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1 in 3 People in Medicare is Now in Medicare Advantage, With Enrollment Still Concentrated Among a Handful of Insurers

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Medicare Advantage 2017 Spotlight: Enrollment Market Update

Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.  The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).  This Data Spotlight reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings.  Key findings include:

  • Enrollment Growth. Since the ACA was passed in 2010, Medicare Advantage enrollment has grown 71 percent. As of 2017, one in three people with Medicare (33% or 19.0 million beneficiaries) is enrolled in a Medicare Advantage plan (Figure 1).

 

  • Market Concentration. UnitedHealthcare and Humana together account for 41 percent of enrollment in 2017; enrollment continues to be highly concentrated among a handful of firms, both nationally and in local markets. In 17 states, one company has more than half of all Medicare Advantage enrollment – an indicator that these markets may not be very competitive.

 

  • Medicare Advantage Penetration. At least 40 percent of Medicare beneficiaries are enrolled in Medicare private plans in six states: CA, FL, HI, MN, OR, and PA. In contrast, fewer than 20 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 13 states, plus the District of Columbia.

 

  • Premiums and Cost-Sharing. While average Medicare Advantage premiums paid by MA-PD enrollees have been relatively stable for the past several years ($36 per month in 2017), enrollees may be liable for more of Medicare’s costs, with average out-of-pocket limits increasing 21 percent and average Part D drug deductibles increasing more than 9-fold since 2011; however, there was little change in out-of-pocket limits and Part D drug deductibles from 2016 to 2017.

Medicare Advantage enrollment is projected to continue to grow over the next decade, rising to 41 percent of all Medicare beneficiaries by 2027.1  As private plans take on an even larger presence in the Medicare program, it will be important to understand the implications for beneficiaries covered under Medicare Advantage plans and traditional Medicare, as well as for plans, health care providers and program spending.

Leadership Takes Self-Control. Here’s What We Know About It

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https://hbr.org/2017/06/leadership-takes-self-control-heres-what-we-know-about-it?utm_campaign=hbr&utm_source=facebook&utm_medium=social

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Philosophers and psychologists have been discussing the importance of self-control for ages. Plato, for example, argued that the human experience is a constant struggle between our desire and rationality, and that self-control is needed to achieve our ideal form. Likewise, Freud suggested that self-control is the essence of a civilized life.

The scientific study of self-control started about 25 years ago in the fields of criminology and psychology. Since then, hundreds of studies have shown the positive effects that come from possessing self-discipline. For instance, people with higher levels of self-control eat healthier, are less likely to engage in substance abuse, perform better at school, and build high-quality friendships. At work, leaders with higher levels of self-control display more effective leadership styles – they are more likely to inspire and intellectually challenge their followers, instead of being abusive or micromanaging. But what happens when people lack self-control at work?

We conducted a comprehensive review of research findings on employee self-control in a forthcoming paper in the Academy of Management Annals. Analyzing more than 120 management papers, we found that there are three main reasons why people occasionally lose self-control: 1) self-control is a finite cognitive resource; 2) different types of self-control tap the same pool of self-control resources; and 3) exerting self-control can negatively affect future self-control if it is not replenished. Think of self-control as analogous to physical strength: Our physical strength is limited, various tasks (e.g., football, basketball, walking, etc.) deplete it, and continued exertion can negatively affect future physical strength if it’s not restored.

For example, our own research has found that service employees in leadership positions who have to force a smile in customer interactions (thereby exercising self-control to suppress their true feelings) are later less able to regulate their interactions with their subordinates – they lie and are more rude to them.

Our review identified a few consequences that are consistently linked to having lower self-control at work:

  1. Increased unethical/deviant behavior: Studies have found that when self-control resources are low, nurses are more likely to be rude to patients, tax accountants are more likely to engage in fraud, and employees in general engage in various forms of unethical behavior, such as lying to their supervisors, stealing office supplies, and so on.
  1. Decreased prosocial behavior: Depleted self-control makes employees less likely to speak up if they see problems at work, less likely to help fellow employees, and less likely to engage in corporate volunteerism.
  1. Reduced job performance: Lower self-control can lead employees to spend less time on difficult tasks, exert less effort at work, be more distracted (e.g., surfing the internet in working time), and generally perform worse than they would had their self-control been normal.
  1. Negative leadership styles: Perhaps what’s most concerning is that leaders with lower self-control often exhibit counter-productive leadership styles. They are more likely to verbally abuse their followers (rather than using positive means to motivate them), more likely to build weak relationships with their followers, and they are less Scholars have estimated that the cost to corporations in the United States for such a negative and abusive behavior is at $23.8 billion annually.

Our review makes clear that helping employees maintain self-control is an important task if organizations want to be more effective and ethical. Fortunately, we identified three key factors that can help leaders foster self-control among employees and mitigate the negative effects of losing self-control.

First, sleep appears to have an amazing restorative effects on self-control. One study found that leaders who slept well at night (defined as having minimal interruptions to sleep) were much more likely to exercise their self-control and refrain from displaying abusive supervision, such as yelling and cursing at low-performing subordinates, compared to their counterparts who did not sleep well. Modern organizations often require employees to work beyond traditional office hours in the name of increased productivity. But this could be counter-productive and lead to negative workplace behaviors due to employees lacking self-control. Instead, organizations should be mindful about how long work hours can impact employees’ behavior and wellbeing. Google, for example, installed sleep pods at the office to allow employees to nap and be reenergized.

Second, “service with a smile” might not always pay. Service-oriented organizations often force employees to smile in front of customers. While this might please customers in the short-term, it can cause other organizational problems. Dropping this practice perhaps is not be a practical option, but companies should consider training employees to tap into the emotions they display. For example, another study showed that physicians who engaged in perspective taking and felt genuine empathy toward their patients did not experience reduced self-control and its associated negative workplace behaviors such as burnout, whereas physicians who were forced to fake empathic behaviors toward patients later reported increased burnout and lower job satisfaction. Service-oriented employees may also benefit from engaging in more perspective-taking rather than faking their emotions.

Third, creating the right environment may help prevent some of the negative behaviors associated with lower self-control. For example, we came across research showing that employees with low self-control were no more likely to engage in deviant behavior when organizations promoted an ethical culture —displaying the company’s code of conduct where employees could see it made them less tempted to behave unethically. This type of intervention tends to be very effective in the short-term.

Ultimately, the keys to avoiding self-control failures are to 1) allow the body to rest and restore self-control, 2) reexamine existing organizational policies that might inadvertently reduce employees’ self-control, and 3) create a culture that deters negative behaviors in moments of reduced self-control.

Children’s hospitals — and their patients — caught in the crosshairs with planned federal cuts

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http://www.healthcaredive.com/news/childrens-hospitals-and-their-patients-caught-in-the-crosshairs-with-p/443825/

Republican plans targeting federal funding for health coverage have drawn ire from Americans in all corners of the country, but some of the loudest voices are coming from parents. They have cornered members of Congress at town halls to ask how the slashed budgets will affect some of society’s most vulnerable.

Suggested cuts to Medicaid and the Children’s Health Insurance Plans (CHIP) would throw millions of Americans off insurance and leave hospitals that are already teetering financially facing more uncompensated care. Children’s hospitals, safety net hospitals and rural hospitals will be most affected, and disabled children will face devastating cuts in coverage.

The funding decreases have been proposed in bills making their way through Congress and separately by President Donald Trump. They would shift the cost burden further onto states, many of which have seen success in expanding Medicaid, which is also on the chopping block.

“Children, the elderly, the disabled, and others from our most vulnerable populations would all be affected by these deep budget cuts,” Joanna Hiatt Kim, vice president of policy at the American Hospital Association, told Healthcare Dive. “For hospitals, this could mean more uncompensated care as millions continue to seek needed healthcare without any coverage. For the patient, this could mean delayed care or foregoing care altogether.”

Impact on children’s healthcare

More cuts to Medicaid and CHIP would reverse the trend of fewer uninsured Americans, including children.

Congress created CHIP 20 years ago when 15% of children were uninsured. CHIP, the Affordable Care Act and Medicaid expansion provided more insurance offerings and now only about 5% of children are uninsured. CHIP, which is a federal/state partnership, includes free well-child visits in many states and also provides prescription coverage, inpatient and outpatient care and emergency services.

While suggesting a two-year CHIP extension in his budget plan, Trump proposed a 20% CHIP cut over the next two years. His budget also seeks a $610 billion cut from Medicaid over 10 years, despite early promises to leave the program alone.

Studies have shown that CHIP helps reduce hospitalizations and child mortality, and improves quality of care. The program has bipartisan support. However, HHS Secretary Tom Price voted twice against expansion when he was a congressman.

CHIP is up for reauthorization by Sept. 30 and governors recently spoke out in favor of expanding it. In his budget proposal, Trump proposes a two-year extension of CHIP, but also suggests program cuts, including the matching rate for states.

Jim Kaufman, vice president of public policy at Children’s Hospital Association (CHA), told Healthcare Dive that CHIP helps children’s hospitals.

“CHIP is good for kids, and that makes it good for children’s hospitals and children’s providers.”

Jim Kaufman

Vice President of Public Policy, Children’s Hospital Association

Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, told Healthcare Dive that the cuts would shift costs to states and reduce benefits. He said Trump’s budget would eliminate a 23-percentage-point increase in each state’s federal CHIP matching rate, which is in effect until 2019. That would mean $3.5 billion cut from the program.

The budget would also cut CHIP funding for children with families that have incomes above 250% of the federal poverty line, which would affect 28 states and Washington, D.C. that provide CHIP coverage to children above the income threshold, according to Park.

This will mean states will need to pick up more of the CHIP program costs if they want to maintain the current coverage level. Park said he believes Congress will reauthorize the program, but questions remain about CHIP’s funding and benefits.

 

NYC Health + Hospitals cuts 476 positions amid financial pressure

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http://www.healthcaredive.com/news/nyc-health-hospitals-cuts-476-positions-amid-financial-pressure/444136/

Dive Brief:

  • NYC Health + Hospitals on Friday cut 476 management positions, which will reduce the current six layers of managers to four and is expected to save the health system $60 million, several news outlets reported.
  • The largest U.S. public health system cut 396 managers and eliminated 80 unfilled positions.
  • The system expects the job cuts to lead to $60 million in savings in fiscal year 2018.

Dive Insight:

The announcement of the health system’s massive restructuring day came after a $673 million loss was posted for Q3 2017. H+H interim President and CEO Stanley Brezenoff said in a statement the restructuring will reduce “unnecessary layers of management.” The health system will now be able to “better direct resources where we need them most —  at the front line of patient care.” It also cut 70 employees in February.

Revenue increased by 1.8% to $6.7 billion during the third quarter. Yet system officials said net patient service revenues dropped by 9%. The reasons behind the drop were “lower payments from the disproportionate share hospital (DSH) and upper payment limit programs,” according to the healthcare system of 11 hospitals.

At that time, H+H predicted that it would cut its $779 million budget gap this year and end with $185 million cash in hand. In April, the health system announced a redesign of its management structure after losing $776 million for the first half of FY 17, but said at that time that they did not expect layoffs.

Hospitals are facing financial issues across the country. Safety net hospitals like H+H may soon face even more difficulties. H+H has a large Medicaid population and potential cuts in President Donald Trump’s budget and the American Health Care Act – the GOP’s proposed bill to replace the Affordable Care Act – could send millions off of Medicaid. This would mean a system like H+H may soon face more uncompensated care.

H+H is looking for ways to improve its finances. One way is through a new Epic revenue cycle system that officials in May said will “improve efficiency and ensure that the health system is collecting the maximum amount of revenue for the services it delivers.” They expect it will improve clinical documentation, reduce claims denials and accelerate reimbursements.