Webinar on insurance marketplace experience

From the Commonwealth Fund:

Join a Commonwealth Fund–sponsored webinar on the Affordable Care Act’s health insurance marketplaces, hosted by the Society of American Business Editors and Writers & the Georgetown University Health Policy Institute. Experts working with the three marketplace models—federal, partnership, & state—will assess progress in their states.

  • What: The Affordable Care Act’s Health Insurance Marketplaces: What’s the Experience So Far?
  • When: 22 Jan. 22, 2:00–3:30 p.m., EST
  • Panelists:  Erin Klug, health insurance exchange program manager, Arizona Department of Insurance; Jennifer Koehler, J.D., director, Illinois Health Insurance Marketplace; & Michael Marchand, director of communications, Washington Health Benefit Exchange
  • Moderator:  Kevin Lucia, J.D., project director of the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms
  • For more information & to register, click here.


Implementing health reform: An October through December enrollment report

From the Health Affairs Blog:

On January 13, 2014, the Department of Health and Human Services released a report on the Health Insurance Marketplace covering the first three months of open enrollment, October 1 through December 28, 2013. The data are reported cumulatively over the three month period rather than only for December, recognizing the fact that enrollment is a process that happens over a period of time and thus data reported separately on a monthly basis could be duplicative. Nevertheless the trends are very clear: the federal and many of the state exchanges are now in business, and enrollment is increasing at a rapid pace.

As of the end of December 2,153,421 Americans had enrolled in a qualified health plan: 956,991 had selected a plan through the state exchanges; 1,196,430 through the federal exchange. Three times as many enrollees selected a plan through the state exchanges in December (729,000) than had done so in October and November (227,000); five times as many selected a plan through the federal exchange in December (1,059,000) than had done so in October and November (137,000).

As of December 28, 2013, the exchanges had received a total of 4,348,224 applications, covering 7,716,824 individuals. Of these individuals, 5,130,798 were determined eligible for enrollment in an exchange-qualified health plan; 1,584,509 were determined or assessed eligible for Medicaid or CHIP. These numbers were dramatically increased from the 2.3 million determined eligible for exchange coverage and 803,077 eligible for Medicaid as of the end of November. A recent survey by the Commonwealth Fund found that 59 percent of adults who are potentially eligible for exchange coverage, but who had visited the exchange and not enrolled or had not yet visited the exchange, planned to enroll by March 31, 2014, the end of the open enrollment period. It is likely that many of the three million who have been determined eligible but not yet enrolled will yet do so.

The December report reveals new information on enrollees who qualified for premium tax credits. In October only 30 percent of enrollees who were determined eligible for exchange enrollment were determined eligible for financial assistance; by November the percentage had climbed to 50 percent. In the December report that number climbed only marginally, to 53 percent. The December report for the first time, however, tells us the proportion of individuals who actually enrolled in a plan who received financial assistance: 78 percent in the state-based exchanges, 80 percent in the federal exchange. This is close to the level of subsidy-eligible exchange enrollees projected by the Congressional Budget Office and suggests that the exchanges are actually reaching the uninsured — those who could not have previously afforded health insurance — as well as individuals who had individual coverage previously but really could not afford it.

To read the complete post, click here.

HCUP’s “Most Expensive Conditions” infographic

From the Agency for Healthcare Research & Quality (AHRQ):

HCUP_MostExpensiveCond2011HCUP has released a new infographic, The Top Five Most Expensive Conditions Treated in U.S. Hospitals, which represents data from the recently released Statistical Brief #160: National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. This statistical brief provides HCUP data on the distribution of costs by expected primary payer & illustrates the conditions accounting for the largest percentage of each payer’s hospital costs.

Find more HCUP infographics & a link to a complete list of statistical briefs here.

State lessons on health system reform

There is a new issue brief available from the Commonwealth Fund:  State Innovation Models: Early Experiences and Challenges of an Initiative to Advance Broad Health System Reform.

Since July 2012, the Centers for Medicare and Medicaid Services has awarded 25 states nearly $300 million to help them plan, design, and test new ways to improve population health and increase the value of health care services they pay for.

Under the State Innovation Models (SIM) Initiative, Oregon, for example, is promoting community-based networks of providers that receive a set fee to deliver a range of chronic disease management and health promotion services for Medicaid enrollees. Maryland, meanwhile, is extending its all-payer hospital rate-setting approach to all health care in a bid to hold cost growth below the state economy’s overall inflation rate.

The new Commonwealth Fund issue brief examines the early experiences of the SIM states, and offers lessons for other states wishing to pursue broad health system reforms while contending with formidable political and budgetary constraints.

The latest Health Wonk Review – Data, medicine, insurance reform, and more

From the Health Affairs Blog and Boston Health News:

Health data is a theme of this edition of the Health Wonk Review because it is also the focus of the current Knight News Challenge. That contest rewards media innovation with seed money. They use the word “challenge” literally, asking for innovative responses to question:  How can we harness data and information for the health of communities?

Our definitions of “health data” and “news” are broad, and range from projects in traditional newsrooms to consumer-facing technology to crunching big datasets. We’re hoping to find and accelerate projects that use data and public information in innovative ways to create strong information flows about health in our communities.

Check it out. Health care produces big, big data. Health information technology, surveillance data, electronic medical records, clinical trials, NIH databases.  Payers and providers produce endless streams of data for millions of people.  On the other end of the scale, the quantified selfers keep blood pressure, diet and exercise logs.

Read the complete post here.

Patient engagement is the key

From the Health Affairs Blog:

Everywhere outside of health care, the consumer is in the driver’s seat. From Angie’s List to Yelp to Uber, consumers have never had more tools, and more ability, to get what they want and need. But “health care is different.” Although 72 percent of Internet users have searched for health information in the past year, many consumers find health care lagging behind in supporting their needs for information and support. The good news is this is changing — fast. A new report published in this month’s Health Affairs describes how health plans and other payers can use patient engagement strategies and financial incentives to engage consumers to improve their health while lowering costs.

We’ve found (along with many others) that patient engagement — the actions that people take to better control their health and benefit from care — is crucial to achieving better health outcomes and a more efficient health system. But we’ve also found that while there’s great promise in patient engagement, a serious gap exists between that promise and current reality. And payers, along with care providers and consumer groups, can play an important role in closing this gap.

“UnitedHealthcare Experience Illustrates How Payers Can Enable Patient Engagement,” published in the August issue of Health Affairs, describes our experience with helping support both consumers and care providers with patient engagement. The report details UnitedHealthcare’s programs for analyzing information to identify gaps in care, using information to enable better treatment decisions, comparing care provider quality and cost to help inform care choices, and promoting better health and disease prevention using financial incentives and rewards.

Read the complete blog post here.

The cure for the $1000 toothbrush

From the Fixes blog at the New York Times:

Here is a basic fact of health care in the United States: Doctors and hospitals know what they charge, but patients don’t know what they pay. As in any market, when one side has no information, that side loses: price secrecy is a major reason medical bills are so high. In my previous column, I wrote about the effect of this lack of transparency on the bills patients pay out of pocket.

We know about these bills, which hit us directly. What most people don’t know, because the costs are hidden, is that the same imbalance exists with insurance. The employers and employees who buy health coverage have delegated vigilance over health care costs to insurers — but insurers, for the most part, have gone AWOL.

Consider the story of Texas811, a company with about 200 employees based in Dallas. (They mark utility lines so people don’t damage them when they dig.)

In January 2010, the company was enrolled in a Blue Cross P.P.O., or preferred provider organization. That month, Blue Cross told Texas811 that it was planning to raise the company’s premiums by 75 percent. That was extreme. But health insurance premiums are rising three times as fast as wages, doubling since 2002. “We freaked out,” said Lee Marrs, the company’s president. They negotiated. Blue Cross agreed to lower the increase to 68 percent. “At that point it was go out of business, drop health coverage, or try something new,” Marrs said.

They tried something new.

What Texas811 did first was drop Blue Cross and its P.P.O. and become self-insured. That means that the company itself paid claims up to a certain amount, and bought an insurance policy that kicked in after that. This isn’t revolutionary – self-insurance is how it’s done for about a third of the insured work force.  After one unsatisfactory year, Texas811 signed up with GPA, a Dallas-based company that administers claims for about 230 workplaces like municipalities, school districts, retail businesses.

The difference was astounding.

Under Blue Cross’s P.P.O., the company had been paying $10,000 per visit for dialysis patients. Now it was paying $975. Other costs dropped commensurately. After the first year, the company lowered premiums by 3 percent and increased coverage, providing free vision, dental and life insurance to all its employees, including part-timers.

      Read the complete post here.

Resources: Affordable Care Act in Michigan

Michigan map from The Century Company's 1897 atlas, digitized by the Stephen S. Clark Library, University of Michigan. Public domain.

Michigan map from The Century Company’s 1897 atlas, digitized by the Stephen S. Clark Library, University of Michigan. Public domain.

Michigan representative John Dingell has created a locally relevant guidebook on the Affordable Care Act (also known as Obamacare) and how it relates to Michigan residents. We’ve previously covered resources from the federal government, but Dingell’s efforts focus on questions and information specifically tailored to Michigan residents.

You can see the full list of questions here and access a PDF of Representative Dingell’s guidebook here.

In nursing homes, an epidemic of poor dental hygiene

From the Well blog at the New York Times:

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush. His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist. The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“I was livid,” said Ms. Ford, 57, a court reporter. “I’m there every day, pointing out he’s in pain — and he had dental insurance. So there’s no reason this wasn’t addressed.”

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean. While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it. Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University. “Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

The neglect can lead to terrible pain for the residents. Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of  institutionalized older people.

Read the complete post here.

Variation in Health Care Spending: Target Decision Making, Not Geography

New from the National Academies Press:

Health care in the United States is more expensive than in other developed countries, costing $2.7 trillion in 2011, or 17.9 percent of the national gross domestic product. Increasing costs strain budgets at all levels of government and threaten the solvency of Medicare, the nation s largest health insurer. At the same time, despite advances in biomedical science, medicine, and public health, health care quality remains inconsistent. In fact, underuse, misuse, and overuse of various services often put patients in danger.

Many efforts to improve this situation are focused on Medicare, which mainly pays practitioners on a fee-for-service basis and hospitals on a diagnoses-related group basis, which is a fee for a group of services related to a particular diagnosis. Research has long shown that Medicare spending varies greatly in different regions of the country even when expenditures are adjusted for variation in the costs of doing business, meaning that certain regions have much higher volume and/or intensity of services than others. Further, regions that deliver more services do not appear to achieve better health outcomes than those that deliver less.

Variation in Health Care Spending investigates geographic variation in health care spending and quality for Medicare beneficiaries as well as other populations, and analyzes Medicare payment policies that could encourage high-value care. This report concludes that regional differences in Medicare and commercial health care spending and use are real and persist over time. Furthermore, there is much variation within geographic areas, no matter how broadly or narrowly these areas are defined. The report recommends against adoption of a geographically based value index for Medicare payments, because the majority of health care decisions are made at the provider or health care organization level, not by geographic units. Rather, to promote high value services from all providers, Medicare and Medicaid Services should continue to test payment reforms that offer incentives to providers to share clinical data, coordinate patient care, and assume some financial risk for the care of their patients.

Order a prepublication copy or read it for free on the National Academies Press web site.