Category Archives: Health Policy

Gainesville health system paying patients’ out-of-network costs

Posted on by • Posted in Health Insurance Coverage Adequacy, Health Insurance Industry, Health Plan, Health Policy, Health System, High Deductible Health Plans, High Prices, Hospital, Hospital Industry, Out of Pocket Expenses, Out-of-Network, Physician, Surprise Bills • Leave a comment

https://www.albanyherald.com/news/gainesville-health-system-paying-patients-out-of-network-costs/article_5a82d58a-f4f1-11e9-b7b5-8bebc4253708.html

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With a contract impasse in its third week, a Gainesville-based health system is spending millions of dollars so that thousands of patients are not having to pay more when visiting the system’s doctors and hospitals.

Northeast Georgia Health System’s contract with Anthem ended Sept. 30, which means that since then, Georgians with Anthem insurance have been out of network for NGHS facilities and physicians.

But in an unusual move, the Northeast Georgia system is making up the financial difference between in-network and out-of-network prices through Dec. 31. That way, Anthem patients won’t pay higher fees when visiting NGHS medical providers, the system said.

“While it will cost millions of dollars per month to protect our patients from out-of-network costs, we’d rather do that than agree to a proposal that would jeopardize the health of our community for years to come,’’ Steve McNeilly, vice president of managed care for NGHS, said.

Most contract disputes between health systems and insurers get resolved before the end of the previous deal, although some agreements come just hours before the end of the expiring pact. The terminated contract between NGHS and Anthem is an exception, and this particular stalemate doesn’t show any sign of progress. Neither side has mentioned any negotiations or even indicated that talks are being scheduled.

The standoff comes at a time when many Georgians are entering their open enrollment period for the 2020 health plan year.

Anthem is by far the state’s biggest health insurer. Northeast Georgia’s hospitals in Gainesville, Braselton, Winder and Dahlonega, as well as its urgent care facilities and many physician group locations, are now out of network for Anthem patients.

“Anthem has only contacted NGHS once since the end of September – and that was only to inform us that they would be processing all claims as out-of-network,’’ McNeilly said. He said Northeast Georgia has proposed a contract with concessions, but that Anthem “refuses to take any meaningful action.’’

“Unfortunately, it appears that Anthem intends for us to be out of network for an extended period of time, so we’re urging patients to switch to a different health insurance plan during open enrollment,’’ McNeilly added.

Northeast Georgia said patients can call its Patient Access Service Center at (770) 219-7678 to get a personalized estimate of hospital charges for upcoming surgeries or procedures. If patients have questions about charges for physician office visits, they can call their physician’s office for more information, NGHS said.

Anthem said Monday that it is “standing firm for our consumers who need greater affordability.’’

The latest proposals from NGHS would increase costs “well above other health systems in the state,’’ Christina Gaines, an Anthem spokeswoman, said. “These increases place a significant burden on consumers because any substantial price increase in the services at these facilities would be directly reflected in increases in medical expenses covered by employer-sponsored group health plans, as well as to member premiums and cost share amounts.’’

What NGHS proposed “was simply not sustainable’’ for Anthem members, she said.

“We provided a revised proposal to them two days before the contract expired and did not receive a response,’’ Gaines said. “We are willing to resume talks so we can come to a new agreement that is fair, provides flexibility and protects affordability.”

Anthem said it can’t guarantee that Northeast Georgia will continue to charge patients the same rates as under the previous contract.

“To protect against unexpected balance billing, and other expenses associated with out-of-network providers, we are urging members to use in-network physicians and facilities,’’ Gaines said. “Anthem continues to have a broad, statewide provider network that delivers access to other quality health care options that remain in-network for our consumers.” Anthem directed consumers to visit www.anthem.com/nghs for information.

Craig Savage, a consultant with CMBC Advisors in North Carolina, said he had not heard previously of a hospital-based system covering the cost gap for patients who are forced out of network by a contract dispute.

“I think it’s a demonstration of good faith to patients,’’ Savage said. “It puts a little marketing pressure on Anthem.’’

But he added that even losing the business of 40,000 patients is “not going to have a huge [financial] impact on Anthem in Georgia.’’

And Savage said the contract standoff may put pressure on local physicians who could lose many patients to another insurer during open enrollment season.

 

 

 

California will be first state to train doctors in how their counsel can prevent gun deaths

Posted on by • Posted in Gun Related Deaths, Gun Violence, Health Policy, Physician • Leave a comment

https://www.sacbee.com/news/politics-government/capitol-alert/article236257503.html

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The state of California will pay $3.85 million to researchers at the University of California, Davis, to develop the nation’s first program to train health care professionals to help their patients reduce firearm-related injury and death, university officials announced Tuesday.

Gov. Gavin Newsom approved the funding on Friday when he signed Assembly Bill 521 . Money will go toward educating a variety of California providers, including practicing physicians, mental health care professionals, physician assistants, nurse practitioners, nurses, health professions students and other specialists.

Dr. Amy Barnhorst, a UC Davis Health psychiatrist, will oversee the training. She has spent a good deal of her career studying gun violence, suicide and public mental health.

“Medical and mental health providers are uniquely positioned to respond to and prevent firearm-related harm,” Barnhorst said. “Many have asked for more information on when and how to discuss firearms with patients and what to do when patients have access to guns and are at high risk for harming themselves or others.”

Barnhorst and other UC Davis researchers look into how to prevent violence, what causes it, and the consequences of it at the Violence Prevention Research Program. This research program is home to the UC Firearm Violence Research Center.

Around the nation, physicians have called for meaningful policy changes to address the public health risk of gun violence in the wake of mass shootings like those at the Gilroy Garlic Festival in July and the Borderline Bar and Grill in Thousand Oaks last November. California reported 3,184 gun-related deaths in 2017, including 1,610 suicides and 1,435 homicides, according to data from the U.S. Centers for Disease Control and Prevention.

Researchers from UCD’s Violence Prevention Research Program, Stanford University and other institutions teamed up to publish guidelines in the Annals of Internal Medicine on how the nation’s physicians could begin to have conversations with patients at risk of harm.

Dr. Garen Wintemute, the program’s director, said the new law allows Barnhorst and other team members to build upon this work.

Physicians can, for instance, counsel patients on safe storage practices or how to initiate gun violence restraining orders or how to intervene on behalf of individuals with mental health issues. To emphasize the importance of these conversations, researchers cited data in the Annals of Internal Medicine that show that as many as 30 percent of firearms owners keep at least one gun loaded but not locked up.

“California health professionals are committed to making firearm violence prevention part of their practices, and we are very excited by the opportunity to equip them with the knowledge and skills they need,” Wintemute said.

In addition to training physicians, Wintemute said, UC Davis will continue its rigorous search for specific gaps in knowledge and structural barriers that prevent society from being able to reduce the threat of gun violence.

Assemblyman Marc Berman, D-Palo Alto, co-authored AB 521 with Assembly members Cecilia Aguiar-Curry, D-Winters; David Chiu, D-San Francisco; Jesse Gabriel, D-San Fernando Valley; Todd Gloria, D-San Diego; Marc Levine, D-Marin County; and Mark Stone, D-Monterey Bay; as well as state Sens. Anthony Portantino, D-La Canada Flintridge, and Scott Wiener, D-San Francisco.

 

 

 

5 WAYS HEALTHCARE ORGANIZATIONS CAN ADDRESS SOCIAL DETERMINANTS OF HEALTH

Posted on by • Posted in Adjustment, Alignment, Assistance, Awareness, Health Policy, Health System, Hospital, Hospital Industry, Outcomes, Patient Outcomes, Social Determinants of Health, Strategy • Leave a comment

https://www.healthleadersmedia.com/clinical-care/5-ways-healthcare-organizations-can-address-social-determinants-health

The National Academies of Sciences, Engineering, and Medicine has published a detailed report on implementing efforts to address the social needs of patients.

KEY TAKEAWAYS

Social needs play a pivotal role in patient outcomes.

Before setting strategies to address social determinants of health, healthcare organizations should assess their level of existing social needs activities.

Partnerships are a crucial component of addressing the social needs of patients.

Healthcare providers can address social determinants of health through five approaches—awareness, adjustment, assistance, alignment, and advocacy, according to a report from the National Academies of Sciences, Engineering, and Medicine.

Social determinants of health (SDOH) such as housing, food security, and transportation can have a pivotal impact on the physical and mental health of patients. By making direct investments in initiatives designed to address SDOHs and working with community partners, healthcare organizations can help their patients in profound ways beyond the traditional provision of medical services.

“The consistent and compelling evidence concerning how social determinants shape health has led to a growing recognition throughout the healthcare sector that improvements in overall health metrics are likely to depend—at least in part—on attention being paid to these social determinants,” the National Academies report says.

The report outlines the “5As” strategies that healthcare organizations can implement to address SDOHs in the communities they serve. The strategies were developed by the National Academies’ Committee on Integrating Social Needs Care into the Delivery of Healthcare to Improve the Nation’s Health, Board on Health Care Services, Health and Medicine Division.

1. AWARENESS

The committee says awareness should focus on identifying the social risks and assets of specific patients and populations of patients.

“On the clinical side, patients visiting healthcare organizations are increasingly being asked to answer social risk screening questions in the context of their care and care planning. In some places, screening is incentivized by payers. As part of the MassHealth Medicaid program, for instance, Massachusetts accountable care organizations now include social screening as a measure of care quality,” the report says.

2. ADJUSTMENT

Instead of addressing social needs directly, healthcare organizations can pursue a strategy that focuses on adjusting clinical care to address social determinants of health.

“Many examples of adjustment strategies were identified in the literature, including the delivery of language- and literacy-concordant services; smaller doctor-patient panel sizes for cases with socially complex needs (e.g., teams caring for homeless patients in the U.S. Department of Veterans Affairs health system have panel sizes smaller than the size of other VA care teams); offering open-access scheduling or evening and weekend clinic access; and providing telehealth services, especially in rural areas,” the report says.

3. ASSISTANCE

Healthcare organizations can pursue strategies to connect patients with social needs to government and community resources.

“The literature contains descriptions of a variety of assistance activities that have been undertaken by health systems and communities. These assistance activities vary in intensity, from lighter touch (one-time provision of resources, information, or referrals) to longer and more intensive interventions that attempt to assess and address patient-prioritized social needs more comprehensively,” the report says.

Intensive interventions include relationship building, comprehensive biopsychosocial needs assessments, care planning, motivational interviewing, and long-term community-based supports.

4. ALIGNMENT

Healthcare providers can pursue an alignment strategy that assesses the social care assets in the community, organizes those assets to promote teamwork across organizations, and invests in assets to impact health outcomes.

“The committee defined alignment activities to include those undertaken by healthcare systems to understand existing social care assets in the community, organize them in such a way as to encourage synergy among the various activities, and invest in and deploy them to prevent emerging social needs and improve health outcomes,” the report says.

5. ADVOCACY

Healthcare providers can form alliances with social care organizations to advocate for policies that promote the creation and distribution of assets or resources to address social determinants of health. For example, healthcare organizations can call for policy changes to overhaul transportation services in a community.

“In both the alignment and advocacy categories, healthcare organizations leverage their political, social, and economic capital within a community or local environment to encourage and enable healthcare and social care organizations to partner and pool resources, such as services and information, to achieve greater net benefit from the healthcare and social care services available in the community,” the report says.

IMPLEMENTING THE FIVE STRATEGIES

Assessing the level of existing social needs activities should be a starting point for healthcare organizations that want to address social determinants of health, the chairperson of the National Academies committee told HealthLeaders.

One of the first steps healthcare organizations can take is identifying activities they may already have underway that fit the 5As, then expand or enhance those activities through greater commitment from leadership, investment of resources into supporting infrastructure, and strengthening of engagement with patients and community stakeholders, said Kirsten Bibbins-Domingo, PhD, MD, MAS, professor and chair, Department of Epidemiology and Biostatistics, UCSF School of Medicine, University of California, San Francisco.

“Healthcare organizations may not have activities in all of the 5As and should use this framework to develop strategies that will work within their local context. In all cases, it is critical to be aware that addressing health-related social needs of their patients is essential to achieving goals of high quality and high-value care,” she said.

“Partnerships are crucial,” Bibbins-Domingo said.

“Activities in the clinical setting should be designed and implemented in a way that engages patients, community partners, frontline staff, social care workers, and clinicians in planning and evaluation, as well as in incorporating the preferences of patients and communities. Establishing linkages and communication pathways between healthcare and social service providers is critical, including personal care aides, home care aides, and others who provide care and support for seriously ill and disabled patients.”

 

 

 

New Legislation to Control Drug Prices: How Do House and Senate Bills Compare?

Posted on by • Posted in 2020 Election Issues, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, Out of Pocket Expenses, Pharmaceutical Industry • Leave a comment

https://www.commonwealthfund.org/blog/2019/new-legislation-control-drug-prices-how-do-house-and-senate-bills-compare

drug pricing and legislation

House Speaker Nancy Pelosi’s (D–Calif.) long-anticipated drug pricing plan — the Lower Drug Costs Now Act of 2019 (H.R. 3) — has shaken up the drug pricing debate. It gives Medicare the ability to negotiate drug prices, further fueling the partisan divide between Democrats and Republicans, but also includes policies similar to those championed by Senate Finance Committee Chair Chuck Grassley (R–Iowa), such as caps on price increases in Medicare Parts B and D, as well as changes to the Part D benefit design. The way the bill approaches drug price negotiation is similar to the Trump administration’s supposedly soon-to-be-released international price index (IPI) proposal, which has been under review at the Office of Management and Budget since June.

The following tables compare H.R. 3 based on the legislative text advanced by key committees of jurisdiction and key provisions of related proposals: the Prescription Drug Pricing Reduction Act of 2019 (S. 2543), advanced by the Senate Finance Committee in July; and the Advanced Notice of Proposed Rulemaking (ANPRM): Medicare Program, IPI Model for Medicare Part B Drugs, issued by the Centers for Medicare and Medicaid Services last October.

Despite the poor prospects of H.R. 3 as currently drafted gaining traction in the Republican-controlled Senate, House Democratic leaders are moving full-steam ahead. The House Energy and Commerce, Education and Labor, and Ways and Means committees recently advanced similarly amended versions of H.R. 3 that will need to be reconciled before a floor vote that will likely occur after the recess in early November. The advanced bills raise the minimum number of drugs subject to negotiation from 25 to 35; retain drugs on the negotiation list until two generic or biosimilar products are available; and require price negotiation of drugs with launch prices in excess of the median household income, among other policy changes.

Even with these new revisions, House progressives are pushing for policies that would go further. The Ways and Means committee rejected a series of amendments offered by Health Subcommittee Chair Rep. Lloyd Doggett (D–Texas) that included extending government-negotiated prices to uninsured individuals and increasing the minimum number of drugs subject to negotiation to 50 after five years and to 100 after 10 years. In contrast, moderate Democrats are calling for a vote on stand-alone drug pricing legislation that can pass muster in the Senate — a talking point reiterated by Republicans throughout the markups. Despite cracks in Democratic support, House leadership is expected to continue backing Medicare negotiation, especially with the initial analysis from the Congressional Budget Office (CBO) — projecting $345 billion in savings over 2023–29 — further bolstering their position.

In the face of the ongoing impeachment inquiry, President Trump remains open to drug pricing talks with the Speaker, emphasizing his desire to pass drug pricing legislation. Notably, he endorsed government negotiations on drug pricing prior to taking office. Viewing the president’s interest in H.R. 3 as a viable threat, Chairman Grassley pushed his Republican colleagues to support what Grassley calls the “less aggressive, but strongly pharma-opposed drug pricing bill passed by the Senate Finance Committee.” Taxpayer savings of $100 billion, preliminarily projected by CBO, makes S. 2543 an attractive offset for other health care policy priorities. However, the chairman has already signaled the possibility of delaying floor action on drug pricing until early next year, giving him more time to win Republican support but perhaps also lowering the odds of ultimately passing significant legislation in an election year.

Both parties are intent on getting something done on drug pricing ahead of the 2020 elections. Amid escalating partisan tensions, the competing yet overlapping proposals from House Democrats and the Senate Finance Committee may create a scenario in which bipartisan, bicameral compromise may still be possible.

 

 

 

Premiums for ACA Health Plans Drop in 2020

Posted on by • Posted in 2020 Election Issues, ACA, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Premiums, Preexisting Conditions, Underinsured, Uninsured • Leave a comment

https://www.realclearhealth.com/2019/10/23/premiums_for_aca_health_plans_drop_in_2020_279468.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=dfd654c92e-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-dfd654c92e-84752421&mc_cid=dfd654c92e&mc_eid=cb200f8a98

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Premiums for the most popular health plans sold under the Affordable Care Act will drop for the second consecutive year, the Trump administration said Tuesday, as the law enters its 10th year and shows further signs of stabilizing.

 

 

 

FTC to probe impacts of state antitrust protections for local hospital mergers

Posted on by • Posted in 2020 Election Issues, Antitrust, Certificates of Public Advantage (COPAs), Federal Trade Commission (FTC), Health Insurance Industry, Health Policy, Health System, Hospital, Hospital Industry, Market Consolidation, Market Power, Monopoly • Leave a comment

https://www.fiercehealthcare.com/hospitals-health-systems/ftc-to-probe-impacts-state-antitrust-protections-for-local-hospital?mkt_tok=eyJpIjoiT0RZNE4yTm1PV1psTmpNeSIsInQiOiJ5R3gxMEwrdUhPWUdZVlBTZ3NWWkdMV08xOCtObDdFaGdHaE1hN0o4Z2p5WnBaN3hjd2lDVm5ybnBhWUtUNFdlTW1LcndtaTN1WUtNVzg1NmUrQjJmWEhqTWpJR3BkUmVuZmVNS2FzdmRWdENuMEtNT0tJMXozUW93N0lVQmZ5WSJ9&mrkid=959610

The Federal Trade Commission (FTC) issued orders to five health insurance companies and two health systems seeking data to study the effects of state-level regulatory approvals known as certificates of public advantage (COPAs) that protect local hospital mergers from antitrust scrutiny.

Federal officials said they want to study the impact of COPAs and hospital consolidation on prices, quality, access, the innovation of healthcare services and employee wages.

The FTC issued orders to Aetna, Anthem, BlueCross BlueShield of Tennessee, Cigna and United Healthcare for patient-level commerical claims data. 

Orders were also issued to Ballad Health in Tennessee and Virginia as well as Cabell Huntington Hospital in West Virginia for aggregated patient billing and discharge data, along with health system employee wage data and other information relevant for analyzing the health systems’ prices, quality, access and innovation. Both health systems were approved for COPAs last year.

Ballad Health was formed in 2018 through the merger of Mountain States Health Alliance and Wellmont Health System. Under a COPA in Tennessee and a similar agreement in Virginia, officials said they agreed to serve oversight and enforceable commitments that include investing $308 million over 10 years to improve population health, expanding access to care and supporting health research and medical education.

Cabell Huntington Hospital was allowed to acquire nearby St. Mary’s Medical Center under a similar cooperative agreement with the state that was initially challenged by federal regulators.

Tennessee regulators describe COPAs as written approvals governing mergers among two or more hospitals that provide “state action immunity to the hospitals from state and federal antitrust laws by replacing competition with state regulation and active supervision. The goal of the COPA process is to protect the interests of the public in the region affected and the state.”

However, the feds say while COPAs “purport to immunize mergers and collaborations from antitrust scrutiny under the state action doctrine,” the approvals are in need of further study. As Kaiser Health News reported, the federal antitrust exemption dates back to a Supreme Court ruling in the 1940s and has been rarely used to allow hospital mergers. There has been little research (PDF) on the impacts of COPAs.

In June, the FTC held a public workshop examining research on the price effects of three COPAs approved in the 1990s—including Benefis Health System in Montana, Palmetto Health in South Carolina and Mission Health in North Carolina—to inform the current study design. Officials said they intend to collect information over the next several years to conduct retrospective analyses of the Ballad Health and Cabell COPAs.

Once the study is complete, the FTC intends to report publicly the study’s findings and will use them to help in future advocacy and enforcement by the agency and to better inform stakeholders about COPAs. 

 

 

 

A group of Republicans has unveiled its healthcare plan. Here is what’s new and what isn’t

Posted on by • Posted in 2020 Election Issues, ACA, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Health Savings Accounts, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, High Risk Pools, Hospital, Hospital Industry, Medicaid, Medicaid Block Grants, Medicaid Expansion, Out of Pocket Expenses, Preexisting Conditions • Leave a comment

https://www.fiercehealthcare.com/payer/a-group-republicans-have-a-new-healthcare-plan-here-what-new-and-what-isn-t?mkt_tok=eyJpIjoiT0RZNE4yTm1PV1psTmpNeSIsInQiOiJ5R3gxMEwrdUhPWUdZVlBTZ3NWWkdMV08xOCtObDdFaGdHaE1hN0o4Z2p5WnBaN3hjd2lDVm5ybnBhWUtUNFdlTW1LcndtaTN1WUtNVzg1NmUrQjJmWEhqTWpJR3BkUmVuZmVNS2FzdmRWdENuMEtNT0tJMXozUW93N0lVQmZ5WSJ9&mrkid=959610

Capitol building in Washington

The Republican Study Committee (RSC), a group of 145 House GOP lawmakers, rolled out a new healthcare plan to counter Democrats’ call for “Medicare for All.”

However, the plan itself closely resembles the Affordable Care Act (ACA) repeal bill called the American Health Care Act (AHCA) that the House passed in 2017 and contributed greatly to the loss of the GOP House majority in 2018.

For the plan to become law, Republicans would have to retake the House in 2020, and President Donald Trump would need to be reelected. However, if those victories happen, the plan could be a blueprint for how a GOP-controlled Congress would move forward on healthcare, as the committee counts among its members both GOP leadership and rank and file.

Here are three takeaways from the plan:

Shifting to high-risk pools

The plan would retain the ACA’s requirement that individual market plans cover pre-existing conditions. However, it takes out provisions that ensure patients with pre-existing conditions get affordable coverage such as requirements that prevent plans from charging sicker people higher premiums than healthy customers.

The plan does introduce high-risk pools that would be used by people with high healthcare costs, a commonly deployed tactic by states for the individual market before the ACA. The high-risk pools would be funded by repackaging the funding used for the ACA’s subsidies and the Medicaid expansion.

However, the plan doesn’t identify the full amount that should be devoted to high-risk pools, which segregate high-cost customers on the individual market.

The plan cites a 2017 report from consulting firm Milliman that estimated a federally supported high-risk pool could require $3.3 billion to $16.7 billion a year. The AHCA also called for high-risk pools but only gave $2.5 billion a year to help states fund them.

While the “$17 billion annual price tag may not seem ideal, it sets up a sustainable path for the individual market,” the RSC report said.

The desire for more funding for high-risk pools is likely a nod to Democratic attacks during the 2018 midterms that the AHCA threatened pre-existing condition protections. The nonpartisan Congressional Budget Office said the AHCA, which let states waive pre-existing condition protections, would lead to people in those states not getting affordable coverage for their pre-existing conditions.

While the AHCA had funding for high-risk pools, experts across the healthcare spectrum said that it wasn’t enough. It would remain to be seen how much more funding would be needed.

Doubling down again on health savings accounts

Bolstering health savings accounts has been a very popular reform idea among Republicans, and that enthusiasm is clear in the RSC plan.

The plan proposes to increase how much an employee can contribute to a health savings account. Currently, an individual can contribute $3,500 and a family can contribute $7,000.

A 2018 bill that passed out of the House but didn’t make it through Congress increased the contribution cap to $6,650 for an individual and $13,300 for a family.

Now, the RSC plan wants to increase the figures again, this time to $9,000 per individual and $18,000 for families, in line with a proposal from libertarian think tank Cato Institute.

“The RSC plan would also expand health savings accounts so that they could be used for a number of health services and products that currently must be paid for with after-tax dollars,” the plan said.

Replace Medicaid expansion with a block grant

This is another common reform in ACA repeal plans. The bill would phase out the enhanced federal matching rate for the Medicaid expansion to pre-expansion levels.

In addition, the bill would replace the existing open-ended federal match with a fixed amount in a block grant.

But the plan has a new twist in a new “flex-grant” that would give more funding to states that adopt a work requirement. However, half of the funding for any flex-grant must go toward supporting the purchase of private plans for low-income individuals.

So far, 12 states have gotten approval from the Trump administration to install work requirements for their Medicaid expansion population. But of those 12 states, three have had their work requirement programs struck down by legal challenges.

Some states are also considering installing their own block grants. Tennessee has released a draft proposal for a block grant but has yet to get federal approval.

 

 

 

Which Health Policies Actually Work?

Posted on by • Posted in Health Policy, Health Policy Research • Leave a comment

Which Health Policies Actually Work?

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We spend a lot of money on healthcare. How much of that goes toward good studies of the health policies we implement? Not much.

This video was adapted from a column Austin wrote for the Upshot. Links to sources can be found there.

 

 

 

If there’s a turning point on health costs, it’ll come from employers

Posted on by • Posted in 2020 Election Issues, Cost Management, Cost Reduction, Health Insurance Coverage Adequacy, Health Policy, Underinsured, Uninsured • Leave a comment

https://www.axios.com/health-care-employers-cost-expensive–778f9435-7dd5-4562-8df6-5d252f1c6ff4.html

Illustration of a pill bottle casting a shadow of a businessman

Employers are the linchpin of the U.S. health care system. But they don’t always act like it.

The big picture: Employers play a minor role in the political debate over health care costs, but they have a lot on the line — and a lot more political muscle than they’re choosing to flex. An increasingly bipartisan cadre of policy experts is trying to tell them that staying on the sidelines is both counterproductive and unsustainable.

Collectively, private-sector employers are one of the biggest and most politically powerful stakeholder groups in the health care debate. They cover more people than any other source, and account for about 20% of all health care spending — almost $700 billion in 2017.

  • “You would think that employers have a ton to gain by engaging in these discussions” around cost, said Dan Mendelson, the founder of the consulting firm Avalere Health. But they have consistently “failed to realize those expectations.”

The catch: Even though businesses are the core of the health care system, health care typically isn’t the core of what they do. They have similar structural interests, but they’re not necessarily organized around those interests.

  • For years, businesses have responded to rising health care costs primarily by shifting more of those costs onto their workers, through higher deductibles and other cost-sharing. The average deductible is now 212% higher than it was in 2008.
  • If employers ever reach the conclusion that they’ve taken this kind of cost-shifting as far as it can go, they could be powerful voices in the political debate over more aggressive cost-control measures — and they do want to control costs. But for now, they’re still on the sidelines.
  • “The frustration is definitely rising, but I would be hesitant to predict a breaking point,” Mendelson said. “It would be great if they were more engaged, but at the same time it’s rational that they are trying to reduce their exposure.”

There are exceptions. Walmart, for example, has undertaken an especially aggressive effort to overhaul its health benefits, even ditching traditional insurers and bargaining directly with health systems that have reputations for high-quality care.

  • Then there’s Haven, the joint effort from Amazon, Berkshire Hathaway and JPMorgan Chase. But it’s still not clear whether that project will try to affect systemwide change, or simply a better deal for its many employees, more similar to Walmart’s direct-purchasing goals. Those tools are only available to the largest companies.

Most employers still rely on their insurers to negotiate the best prices, preferring to stay out the weeds themselves. But insurers are becoming increasingly vocal about the difficulty of negotiating big discounts on hospital care, as hospitals consolidate, and for new prescription drugs that don’t have any competition.

  • Government-led efforts to directly control those costs run into fierce industry opposition. But if anything could help them break through politically, the most likely inflection point would likely be some kind of “enough is enough” moment from employers.
  • “I think you’re going to see more and more pressure, and even openness to public policy interventions that take advantage of negotiations” — for example, tying some private payment rates to Medicare’s, Democratic health care strategist Chris Jennings said.

It’s not just Democrats.

  • John Bardis, a former Trump administration health care official, said in a speech this week that employers need to take more aggressive stances toward cost containment.
  • Avik Roy, a conservative policy analyst who advised Mitt Romney’s presidential campaign on health care, has also endorsed more direct intervention. In the most concentrated, least competitive markets, the government should cap how much hospitals can charge private insurers, using Medicare rates as a baseline, he says.

The bottom line: If there’s ever going to be a turning point that would make cost containment more politically attainable, employers would probably need to be the ones who drive it.

 

 

 

Employers aren’t changing their health benefits

Posted on by • Posted in 2020 Election Issues, Employee Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses • Leave a comment

https://www.axios.com/employers-health-care-coverage-insurance-2020-election-e0ce92cf-c106-44fe-bb35-1c3c6e452712.html

Image result for Employers aren't changing their health benefits

Companies rarely switch the health plans they offer to their workers, and seem to be especially cautious in the 2020 election year.

The big picture: Medical and drug costs are crushing employers and workers alike. But altering benefits — which could require employees to change their doctors — could provoke even more anger.

By the numbers: Roughly half of employers offering health benefits did not shop around for new plans or insurance companies for 2019, according to the Kaiser Family Foundation’s latest employer benefit survey.

  • Of the half that did shop, just 18% changed to a new insurance carrier.
  • That means fewer than 10% of all employers switched carriers.
  • Large corporations, like GM, are much less likely to tinker with coverage than smaller firms.

“Disruption is the enemy,” Mike Turpin, an employer health care consultant at the brokerage USI Insurance Services, said on a call with Wall Street investors last week.

  • Turpin said he has seen even less switching for 2020 because employers don’t want to make waves over health care in an election year — “which buys another year” for the large, incumbent health insurance companies.

Between the lines: More companies have moved workers into less comprehensive plans since the Affordable Care Act was passed, but those changes often have been met with either immediate condemnation (like Harvard in 2015) or delayed outrage as workers shoulder more costs.

  • “It is telling that brokers perform an analysis for employers that’s called ‘disruption analysis’ — the goal of which is not to be disruptive, but to minimize disruption,” said Katherine Hempstead, a health policy adviser at the Robert Wood Johnson Foundation.

Yes, but: Millions of people still switch health plans every year when they buy it on their own, change jobs, get laid off or retire.