HAP and Henry Ford collaboration creates new health plan for Michigan businesses

https://www.healthcarefinancenews.com/news/hap-and-henry-ford-collaboration-creates-new-health-plan-michigan-businesses

HAP introduces innovative health plan for Michigan businesses in  collaboration with Henry Ford Health System

Health Alliance Plan (HAP) and Henry Ford Health System have furthered their partnership through the release of Pivotal, a new health plan for Michigan-based businesses.

The plan was created for businesses with more than 100 employees and offers customized benefit options for each company.

WHAT’S THE IMPACT

Pivotal’s network includes seven hospitals, more than 6,000 physicians and 3,500 ancillary providers including urgent care, labs, radiology, imaging, rehab services, long-term care and nursing facilities, and physical, occupational and speech therapy.

Its members will have access to providers within the Henry Ford Health System, Henry Ford Physician and Jackson Health networks, Henry Ford Allegiance Health, as well as HAP’s ancillary provider and pharmacy network, and its contracted pediatric providers.

The plan recognizes the current need for telehealth services by offering virtual care for zero cost-share for in-network visits.

Members can use Pivotal’s telehealth offerings in three different ways: through at-home video visits, clinic-to-clinic video visits where providers can connect with specialists at other facilities, and with e-visits where non-emergency visits are conducted through email.

Pivotal plans also come with concierge services that include personalized onboarding for every employer group, phone support, as well as guaranteed same-day appointments with a primary care physician for sick visits and specialist appointments within 10 business days.

THE LARGER TREND

HAP has been working with Henry Ford since it became a subsidiary of the health system in 1986.

Henry Ford leveraged another partnership with CarePort during the COVID-19 public health emergency to communicate directly with post-acute care providers to share the COVID-19 testing status of patients. This allows providers to take the necessary safety precautions, including deciding if the facility can admit the patient at all, triaging care and managing the use of personal protective equipment.

ON THE RECORD

“HAP and Henry Ford have a long history of working together and sharing the same focus,” Genord said Dr. Michael Genord, president and CEO of HAP. “Working together, we’ve made sure that as many Michigan businesses as possible have access to high-quality affordable care, whether they’re in Detroit or Jackson or anywhere in between.”

 

 

 

 

UPMC’s revenue tops $11B in first half of year

https://www.beckershospitalreview.com/finance/upmc-s-revenue-tops-11b-in-first-half-of-year.html?utm_medium=email

UPMC tops $11B in revenue in 1st half of 2020 | TribLIVE.com

UPMC reported higher revenue in the first half of this year than in the same period of 2019, but the Pittsburgh-based health system’s operating income declined year over year, according to unaudited financial documents.

UPMC reported revenue of $11.1 billion in the first six months of this year, up nearly $1 billion from the same period of 2019. A year-over-year decline in net patient service revenue attributed to volume declines linked to the COVID-19 pandemic was offset by gains in insurance enrollment revenue. Enrollment in UPMC’s health plans grew to 3.9 million members as of June 30.

Expenses also increased year over year. UPMC reported operating expenses of $11.1 billion in the first half of this year, up from $10.1 billion a year earlier. Operating income for the first two quarters of 2020 totaled $59 million, down $20 million from the same period last year.

The health system ended the first half of this year with a net loss of $165 million, compared to net income of $372 million a year earlier. The net loss was attributed to a $423 million loss on investments from January through July. 

Though UPMC continues to experience some disruption to operations as a result of the COVID-19 pandemic, the system’s interim CFO Edward Karlovich said it’s on solid financial footing.

“We’re positioned with an organization of great financial strength to deal with what comes at us,” Mr. Karlovich said during a news conference Aug. 26, according to TRIBLive

 

 

 

 

In-Person, Mask-Free Classes: Some Schools About To Resume Despite Coronavirus Resurgence

https://www.forbes.com/sites/danielcassady/2020/07/28/in-person-mask-free-classes-some-schools-about-to-resume-despite-coronavirus-resurgence/#52f69637511d

In-Person, Mask-Free Classes: Some Schools About To Resume Despite ...

TOPLINE

As coronavirus infection rates continue to spike across the nation, some school districts—including Jefferson City Schools in Jefferson, Georgia—have decided to trudge forward with reopening plans and offer face-to-face classes without requiring face masks.

 

KEY FACTS

Jefferson City Schools plans to begin face-to-face classes on Friday, one of the earliest starting dates in the country, according to a report from the New York Times.

School officials in Jefferson said they would strongly encourage students or teachers to wear face masks, but wouldn’t require them to do so.

The debate over face masks has proven divisive among the town’s residents, 80% of whom voted for Trump in 2016, with high school students creating petitions both for and against mandatory face masks.

Jackson county, of which Jefferson is the county seat, has seen 162 new Covid-19 cases in the past 7 days while Georgia as a whole, a recent hotspot for the virus, has seen over 170,000 cases and more that 3,500 deaths.

At least 14 other school districts have chosen to open for full, in-person classes between July 27 and August 7, according to Ed Week, each with different rules regarding face masks.

At least 14 other school districts have chosen to open for full, in-person classes between July 27 and August 7, according to Ed Week, each with different rules regarding face masks.

KEY BACKGROUND

There has been a debate about when and how schools should reopen almost since the coronavirus pandemic began. Last week President Trump, who has been adamant that schools reopen in the fall, reversed course saying that schools in coronavirus hotspots should delay reopening, but that doing so would prevent them from receiving billions in federal aid. The CDC has also backed reopening schools as of last week, saying in a statement “Reopening schools creates opportunity to invest in the education, well-being, and future of one of America’s greatest assets — our children — while taking every precaution to protect students, teachers, staff and all their families.” Some school districts are operating more judiciously, halting reopenings until the coronavirus outbreaks subside, or relying on virtual lessons and hybrid classes.

 

 

 

 

Appeals court rules HHS has authority to implement site-neutral payments, dealing blow to hospitals

https://www.fiercehealthcare.com/hospitals/appeals-court-rules-hhs-has-authority-to-implement-site-neutral-payments-dealing-blow-to?mkt_tok=eyJpIjoiWXpGa016azRZekJqTTJZeSIsInQiOiJ6ajZGSWlYUGh1TTZqTFBDMEgwaXk3ZFZZSCtBVkdUWHNhemZ0SDJZWnhJVHlHVUpjRTdFVUlpbVBSdng4dTFXUEhhOGV2S3lRcElVVWNuZWpqakdEZE1DRmhleHRzdlY4RDRxYkxtZUNYNVI3Rmg5Kys5SVd1aGdseUR6Y1hxSCJ9&mrkid=959610

Appeals court rules HHS has authority to implement site-neutral ...

A federal appeals court ruled the Department of Health and Human Services has the authority to cut Medicare payments to off-campus clinics to bring them in line with independent physician practices, reversing a lower court’s decision.

The ruling from the U.S. Court of Appeals for the District of Columbia delivered Friday strikes a major blow to the hospital industry which has been fighting HHS over the controversial rule.

The American Hospital Association (AHA) led a lawsuit against HHS arguing it did not have the statutory authority to cut payments to the off-campus, provider-based departments. HHS made the cuts in its annual hospital payments rule and the hospitals argued they were unlawful because the cuts were not budget-neutral, a requirement of the payment rule.

But the appeals court agreed with HHS that it had the authority to make the change in the payment rule because of how the law is structured.

 

 

 

 

National insurer stocks: Where UnitedHealth, Anthem & 5 others stand year to date

https://www.beckershospitalreview.com/payer-issues/national-insurer-stocks-where-unitedhealth-anthem-5-others-stand-year-to-date.html?utm_medium=email

3 Numbers That Make UnitedHealth Stock a Buy | The Motley Fool

Some of the nation’s largest commercial payers have seen their stocks fall slightly this year, while others have seen gains despite new pressures presented by the COVID-19 pandemic.

Here is an update on how the stocks of seven commercial payers are performing year to date as of May 20 at 2 p.m. CT:

1. Molina Healthcare: Up 32.9 percent to $177.23
2. Humana: Up 7.9 percent to $391.80
3. Centene Corp.: Up 5.7 percent to $65.40
4. UnitedHealth Group: Down 1.4 percent to $288.85
5. Anthem: Down 6.7 percent to $280.81
6. Cigna: Down 7.8 percent to $189.31
7. CVS Health (Aetna): Down 14.7 percent to $63.29

Fighting for Coverage

https://www.managedhealthcareexecutive.com/news/fighting-coverage?rememberme=1&elq_mid=12155&elq_cid=876742&GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F

Fighting for Coverage | Managed Healthcare Executive

One of the main goals of the ACA, sometimes referred to as Obamacare, was to provide affordable health insurance to every American.

The law’s passage in 2010 made it possible for nearly 54 million Americans—previously denied coverage due to pre-existing medical conditions—to purchase coverage, as well as landmark provisions to protect those who developed an expensive medical condition while insured from being unexpectedly dropped by their health plan.

By all accounts, such provisions helped a record number of Americans procure medical insurance coverage—and, by extension, reduce healthcare costs and avoid medical bankruptcies.

Yet, with the elimination of the individual mandate penalty in 2017, and other policy changes that have forced up the cost of premiums, many Americans are looking for options off the healthcare exchange.

One such option is the short-term limited duration insurance (STLDI) plan, loosely defined as bare bones medical coverage that can last up to 12 months with the potential for renewal. Managed Healthcare Executive® Editorial Advisor Margaret Murray, chief executive officer of the Association for Community Affiliated Plans (ACAP), said such plans “are not really insurance,”—and refers to them as “junk insurance.” With a new 2018 HHS rule that dramatically expands access to this type of coverage, she worries that their availability will hurt consumers.

“Insurance brokers may offer these plans to consumers and those consumers may not realize that they largely reverse ACA protections regarding pre-existing conditions and coverage limits,” she says. “These plans don’t cover what you think they will cover, the insurance companies can cancel your policy at any time, and they can deny your access to maternity care and certain drugs. It’s not really major medical insurance and it’s not always easy for your average consumer to see that.”

Changing regulations

The Trump Administration contends, with rising insurance premiums, that such short-term plans make health insurance more affordable for the average American.

Cathryn Donaldson, a spokesperson for America’s Health Insurance Plans, a health insurance trade association, says such plans “can provide a temporary bridge for those who are going through a life transition or gap in coverage such as having a baby or changing jobs.”

Yet, Karen Pollitz, a senior fellow at the Kaiser Family Foundation, says STLDI plans embody the old adage about getting what you pay for. STLDI are not required to comply with many of the ACA’s most important protections, which means insurance companies can exclude coverage for pre-existing conditions, charge higher premiums based on health status, impose annual and/or lifetime caps, and opt out of coverage for things like maternity care or mental health treatment. They can also revoke coverage at will.

“Under the ACA, it used to be that short term and minimum essential coverage [MEC] policies had to have a prominent warning printed on the front place that said, if you buy this, you are not getting full coverage and may even owe a tax penalty,” she explains. “Those warnings are no longer there and that’s of concern.”

Furthermore, late last year, HHS put forth a final rule extending the duration of STLDI from a mere three months up to 364 days. In addition, insurers can offer renewals and extensions for up to three years. What is even more concerning, Murray says, is the current Administration is now actively promoting the use of private web broker sites to market STLDI. This can make it more difficult for consumers to understand which plans offer comprehensive medical coverage and which are the riskier STLDI plans.

“The current administration says such plans offer consumers more affordable options—and more choice,” Murray explains. “But the marketing for these plans is really disingenuous. It’s not just that they are just short-term. They don’t cover what people think they will cover. They are very profitable for insurance companies. But they can be very costly for consumers, who likely won’t realize they don’t have comprehensive coverage until they are sick or injured.”

The fall-out

Over the past few months, several high-profile publications like Consumer Reports and the Washington Post have printed stories about the dangers, and unexpected costs, of STLDI for consumers.

“It’s like you are in the market for a car and someone offers you a really affordable roller-skate,” says Pollitz. “But a roller-skate is not the same thing as a car. It’s not going to get you as far if you really need to travel. And it’s going to cost you more in the long run.”

Murray also cautions more widespread adoption of such plans can affect the entire insurance market, siphoning cost-conscious consumers from risk pools and driving up premium costs for everyone.

“There are always some young invincibles, who think they won’t get sick—and there are some invincibles, too—and they will be attracted by the lower premiums,” she says. “But in doing so, that will leave people who are sicker to pay higher rates by moving people out of the ACA marketplace.”

That’s one reason why ACAP, as well as six other health organizations, filed a lawsuit in the U.S. District Court for the District of Columbia on September 14, 2018 in order to roll back the new STLDI rule and stop the expansion of such plans. Murray said the HHS rule violates the ACA, “undercutting plans that comply” with the still active legislation. They argue the Trump Administration is using these new rules to try to overturn the ACA—which they have not yet been able to successfully repeal in Congress.

“We thought this was important enough that it was worth suing the federal government in order to try and stop it,” she says. “We had hoped to get a summary judgment last year because we wanted to stop the spread of STLDI plans for the 2020 open enrollment. Unfortunately, we didn’t get that. The judge ruled against us. But we are appealing it—and the hope is that we will have a decision to stop these things being sold in 2021.

The take-home message

Donaldson says it is vital the healthcare community educate consumers about the risks of STLDI plans and make sure they are better aware of what sort of comprehensive plans are available on the Healthcare.gov marketplace.

“While alternative plans such as association health plans and STLDI may present more affordable premiums, they are not a replacement for comprehensive coverage and may not cover the treatments or prescriptions an individual may need throughout the year,” she says.

Pollitz agrees.

“We understand that life happens and there may be all manner of reasons why you are separated from coverage,” she says. “But it is becoming harder and harder to distinguish these plans from real coverage especially now that they are now being aggressively marketed to people all over the country. And it’s vital that people understand that 90% of consumers will play less than the listed price on Healthcare.gov marketplace because they qualify for subsidies. It really does pay to take the time to look before you sign up for one of these short-term plans.”

 

 

 

 

Massive benefits consulting merger in the works

https://www.axios.com/newsletters/axios-vitals-f4216088-ea87-4fb4-ae0b-ab76f9368c8d.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for Massive benefits consulting merger in the works aon willis towers watson

Aon is proposing to buy Willis Towers Watson in an all-stock transaction that would combine the second- and third-largest insurance brokerages, Bob writes.

Why it matters: Employers hire Aon and Willis Towers Watson to help them choose health plans and pharmacy benefit managers for their workers, but the major consultants don’t always steer companies toward the best deals.

  • Combining into the largest consulting house on Earth will give Aon that much more power over employers.

What’s next: The two companies don’t expect to close the deal until the first half of 2021, indicating they know antitrust regulators will be closely scrutinizing this.