“Medicare ACO programs are associated with modest savings on average across all beneficiaries, with savings concentrated in clinically vulnerable beneficiaries and use of institutional settings.”
Tag Archives: ACA
iFHP cost report highlights cause for concern over lack of provider competition
The International Federation of Health Plans (iFHP) today released its2015 Comparative Price Report, detailing its annual survey of medical prices per unit. Designed to showcase the variation in healthcare prices around the world, the report examines the price of medical procedures, tests, scans and treatments in seven countries.
The report undercuts the idea of what’s being played out in the recent Sutter Health case which alleges the health system is overcharging insurers causing medical costs to be pushed downstream to patients. Last Friday, the suit was allowed to seek class-action status. Matthew Cantor, partner and attorney at Constantine Cannon and lead lawyer for the plaintiffs, told Healthcare Dive the plaintiffs allege to have contracts which require health plans to purchase all the hospital services that Sutter provides in Northern California.
Sutter is “leveraging its larger power in those markets to say to these health plans that they have to also purchase Sutter Health hospital services elsewhere and not only do they have to purchase them but they have to purchase those Sutter services at higher, super competitive prices,” Cantor said, adding that this, in turn, raises the costs of medical services to health plans. These higher costs, Cantor said, are then sent downstream to insurance policyholders.
“Competition is not working,” Sackville told Healthcare Dive. “The market’s not working because if it was, no one would get away with charging $17,000 [for a day of hospital care].”
The report put a focus on the lack of provider competition and consolidation. There’s been a fair amount of consolidation in various states and more systems are pursuing the idea of mergers or partnerships. Such activity, in theory, could bring down competition in an area and tick up costs for consumers as hospitals’ market power grows. “Powerful hospital systems have the ability to raise the prices of medical care. Health plans have no alternative but to take these forced, higher costs upon them because [if they refused] then no one would buy their insurance,” Cantor told Healthcare Dive.
Where’s the value in accountable care?
Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”
Hospitals oppose potential rebirth of ‘public option’ coverage
Under pressure from onetime rival Bernie Sanders and the liberal wing of her party, Hillary Clinton has pushed for a “public option” form of coverage in the state and federal health insurance exchanges.
The decision is considered to be a middle ground option away from Sanders’ primary campaign push for single-payer coverage. The proposal was recently endorsed by President Barack Obama.
However, the public option has drawn fire from the hospital sector, which fears it would depress the payments it receives to provide care. As a result, the American Hospital Association and the Federation of American Hospitals reached out last week to the Democratic Platform Drafting Committee.
Healthcare spending will make up 20% of U.S. economy within a decade
Healthcare spending will comprise 20 percent of the U.S. economy by the middle of next decade, according to new data from the Office of the Actuary of the Centers for Medicare & Medicaid Services and published in Health Affairs.
Expenditures on healthcare services will grow at an average rate of 5.8 percent per year between 2015 and 2025, about 1.3 percent higher than projected annual growth in the U.S. gross domestic product, CMS concluded. By 2025, healthcare spending will comprise 20.1 percent of the U.S. economy, up from 17.5 percent in 2014. Expenditures totaled $3.2 trillion last year.
Despite the seemingly robust spending growth, it remains lower than the 8 percent annual growth clip that occurred in the two decades before the Great Recession of 2008, which helped to slow expenditures significantly. In 2015, spending grew at a 5.5 percent rate. This year, it is projected to be 4.8 percent, attributable in part to the slower expansion of newly insured under the Affordable Care Act.
“The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades. This progress is occurring while also helping more Americans get coverage, often for the first time,” said CMS Acting Administrator Andy Slavitt in a statement.
Reflections on 17 Years in California Health Policy
http://www.chcf.org/articles/2016/07/reflections-17-years?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t
California’s individual health insurance marketplace today bears little resemblance to that of the mid-2000s. Since 2014 Californians have been able to purchase individual coverage without regard to their medical history. They can switch plans and carriers during annual open enrollment periods. Consumers face strong incentives to obtain coverage: They incur tax penalties if they remain uninsured, and all who are lawfully present and meet income standards are eligible for subsidies through Covered California. As a result, a greater share of Californians is now covered through the individual market than is uninsured (14% versus 11%, according to one national survey). While affordability concerns remain, early data show that Californians who bought insurance through the individual market spent significantly less than those buying before the ACA. And the percentage of Californians with individual coverage spending more than 10% of their household income on health care costs also went down.
Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags
http://www.chcf.org/aca-411/insights/physician-participation?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t
The share of physicians accepting new Medi-Cal patients is an indicator of the program’s capacity to meet demand. If a decreasing share of participating physicians are willing or able to take new Medi-Cal patients, beneficiaries in the program may have trouble getting the care they need. The proportion of physicians accepting new Medi-Cal patients has historically lagged behind the proportion accepting new patients covered by Medicare, which has a higher reimbursement rate, as well as behind the proportion accepting new patients with private health insurance.
New 2015 data now available on ACA 411 show the percentage of physicians participating in Medi-Cal has declined since 2013 — during the same period Medi-Cal enrollment skyrocketed by 39%. This raises serious concerns about whether the supply of physicians participating in Medi-Cal can meet the increased demand.
Physicians’ willingness to treat Medi-Cal beneficiaries is critical to ensuring Medi-Cal enrollees have adequate access to care. Without a sufficient number of doctors serving Medi-Cal beneficiaries, Medi-Cal enrollees may not be able to receive care in a timely manner. Beneficiaries may delay seeking needed care with disastrous effects or may end up receiving care in more costly settings.
Balancing the Books: How Affordable Is Health Insurance Through Covered California When Local Cost of Living Is Taken Into Account?
Click to access PDF%20BalancingAffordableCoveredCa.pdf
Subsidies offered through the health insurance marketplaces established under the Affordable Care Act (ACA) have reduced the cost of health insurance for millions of Californians. Subsidy amounts, however, are set nationally and do not take into account the local cost of living, which varies dramatically across the state.
Even with the help of subsidies, many Californians struggle to afford coverage through Covered California, the state’s health insurance marketplace, especially those living in areas where a high cost of living already strains household budgets.
In this analysis, researchers identified an affordability threshold — the minimum amount a typical household would need to earn to have sufficient funds to cover their basic needs and Covered California premiums and out-of-pocket costs after federal subsidies.
The affordability threshold varied widely by county, mostly due to the local cost of living, but in every county it fell above the maximum income to qualify for Medi-Cal as an adult (138% of the federal poverty level or $33,543 for a family of four or $16,395 for one person). This suggests that in every California county, there are families and individuals — specifically those earning above 138% of FPL and below the local affordability threshold — who are falling into an affordability gap. They earn too much for Medi-Cal but not enough to afford health insurance through Covered California, even with subsidies.
New Health System Scorecard Finds Improvement in Most U.S. Communities Since ACA Took Effect
Many U.S. communities saw gains in their health and health care between 2011 and 2014, but wide variation in progress indicates there is room for improvement across the country, The Commonwealth Fund’s newly updated Scorecard on Local Health System Performance finds.
Those areas of the U.S. that improved did so largely because more people had insurance coverage and could afford to get the care they needed, and because health care providers performed better on quality and efficiency measures—such as limiting hospital readmissions. The Affordable Care Act (ACA) has contributed to many of these improvements, the researchers say.
Still, the analysis of 306 U.S. local areas on health care access, quality, avoidable hospital use, costs of care, and health outcomes shows that while care improved more than it worsened in nearly all communities, the gains were often modest. Among the more worrisome trends are the rise in obesity rates in more than 100 areas and the stagnation in preventable death rates nearly everywhere.
The Commonwealth Fund’s interactive scorecard features data visualizations, an online tool enabling comparisons of U.S. communities, and complete area-by-area results on the scorecard’s 36 health system indicators.
In Nod to Sanders, Clinton Offers New Health Care Proposals
Clinton’s campaign says the proposal is part of her plan to provide universal health care coverage in the United States. The presumptive Democratic presidential nominee also is reaffirming her support for a public-option insurance plan and for expanding Medicare by letting people age 55 year and older opt in.
HENRY KOTULA 