Medicaid Expansion Out of Pocket Spending Low Income

http://www.commonwealthfund.org/publications/newsletters/ealerts/2017/aug/low-income-families-in-medicaid-expansion-states-have-much-lower-oop-spending?view=newsletter_email&email_web=true&omnicid=EALERT1260685&mid=henrykotula@yahoo.com

New Commonwealth Fund research out today demonstrates how states that expanded Medicaid eligibility have not only improved low-income residents’ access to health care but have also reduced what families must spend out of pocket on premiums, cost-sharing, and other related expenses.

Prior studies had shown that low-income residents of states that expanded Medicaid under the Affordable Care Act (ACA) are less likely to experience financial barriers to health care access. But the impact on people’s out-of-pocket spending had not been measured until now.

The new analysis, conducted by a team headed by Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, found that the average low-income family in a Medicaid expansion state saves about $382 annually relative to a comparable family in a nonexpansion state. Moreover, low-income families in states that expanded Medicaid are less likely than their counterparts to have any out-of-pocket health care costs at all.

The authors say there was no statistically significant difference in outcomes for states that expanded through conventional Medicaid or through a waiver program.

http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income?omnicid=EALERT1260685&mid=henrykotula@yahoo.com

 

Advanced Analytics: A Triple Win for Payers

http://www.healthcarefinancenews.com/sponsored/advanced-analytics-triple-win-payers

Virtually every organization working in healthcare – payers, hospitals, physicians, and employer group health plans – must do more with fewer resources. That’s especially true for payers.

The Affordable Care Act may have created what Gartner Research estimates to be a $33 billion opportunity for payers in the form of new individual customers, but it also generated new demands. For starters, payers are now held to a higher standard for administrative spend. The ACA’s Medical Loss Ratio (MLR) provisions require payers to spend at least 80 percent and 85 percent of premium dollars, for individuals/small groups and large employer group health plans respectively, on medical care and quality activities or issue a rebate to customers. As intended, this limits profits, salaries and broker commissions and administrative spend on business activities such as customer service, network and product development, and information technology.

In many markets, premium pressures have increased. As the result of the ACA and healthcare exchanges, there is a much higher level of transparency about individual and small group premiums, often leading to price competition. Large employer group health plans too have more options, including contracting directly with provider groups, all of which translates to premium challenges for most payers.

Why Low Growth in Health Costs Still Stings

http://blogs.wsj.com/washwire/2015/04/08/why-low-growth-in-health-costs-still-stings/?utm_campaign=KFF%3A+Drew%27s+Columns&utm_source=hs_email&utm_medium=email&utm_content=16962011&_hsenc=p2ANqtz–38gNBe4tArXEi1kR4gIoGPcB2uGQndAtR9a57fX7sixUnjJtHdETi4iYn613Dneh6G2TarKm9MCTz9h8Q_rrLuRwo4Q&_hsmi=16962011