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As Commercial Capitation Sinks, Can California’s Physician Organizations Stay Afloat?
http://www.chcf.org/publications/2016/11/commercial-capitation-sinks
California is seeing the decline of capitation — fixed prepayment for care of a defined population — particularly for commercial health insurance products. This issue brief explores the impact of this trend on the state’s medical groups and independent practice associations (IPAs). The main question at hand is whether California’s delegated model will remain sustainable with lower levels of commercial capitation.
The analysis is based on both quantitative and qualitative data. The medical group and IPA leaders interviewed for this research made a number of observations, including:
- The near future is uncertain. Declining capitation has not yet had a big impact on their operations, but they suspect it may soon.
- Change thus far has been slow enough that organizations have been able to adapt.
- Declining prepayment will not impact clinical decisionmaking.
- Medicare and Medi-Cal offer more opportunities to accept capitation, but these do not necessarily compensate for the loss of commercial capitation.
- Leaders are concerned that high deductibles may adversely affect the health of patients.
The research points to the importance of continuing to track changes in the payment environment of California’s capitated, delegated physician organizations. Although the decline in commercial capitation has been slow enough that it has not yet led to significant changes in operations, it may soon do so.
The full issue brief is available as a Document Download.
Click to access PDF%20CommercialCapitationSinks.pdf
Dynamics of Decline: The Truth About HMOs
http://www.chcf.org/articles/2016/11/dynamics-decline-truth-hmos
California’s commercial health maintenance organization population shrank from 11.9 million to 9.8 million enrollees between 2004 and 2015 (see figure below), a 17.5% decline. But the decline has not been consistent across all HMOs — Kaiser’s commercial enrollment has actually grown during this period.
Two new publications from CHCF take a closer look at how commercial managed care enrollment (including individual enrollment) and the public sector’s embrace of managed care are shifting the way physician organizations are paid — important trends that could affect California’s delivery system.
When It Comes to Seeing a Doctor in California, the Uninsured Still Fare Worst
http://www.chcf.org/articles/2017/01/when-seeing-doctor
With repeal of the Affordable Care Act (ACA) on the horizon, and no replacement plan in sight, millions of Californians are at risk of losing their coverage. Approximately 5 million Californians are currently covered under the ACA. The state’s uninsured rate, which hit a historic low under the ACA, could start to rise again depending on what happens in Washington in the coming weeks and months.
It’s worth remembering the multiple barriers that people without insurance face in our health care system. I am reminded of some key findings from a 2015 survey of California physicians that the University of California, San Francisco, released last fall with support from the California Health Care Foundation.
The survey asked, among other questions, if physicians were accepting new patients who had various types of insurance (private, Medicare, or Medi-Cal) or who were uninsured. The survey also asked physicians if any of their existing patients were uninsured.
As the slides below show, the uninsured face the hardest time getting accepted into a physician’s practice. Only 38% of all California physicians said they accepted new uninsured patients in 2015; only 55% said they had any uninsured patients. The sample of physicians includes emergency department (ED) doctors who are legally required to see all persons who come to an ED, regardless of whether they have insurance.
Health Spending Projections: 2015-2025
National health spending will reach $5.6 trillion by 2025. Get the data on payers, per enrollee costs, payment sources, and spending on types of services.
Repealing Obamacare without replacement would hike premiums 20% and leave 18 million uninsured, report says
http://www.latimes.com/politics/la-na-obamacare-repeal-costs-20170117-story.html
Repealing Obamacare without a replacement would result in higher costs for consumers and fewer people with insurance coverage, according to a report Tuesday from the nonpartisan Congressional Budget Office.
In the first year, insurance premiums would jump by 20% to 25% for individual policies purchased directly or through the Obamacare marketplace, according to the report. The number of people who are uninsured would increase by 18 million.
Those numbers would only increase in subsequent years. Premium prices would continue to climb by 50% the next year, with the uninsured swelling to 27 million, as full repeal took effect, the report said.
Americans may be beginning to worry about such costs. For the first time, more Americans view the Affordable Care Act as a “good idea,” rather than a bad one, according to a new Wall Street Journal/NBC News poll also released Tuesday.
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