The Next Big Debate in Health Care

http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/?utm_campaign=KFF-2016-Drew-WSJ-June-30-adequacy-coverage&utm_medium=email&_hsenc=p2ANqtz–xQ5m7mTzVOQDJ-gEuLbZl7pkPEfb_Iw0ezewQc1ln7AN8seXIMO73B28qbm9dojkj8aBYyKmMoIvL46iTkyv7FWksVw&_hsmi=31195410&utm_content=31195410&utm_source=hs_email&hsCtaTracking=ed044791-0cff-437c-b853-bcb03570f762%7C6f34b697-a7d1-4d2a-b580-e9d37afa69ac

Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA.

The rural hospital closure crisis: 15 key findings and trends

http://www.beckershospitalreview.com/finance/the-rural-hospital-closure-crisis-15-key-findings-and-trends.html

http://www.ivantageindex.com/vulnerability-index/

Click to access Rural-Vulneravbility-2016_FINAL.pdf

12 hospital closures so far in 2016

http://www.beckershospitalreview.com/finance/12-hospital-closures-so-far-in-2016-june22.html

OR Efficiencies

Hospitals across the nation face a myriad of financial challenges, including underpayments from Medicare and Medicaid and new reimbursement cuts.

These financial challenges, combined with other issues such as declining patient volumes, have caused more than 60 rural hospitals to close over the past five years.

Below are 12 hospitals closures reported so far this year.

CHI to exit health insurance business

http://www.beckershospitalreview.com/finance/chi-to-exit-health-insurance-business.html

CHI ended the first nine months of fiscal 2016 with an operating loss of $265.6 million on revenue of $12.2 billion. In April, S&P and Moody’s Investors Service lowered their ratings on CHI’s debt due to the system’s persistent losses.

The top 8 takeaways from HFMA’s 2016 National Institute

http://www.beckershospitalreview.com/finance/the-top-8-takeaways-from-hfma-s-2016-national-institute.html

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When close to 5,000 healthcare professionals get together to talk numbers, it’s worth paying attention. The Healthcare Finance Management Association Annual National Institute took place in Las Vegas this week. Given the seismic changes in motion relative to the business model of hospitals and healthcare delivery networks, this is likely (and perhaps surprisingly) one of the more important and interesting conferences that will take place in healthcare this year.

In the $3 trillion market which is healthcare, roughly $1 trillion flows directly through hospitals. But the story isn’t what you think it is, as average operating margins are only 2 percent and inpatient volumes have been declining at a rate of close to 2 percent annually for the last few years. With margins that small, volume declining, and this much at stake, clearly the game is going to change in a big way. The bottom line is there is a truly stunning shift in focus taking place in finance, and that was evident at the HMFA conference this year.

This is a landscape view of some of the hot topics, but I think the bottom line is there has never been a better time for new ideas and true collaboration relative to solving healthcare’s most fundamental puzzle — figuring out how to deliver the best and most cost effective care possible to everyone, every day, in every community.

There is a line in a song from the musical Hamilton that says “Look around, look around, how lucky we are to be alive right now.” I think that captures the mindset we need from every stakeholder at the table right now. This is a great time to be in healthcare, perhaps the best.

Appeals Panels Affirm Injunction Against Fixed Indemnity Regulation, Turn Back Challenge To ‘Administrative Fix’

http://healthaffairs.org/blog/2016/07/03/appeals-panels-affirm-injunction-against-fixed-indemnity-regulation-turn-back-challenge-to-administrative-fix/

Tim-ACA-slide

On July 1, the D.C. Circuit decided two appeals challenging aspects of the implementation of the Affordable Care Act, accepting one challenge and rejecting the other. In Central United Life v. Burwell, a three-judge panel of the D.C. Circuit Court of Appeals affirmed a lower court injunction against a 2014 HHS regulatory prohibition on the sale of fixed indemnity insurance unless the purchaser attests that he or she already has minimum essential coverage. And in West Virginia v. HHS, a different panel of the D.C. Circuit rejected a challenge brought by the state of West Virginia to the “administrative fix” announced by HHS late in 2013. Under this arrangement, HHS deferred for 2014 enforcement of eight of the ACA’s insurance market reform requirements against existing insurance plans in the individual and small group market.

7 ESSENTIAL BELIEFS FOR LEADERSHIP SUCCESS

https://leadershipfreak.wordpress.com/2016/07/03/7-essential-beliefs-for-leadership-success/

inconsistent leaders need positional authority to get what they want

#4. Treat everyone like a volunteer. Peter Drucker wisely said, “Accept the fact that we have to treat almost anybody as a volunteer.” What happens to your attitude when you stop using pay checks as billy clubs?

Winning hearts is more powerful than coercing conformity.

How social factors are driving precision medicine

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/how-social-factors-are-driving-precision-medicine?cfcache=true

Precision Medicine2

Mention precision medicine, and genomics quickly comes to the top of mind. While genomics and clinically oriented analysis are extremely valuable in implementing precision medicine as the next step in population health management, they are really only a small part of the big picture.

Increasingly, the value of environmental, social and lifestyle factors that live outside the medical system is also getting recognized in the effective implementation of personalized medicine in this country. The federal government’s Precision Medicine Initiative (PMI) that calls for $215 million in fiscal year 2016 to support research in this area focuses not just on genetics and biology, but also behavior and environment — “with the goal of developing more effective ways to prolong health and treat disease.”

The changing face of healthcare leadership

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/changing-face-healthcare-leadership?cfcache=true

Despite all the change health plans are facing today, there’s one key way of measuring leaders’ effectiveness that won’t change: Profitability.

Health plan executives will be evaluated based on the sustainability of their businesses during a time when profit margins are tight. They’ll also be measured based on their ability to retain employees and maintain current local relationships. Health plans will be investing in a lot of new talent. That means that leaders will be measured on their ability to grow their teams, while maintaining deep relationships in the communities where they’re doing business.