Canopy Health Receives License, Names New Leadership; Accountable Care Network Builds Executive Team to Spur Bay Area Growth

http://finance.yahoo.com/news/canopy-health-receives-license-names-221800300.html

Canopy Health, the Bay Area-wide health care network being developed by UCSF Health, John Muir Health and three physician groups, has received its Knox-Keene license to operate in seven Bay Area counties. It also has built out its management team, naming Meg Durbin, MD, as chief medical officer and Patrick Caster as chief financial officer.

The restricted license from the California Department of Managed Health Care enables the network to provide services in Marin, Southern Sonoma, San Francisco, Alameda, Contra Costa, and portions of San Mateo and Solano counties. Canopy Health will contract directly with health plans on behalf of all providers who are part of the network to develop an insurance product that provides access to high-quality care at an affordable price. Canopy Health currently includes more than 4,000 physicians and 12 hospitals throughout the San Francisco Bay Area.

“Our model is unique, as we are partnering with health plans to offer a competitively priced insurance product, rather than selling our own plan,” said Canopy Health Chief Executive Officer Joel Criste. By accepting risk, we are accountable for the overall health of the patients we serve. It puts the focus where it should be – keeping patients as healthy as possible and providing the care they need in the most appropriate setting, whether that is the primary care physician’s office, an outpatient center or acute care hospital.”

3 possibilities for the future of the ACA exchanges

http://www.fiercehealthcare.com/payer/3-possibilities-for-future-aca-exchanges?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWldRd1kyUXpNalUwWXpFeCIsInQiOiJaWkJVWkdKWG9DSFJwYytCZmVHV1JKcFhVd1lZbUlHS1JjZTZHZWI2ZDl3dU1XNU5oTWpCY3lSU3BYaWtyZXVyeGZmbDdyTVFHWk5OQUhEQzhlZkdlNm9lTnE3Y2M2elhcLzRrN3F5aXFKXC9RPSJ9

With health insurers struggling to turn a profit on the Affordable Care Act exchanges and premiums likely to rise, many have wondered what the future will hold for this prominent feature of the Obama administration’s healthcare reform law.

This week, Aetna became the latest major insurer to indicate it will re-evaluate its participation in the ACA marketplaces amid climbing financial losses that mirror those experienced by UnitedHealth, Humana and much smaller consumer operated and oriented plans.

What’s more, the cost of the ACA’s “benchmark” silver plan will increase by a weighted average of about 9 percent in 2017, compared to a 2 percent average increase in 2016. And in some areas of the country, insurers have requested steep rate increases–as much as 60 percent–for their exchange plans.

Struggling to Stabilize the Exchanges

Struggling to Stabilize the Exchanges

Six years after passage of the Affordable Care Act (ACA), the individual and small-group insurance markets—the markets that the ACA remade—are still having growing pains. Health insurers have endured large losses and a number of ACA-created co-ops and other small insurers have failed. Consolidation among providers and insurers is an increasing and concerning trend. And many insurers are poised to raise premiums substantially for 2017, further stoking frustration with the insurance industry.

Even as the press vilifies insurers, however, the ACA’s supporters can’t afford to be indifferent to their struggles. Private insurers sell the managed care plans that are the central vehicle for expanding access to middle- and lower-income Americans. One day, those plans may cover many of the 11 percent of Americans who remain uninsured.

Part of insurers’ difficulty is that the risk pool in the individual and small-group markets, particularly on the exchanges, is sicker and smaller than originally projected. But the three programs—reinsurance, risk corridors, and risk adjustment—that the ACA’s drafters would hope stabilize premiums in the revamped markets have also not performed as expected. Dashed expectations have led to market instability and to a flurry of lawsuits around the “3Rs.” What does this unpredictable and difficult situation mean for 2017 and for the ACA more generally?

Healthcare Coverage Reform Proposals

Click to access RyanPlanAnalysis-brief.pdf

 

What can we expect in healthcare with Clinton, Trump?

http://thehill.com/blogs/congress-blog/healthcare/289527-what-can-we-expect-in-healthcare-now-that-clinton-and-trump

Now that our presidential nominees are set and the general election has begun, what do our nation’s hospitals and health systems need to do, whether Secretary Clinton or Mr. Trump is elected in November? They, and their parties, offer stark contrasts, but what will they mean for hospitals?

CMS needs to halt the march to health care gigantism

CMS needs to halt the march to health care gigantism

From a major speech by Sen. Elizabeth Warren to a recent report from the President’s Council of Economic Advisers, there has been a renewed interest by Democrats in monopolies and market consolidation. From tech to airlines, they argue, too many sectors of the economy are being dominated by a few big players.

In American health care, this is not only the case, but has been the default preferred stance. In health care, there is an almost Darwinian belief that the evolution to bigger is better. This is why last year saw 112 hospital mergers (up 18 percent from 2014), and the percentage of physician practices owned by hospitals doubled between 2004 and 2011.
Yet, there is no evidence that consolidation of hospitals and physician practices leads to better clinical outcomes or cost reductions. In fact, recent studies suggest that small, physician-owned practices have a lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than hospital-owned practices.
That is why it is so unfortunate that, as part of the largest rewriting of doctor payment rules in a generation, the Centers for Medicare and Medicaid Services (CMS) unwittingly has drafted regulations that—as currently proposed—further neglect the power of physician independence and create strong incentives for further consolidation in health care.

Are insurers ditching PPOs?

http://www.healthcaredive.com/news/are-insurers-ditching-ppos/423291/

Insurers that have been offering PPO plans in the healthcare marketplace appear to be cutting back on the number of offerings or eliminating PPOs from the marketplace altogether, leaving consumers with fewer options. Is this becoming an industry-wide trend?

“In the large group market, traditional PPO offerings have been on the decline for the last several years as Consumer Driven Health Plans have gained popularity,” says John Greenbaum, senior vice president and employee benefits practice leader at national insurance brokerage Risk Strategies Company. “In the group market, the move has largely been driven by market concern over the now-delayed Cadillac tax.”

According to Greenbaum, insurers offering products on the public exchanges have curtailed their PPO offerings in favor of high-deductible plans. “Their motivation has been the difficulty of achieving profitability in a regulated market with no ability to underwrite the quality of risk,” he says.

Teri Mullaney, President and CEO of DST Health Solutions, says there are benefits to both payers and consumers to moving away from PPOs:

Hospitals show some benefit from ACA

http://www.post-gazette.com/news/health/2016/07/24/Hospitals-show-some-benefit-from-ACA/stories/201605090123

The Affordable Care Act has cut hospital charity care and bad debt expenses, but opponents say it is not enough to contain healthcare costs.

C-suite feels ripple effect from Medicaid expansion, study says

http://www.healthcarefinancenews.com/news/c-suite-feels-ripple-effect-medicaid-expansion-study-says

Arkansas is one of the four Medicaid expansion states who participated in the study.

Arkansas is one of the four Medicaid expansion states who participated in the study.

Medicaid expansion is making a difference as to whether hospitals are investing in clinics, new equipment and hiring new staff, or looking at the status quo and layoffs, according to a recent report by Georgetown University Health Policy Institute.

Hospitals in Medicaid expansion states have realized a drop in uncompensated care; an increase in institutional financial security; new community efforts to integrate and improve care; and innovative programs to expand access to specialists, according to the study.

CEOs who head hospitals in both expansion and non-expansion states said they saw a drop in uninsured rates in expansion states that was not as dramatic in non-expansion states.

This has translated to a decline in uninsured patient stays by close to 40 percent. Non expansion states reported a decline of 2.9 percent.