has made that very clear to the Republicans in Washington, he added.

Instead, making cuts to Medicare and Medicaid now -- just as the ACA is about to lift off the ground with health insurance exchanges and Medicaid expansion -- would be devastating to healthcare, he said.

"Every time somebody thinks it's a politically easy thing to do to cut and go after Medicaid because they think nobody will care," Sperling said. "It is incumbent on all of us to let them know that they are wrong."gn Up

David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/37134?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-02-01&eun=g350341d0r&userid=350341&email=john@thebrokerageinc.com&mu_id=5344066

Affordable Care Act “sunshine” rule increases transparency in health care

CMS NEWS

FOR IMMEDIATE RELEASE                                    Contact: CMS Media Relations

February 1, 2013                                                                            (202) 690-6145

Affordable Care Act “sunshine” rule increases transparency in health care

The Centers for Medicare & Medicaid Services (CMS) announced today a final rule that will increase public awareness of financial relationships between drug and device manufacturers and certain health care providers. Called the “National Physician Payment Transparency Program: Open Payments,” this is one of many steps in the Affordable Care Act designed to create greater transparency in the health care market.

“You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need,” said Peter Budetti, M.D. CMS deputy administrator for Program Integrity. “Disclosure of these relationships allows patients to have more informed discussions with their doctors.”

This rule finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report payments or other transfers of value they make to physicians and teaching hospitals to CMS. CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests.

This increased transparency is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers.

This new reporting will apply to applicable manufacturers and GPOs. These organizations, as well as the physicians and teaching hospitals, will have an opportunity to review and correct reported information prior to its publication.

In order to give applicable manufacturers and applicable GPOs sufficient time to prepare, data collection will begin on August 1, 2013. Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by September 30, 2014. CMS is developing an electronic system to facilitate the reporting process.

The final rule can be downloaded at: https://www.federalregister.gov/public-inspection.

Aetna, Health Net look toward 2014

By Allison Bell

January 31, 2013

Aetna hopes to use networks of providers who agree to take "value-based reimbursement" to drive membership growth in the face of a soft economy and the changes imposed by the Patient Protection and Affordable Care Act (PPACA), Aetna President Mark Bertolini said today during a conference call his company held to discuss results for the fourth quarter of 2012.

"Aetna continues to be a leader in enabling providers to change their business model from episodic acute care management to population management," Bertolini said.

Jim Woys, the chief operating officer of Health Net, also talked about network management in a discussion of the performance of the California-based company in its Western region.

"Membership in ur commercial tailored network products continues to grow," Woys said, in a statement accompanying the company's earnings release. "We believe these cost-effective products will play a critical role as health care reform is implemented.”

Aetna, networks and 2014
Aetna already has set up 17 "accountable care organization" (ACO) collaboration agreements, has 32 ACO letters of intent in place, and has about 200 other ACO opportunities in the pipeline, Bertolini said.

"Obviously, as you can see from our ACO business and our narrow network business, we're getting substantial discounts from the providers with which we're contracting," Bertolini said.

Aetna executives said the company will take a "measured approach" to deciding whether to participate in specific states' PPACA health insurance exchanges, or Web-based insurance supermarkets for individuals and small employers, which are supposed to open for business Oct. 1.

Getting products like the exchange products approved typically takes about three months, but that could slow down as the Oct. 1 exchange startup date nears, Bertolini said.

Although the exchanges might be popular with individuals, it looks as if the only small employers that will jump to the exchanges will be employers that expect to get large subsidies, Bertolini said.

"We do see some potential for small groups to drop coverage" and send employees to the individual exchange programs, Bertolini said.

Even after the exchanges start up, about 20 percent of the individual market will operate outside the exchange system, and Aetna may continue to serve those off-exchange customers in states in which the company is not on the state's exchange, Bertolini said.

Aetna is reporting $190 million in net income for the latest quarter on $9.9 billion in revenue, compared with $373 million in net income on $8.6 billion in revenue for the fourth quarter of 2011.

The company ended the quarter providing or administering health coverage for 18 million people, about as many people as it was covering a year earlier.

Enrollment in commercial medical plans fell 2 percent, to 16 million.

Enrollment in plans that include health savings accounts or health reimbursement arrangements increased 6.8 percent, to 2.6 million.

Aetna expects to see growth this year in enrollment in group plans it runs for self-insured employers, but enrollment in insured group plans likely will fall, Bertolini said.

"We remain committed to our disciplined pricing model and when faced with a choice, we will continue to favor achieving target margins over membership growth," Bertolini said.

Aetna executives noted that a bad flu season increased use of medical services in the fourth quarter but that the effects of Sandy offset the flu spike by depressing use of health care services in some major Aetna markets.

Health Net

Health Net is reporting $5.1 million in net income for the latest quarter on $2.8 billion in revenue, compared with $60 million in net income on $2.8 billion in revenue for the fourth quarter of 2011.

Total civilian health plan enrollment held steady at about 2.6 million.

Enrollment in Health Net's TRICARE plan fell to 2.9 million, from 3 million.

http://www.lifehealthpro.com/2013/01/31/aetna-health-net-look-toward-2014?eNL=510ace76ca9f80550f000340&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=105824905&t=individual-health&page=2

Quote of the Day

“Pressures from the public in the wake of the Newtown tragedy will be one of the triggers [that will make behavioral health a big issue for insurers in 2013]. Other triggers include the federal behavioral health parity legislation enacted in 2008 and the ACA’s essential health benefit definitions that will be implemented under state benchmark plans. All three of these factors will necessitate that insurers build more diverse and deeper behavioral health provider networks that can address prevention, screening and treatment capacity.”

— Bill TenHoor, president of the consulting firm of TenHoor & Associates, told AIS’s Health Plan Week.

Today's Datapoint

$1.5 billion … in additional grants were awarded recently by HHS to permit 11 states to set up their health insurance exchanges: California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon and Vermont.