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Dignity Health, UCSF Health Announce Bay Area Collaboration
Dignity Health and UCSF Health have formalized an affiliation that will combine the best of academic medicine and community-based care, increasing access to high-quality, affordable care and improving the overall health care experience for patients in the San Francisco Bay Area.
The affiliation will bring UCSF Health’s academic medical center expertise to three Dignity Health hospitals in the Bay Area: Sequoia Hospital in Redwood City, and Saint Francis Memorial Hospital and St. Mary’s Medical Center in San Francisco. The organizations also have signed a Letter of Intent for physicians at Dignity Health Medical Group Sequoia and at Dignity Health Medical Group Saint Francis/St. Mary’s, both services of Dignity Health Medical Foundation, to collaborate with UCSF clinical faculty in sharing best practices and improving access, quality, efficiency and coordination of care for shared patients. In addition, these three Dignity Health hospitals have joined the Canopy Health accountable care network, to provide a strong continuum of care as patients’ health needs transition between primary and specialty care.
“Health care works best when we collaborate to offer the best thinking and the latest medical advances to our patients,” said Shelby Decosta, senior vice president and chief strategy officer for UCSF Health. “Dignity Health’s focus on excellent care, as well as the humanity of that care in a community setting, is the perfect balance for UCSF Health’s depth of knowledge and specialty services. Together, we can draw upon each other’s expertise for quality and service improvements, and best practices, and to provide specialty care with shorter wait times and a better patient experience.”
This new affiliation will enhance medical, surgical and related health care services in the Bay Area by bringing together UCSF’s and Dignity Health’s expertise, while providing patients with a more seamless experience between primary and specialized care in a community hospital setting.
“UCSF Health is an excellent partner in the Bay Area, and we are looking forward to a collaboration that provides increased patient access to high-quality care,” said Todd Strumwasser, MD, senior vice president of operations for Dignity Health Bay Area. “We are pleased to welcome UCSF physicians to our community hospitals, and offer patients a continuum of care never before available in the Bay Area.”
The alliance brings together the two longest-serving health providers in San Francisco, and reflects a long-standing and evolving relationship between Dignity Health and UCSF Health – two health systems known for their clinical excellence and missions to provide quality, affordable care to all, including the underserved. Dignity Health and UCSF Health have previously collaborated to improve pediatric burn care, acute rehabilitation, and cardiac arrhythmia, among other conditions.
Trump administration, HHS stepping away from Affordable Care Act promotion, bundled payments
New bundled payment models for cardiac care may be on chopping block, along with changes to joint replacement.
Lacking a repeal and replacement bill for the Affordable Care Act, President Trump appears to be following through on his Twitter promise to “let Obamacare implode.”
The Trump administration and the Department of Health and Human Services is distancing itself from several groups which in the past have helped market open enrollment, according to talkingpointsmemo.
HHS has not reached out to the Latino Affordable Care Act Coalition, the United Methodist Church, the American Congress of Obstetricians and Gynecologists, the American Medical Student Association, the National Urban League, the National Latina Institute for Reproductive Health, the National Hispanic Medical Association, and the National Partnership for Women and Families, according to the report.
Open enrollment in the ACA marketplace starts November 1.
The new bundled payment model for cardiac care coordination and cardiac rehabilitation may also be on the chopping block, along with unspecified changes to the joint replacement model, according to a proposed rule published August 10 in the Office of Management and Budget.
The models were introducted by the Centers for Medicare and Medicaid Services’ Innovatoin Center, or CMMI, run by Patrick Conway, MD, who last week announced he was leaving CMS to head Blue Cross Blue Shield North Carolina.
HHS Secretary Tom Price, an orthopedic surgeon appointed by the president, has consistently voiced his opposition to mandatory bundled payment programs.
Chinese billionaire Tianqiao Chen makes big stock buy in CHS, brings stake to 22.1%
The purchases were made through Chen’s various Shanda affiliates, documents showed.
Chinese billionaire Tianqiao Chen is once again raising eyebrows in the healthcare sector, after significantly increasing his stake in struggling healthcare organization Community Health Systems, which is based in Franklin, Tennessee.
According to a filing with the Securities and Exchange Commission, now owns 22.1 percent of CHS‘ outstanding shares of common stock after buying up roughly 9.8 million additional shares over the last week. The price per share varied from $6.1 to $8 per share.
The purchases were made through Chen’s various Shanda affiliates, documents showed.
The big stock buy will inevitably be viewed by at least some as a move to take a bigger interest in the struggling company, something that has been speculated about in the past when Chen first came on the scene and bought a large block of stock in the company last year.
A spokesperson for Shanda Group issued the following statement. “Shanda maintains a good relationship with the CYH management team and intends to engage with them regarding business and operations, and the status of CYH’s ongoing turnaround strategy.”
CHS has been in the news lately as it forges ahead with its ambitious divestiture plan to offload 30 hospitals in hopes of alleviating its billions-large debt load and tightening up its operations. So far the company has sold 20 of those hospitals and has plans in the works to unload the remaining ten. It has also said in a recent earnings call that they are entertaining plans to sell even more, but no definitive details have been released.
What Will You Do When One of Your Employees Is Outed Online For Their Activism?
It should be no secret to anyone that political activity and tensions are currently high in the US. And by now, everyone in HR has heard about the Top Dog restaurant employee who resigned as a result of his participation in the Charlottesville turmoil and the Google employee who was fired because of his controversial “diversity manifesto.”
Rather than just being news items, these cases should be treated as illustrative examples of the recent dramatic increase in political sensitivity in and around the corporate world. Executives and HR should treat them as a wake-up call and begin asking themselves a question that has become extremely pertinent. And that question is:
Does our firm have a formal plan of action covering what to do and how to limit the damage if one of our employees is publicly ridiculed as a result of what is known as Internet shaming?
If you’re not familiar with the term “Internet shaming” in the corporate world, it is when a firm’s employee is publicly exposed and ridiculed on the Internet for something they did that was controversial.
The need for a social controversy plan
The need for a policy and an action plan relating to political and social controversy increases every day for a variety of reasons. They include the combined impact of a higher number of public marches, the proliferation of mobile phone videos of these protests and the rise of Internet and social media websites (e.g. YesYoureRacist Twitter account) that actively use pictures/videos to shame individuals and their employer. Unfortunately, this shaming often results in the public making the connection (fairly or not) between an individual’s actions and the company that employs them. And that becomes a major corporate issue when that employee shaming leads to on-site protests, a loss of customers and damage to your firm’s product and employer brand image.
In the past, at least in the US, many firms have been operating under the legal principle that activities outside of work and that an employee’s personal beliefs are none of an employer’s business. However, when an employee’s actions or publicly exposed beliefs hurt the company or its employees, in my view a firm must at least consider revisiting its existing approach to employee activities.
Top 10 “Should I fire a controversial employee” action steps to consider
You should of course always consult with legal counsel before taking any action. But as part of your policy review process, here are 10 steps you should consider.
- Make a strong business case – You can’t expect executives to take action until they fully understand the dollar consequences of an action. So start by working with the CFO’s office to identify and then quantify in dollars all of the possible negative consequences that may result when an employee is publicly shamed. These consequences should include on-site protests, boycotts, employee turnover, employee brand/recruiting damage and damage to product sales and your product brand image.
- Consult with your corporate counsel – There are many complex legal issues involved so work closely with legal counsel. Also be aware that some states (e.g. California) specifically prohibit the firing of employees for lawful activities outside of work. And it’s also true that the laws and employee expectations are completely different in each country around the world. If you have a union, you should also consider involving them.
- Be aware that every available solution has negative consequences – Be aware from the start that, unfortunately, there are no perfect solutions to political controversies surrounding your employees. And that means that whatever solution you select will have many negative downsides. Prevention is the highest impact action, so begin by warning your employees to avoid controversy. Ignoring the problem is the solution with the highest negative consequences. However, firing or releasing controversial employees can also result in a backlash (e.g. marches are planned this weekend on Google headquarters and elsewhere protesting the firing of the employee who wrote the diversity manifesto).
- Educate your employees and applicants – Because your employees will likely be thinking about this issue already. It’s critical that you quickly let them know your expectations and provide them with illustrative examples of activities that they should avoid. You should also have a process for answering anonymous questions in this area. And if your policy extends to job applicants, you may want to add a social media check to your hiring process so that you don’t hire already controversial employees.
- Clearly define the activities that are prohibited/questionable – Perhaps the most difficult task is clearly defining what is acceptable behavior and what is not. Start by assuring employees that you are politically neutral and that you will look at damaging behaviors across the political spectrum. Whatever boundaries you set, it’s critical that you pretest them to ensure that they are clear to your employees. In most cases, it is easier to legally terminate an employee if violence or illegal activities are involved. It is also sometimes easier to terminate if the controversial employee is highly visible or if they are a manager.
- Specify the possible outcomes – If you are going to sanction or even fire employees for controversial beliefs or actions, you need to make those punishments crystal-clear. Some possible actions include: asking the employee to disavow, suspension, encouraging them to resign, or termination. In some cases, it may be wise to simply provide the employee with a severance package if they voluntarily leave and agree not to sue and if they stay out of the public limelight.
- Monitor what’s happening – As long as the political climate is highly charged, your social media employees could be asked to pass on any possible social media issues in this area. Internal employee forums and affinity groups could also be monitored. You might also encourage your employees to make HR aware when they spot potential issues.
- React quickly – No one that I have encountered has ever suggested that a delay is a good thing. So be able to react within a day or two if you want to minimize the damage to your firm.
- Reveal the actions that you take – The company’s image may continue to be damaged if you fail to make the public aware of the corporate actions that you took to resolve the controversy.
- Learn from each event – Finally, because this problem will be continually evolving, it’s important to learn from your errors and those made by other firms. And then, continually update your policies and processes to reflect the latest best practice approach.
Final thoughts
The free-speech article of the Constitution only protects citizens against government actions. So if you are a private employer, rather than the Constitution, you need to consider other elements including local employment laws and the best interests of your employees, customers and shareholders.
Because this is a highly complex and risky area, I expect many firms to do nothing. However, that can be a major mistake because in the near future you are likely to see many more protests that are videoed, an increase in Internet shaming and many more controversial tweets and Internet exchanges covering your employees and contractors. As a result, in my view, the time to at least begin the conversation on how to improve your reaction is today.
What’s the Near-Term Outlook for the Affordable Care Act?
If Congress abandons efforts to repeal and replace the Affordable Care Act (ACA), President Trump has said he would “let Obamacare fail.” This Q&A examines what could happen if the Affordable Care Act, also called “Obamacare,” remains the law and what it might mean to let Obamacare fail.
Is Obamacare failing?
The Affordable Care Act was a major piece of legislation that affects virtually all payers in the U.S. health system, including Medicaid, Medicare, employer-sponsored insurance, and coverage people buy on their own. One of the biggest changes under the health reform law was the expansion of the Medicaid program, which now covers nearly 75 million people, about 14 million of whom are signed up under the expansion. Most Americans, including most Republicans, believe the Medicaid program is working well.
When people talk about the idea of the ACA failing, they are usually referring to the exchange markets, also called Marketplaces. These markets, which first opened in 2014, are part of the broader individual insurance market where just 5-7% of the U.S. population gets their insurance. People who get insurance from other sources like their work or Medicaid are not directly affected by what happens in the individual insurance market.
The exchange markets have not been without problems: There have been some notable exits by insurance companies and premium increases going into 2017, and in the early years of the exchanges, insurers were losing money. The structure of the ACA’s premium subsidies – which rise along with premiums and cap what consumers have to pay for a benchmark plans a percentage of their income – prevents the market from deteriorating into a “death spiral.” However, premiums could become unaffordable in some parts of the country for people with incomes in excess of 400% of the poverty level, who are ineligible for premium assistance.
Insurer participation in this market has received a great deal of attention, as about 1 in 3 counties – primarily rural areas – have only one insurer on exchange. Rural counties have historically had limited competition even before the ACA, but data now available because of the Affordable Care Act brings the urban/rural divide into sharper focus. On average at the state level, competition in the individual market has been relatively stable – neither improving nor worsening.
Premiums in the reformed individual market started out relatively low and remained low in the first few years – about 12% lower than the Congressional Budget Office had projected as of 2016 –before increasing more rapidly in 2017. Most (83%) of the 12 million people buying their own coverage on the exchange receive subsidies and therefore are not as affected by the premium increases, but many of the approximately 9 million people buying off-exchange may have difficulty affording coverage, despite having higher incomes. As might be expected, after taking into account financial assistance and protections for people with pre-existing conditions, some people ended up paying more and others paying less than they did before the ACA. Our early polling in this market found that people in this market were nearly evenly split between paying more and paying less. About 3 millionpeople who remain uninsured are not eligible for assistance or employer coverage and many of them may be going without coverage due to costs.
Our recent analysis of first quarter 2017 insurer financial results finds that the market is not showing signs of collapse. Rather, insurers are on track to be profitable and the market appears to be stabilizing in the country overall. In other words, those premium increases going into 2017 may have been enough to make the market stable without discouraging too many healthy people from signing up. However, there are still markets – particularly rural ones – that are fragile.
How would administrative actions affect market stability?
Despite signs that the individual insurance market is generally stabilizing on its own, certain administrative actions could cause the market to destabilize again. Actions the Administration might take that would weaken the market include:
STOP ENFORCING OR WEAKEN THE INDIVIDUAL MANDATE
The individual mandate is the Obamacare requirement that most people either have insurance or pay a penalty. The purpose of it is to get young and healthy people into the market to bring down average costs. If there are not enough young and healthy people signing up, insurers have to raise premiums. If the administration signals it will either stop enforcement of the individual mandate or give broad exemptions, insurers will respond by raising premiums or exiting the market. The Congressional Budget Office (CBO) estimates that without the individual mandate, premiums in the individual insurance market could rise by 20%.
SCALE BACK OUTREACH AND CONSUMER ASSISTANCE
The individual market is often a transitional source of insurance when life circumstances change. People who are temporality unemployed, in school, or early retirees make up a substantial share of the individual market. Additionally, people in this market often experience income volatility and may cycle between Medicaid and subsidized exchange coverage. Those who are sick will be most likely to seek insurance coverage on their own when they go through a change in life circumstances, but outreach and consumer assistance programs – particularly those targeted at young and healthy individuals – can help balance out the risk pool and bring down average costs.
This coming open enrollment period (November 1 – December 15, 2017) is shorter than previous periods and may require more outreach to get people signed up before the deadline. This will also be the first enrollment period run from start to finish by the Trump administration and it is not yet clear how much outreach the administration will take on. Toward the end of the last open enrollment period, the Trump administration cut marketing and more recently has used outreach funds for messages critical of the health care law.
STOP MAKING COST-SHARING SUBSIDY PAYMENTS
Under the Affordable Care Act, insurers are required to offer low-deductible plans to low-income people (58% of marketplace enrollees benefit from these cost-sharing subsidies). For the lowest-income enrollees, these subsidies can bring down the deductible from a few thousand dollars to a couple hundred dollars (Figure 2 below). Providing these higher-value plans to low-income enrollees costs insurers more money (an estimated $10 billion dollars in 2018), so under the ACA the federal government reimburses insurers in the form of a cost-sharing subsidy payment. However, these payments are the subject of a lawsuit and the Administration has signaled they might stop making payments.
If these payments stop, we estimate that insurers would need to raise rates on silver-level plans – which are the only plans where consumers can access cost-sharing reductions – by 19 percent, with states that did not expand Medicaid (primarily red states) facing higher premium increases (Figure 3 below). Lower-income marketplace enrollees receiving premium subsidies would be protected from premium increases because subsidies would rise as well. However, higher-income enrollees not receiving premium subsidies would face higher premiums if insurers expect cost-sharing subsidy payments to end.
The combined effect of these policy changes (not enforcing the individual mandate and defunding cost-sharing subsidies) could cause some insurers to raise premiums on some plans by as much as 40 percentage points higher than they otherwise would. Because premium subsidies increase as premiums rise, administrative actions that cause premiums to rise can also cause taxpayer costs to increase. For example, we estimate that ending cost-sharing subsidy payments could increase net federal costs by about $2.3 billion per year.
Insurers have already submitted their preliminary premiums for the upcoming calendar year to state regulators. Since there has not been clarity on these issues, some insurers are already assuming that the Trump Administration or Congress may take an action that would destabilize the market. Some companies have either significantly raised premiums for next year, scaled back their footprints, or made plans to exit the exchange or individual market all together. Insurers are still negotiating rates for 2018, so if they do not get clarity soon, premiums could go up even more or more insurers could leave.
Again, these premium increases would only affect people who buy their own insurance (particularly middle-income or upper-middle-income people who buy their own insurance without a subsidy to offset the costs), and this group does not make up a large share of the American public. Nonetheless, more insurer exits or large premium increases on the exchange markets could be seen as Obamacare failing. It is worth noting, though, that a majority (64 percent) of the public – including 53 percent of Republicans – say that because President Trump and Republicans in Congress are now in control of the government, they are responsible for any problems with the ACA moving forward.
What happens if the market fails?
Following some announcements of 2018 exits by major insurers, there are some counties at risk of having no insurer on the exchange next year. This would be a first; thus far, all counties have had at least one insurer on the exchange. As negotiations between insurers and state regulators are still underway, there is still time for other insurers to come in and fill these gaps. Thus far, in most cases, a new or expanding insurer has already moved in to cover counties once thought to be “bare.” However, administrative actions that destabilize the market could encourage more insurers to exit.
If no exchange insurer ultimately moves in to some of these counties, people buying their own insurance will not be able to get subsidies and would have to pay full price for insurance. Paying for unsubsidized insurance would be particularly difficult for low-income and older adults living in high-cost areas like many rural parts of the country. Our subsidy calculator can show the difference in cost. For example, in Knox County Ohio, a low-income 60-year-old could get a silver plan for $83 per month but would have to pay $775 per month if he bought that plan without a subsidy, plus he would have a higher deductible because he would no longer benefit from cost sharing subsidies that are only available on the exchange. That same person would also qualify for a free ($0 premium) bronze plan if he buys on exchange, but off-exchange without a subsidy he would have to pay more than $600 per month for a similar plan. People shopping for coverage off-exchange in a county left without an exchange insurer – particularly lower income or older exchange shoppers – may not be able to afford any option and may drop their coverage.
If the market becomes destabilized, and particularly if the individual mandate is not enforced, insurers may decide to exit the off-exchange market as well. This would mean that people in these counties who would otherwise buy their own insurance may not have any option even if they could afford to pay full price.
What might be done to strengthen the Marketplaces?
Although the individual health insurance market is stabilizing on average, insurer financial performance varies and some companies in some states are still struggling. Additionally, some insurers have already decided to increase premiums significantly or exit the market in 2018 on the assumption that the Trump Administration or Congress will take actions that destabilize the market. Although there are many ideas on both the left and the right for how to improve these markets, there are not many options that have bipartisan support.
One possible policy response that could receive bipartisan support would be to reestablish a reinsuranceprogram. Reinsurance programs provide funds to insurers that enroll high-cost (sicker) individuals and can work to lower premiums. The Affordable Care Act included a reinsurance program but it was temporary and phased out in 2016. Republicans in Congress and the Administration have also signaled a willingness to establish reinsurance programs: Both the House and Senate repeal bills included stability funds for reinsurance and Health and Human Services Secretary Price has supported Alaska’s request for a waiver to support its reinsurance program. Though such a program could receive bipartisan support, it would require additional funds (for example, taxing insurers in other markets).
Additional state flexibility to address local challenges in implementing the health care law may also receive some bipartisan support. The challenge of attracting insurers to rural areas or certain states, for example, may warrant state-specific solutions – either as part of the ACA’s waiver program or by Congress giving states additional flexibility.
CBO: ObamaCare premiums could rise 20 percent if Trump ends payments
CBO: ObamaCare premiums could rise 20 percent if Trump ends payments
Insurance companies would raise premium prices about 20 percent for ObamaCare plans if President Trump ends key payments to insurers, according to the Congressional Budget Office (CBO).
At the request of House Democratic leadership, CBO estimated what would happen if the payments to insurers ended after December. It found that halting payments would increase the federal deficit by $194 billion through 2026.
Many people would be cushioned from the impact of the increases because federal tax credits rise automatically when premiums do.
If the payments ended, some carriers would withdraw from ObamaCare and about 5 percent of people would live in an area without any options on the exchanges in 2018, according to CBO. But by 2020, CBO estimates more insurers would participate again, so that most areas would be covered.
The number of people without insurance would be slightly higher next year but a little lower in 2020, according to the analysis.
Cost-sharing reduction payments are made to insurers, compensating them for discounting out-of-pocket costs for certain enrollees.
Insurers have been pleading for certainty from the administration on whether they’ll continue to receive the payments, which total about $7 billion for fiscal 2017.
The administration has been making these payments on a monthly basis. But Trump has threatened to halt the funds, calling the money “bailouts” for insurance companies.
The issue has also been caught up in court, and if Trump decides to stop appealing a court ruling against the administration, CSR payments could stop. The deadline for another update is coming up quick — Aug. 20. The case has been on hold for months and could be delayed again.
Additionally, the Senate Health Committee will hold hearings on a bipartisan, short-term stabilization measure the first week of September. The goal, according to Chairman Lamar Alexander (R-Tenn.), is to craft a bill by mid-September that includes funding the payments to insurers.
But insurers are bumping up against major deadlines.
Last week, the administration extended the deadline for carriers to finalize how much their premiums will cost on HealthCare.gov. That date is now Sept. 5, and insurers sign contracts locking them into selling plans Sept. 27.
If insurers don’t know if CSRs will be funded, they could exit the marketplaces, health experts warn. That could possibly lead to some areas have no insurers selling plans on their exchanges.
CBO: Ending cost-sharing reduction payments will increase premiums, federal deficit
If the Trump administration stops funding cost-sharing reduction payments, silver-plan premiums on the Affordable Care Act exchanges will rise considerably and the federal deficit will increase, the Congressional Budget Office said Tuesday.
Officially, the administration remains undecided about how long it will continue making CSR payments, which are at the center of a federal court case that challenges their legality. Many insurers have had to factor this uncertainty into their preliminary rate filings.
To map out the consequences of one possible move by the administration, the CBO examined what would happen if federal officials announced at the end of August that they would continue CSR payments through the end of the year but discontinue them after that.
That policy would result in silver-plan premiums rising by an average of 20% in 2018 and 25% by 2020, the CBO estimates. Because tax credits rise in tandem with premiums, most eligible enrollees would not pay higher rates than they would if CSR payments continued—though the report also notes that overall, “the share of people facing slight increases would be higher during the next two years.”
Since more people would likely receive premium tax credits and in greater amounts, the CBO predicts that ending CSR payments would raise the federal deficit by $6 billion in 2018, $21 billion in 2020 and $26 billion in 2026.
The CBO also predicts that ending CSR payments would cause some insurers to exit the individual marketplaces, leaving about 5% of people living in areas that have no ACA exchange insurer in 2018. However, the agency predicts that more insurers would likely return to the exchanges in 2020 after having adjusted to the new policy.
Overall, the number of uninsured people would be slightly higher in 2018 but slightly lower starting in 2020 under the scenario the CBO examined, per the report.
Cartoon – Your Daughter’s Surgery went fine
