The Pennsylvania health care battle

https://www.axios.com/the-pennsylvania-health-care-battle-2519142732.html

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Highmark Health, a powerful Blue Cross Blue Shield insurer that also owns a hospital network in Pennsylvania, and academic system Penn State Health signed an agreement last week to build a health care network in central Pennsylvania.

The deal sounds like a merger, but it’s not. It also adds another layer to the turf war between Highmark and UPMC — the two have feuded for years, and UPMC recently embarked on a hospital buying spree. I spoke with executives from Highmark and Penn State to explain what their deal is and why it matters.

The details: Highmark and Penn State Health are investing $1 billion to build out a network of doctors and health care facilities, but the organizations aren’t disclosing how much each side is contributing. Penn State Health CEO Craig Hillemeier said the deal is a strategic partnership, not a merger of assets. Here’s a condensed version of the conversation:

You all are talking a lot about “value-based care.” But what will you do specifically to fulfill the promise that this deal will lower health care costs for people in your region?

Highmark CEO David Holmberg: “This is about making sure that we design insurance products so that when a member has to make a decision, they have access to care near where they live. (Penn State’s academic medical center) is also more affordable and more effective than many of the other academic systems.”

So how much did UPMC play into this? UPMC has bought a lot of hospitals this year, and I have to imagine that name came up multiple times in discussions.

Penn State Health CFO Steve Massini: “We’ve had a strategy for a number of years to build out this community-based network and support the academic center. We felt that having an insurance partner like Highmark was a very valuable piece of that strategy … what others do is not what we tend to get hung up on.”

Holmberg: “We’re in this for the long term. We’re not going to worry about what the other guys do.”

Will you create health plans that, for example, have cheaper premiums but limited networks where people can only go to Penn State doctors and hospitals?

Highmark President Deborah Rice-Johnson: “We have those in the market today. It’s not new to the industry. We’ll still have broad-network products … but we have absolutely seen premiums and care costs moderate very differently (in limited-network plans) than the broad-network products.”

Can you guarantee that premiums for those types of narrow plans won’t rise faster than the rate of inflation?

Rice-Johnson: “We have done that, yes.” But employers need to sign multiyear agreements with Highmark to get those capped rates.

 

Getting In-Network Care is Harder Than You’d Think

 

 

Why selling insurance across state lines is an unlikely solution

http://www.healthcaredive.com/news/why-selling-insurance-across-state-lines-is-an-unlikely-solution/429610/

Proposals to sell insurance across state lines have been floating around for a while. In 2005, Congress considered the first proposal to sell insurance across state lines at the federal level. Many of the candidates running in the recent Republican presidential primary endorsed the idea, including Scott Walker, Marco Rubio, Ted Cruz and Rand Paul. A proposal to sell insurance across state lines is a core component of Republican presidential nominee Donald Trump’s healthcare agenda.

With election day approaching and attention returning to plans that would allow the sale of insurance across state lines, it is worth asking whether these proposals would be effective.

Healthcare Triage News: Health Care Reform, and the Issues We Face

Healthcare Triage News: Health Care Reform, and the Issues We Face

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As we approach the election this fall, it seems like the news media report on little else. Unfortunately, too little news coverage addresses health care reform. That’s wackadoo, because there is still so much to be done to improve the cost, quality, and access for patients within the US health care system.

So let’s talk about the major health policy issues we in the US face. This is Healthcare Triage News.

A “Volatile Marketplace”: Second Quarter Earnings Calls Offer Glimpse of How Insurers Are Faring on ACA Marketplaces—and What 2017 Might Bring

http://www.commonwealthfund.org/publications/blog/2016/sep/volatile-marketplace?omnicid=EALERT1094761&mid=henrykotula@yahoo.com

This has been a turbulent year for the Affordable Care Act (ACA) marketplaces. As part of our ongoing efforts to better understand how the post-ACA insurance markets are evolving, we reviewed the 2016 second-quarter (Q2) earnings calls and financial filings of several large, publicly traded insurers that participate on the marketplaces: Aetna, Anthem, Centene, Cigna, Humana, Molina, and United.1  While the picture provided by these calls and financial reports is limited – dozens of other participating insurers are not required to report to investors because of their nonprofit or private status – they can help us better understand some of the trends affecting the marketplaces’ stability, including insurer exits from some health insurance marketplaces and increases in 2017 premiums.

 

Four predictions for the future of healthcare

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-predictions-future-healthcare?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=12082016

Healthcare policy has long been a moving target, but it’s hard to remember a time when more change was cycling through the industry. Now, more than half a decade since the passing of the Affordable Care Act (ACA), the focus has shifted from expanding access to health insurance to reforming the delivery of healthcare.

In particular, policymakers have embarked on a series of experiments and initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement.

We are in the first generation of pursuing approaches better than FFS, and expect the industry’s shift toward value-based care (VBC) to accelerate and continue to impact providers, patients, vendors, and payers in different ways.

Now a little more than halfway through 2016, we thought it would be a good time to look at trends in the industry and how they will shape the relationships among stakeholders for the years to come.

4 forces that will influence medical cost trends in 2017

http://www.healthcaredive.com/news/4-forces-that-will-influence-medical-cost-trends-in-2017/421162/

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The healthcare industry is in a transformational period. The rising use of retail clinics, MACRA, population health efforts and the Medicare Part B demonstration are but a few examples of disruptive conversations being had in board rooms. Yet, all of these discussions are underscored by the one topic underlying most business conversations: the almighty dollar.

There’s a push and pull between healthcare services utilization and narrow networks focusing on value that could shift the medical cost growth rate in future years. “When medical growth outpaces general inflation, a flat trend is not good enough,” the report states.

“As a result, 2017 will be a tough balancing act for the health industry,” the report states, adding, “Healthcare organizations must simultaneously increase access to consumer friendly services while decreasing unit cost. Employers, worried that this current trend is at an inflection point that could turn back up, will demand more value from the health industry.”

Health Affairs Study On Hospital Profitability Gives Us Some Important Factors To Watch Going Forward

http://healthaffairs.org/blog/2016/06/21/health-affairs-study-on-hospital-profitability-gives-us-some-important-factors-to-watch-going-forward/

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Bai and Anderson report two profitability-related factors that reflect the effect of hospital consolidation trends: regional power and system affiliation. Regional power refers to hospitals that face less competition in their local markets, while system affiliation indicates hospitals that are part of multi-hospital systems. Both are associated with higher profitability in their study.

More and more hospitals across the country are joining systems that operate outside their local markets. This is due, in part, to the fact that antitrust regulators have limited local market mergers but have not, in general, adapted their models of hospital market competition and antitrust to address non-local mergers. As a result, hospitals in some instances are able to join systems, gain market power, and raise their prices without necessarily improving quality or service. My own research in this area (forthcoming inINQUIRY) shows that hospitals that are part of the largest multi-hospital systems in California were able to negotiate price increases that are consistently well above all other hospitals in that state.

Unexpected medical bills can cost American consumers thousands

http://www.pbs.org/newshour/bb/unexpected-medical-bills-can-cost-american-consumers-thousands/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31025728&_hsenc=p2ANqtz-_w0iZON_VFW9xi2r9d3HOiykTJ_YND30E5HOAHhuWAio-qbr61Jfk6MqgtuWR8-lR0pZzgxirKKmV2hqg_CbtEf7rXTg&_hsmi=31025728

Who is In Network

http://www.pbs.org/newshour/updates/americans-who-confronted-surprise-medical-bills-share-their-stories/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31025728&_hsenc=p2ANqtz-_6OV-5Ij1pT2YTVAVrdazaB9p8aPoIXD_9L5_HrzAhpJcuAUqEb9lpLG6ehkNgCQSxaAYVzW5LuUjvOVEB7NCIEPp3XA&_hsmi=31025728

 

Payment Methods and Benefit Designs:How They Work and How They Work Together to Improve Health Care

http://www.urban.org/research/publication/benefit-designs-how-they-work/view/full_report

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