Towers Perrin Survey: Mid Sized Employers Debate Offering HI Coverage Come 2014

This is a good summary of a recent TP survey:

http://www.healthleadersmedia.com/page-1/HEP-270273/Midsized-Businesses-Grapple-with-Healthcare-Coverage-Options

ACOs Are Alive and Well in the Private Sector

HHS's regs for Medicarew ACOs have been roundly criticized and many major players say they have no intention of participating. But the concept of the ACO is alive and well among health insurers and providers looking to improving quality; reducing care and improving health:

http://www.healthleadersmedia.com/page-1/HEP-270395/Commercial-ACOs-May-Find-Footing-Where-CMS-Slips

Wellmark BC Unsure of Participation in HI Exchange

CEO is concerned about losing money but the details for the exchange have not even been worked out yet according to the Insurance Commissioner so perhaps this speculation is premature:

http://www.desmoinesregister.com/article/20110831/NEWS/308310048/Wellmark-undecided-on-insurance-exchange?odyssey=tab|topnews|text|Frontpage

GAO Report; MLR Regs Cut Broker Commissions

According to the report it will also reduce the number of options available:

http://www.gao.gov/new.items/d11711.pdf

Good Review of Just Post HI Regs by HHS

Jost from Health Affairs does a good job here:

http://healthaffairs.org/blog/2011/08/13/implementing-health-reform-premium-tax-credits/

HHS Releases Additional HI Exchange Regs

These focus on seamless enrollment and application of tax credits:

http://www.commonwealthfund.org/Newsletters/Washington-Health-Policy-in-Review/2011/Aug/August-15-2011/Exchange-Construction.aspx

HHS Awards More Funding for HI Exchanges

HHS gave out $185M in grants to 13 states on Friday. Alas my state of PA was not among them:

http://www.commonwealthfund.org/Newsletters/Washington-Health-Policy-in-Review/2011/Aug/August-15-2011/HHS-Awards-13-States-Grants-to-Build-Exchanges.aspx

Seniors Overuse Healthcare Because of Medigap Coverage

Senators Coburn and Lieberman think seniors need "more skin in the game" even if they are low income:

http://www.ctmirror.org/story/13574/medigap

How to Cut Medicare's Cost

Some great suggestions here from the Incidental Economist:

1. Competitive bidding, also known as competitive pricing. This idea really puts the market to work to buy Medicare benefits for the lowest possible price on a market-by-market basis. Participants can be public and private entities. It piggybacks on the exiting, hybrid structure of Medicare (FFS Medicare + Medicare Advantage) and makes all participating plans compete directly in a way they never have. Scholars have estimated the savings to be 8% of Medicare spending. I’ve written a lot about this elsewhere. Perhaps this post is the best place to start.
2. Competitive bidding can be put to work for durable medical equipment too. See the work of Peter Crampton.
3. Part D formulary design and drug pricing. Did you know the VA buys drugs for 40% less than Medicare? True! That alone suggests Medicare could spend a lot less on drugs. There are many possible Part D reforms that would lower program spending. Kevin Outterson wrote about some. For more about what it would take and mean to make Medicare’s drug benefit more like the VA’s see my post, which links to my paper with Steve Pizer and Roger Feldman.
4. Reference pricing. This idea came to me via David Leonhardt and Peter Orszag (smart guys, by the way; you should talk to them). The basic idea is that Medicare should only spend an amount on therapy for a condition equal to the lowest cost, effective one (that’s the “reference price”). If individuals want more costly therapies that are no more effective, they should pay the difference out of pocket. There’s more to this. See this prior post and related links therein.
5. There are lots of things Medicare shouldn’t even be paying for at all because they don’t work. See Rita Redberg’s NY Times op-ed on this.
6. Support comparative effectiveness research so we can learn more about which therapies are most effective. There is too much we don’t know and it is costing us.
7. Let ACOs be tested. We don’t know if they’ll work, but they’re worth a try.
8. Support the IPAB. Isn’t it obvious by now that Congress itself can’t control Medicare costs?
9. Consider all-payer rate setting. More on that here. Perhaps this post is a good starting point.

Excellent Post on Medicare's Cost Pressures

This is really worth reading. Major point is that the Medicare payroll tax covers only 33% of the program's costs.

http://www.dailykos.com/story/2011/08/14/1005951/-Medicare:-Why-is-it-on-the-table?via=blog_1

Health Insurance Exchanges and Adverse Risk Selection

If employers drop coverage and their high risk employees then seek coverage through their state's HI exchange, adverse selection could be a problem:

http://aishealth.com/archive/nhex0811-02

Kansas Joins Oklahoma and Returns Exchange Money to HHS

First OK returned over $54M and now KS returns $31,5M to HHS. This makes little sense to me:
http://www.businessinsurance.com/apps/pbcs.dll/article?AID=/20110810/NEWS03/110819992/1233

Humana ACO Shows Initial Cost Savings

So far so good:

http://www.healthleadersmedia.com/content/LED-269502/Norton-Humana-Commercial-ACO-Notches-Cost-Savings.html

Good Thoughts on How We Reimburse Docs Needs to Change

This is a good review on the disparity in Medicare reimbursement between primary docs and specialists:

http://healthpolicyandmarket.blogspot.com/2011/08/rethinking-value-of-medical-services.html

Sterling Offers New Self-Funding Package

The interesting feature of this package are the rebates the PBM will share w/employers to fund its health incentives program:

http://www.businessinsurance.com/apps/pbcs.dll/article?AID=/20110804/NEWS05/110809947/1250

Employees Need Benefit Decision Help

This is just incredible to me. 96% of HR professional recently surveyed said employees need guidance in making benefit decisions. Not surprising. But only 23% of these same professional said that their companies were doing a good job in providing this guidance. Are you kidding me? Isn't this one of their responsibilities?

http://www.businessinsurance.com/apps/pbcs.dll/article?AID=/20110804/NEWS05/110809946/1234