Cartoon – Good Investments
Monthly Archives: December 2016
Cartoon – Importance of Project Buy In
The Two Mysteries of Medicare
A growing proportion of Medicare beneficiaries are opting out of the government-run insurance program. They are instead choosing a private plan alternative, one of the Medicare Advantage plans. The strength of this trend defies predictions from the Congressional Budget Office, and nobody can fully explain it.
Here’s another mystery. Traditional Medicare spending growth has slowed, bucking historical trends and expectations. Though there are theories, we don’t fully know what’s causing that either.
Pinning down explanations for these two mysteries is important. Doing so could help us understand the structure and cost of Medicare in the future.
The mysteries may be connected by something that appears, at first, to be unrelated: Doctors and hospitals tend to treat insured patients the same way, regardless of what kind of coverage they have. A traditional Medicare patient admitted to the hospital with, say, pneumonia will receive the same standard of care as a similar but privately insured pneumonia patient.
From this, an idea emerges that links the two mysteries. As enrollment in Medicare Advantage plans grows, so too do the plans’ influence over how doctors and hospitals provide care. Unlike the traditional program, Medicare Advantage plans establish networks, covering care provided only by certain doctors and specific hospitals. Often those are the ones with lower cost growth. As doctors and hospitals reduce their cost growth to gain access to Medicare Advantage networks and the increasing number of patients enrolled in the plans, they do so for traditional Medicare patients as well.
So, as Medicare Advantage enrollment swells, the growth in the cost of care for traditional Medicare falls — a spillover effect. That’s the theory, anyway. Does it hold water?
The Problem With One-Size-Fits-All Health Insurance
The top 5 conditions affecting communities, according to new BCBSA tool
http://www.healthcaredive.com/news/blue-cross-blue-shield-health-index/431194/
Mapping technologies and population health make a beautiful pairing. Using geographical data can assist care delivery strategies as tech tools such as GIS can track and trend health data for a community overtime.
“As the move to accountable care and value-based payments takes hold, providers and health plans are increasingly interested in applying GIS to assess risk based on geography and the populations that live there, reveal where the greatest need is, and prioritize areas for interventions,” Danny Patel, account executive for health and human services at GIS software maker Esri, told Healthcare Dive in May.
While providers can look to reduce unnecessary readmissions using such efforts, plans like Blue Cross Blue Shield Association – which recently released its new BCBS Health Index – can use local health data to understand the health of a county/population. The tool, using blinded claims data from more than 40 million commercially-insured BCBS members, identifies the health conditions with the greatest impact on the commercially insured. The tool includes information on over 200 conditions.
“What the health index gives us is the ability to work with local stakeholders…to talk about where we need to focus broader health resources,” Maureen Sullivan, chief strategy and innovation officer at Blue Cross Blue Shield Association, told Healthcare Dive. She said the tool isn’t a “healthiest place to live” navigator but rather a starting point to understand conditions affecting communities and develop peer networks.
Life expectancy in the US has decreased. That’s troubling
http://www.healthcaredive.com/news/life-expectancy-in-the-us-has-decreased-thats-troubling/431984/
Dive Insight:
Recent data show that a human’s lifespan is “fixed and subject to natural constraints” and that the limit of the “world’s oldest person” has not increased since the 1990s, when French woman Jeanne Calment died at age 122.
Still, the CDC’s findings paint a poor picture of the health of the U.S. population, as it shows an increase in “virtually every cause of death,” David Weir from the Institute for Social Research at the University of Michigan was quoted in The Washington Post. In fact, the rate of deaths related to eight of the 10 leading causes of death increased from 2014 to 2015. Only one decreased. The rate for heart disease increased 0.9% while the rate for cancer decreased by 1.7% from 2014 to 2015.
For American males, life expectancy changed from 76.5 years in 2014 to 76.3 years in 2015 and American females saw a decrease from 81.3 years in 2014 to 81.2 years in 2015. Earlier this year, CDC released data that showed more Americans died in 2014 from heart disease than any other cause with 74% of American deaths attributed to the same 10 common causes of death.
Worldwide, a recent study found in 2010, nearly a third of adults had hypertension.
“We’re seeing the ramifications of the increase in obesity,” said Tom Frieden, director of the Centers for Disease Control and Prevention, was quoted in The Washington Post.
Hospital groups: ACA repeal may cost billions, jobs
http://www.healthcaredive.com/news/hospital-groups-aca-repeal-may-cost-billions-jobs/431786/
Click to access impact-repeal-aca-exec-summary.pdf
Click to access impact-repeal-aca-report.pdf
Members of the Republican party have been attempting to repeal the ACA ever since the healthcare law was implemented in 2010. In the proposed ACA repeal-and-replace plans currently available, such a replacement plan may not come for up to three years, Kahn said. In addition, there still doesn’t seem to be a unified front on what that replacement would actually entail.
President-elect Donald Trump has said he would make repealing and replacing the healthcare law a top priority. However, HHS Secretary Sylvia Mathews Burrell has warned that getting rid of the ACA could potentially have dire consequences, including the estimated 22 million people that could be left without health insurance coverage. In addition, current repeal-and-delay plans could widely change the already fragile individual insurance markets.
The hospital groups sent a letter to Trump and members of Congress to urge any repeal bill include a simultaneous mechanism for replacement coverage. “We strongly believe that any repeal legislation must be accompanied by provisions that protect the coverage for those currently receiving such protection,” the letter noted. What would be “absolutely essential” to include would be to restore the Medicare and Medicaid payment cuts so that hospitals can provide the care that communities “both respect and deserve,” according to Tom Nickels, executive vice president of government relations and public policy at the American Hospital Association.
Hospitals were under the impression that they would be getting more insured patients, so they reasoned that the Medicare and Medicaid payment cuts that came with the ACA implementation were not necessarily going to have a major impact, both AHA President and CEO Richard Pollack and Kahn noted on the media call. Yet the payment cuts to hospitals that date back to 1997 with the Balanced Budget Act have caused hospitals to “cut back staff, services, education, research, investments in new technology, and modernization, and upgrading of aging facilities,” the letter stated.
The losses that would come from ACA repeals as they have been proposed “cannot be sustained and would adversely impact patients’ access to care, decimate hospitals’ and health systems’ to provide services, weaken local economies that hospitals sustain and grow and result in massive job losses,” Nickels said on the media call.
One of the Dobson reports explains why the groups support using HR 3762 as a starting point. Even though the bill, which President Obama vetoed after it passed Congress, repeals ACA provisions that expand health insurance coverage and does not offer a replacement plan, it restores all ACA reductions in hospital payments that were supposed to help to finance the additional coverage, the report states.
21st Century Cures Act: 4 health industry impacts summarized
http://www.healthcaredive.com/news/21st-century-cures-act-explained/431491/
On Wednesday, the Senate voted 94-5 to pass the long-awaited 21st Century Cures Bill. As it has backing from the current White House administration, President Barack Obama is expected to sign the legislation into law.
The law has been called the “most important bill of the year” by Senator Lamar Alexander (R-TN), as Politico Pulse reported Tuesday. The bill, while bipartisan, is not without controversy. While the House version of the legislation passed swimmingly with a vote of 392-26, the bill did have its share of opponents in the Senate– including Sen. Elizabeth Warren (D-MA) and Sen. Bernie Sanders (I-VT) – who think the bill is too favorable to pharmaceutical companies. Both Sanders and Warren were among the five Senators to vote against the measure.
And as Modern Healthcare’s Merrill Goozner notes in an editorial, it’s likely the true impact of the bill won’t be known right away but will be realized as the years pass. “The final details of the 996-page legislation…weren’t known until five days before it passed,” Goozner wrote.
About three years of work and efforts from 1,400 lobbyists for 400 companies went into the making of this $6.3 billion package. It seeks to deliberately speed medical research and treatments. Because seemingly no healthcare legislation can be a reasonable length (it’s about 90 pages longer than the ACA) and because nothing in healthcare is simple, we’ve summarized some of the notable implications of the bill in four buckets: Health IT, mental health, FDA reform and research and care funding.
Healthcare Triage News: Republicans’ Many Plans to Replace Obamacare
Cartoon – Healthcare Mgmt Today
HENRY KOTULA 