More than $1 million

... was saved in a BCBS of Rhode Island pilot program that placed pharmacists inside six patient-centered medical homes, with $800,000 of the savings coming from Medicare Advantage patients.

"[Part D] is a fiercely competitive market

... where the plans are really pushed to try to bring the most value to consumers, [but] plans also have to feel that their benefit design is no more generous than others in the market because they will fear selection. So they will not want to be the plan that is the most generous for oral oncolytics or for [multiple sclerosis] because they don't want to attract those patients because that will make it more difficult for them to bid. There's always a drive to get more cost-effective medication and a need to accommodate technology, and so it's always a mix."

— Dan Mendelson, CEO of Avalere Health LLC, told AIS's Drug Benefit News.

CMS awards $67 million in Affordable Care Act funding to help consumers sign-up

CMS NEWS   FOR IMMEDIATE RELEASE September 2, 2015                                                                                                                             Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries   CMS awards $67 million in Affordable Care Act funding to help consumers sign-up for affordable Health Insurance Marketplace coverage in 2016 With Marketplace Open Enrollment set to begin on November 1, 2015, the Centers for Medicare & Medicaid Services (CMS) today announced grant awards totaling $67 million to support outreach efforts designed to connect people with local help as they seek to understand the coverage options and financial assistance available at HealthCare.gov. Awarded to 100 organizations located in 34 states that operate Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces, the three year-long Marketplace Navigator grants will fuel efforts to help consumers enroll in a health plan that fits their budget and best meets their family’s needs. “There are a lot of choices when it comes to signing up for health insurance and we want to help make sure consumers feel confident that they’ve picked the right plan,” said Kevin Counihan, CEO of the Health Insurance Marketplaces. "In person assistance from Navigators and assisters has proven to be an incredibly important avenue for consumers to get the right coverage. I'm pleased that Navigators and assisters will be available in even more geographic areas this year." Navigators and assisters are trained specialists who provide consumers in their communities with in-person help, answering their questions about their health insurance and financial assistance options and assisting them as they complete their application. Navigators and assisters are knowledgeable about the range of health plans available on HealthCare.gov as well as other public health insurance programs offered in their state, including Medicaid and the Children’s Health Insurance Program (CHIP). The navigator awards announced today will allow organizations to work with consumers for the next three years.    This year’s Navigator grantees will expand access to local help in many states.  In Illinois, Indiana, Iowa, Montana, New Jersey, West Virginia, and Wisconsin, more counties will be covered by Navigator entities during the Marketplace’s third open enrollment period than during the second open enrollment.  In West Virginia alone, an additional 42 counties will be covered, providing improved access across the state.  These gains will enable more consumers to get the help they need with enrollment.  Of the Navigator grantees awarded for this three-year cycle, 67 are returning grantees, providing stability and continuity for many consumers who have come to rely on the assistance offered by these Navigator grantees both for enrollment and post-enrollment concerns. While grants could continue for three years, each year, CMS will assess Navigator grantees’ performance for ongoing support. In addition to Navigators, Marketplaces make other resources available to consumers to help them access Marketplace coverage, such as certified application counselors, non-navigator assistance personnel (also known as in-person assisters), and agents and brokers. Consumers in federally-facilitated and state partnership Marketplaces can visit Find Local Help to find assistance in their area. For a list of HHS Navigator awardees or more information about Navigators and other Marketplace resources, please visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html   ###   Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov

Implentation of a $20 per month premium discount incentive

...triggered a 50 percentage point increase in participation in health risk assessments (HRAs) among members of unions that bargained for the incentive, and a 22 percentage point increase in participation among non-union members, according to 2013 patient data from one large Midwest employer.

Source: "Financial Incentives Boost Wellness Program Participation," Employee Benefit Research Institute (EBRI) News Release, August 26 2015, http://www.ebri.org/pdf/PR1137.Wellness.26Aug15.pdf

1 in 4 Employers Could be Subject to the 'Cadillac Tax' in 2018

The Kaiser Family Foundation recently released an prospective analysis on the Affordable Care Act's tax on high-cost health plans ('Cadillac Tax'). Here are some key findings from the report:

·         1 in 4 employers offering health benefits could be subject to the 'Cadillac Tax' in 2018.

·         The 2018 tax thresholds are $10,200 for single coverage and $27,500 for other coverage.

·         The tax is 40% of the difference between the annual cost of health benefits and the threshold amount.

·         An estimated 30% of employers would be subject to the tax by 2023.

·         By 2028, 42% of employers may have plans where costs exceed the threshold for some or all employees.

·         Today, 19% of employers would be taxed if the 'Cadillac Tax' was in effect.

Source: Kaiser Family Foundation, August 25, 2015

CMS announces Value-Based Insurance Design Model

CMS NEWS   FOR IMMEDIATE RELEASE September 1, 2015                                                                                                                             Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries   CMS announces Value-Based Insurance Design Model to improve care and reduce costs in Medicare Advantage Plans   The Centers for Medicare & Medicaid Services (CMS) announced today the Medicare Advantage Value-Based Insurance Design Model, which will test the hypothesis that giving Medicare Advantage plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees who have specified chronic conditions can lead to higher-quality and more cost-efficient care, helping health plans and consumers have the tools they need to improve costs and spend dollars more wisely. The goal of the model is to improve beneficiary health, reduce the utilization of avoidable high-cost care, and reduce costs for plans, beneficiaries and the Medicare program. The model focuses on Medicare Advantage enrollees with the chronic conditions of diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of these categories. “The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer. Part of the Department of Health and Human Services’ (HHS) “better care, smarter spending, healthier people” approach to improving health care delivery, the model is intended to improve outcomes and reduce costs by giving health plans the flexibility to provide new supplemental benefits specifically tailored to the enrollees’ clinical needs, such as the elimination of co-pays for eye exams for beneficiaries with diabetes or extra tobacco cessation assistance for enrollees with COPD. The model will begin January 1, 2017 and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care and reduce the cost of care for Medicare Advantage enrollees with chronic diseases. The Medicare Advantage Value-Based Insurance Design Model was developed by the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center was created by the Affordable Care Act to test innovative health care payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program expenditures while preserving or enhancing the quality of beneficiaries’ care. More information about the MA-VBID model test can be found in the model’s announcement. It includes instructions for providing CMS with feedback on this model test’s design. CMS will also hold a webinar introducing the model on September 24, 2015. The announcement and webinar registration information are both available at http://innovation.cms.gov/initiatives/VBID/.   CMS will accept applications for the MA-VBID via a Request for Applications (RFA), to be released shortly. Once released, application materials will be available at: http://innovation.cms.gov/initiatives/VBID/.   CMS Fact sheet: http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-09-01.html     ###   Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMS.gov

According to a recent survey:

• 28% of Americans say they want Congress to expand what the Affordable Care Act does
• Another 28% would like to see the law completely repealed
• 22% want Congress to continue implementing the law as it is
•  12% want Congress to scale back the law

Source: "Kaiser Health Tracking Poll: August 2015," the Henry J. Kaiser Family Foundation, August 20, 2015, http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/