Healthcare Triage News: Health Care Reform, and the Issues We Face
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.
As we pass the 3-year anniversary of the opening of the insurance exchanges, most news seems to focus on the private insurance people can purchase there. In recent months, many have complained about private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence.
But it’s important to remember that many, if not most, of the newly insured are part of the Medicaid expansion. As of today, 19 states have still refused to participate in that program. Some cite reports and news that Medicaid offers poor quality and little choice of providers. But most seem to cite the cost of Medicaid, claiming that its growing cost will eventually bankrupt states.
Such declarations only consider one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. That’s the topic of this week’s Healthcare Triage.
http://www.commonwealthfund.org/publications/case-studies/2016/oct/hennepin-health
This case study is one in an ongoing series examining programs that aim to improve outcomes and reduce costs of care for patients with complex needs, who account for a large share of U.S. health care spending.
Each year, we put together a cost trend report that outlines what forces are at play in the state in terms of raising spending and we have hearings every October. We are trying to play an interesting role which is not be regulatory, but really to be in the face of the healthcare system in terms of saying, “Hey be careful. Don’t go the extra mile on in spending or pricing.”
We want to do it in a way that doesn’t destroy or even hurt the health system. In any attempt to do that, some of the forces within the health industry scream.
But, for the most part, the hospitals have been supportive of our efforts. If we were to squeeze too hard, they would react more negatively. Everyone is engaged in a very interesting balancing act. We are trying getting the system to work more efficiently… and they are trying to control costs without destroying themselves. So far it’s working.
http://blogs.wsj.com/washwire/2015/04/16/public-vs-private-health-insurance-on-controlling-spending/
No single fact can settle the long-running debate of whether public or private health insurance is preferable. But by one basic metric, the rate of increase in per capita spending, public insurance has an edge.
The country’s aging population, which is using more Social Security and requiring more Medicare coverage, is driving most of the spending increases, according to the report. Compared to 50 years ago, the number of people who are 65 years old and older has more than doubled, CBO found. As a result, Medicare outlays will remain at about 3% of GDP until 2018 but then increase on an annual basis through 2026.
“Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries of those programs,” the report states, adding, “As a result, projected spending for people age 65 or older in three large programs — Social Security, Medicare, and Medicaid — increases from roughly one-third of all federal noninterest spending in 2016 to about 40% in 2026.”
Meaningful improvement in the health system will require improvement in care for those patients using it the most: people with multiple chronic conditions. Within this clinically diverse group are patients who remain stable for years with appropriate treatment, others who live with extreme functional limitations, and still others with persistent behavioral health challenges or related social needs, like housing or food, that exacerbate their conditions. Care for these high-need, high-cost patients is expensive: despite comprising just 5 percent of the U.S. population, they account for 50 percent of the nation’s annual health care spending.
http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/
Medicare, the federal health insurance program for 57 million people ages 65 and over and people with permanent disabilities, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute care services. In 2015, spending on Medicare accounted for 15% of the federal budget (Figure 1). Medicare plays a major role in the health care system, accounting for 20% of total national health spending in 2014, 29% of spending on retail sales of prescription drugs, 26% of spending on hospital care, and 23% of spending on physician services.1 This issue brief includes the most recent historical and projected Medicare spending data from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT), the 2016 annual report of the Boards of Medicare Trustees2 and the 2016 Medicare baseline and projections from the Congressional Budget Office (CBO).3
“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.”
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?”
HENRY KOTULA 