Entries in Riddle, Clive (260)


Urban Institute: Implications of Partial Repeal of the ACA through Reconciliation

By Clive Riddle, December 9, 2016

CNBC called it the Obamacare Doomsday Scenario: the Urban Institute has released a 33-page brief - Implications of Partial Repeal of the ACA through Reconciliation - examining what would happen if the new congress goes forward with an ACA partial repeal with a replace to be named later – using a reconciliation bill similar to one President Obama vetoed in January 2016. Their analysis determined that “the number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).”

The Urban Institute points out that “there is currently no consensus around alternative health policies to enact as the ACA is repealed; consequently, partial repeal via reconciliation without replacement is possible and merits analysis.” The scenario they lay out is that “Congress is now considering partial repeal of the Affordable Care Act (ACA) through the budget reconciliation process. Since only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates; it would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place.”

Here’s some highlights from their report of what is in store for us if the scenario takes place:

  • The share of nonelderly people without insurance would increase from 11% to 21%
  • 22.5 million people will become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate
  • An additional 7.3 million people will become uninsured because of the near collapse of the nongroup insurance market.
  • 82% of the people becoming uninsured would be in working families, and 80% of adults becoming uninsured would not have college degrees.
  • 38% becoming uninsured would be ages 18 to 34, and 56% would be non-Hispanic whites.
  • There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
  • Approximately 9.3 million people who would have received tax credits for private nongroup health coverage in 2019 would no longer receive assistance.
  • Federal healthcare spending would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.
  • State spending on Medicaid and CHIP would decrease $76 billion between 2019 and 2028.
  • The newly uninsured would seek an additional $1.1 trillion in uncompensated care at the state/local level between 2019 and 2028.
  • The 2016 reconciliation bill did not increase funding for uncompensated care beyond current levels.
  • If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016 and eliminates the individual and employer mandates immediately, in the midst of an already established plan year, insurers would suffer substantial financial losses (about $3 billion); the number of uninsured would increase right away (by 4.3 million people); at least some insurers would leave the nongroup market midyear.

Focus on Value to Survive, Maybe Flourish, for Next Four Years

by Clive Riddle, December 2, 2016

What shall be the fate of value-based care initiatives in the wake of a new administration’s zeal to slash away at all thing Affordable Care Act? The following article: Focus on Value to Survive, Maybe Flourish, for Next Four Years, recently appeared in the Inaugural issue of Value-Based Payment News, Russell Jackson, editor:

The quadrennial change of who’s who in the nation’s capital generally brings with it a shift in focus at the federal regulatory agencies and a reboot of the dynamic between the White House and the Capitol. But despite the magnitude of change that could reverberate throughout the national-level political apparatus this time around, experts pretty much agree that the value- and quality- and other payment reform-related programs – the Medicare Access and CHIP Reauthorization Act included – will likely continue in much their current form, albeit, in some cases, under different names and with, in all likelihood, different, and surprising, claims of original ownership.

Don’t be surprised, in other words, if a newly named Centers for Medicare and Medicaid Innovation turns out to have been the new president’s idea all along. Here’s a sampling of what the policy experts have been telling the press about value-based healthcare programs for the next four years.

“Premier Senior Vice President Blair Childs says Republicans strongly support Accountable Care Organizations. ‘They first ran the ACO demonstrations under the Bush Administration,’ he said by email. ‘They are envisioned in MACRA, of which the Republicans are strong supporters.’”

== ‘Republicans Expected to Spare ACOs, Other Demos from ACA Repeal;’ http://insidehealthpolicy.com/

“Ian Spatz, a senior advisor at Manatt Health, said there is no reason to think Republicans would reverse the trend toward providers sharing risk. He said ACOs and other demonstrations that move away from the fee-for-service system are not partisan. However, Spatz said it’s likely that Republicans will place restrictions on CMMI, such as prohibiting mandatory demonstrations, and they might change the Centers’ name.”

== same article

Gilberg, senior vice president of government affairs for the Medical Group Management Association, said they are advising members to continue preparation for MACRA. ‘We don’t see that that is going to be repealed. It was bipartisan, nearly a unanimous vote.’”

== ‘MACRA will move forward largely untouched when Trump steps in, experts say;’ http://www.healthcarefinancenews.com/news/macra-will-move-forward-largely-untouched-when-trump-steps-experts-say

 “Christopher Kerns, managing director at The Advisory Board, said, ‘MACRA is not in trouble, but mechanisms by which they control spending could change.’ Kerns said there might be a shift away from ACOs as a principal driver of controlling spending, and more toward bundled payments or price controls, cuts or other forms of utilization control in the form of reduction in reimbursement for different kinds of services.”

== same article

“The American Academy of Family Physicians said [it doesn’t] believe MACRA as a whole is in any real danger of repeal. ‘The election of Mr. Trump will have a limited impact on the MACRA law in the short-term,’ said AAFP President John Meigs Jr. ‘Looking forward, this law was supported by 91% of Congress. Based on the bipartisan support, it is difficult to see how there would be any fundamental changes under the Trump Administration.’”

== same article

“’This is a movement that’s happening independent of the ACA, or parallel to it,’ said David Jones, an assistant professor of health law, policy and management at Boston University’s School of Public Health. ‘It’s very unclear when they say they’re going to repeal ObamaCare whether they’re even thinking about things like CMMI or to shift away from things like fee-for-service.’”

== ‘Will value-based payment initiatives continue under Trump?;’ http://www.modernhealthcare.com/article/20161111/MAGAZINE/161109907

On the other hand …

“House Budget Chair Rep. Tom Price (R-GA) has had CMMI in his sights for a while now, and Sen. Orrin Hatch (R-UT) is no big fan. Both claim the center lacks accountability and hasn’t shown clear results. They may try to eliminate mandatory CMMI payment models and could seek to legally trim its sails.”

== ‘CMS CMMI, ONC and AHRQ preparing to take hits;’ https://www.g2xchange.com/statics/cms-cmmi-onc-and-ahrq-preparing-to-take-hits


You can request a sample copy of Value-Based Payment News by going here: http://valuebasedpaymentnews.com/sample.html


The Somewhat Confident but Confused Open Enrollment Consumer

By Clive Riddle, November 4, 2016

This November, many consumers across the country are voting on more than a President, Congressmen and a hot mess of ballot propositions. They are also voting on their health insurance coverage for 2017. And many consumers may be more befuddled about choosing their health plan than their choices at the ballot box.

PolicyGenius has just released their Health Insurance Literacy Survey that “reveals 2017 open enrollment shoppers are overconfident in health insurance knowledge and under prepared to select a new plan.” Here’s an excpert from the infographic PolicyGenius provided on their findings:

Here’s additional PolicyGenius findings from the survey:

  • There was 22% gap between women’s self-rated confidence in their knowledge of insurance terms and their actual comprehension, compared with a 29% gap for men.
  • Millennials had a 29% gap between their confidence and comprehension.
  • 72% of those with non-employer-provided health insurance policies plan to shop on the open marketplace for coverage this year.
  • Most insured Americans are satisfied with their current plan, at 70% of total respondents
  • People who used their health insurance 2-3 times in the past year are 12% more likely to be satisfied with their plan than those who used it just once
  • Millennials are most likely to be satisfied with their health insurance plan, at 77%.
  • There is no variation in plan satisfaction between those who have individual insurance versus employer-provided insurance.
  • More than half of respondents aren’t very confident in their ability to choose the best health insurance plan for their needs.
  • Only one-third of women overall are “very confident” in their ability to choose the best health insurance plan for their needs.
  • The two groups that showed the highest confidence in their ability to choose the best plan were men at 58% and millennials at 43%.
  • The survey found higher confidence levels in men over women (12% difference) and younger vs older respondents (millennials were most confident at 43%, 10% more than ages 45-55) in their ability to choose the best plan.

Sticking with the confusion theme, Walgreens has just released results of a survey of 1,000 Medicare Part D beneficiaries in advance of the Medicare open enrollment. Here’s what they found:

  • 34% aren’t taking time to review their prescription drug plan prior to renewing it
  • 19% don’t have a good understanding of their plan
  • 22% look at just one component, checking, for example, to see if their own medications are covered, yet not looking at any other important considerations
  • 21% falsely believes that all pharmacies charge the same copay
  • 33% don’t know they can switch pharmacies outside of the enrollment period, at any time of year.
  • 30% said copay costs are the most important factor, followed by pharmacy location (18%) and the opportunity for one-stop shopping (18 percent).

HHS-CMS Share Marketplace Projections and Nine Open Enrollment Strategies

By Clive Riddle, October 21, 2016

Earlier this Week, HHS Secretary Sylvia M. Burwell “announced that she expects 13.8 million individuals to sign up for coverage through the Marketplaces during the upcoming Open Enrollment.” In conjunction with her announcement, the HHS Office of the Assistant Secretary for Planning and Evaluation released a report detailing these 2017 enrollment projections for 2017, telling us:

  • The projected enrollment of 13.8 million would represent an increase of 1.1 million from 12.7 million plan selections at the end of 2016’s Open Enrollment.
  • They estimate this will net down to monthly effectuated enrollment averaging 11.4 million people during 2017.
  • 10.7 million uninsured Americans are eligible for Marketplace coverage. Among them, 85% are potentially income eligible for financial assistance,  and 60% have incomes that would also qualify them for cost-sharing reductions in addition to tax credits
  • 40% of the eligible uninsured are 18-34 years old
  • 5.1 million eligible for the Marketplace currently purchase off-Marketplace coverage. Of this group, they estimates 2.5 million people could be eligible for financial assistance via Open Enrollment signups for Marketplace coverage

So how are they going to increase the open enrollment signups to 13.8 million? Last week, CMS shared their open enrollment marketing strategies, noting that “nearly half of uninsured adults are unaware of the financial assistance available to help pay for health insurance, even though about 85 percent of Marketplace-eligible uninsured Americans could qualify for financial help.” Their marketing plan includes:

  1. Increasing direct mail pieces from 800,000 last year to 10 million this year, targeted to “people who were recently uninsured, recently lost coverage, or sought coverage in the past through HealthCare.gov or a state Medicaid program,” including “people who started to sign up at HealthCare.gov last year, but didn’t complete the process”; “consumers who lost eligibility for Medicaid or CHIP coverage last year, or who applied for Medicaid or CHIP but had incomes too high to qualify.”
  2. The IRS “will conduct new outreach to uninsured people who paid the penalty or claimed an exemption, letting them know that tax credits are available for Marketplace coverage and providing information about their health coverage options.”
  3. E-Mail marketing will be expanded, as “HealthCare.gov’s email list has grown by over 30 percent” to 20 million+ people
  4. Healthcare.gov notes they “learned that simply reminding a consumer about their eligibility for financial assistance in an email increased enrollment rates by 17 percent compared to emails that did not include that information,” and that “emails informing returning consumers of increased costs in their current plan and encouraging them to review their options by shopping increased active renewal rates by 279 percent.”
  5. Healthcare.gov also learned merely mentioning a deadline in an email increased enrollment by 14 percent compared to emails that did not mention deadlines.
  6. HealthCare.gov will remind consumers about the a penalty for not having coverage, and cite a study in which “consumers who received an email with additional language referencing the penalty were 13 percent more likely to enroll,” and a test that “found that more prominently displaying penalty information with the deadline (for example, in the email subject line) produced a larger lift in enrollment, 97 percent,” and a “message that gave higher-income people information about the higher penalty levels likely to apply to them increased enrollment by 18 percent.”
  7. Outreach is being expanded to mobile and streaming platforms, and gaming platforms in order to reach younger audiences. Healthcare.gov cites a partnership with gaming platform Twitch, and notes that they will run ads and sponsor content on YouTube, Instagram and Facebook
  8. Healthcare.gov will emphasis optimized search efforts and cite that “CMS increased overall search conversion rates by 24 percent compared to the previous year.”
  9. Healthcare.gov  will “double the number of impressions a consumer sees (“Gross Rating Points”) on TV in the week leading up to December 15th compared to the same week last year.”

Opportunities With Consumer Angst About ACA Exchanges and Out of Pocket Costs

By Clive Riddle, October 7, 2016

GfK has just released updated survey results on consumer health insurance purchasing which found that “one-third of consumers who purchased on ACA exchanges do not expect that their present insurer (33%) – or any other carrier (34%) – will offer insurance through their exchange in 2017. And 32% do not think they will find options on the exchange that meet their needs.”

Additional findings they report include:

  • 13% of consumers purchasing through ACA exchanges plan to revert to becoming uninsured if their current coverage was not offered.
  • For ACA exchange consumers earning less than $25,000 a year, 34% plan on becoming uninsured if current coverage isn’t available
  • 43% of exchange users say they would seek new options through the exchanges – with levels highest among 50 to 64 year olds.
  • 35% of exchange users would go directly to an insurer or agent for solutions if their coverage lapses
  • 66% say they would choose the best option to meet their needs, regardless of the insurance company
  • Only 12% would make a point of staying with their current carrier
  • 20% say they would explore coverage through a different insurer

Liz Reyer, GfK Vice President and health insurance lead concludes that “as a ’brand,’ the ACA has taken some hits in 2016. While most observers expected insurance companies to reassess their offerings on the exchanges now and then, the outright defections we have seen have quickly limited consumers’ choices and eroded confidence that the ACA will find ways to meet their needs. We need to see a high-profile campaign making clear the options that consumers still have – so no one goes without insurance unnecessarily – and stronger collaboration between the insurance industry and the government in keeping the ACA viable.”

Health Plans remaining on the ACA exchanges certainly have a market opportunity to mop up the mess left by large national plans exiting the exchanges. Outside the ACA exchanges, plans active in individual markets, and applicable private exchanges have a major opportunity to gain ground with consumers not eligible for subsidies (which are only available through the ACA exchanges.)

Meanwhile, Navicure, in conjunction with Porter Research has just released provider survey results from a study on how healthcare organizations are responding to patient engagement and consumerism, with a focus on consumer concerns about price transparency, financial responsibility and payment options. The survey included hospitals (19%) and medical groups ranging in size (33% in practices with ten providers or less and 21% with 100 providers or more.)

Of the most common questions patients ask about their financial responsibility, provider respondents said “58 percent inquire about payment plans, and 56 percent ask about total treatment cost. Other top questions include asking what balance is due (53%) and what payment options are available (43%).”

67% of provider respondents say patients do not understand their payment responsibility versus their insurance provider’s responsibility, and 42% of providers find that attempting to estimate prices for services is a major problem.

The study found that most healthcare organizations aren’t using available tools to help with consumer confusion over out of pocket costs, with 33% of providers using patient bill estimation tools, 26% sending patients electronic statements, and 25% securely store debit or credit card information on file.

In this era of ever increasing consumer cost sharing, a major market opportunity exists for providers and health plans that can easily answer patient questions on what their out of pocket will be, and offer a range of options for how patients can pay for them.