Consensus Reached on ACO Key Principals

The four principals are:

• access
• care coordination
• health information technology
• payment reform

To find out more:

http://healthaffairs.org/blog/2011/03/31/acos-medical-homes-and-reform-a-crucial-consensus/

Defining Essential Benefits: Cost is Critical

As IOM prepares its definition of essential benefits (due September) industry experts debate what should be covered. One thing is that everyone agrees that cost be kept in mind:

http://aishealth.com/archive/nhpw031411-04

What Decisions Are Ahead for Employers

An excellent summary from the Commonwealth Fund on the decisions employers will have to make because of the ACA. Among them are should I "grandfather" my plan or should I drop coverage all together and pay a $2,000 penalty?

http://www.commonwealthfund.org/Content/Newsletters/Purchasing-High-Performance/2011/March-29-2011/Perspectives-on-Policy/As-Health-Reform-Moves-Ahead.aspx

Health Risk Assessments: Just a First Step

Sixty percent of large employers offer HRAs to their employees. But to be truly effective, identified health issues must be treated:

http://www.commonwealthfund.org/Content/Newsletters/Purchasing-High-Performance/2011/March-29-2011/Featured-Articles/Health-Risk-Assessments.aspx

How One Republican Solves Health Care

For all their criticism of "Obama" care, Reps really do not offer a viable alternative. However, Mitch Daniels, former Republican governor of Indiana, reformed his state's Medicaid program to try to make recipients more financially responsible. Here is a link to explain aspects of "healthy Indiana".

http://www.tnr.com/blog/jonathan-cohn/85908/mitch-daniels-healthy-indiana-medicaid

LA Joins FL in Health Exchange Opt-Out

How many more will there be? The Feds will then have to step in.

http://aishealth.com/archive/nref032811-21

So Are Providers Consolidating and Raising Their Fees to HIs?

The HIs say providers are doing so while providers say HIs still have all the power. A study in MA blamed the providers for the increasing cost of care.

http://aishealth.com/archive/nhpw030711-02

WSJ Weighs in on ACOs

The WSJ does not like the fact that ACOs are "ill defined"

http://online.wsj.com/article/SB10001424052748703300904576178213570447994.html?KEYWORDS=medicare

VT Moves Closer to Single Payer

This should be interesting. Funding source TBD:

http://www.businessinsurance.com/apps/pbcs.dll/article?AID=/20110325/BENEFITS03/110329934/1233

OPM to HIs: Provide Health Incentives

OPM wants federal employees to improve their health through incentives. Who will pay for the "carrots"? Will OPM allow for "sticks"?

http://www.washingtonpost.com/local/politics/opm-asks-health-insurers-to-provide-incentives-for-wellness-programs/2011/03/24/ABV58QRB_story.html

Most Surprising Reselt of the ACA after 1 Yr.

I really thought more people would have signed up for the high-risk pools:

The vast army of uninsurable people is AWOL. I thought one of the strongest arguments for the mandate--and the broad outlines of PPACA--was people with pre-existing conditions. The new high-risk pools were supposed to be a stop-gap for those people until PPACA kicked in. But so far, just 12,000 have signed up, or about 3% of the expected total. Either pre-existing conditions just aren't the large problem that advocates claimed, or something has gone disastrously wrong with the implementation of these pools. (from the Atlantic.com)

Towers Employer Benefit Survey Results

http://ifawebnews.com/2011/03/23/cost-challenges-health-reform-lead-to-%E2%80%98bold%E2%80%99-health-plan-redesign/?bold?-health-plan-redesign/

Most interesting survey fact to me:

A third of employers plan to reward or penalize their employees based on biometric outcomes (for weight and cholesterol), compared to 6% in 2010, the survey reported.

Cigna Study Shows ACOs Reduce Cost

This is the first proof by a health insurer that I have seen.

Preliminary results from two of CIGNA's collaborative accountable care pilot initiatives – CIGNA's approach to accountable care organizations, or ACOs – show that quality is improving and costs are being reduced. In New Hampshire, Dartmouth-Hitchcock is closing gaps in care 10 percent better than the market, while in Phoenix, Cigna Medical Group has lowered average annual costs per patient by $336. CIGNA plans to build on these successes with a national expansion of its accountable care initiatives in 2011.

http://newsroom.cigna.com/NewsReleases/CIGNA-s-Collaborative-Accountable-Care-Programs-Improving-Quality-and-Reducing-Costs.htm?view_id=3897

Deloitte Study on Out-of-Pocket HC Costs

The Deloitte Center for Financial Services and the Deloitte Center for Health Solutions recently embarked on a major study examining some of the hidden costs of U.S. health care spending patterns. The Center hypothesized that consumers spend more out-of-pocket than is typically reported in the insurance industry or government reports. This hypothesis was confirmed and the Center found that the cost to consumers was $363 billion heretofore not recognized and, in many cases, these are supplemental to traditional costs for doctors, drugs, hospitals, and insurance coverage — no small matter. Some of the study's key findings include:

• 2009 U.S. total health care expenditures are $2.83 trillion, 14.7 percent ($363 billion) more than calculated by the NHEA
• 55 percent of the $363 billion in additional health care costs are the imputed costs of supervisory care
• Total discretionary costs for health care (direct and indirect) totaled $1,892 per capita in 2009

For the complete study please click on the link below:

http://www.deloitte.com/view/en_US/us/Industries/Banking-Securities-Financial-Services/center-for-financial-services/87e022a77acde210VgnVCM3000001c56f00aRCRD.htm?id=us_email_fsi_032311

Update on Health CO-OPS

On March 21 the 15-member Consumer Operated and Oriented Plan (CO-OP) program Advisory Board submitted recommendations to HHS about the circumstances that would warrant the development of a nonprofit, member-run co-operative health plan (PPACA Section 1322). Among its suggestions:

• HHS should develop flexible criteria that recognize the diversity of market conditions around the country and enable differing models of CO-OPs created and supported by different types of sponsors to develop.
• In awarding loans and grants, preference should be given to applicants with a strong local network and model of integrated care over an application that includes a state-wide network with little emphasis on care coordination.
• HHS should make every effort to help a CO-OP succeed by providing or arranging for needed technical and management support as well as additional funding.

Note: Per Section 1322, $6 billion in loans are available to capitalize eligible prospective CO-OPs: start-up loans to be repaid in five years and grants to meet state insurance solvency/reserve requirements to be repaid in 15 years. Draft regulations for this program are expected later this spring.

Health Insurers Branch Into Other Ventures

Fearing profits will be cut by the new medical loss ratio requirements, HIs are purchasing a variety of businesses including wellness, health management and data companies:

http://www.kaiserhealthnews.org/Stories/2011/March/20/health-insurers-reform-business.aspx

Providers Don't Like CMS Value Based Regs

No one said this was going to be easy.

http://www.healthleadersmedia.com/page-5/QUA-263564/10-Ways-CMSs-ValueBased-Purchasing-Proposal-is-Flawed

ACO Regs: Give Providers the Flexibility to Promote Healthy Behavior through Incentives

This idea really makes sense:

http://www.kaiserhealthnews.org/Columns/2011/March/031511lutesbrill.aspx

Employers Do Not See the Real Costs of Underinsuring Their Workforces

It is more than just the cost of premiums:

http://healthaffairs.org/blog/2011/03/15/what-employers-don%E2%80%99t-spend-for-health-will-cost-them/

Cost of Chronic Conditions

Good chart from McKinsey:

http://www.mckinseyquarterly.com/newsletters/chartfocus/2011_03.htm

Pharmacists Step in to Fill the Gap

With the shortage of primary care physicians and the regular contact many people have w/their pharmacy this idea makes sense:

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/Michelle-Andrews-on-Pharmacy-Outreach-and-Chronic-Health-Problems.aspx

5 Components of High Quality Health Plans

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2011/Mar/Success-Factors-in-Five-Health-Plans.aspx

Year Two of ACA

There will be more nitty gritty matters to resolve. The big one will be deciding what services must be covered by health plans:

Department of Health and Human Services (HHS) officials will create a Medicare initiative to encourage hospitals and physicians to coordinate more closely on patient care in the coming year. Regulators will start deciding which medical services health plans must cover as of 2014. Negotiations between federal and state officials will escalate as states prepare to launch the health insurance markets that will expand coverage. And researchers will get federal money to find the most effective way to treat diseases.

HHS Assisting States in Health Exchange IT Issues

Joel Ario spoke at an AHIP conference on states' efforts to establish health insurance exchanges by 2014.

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2011/Mar/March-14-2011/Insurer-Friendly-Exchange.aspx

Connector Popular in MA: Shades of Things to Come in 2014?

The health insurance exchange in MA gets high marks from its customers. 86% are satisfied w/its services:

http://www.boston.com/news/local/massachusetts/articles/2011/03/11/health_connector_patients_mostly_satisfied_with_service/

ACOs vs. Bundled Payment Pilots

If you are a hospital, a Medicare bundled payment pilot is the way to go:

http://www.beckershospitalreview.com/hospital-physician-relationships/evaluating-the-medicare-pilot-programs-comparing-acos-and-bundled-payments.html

Aetna and Carillion Clinic Form ACO in VA

Aetna will perform the back office support for the venture. No word on how risk will be shared for global payments.
http://www.healthleadersmedia.com/content/COM-263594/Aetna-Carilion-Clinic-Building-ACO-in-VA

BCBSMA Suspends Pay to Board Members

This is not surprising:

http://www.healthleadersmedia.com/content/COM-263482/BCBSMA-halts-payments-to-directors.html

Good Post on Medical Homes

Medical homes are gaining in popularity and showing good results. I truly believe that medical homes are an essential element to any ACO. Here is the link:

http://blog.healthintegrated.com/index.php/2011/03/08/pcmhs-acos-and-reality/?utm_content=0000-00-00%2000%3A00%3A00&utm_source=VerticalResponse&utm_medium=Email&utm_term=&utm_campaign=PCMHs%2C%20ACOs%20and%20Realitycontent

So What Will HIEs Look Like?

It really will depend on the political philosophy of the state:

http://www.healthleadersmedia.com/content/HEP-263497/HIEs-Still-More-Questions-than-Answers.html

BCBSMA Former CEO's Goodbye Package

$11M is quite the goodbye present for Cleve Killingsworth, particularly since he worked for a not for profit health insurer:

http://www.healthleadersmedia.com/content/HR-263382/ExBlues-CEOs-11M-Severance-Package-Slaps-Policyholders

But it was approved by the Board in 2005 as the article notes. But as is also noted board members collect anywhere from $55-90,000 in annual salary so what do they care?

Agents Are Concerned

With the new MLR requirements agents are feeling the squeeze and are not happy about it:

http://aishealth.com/archive/nhpw022111-03

Once state insurance exchanges are operational in 2014, there will be a role for brokers and agents, particularly in the small-group market, said former Pennsylvania Insurance Commissioner Joel Ario, who has headed HHS’s Office of Insurance Exchanges since September. A provision in the law requires states to create Small Business Health Options Programs (SHOP) exchanges to help small employers find coverage and enroll workers. Agents, he explained, often do more for small employers than just help them choose health plans. NAHU has long argued that navigators need to be licensed, as agents are, to ensure that they understand the complexities of

health coverage. Ario said the law envisions “baseline similarities” between navigators and insurance agents. However, he said agents sometimes don’t possess necessary “linguistic capacities” and “don’t necessarily serve all of the different populations as well as they could be served.” Those comments were met with boos.

It's Health Inflation Stupid

To control the deficit we need to control health care costs. To control health care costs we need to control health care inflation. Here is a good post on the topic:

http://healthaffairs.org/blog/2011/03/04/the-real-issue-controlling-all-health-care-costs/

High Performing Networks and Tiered Benefits: The Answer to Rising Premiums?

Once again Massachusetts is leading the way to reduce the rising costs of premiums:

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/Michlle-Andrews-on-Premiums-and-Prices.aspx