Monthly Archives: July 2018

MAINE SECURES WAIVER TO RESURRECT ‘INVISIBLE HIGH-RISK POOL’

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https://www.healthleadersmedia.com/finance/maine-secures-waiver-resurrect-invisible-high-risk-pool

The reinsurance program, which the state operated in 2012 and 2013, before the ACA’s transitional reinsurance took effect, is expected to reduce insurance costs in Maine’s individual insurance market.

The federal government approved another waiver application Monday under the Affordable Care Act, giving Maine the go-ahead to reinstate a reinsurance program it had operated briefly before the ACA took effect.

Maine is the fifth state to secure a Section 1332 waiver to establish a state-run reinsurance program, following closely on the heels of Wisconsin’s waiver request being granted Sunday. Alaska, Minnesota, and Oregon won their waivers last year, and two other states—Maryland and New Jersey—have similar applications pending.

Although the Trump administration has taken a number of actions that would appear to harm the individual market, approving these waivers seems to be a positive step in the opposite direction, says Matthew Fiedler, PhD, a fellow with the Brookings Institution Center for Health Policy who served as chief economist of the Council of Economic Advisers during the Obama administration.

“Reinsurance waivers will reduce premiums in the individual market in these states and will result in more people being covered. I think they’re a reasonable way for states to spend money,” Fiedler tells HealthLeaders Media. “There may be better ways to spend money to improve the individual market, but this is certainly an actionable one and one that states can implement more or less on their own.”

Maine projects that premiums will be 9% lower in 2019 than they would be without reinsurance. Those lower premiums are expected to encourage more people to sign up for coverage, reducing Maine’s uninsured population by 1.7%, according to independent actuarial projections cited by the state and federal governments.

A modest gain in enrollment could translate to a slight benefit for insurers and could reduce the burden of uncompensated care on hospitals, Fiedler says.

‘INVISIBLE HIGH-RISK POOL’

In a letter submitted last May to Health and Human Services Secretary Alex Azar, Maine Bureau of Insurance Senior Staff Attorney Thomas M. Record said the program, which is known formally as the Main Guaranteed Access Reinsurance Association (MGARA), had “become popularly known as Maine’s ‘ invisible high risk pool.'”

Record described the program as a key feature of health reform legislation Maine lawmakers passed in 2011. The program, which was active in 2012 and 2013, successfully reduced premiums in the individual market by about 20%, he said.

Despite that success, MGARA was suspended at the beginning of 2014, when the ACA’s transitional reinsurance program rendered it redundant, according to Maine’s waiver application. The federal reinsurance program ended as scheduled on the final day of 2016.

Material released by the Centers for Medicare & Medicaid Services describe MGARA as operating a hybrid-model reinsurance program that includes traditional and conditions-based components. High-risk patients with any of eight conditions will be ceded automatically. Other high-risk enrollees will be ceded voluntarily. The program will offer 90% coinsurance for claims in the $47,000-77,000 range and 100% coinsurance for higher claims up to $1 million.

For claims above $1 million, the program will cover the amount left uncovered by the federal government’s high-cost risk-adjustment program.

Maine estimates that its program will result in a net spending reduce of more than $33 million per year, for 2019 through 2023, with that federal savings to be passed along to the state to fund the program.

The program’s total expenses are projected to cost $90-104 million annually during the five-year waiver period.

Insurers and providers have responded positively to the prospect of state-run reinsurance programs, seeing the development as good news for business and patients alike. But the benefits should not be overstated.

“The one downside of these programs is that because tax credits fall dollar-for-dollar when premiums fall, they don’t really do anything to make coverage more affordable for people with incomes below 400% of the poverty line,” Fiedler says.

“That doesn’t mean they’re a bad thing. But they can only be one part of an overall strategy for making individual market insurance affordable.”

 

 

Market Concentration Variation of Health Care Providers and Health Insurers in the United States

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https://www.commonwealthfund.org/blog/2018/variation-healthcare-provider-and-health-insurer-market-concentration?omnicid=EALERT%%jobid%%&mid=%%emailaddr%%

Market concentration will cause high prices

 

Over the past several decades in the United States, more and more health care providers and health insurers have consolidated, increasing their market power.1,2Highly concentrated markets have contributed to the growth in U.S. health care spending because they are associated with higher health care prices and insurance premiums, yet are not typically associated with higher quality of care.2-4 Given that states play a large role in regulating health care provider and insurer markets, it’s important to understand how concentration levels vary across the country, as well as examine the relative concentration levels between providers and insurers at the local level. Our previous research has shown that in markets with both high provider and insurer concentration, insurers have bargaining power to reduce prices, yet consumers and employers don’t usually benefit.5Regulators can use this information to determine if policies are needed to protect consumers, as well as employers that provide health benefits to their workforces.

To illustrate health care market concentration variability across the United States, we tabulated the market concentration of health care providers — hospitals, specialist physicians, and primary care physicians — and health insurers for each metropolitan statistical area (MSA) in 2016 using the methods and data described in the Appendix. Regulators classify markets into categories that range from unconcentrated to moderately concentrated to highly concentrated.6 We created a fourth category called “super concentrated,” to distinguish among the most concentrated markets (see the Appendix for details).

Market Concentration Levels Across the United States

When looking at market concentration levels across the United States, we found that, for both providers and insurers, the concentration levels varied, typically between two concentration categories (see table). For providers, the vast majority of the MSAs were at the concentrated end of the spectrum, either being highly concentrated (47.1%) or super concentrated (43.0%). By comparison, for insurers, almost all the MSAs fell into the middle categories, either being highly concentrated MSAs (54.5%) or moderately concentrated (36.9%).

When examining the relative concentration between providers and insurers, providers generally had the upper hand. Provider concentration was in a higher category relative to insurers in 58.4 percent of the MSAs, while the opposite was true in only 5.8 percent of the MSAs.

State and Federal Scrutiny Is Needed

This study shows that health care market concentration levels vary across the United States. To protect consumers and employers from high prices and premiums, state-level regulatory scrutiny — coupled with federal regulatory scrutiny — of potentially anticompetitive behavior is needed. State officials better understand the nuances of their local markets and are able to ascertain what steps, if any, may be required. For example, more populous MSAs may have lower measured concentration levels because they comprise more than one market. And even if a market is found to be highly or super concentrated, regulators should examine other competitive factors that may mitigate the potentially harmful impact of high concentration. These might include whether it is easy for competitors to enter a market or if there are economies of scale that might lead to lower costs.6 For example, as health care diagnoses and treatments become more complex, larger, more-integrated, and well-capitalized health care providers may be better equipped to lower costs and improve quality. Still, it is important for regulators to increase the likelihood that the benefits of consolidation ultimately flow to consumers and employers.

The Six Letter Word Healthcare Solutions Providers are Coveting & How to Get It

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https://www.linkedin.com/pulse/six-letter-word-healthcare-solutions-providers-how-get-stamatinos/

If you’re like most people, you’re looking ahead to the New Year and thinking about what you would like to accomplish. With innovation being on the brink in healthcare the last several years, one thing has surely taken place: restricted access to the right people in order to talk about your solution.
It may sound very simple on the surface; however, navigating the murky waters of healthcare successfully towards gaining access to the decision maker is difficult. And if it’s your goal to gain “Access” in the New Year, it’s a highly coveted and ambitious one.

When the healthcare world was less commoditized, conveying trust was enough to make the sale. Today, there’s simply too much noise in the market place and erodes the ability to gain traction or trust. This leads to many solutions providers ending up swimming in the dreaded sea of similar.

3 Ways Trust Can Be Ruined In an Instant
Gaining access to a decision maker has a lot to do with compatibility and reputation. If you have a great reputation, they’re more likely to listen to what you have to say. Compatibility is not just about how well your personalities mesh. It has more to do with how the healthcare solutions provider sees you and whether or not they trust you.

Trust is vital in any relationship; especially, a sales relationship. It’s been said that trust is the foundation upon which salespeople will achieve success. It will keep your customers coming back and choosing you over your competitors. Unfortunately, trust can be lost in an instant. Here are three ways you can lose the trust of a healthcare solutions provider.

1. Having a Hidden Agenda
A lot of salespeople are focused solely on sales. While sales are important—after all, sales are the lifeline of any organization looking to survive and thrive—it shouldn’t be the only focus. A salesperson doesn’t necessarily have to blatantly show or tell the client that they’re focused solely on themselves. Subconsciously, clients can pick up on even the subtlest of signs. When they feel like they’re not as important as the sale, trust goes right out the window.
Here’s the cool thing, you can eliminate rejection forever simply by giving up the hidden agenda of hoping to make a sale. Instead, be sure that everything you say and do aligns with basic mindset that you’re there to help identify and solve their issues.

2. Moving Too Quickly
Customers, especially one’s in healthcare, don’t like to be forced to do anything. In many situations, customers feel like they’re almost being bullied by a salesperson. Trying to move the relationship too quickly is detrimental to the trusted relationship between the customer and salesperson. Relationships are complex and multi-dimensional, which means that pressure leads to resistance and road blocks in your trust equity building efforts.
Contemplate letting go of trying to close the sale or get the appointment. What you’ll discover is that you don’t have to take responsibility for moving the sales process forward.

Simply focus your conversation on the problems that you can help prospects solve. By not jumping the gun and trying to move the sales process forward, you’ll learn that your potential customers will give you the direction you need.

3. Having No Understanding or Empathy for the Customer
Everyone wants to feel understood; it’s a basic human essential. At the very least, they want those around them to feel some empathy for what they’re going through, even if they can’t completely understand the situation. Your Potential clients & customers feel the same way. They have bad days, they may be dealing with difficult life circumstances, or they may be overwhelmed by all of their responsibilities at work.
Trust will be lost if you or anyone on your sales team fails to acknowledge the challenges that your customers are going through. In essence, the customer will feel like their feelings, even their existence, have been belittled. And, when they feel this way there is no way they’re going to trust the person who is contributing to them feel this way.

How to Build Trust and Gain Continual Access to Potential Customers
What will it take for healthcare solutions provider to start gaining access to the decision makers during the New Year? There are three steps they can take.

1. Tell the Truth
There’s no better way to earn a client’s trust than with honesty. Clients want to know what you can and can’t provide for them. Stretching the truth to gain the sale will only lead to disappointment, both for them and for your wallet.

2. Embrace Transparency
This goes hand-in-hand with honesty. Keep your promises for sure, however, don’t start making promises that you can’t keep. A lack of honesty and authenticity will definitely have an adverse effect on your reputation with the decision-makers.

3. Replace “Selling” With “Caring”
Those in the healthcare field enter the field because they want to help other people. They’re constantly caring for others. They need to be cared for, too. This is where you come in. If you make your customers feel well cared for, they’re sure to become loyal customers.
Instead of burning a lead by asking “probing” questions to qualify a potential client, you might want to consider how you can add value through concrete insights and build trust beforehand.

Moving Ahead, Access Will Be Predicated Upon Building “Trust Equity”
In the world of quotas and benchmarks things have become watered down and sales conversations have somehow become surface level and NOT authentic.
The currency of the new economy is trust. And you need TRUST beforehand to even get ACCESS.

Building “trust equity” is a long-term, never-ending effort of communicating, listening, building trust and establishing credibility. My belief is that you’ll be more likely to win over customers’ trust over time and tap into a well of abundance that’ll never dry out.

Learn How You Measure Up on the “Trusted-Access” Scale
Like any business strategy, determine what measurements need to be in place to determine effectiveness. Have a strong grip on what those KPI’s are and manage towards those goals each month.

 

CMS Adminstrator dismisses Affordable Care Act

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CMS Adminstrator dismisses Affordable Care Act

Image result for 2018 midterm elections

 

About 1.4 million Californians buy coverage through the state’s Obamacare exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.

Stepping into the land of the Trump resistance, Seema Verma flatly rejected California’s pursuit of single-payer health care as unworkable and dismissed the Affordable Care Act as too flawed to ever succeed.

Speaking Wednesday at the Commonwealth Club here, the administrator of the Centers for Medicare & Medicaid Services said she supports granting states flexibility on health care but indicated she would not give California the leeway it would need to spend federal money on a single-payer system.

“I think a lot of the analysis has shown it’s unaffordable,” Verma said during a question-and-answer session following her speech. “It doesn’t make sense for us to waste time on something that’s not going to work.”

During her speech, Verma issued a broader warning to advocates pushing for a Medicare-for-all program nationally. She said that “socialized” approach to medicine would endanger the program and the health care it provides for millions of older Americans.

“We don’t want to divert the purpose and focus away from our seniors,” Verma said in the address before more than 200 people. “In essence, Medicare for all would become Medicare for none.”

Single-payer has emerged as a key issue in the California governor’s race this year. The current front-runner for governor, Gavin Newsom, a Democrat and the current lieutenant governor, has vowed to pursue a state-run, single-payer system for all Californians if elected in November. Many California lawmakers have endorsed that idea as the next step toward achieving universal coverage and to tackling rising costs.

California has enthusiastically embraced the Affordable Care Act, and state leaders have struggled with — and even bucked — the Trump administration on a variety of health-policy fronts. The state stands to lose more than any other if the Trump administration is successful in further dismantling the ACA.

About 1.4 million Californians buy coverage through the state’s Obamacare exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.

Verma wields enormous power as head of CMS, overseeing a $1 trillion budget. The agency sets policy for Medicare, Medicaid and the federal insurance exchanges under the ACA.

The landmark health law, she said, was so flawed it could not work without further action from Congress.

“It wasn’t working when we came into office and it continues not to work,” Verma said, responding to a question from moderator Mark Zitter, founder of the Zetema Project, a nonprofit organization that promotes debate on health care across partisan lines. “The program is not designed to be successful.”
Zitter billed the event as a rare chance for Californians to hear directly from a top Trump administration official, although Verma’s remarks broke little new ground, he said.

Trump health care policies figure into many of California’s congressional races this fall in which incumbent Republicans are fending off Democratic challengers. And in court, California Attorney General Xavier Becerra is leading a coalition of attorneys general who are defending the constitutionality of the ACA in a Texas case with national implications.

The Trump administration has sided with the officials waging the lawsuit, choosing not to defend the health law’s protections for people with preexisting conditions. Separately, the administration has backed work requirements for many people on Medicaid.

Short
California’s state Senate passed a law in May banning such requirements as a condition for eligibility in Medi-Cal, the state’s Medicaid program. The bill is pending in the state Assembly.

“Making health insurance coverage contingent on work requirements goes against all we’ve worked for here in California,” state Sen. Ed Hernandez (D-West Covina), author of SB 1108, said in May.

State lawmakers also are considering bills that would limit the GOP-backed sale of short-term health policies and prevent people from joining association health plans that don’t have robust consumer protections.

In an interview after the speech, Verma criticized those legislative efforts in California because they would limit consumer choice.
“Any efforts to thwart choice and competition and letting Americans make decisions about their health care is bad health policy,” she said.

Peter Lee, executive director of Covered California, the state’s ACA marketplace, has criticized the Trump administration for promoting those cheaper, skimpier policies as an alternative to ACA-compliant plans. He said he fears consumers will be harmed by “bait-and-switch products” that don’t provide comprehensive benefits.

“There have been a series of policies from Washington that have the effect of raising costs, particularly for middle-class Americans, and pricing them out of coverage,” Lee said in an interview last week. “This is not a failure of the ACA. This is entirely happening since the new administration.”

Most of Verma’s speech in San Francisco focused on Medicare. She outlined a number of initiatives designed to strengthen the program and protect taxpayers from ballooning costs. After the speech, CMS announced proposed changes to Medicare payment policies for outpatient care that could yield savings for the government and patients.

In her remarks, Verma reiterated the Trump administration’s efforts to reduce prescription drug prices, improve patients’ access to their own medical records and eliminate burdensome regulations on doctors and other medical providers.

Verma received a polite round of applause at the beginning and end of her appearance.