Entries in Thayer, Claire (96)

Wednesday
Oct152014

Population Health Management Costs & Risks

By Claire Thayer, October 15, 2014

Chronic disease is defined as a long-lasting condition that can be controlled but not cured.  In the United States alone, 75% of our healthcare spending is now directed towards the treatment of chronic disease.  Studies find that almost 50% of this population copes with at least one chronic condition.  MCOL’s infoGraphoid this week highlighted these trends, along with a recent study published in the journal Health Affairs  on the cost impact of disease management and components of Pepsico’s wellness program focused on reducing employee costs and hospital readmissions:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Thursday
Oct022014

Kaiser Family Foundation’s 2014 Employer Health Benefits Survey 

By Claire Thayer, October 2, 2014

Findings from the latest Kaiser Family Foundation’s annual survey of employer-sponsored health benefits are now available in the 2014 Employer Health Benefits Survey. This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and employer opinions.  Here are a few of the key findings pertaining to trends in premium rates and worker contributions:

  • Average annual family premium: $16,834, a 69% increase since 2004 and doubled since 2002
  • Workers contribution to premiums: $4,823
  • Workers average deductible: $1,217, up 47% since 2009

The complete report, all 275 pages, includes comprehensive analysis, findings and lots and lots of charts! 

 

Wednesday
Sep242014

Problems with Accuracy in Health Plan Member Data

By Claire Thayer, September 24,2014

LexisNexis illustrates the types of problems encountered with accuracy in health plan member data in MCOL’s infoGraphoid this week:

Wondering if your member data is current and complete? LexisNexis offers a no-cost evaluation. MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and eleased each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Tuesday
Aug122014

The $10 Billion Search for Healthcare Innovation

By Claire Thayer, August 12, 2014

The hunt is on for the discovery of innovative ideas to change the delivery of health care at all levels.   Kaiser Health News published a great summary of this massive quest in this article: Washington's $10 Billion Search For Health Care's Next Big Ideas.  Funded by the new health care law, experiments are taking place in every state in the country with oversight provided by the newly created Center for Medicare and Medicaid Innovation.  Kaiser Health News tells us that the center’s ten-year, $10 billion budget is the largest ever devoted to transforming care. In several states the office is working to overhaul medicine for nearly all residents — not just those with government Medicare and Medicaid coverage.

In addition to seeking out new payment and service delivery models, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS and categorizes these Innovation Models into seven areas:

  • Accountable Care
  • Bundled Payments for Care Improvement
  • Primary Care Transformation
  • Initiatives Focused on the Medicaid and CHIP Population
  • Initiatives Focused on the Medicare-Medicaid Enrollees
  • Initiatives to Speed the Adoption of Best Practices
  • Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

So far, the American Hospital Association has received $75.8 million towards it’s innovation initiatives, Johns Hopkins Univeristy has received $32 million, followed by several others receiving close to $25 million. Here’s a look at the Top 10 Recipients of the new Innovation Dollars:

week, HealthSprocket, the home for healthcare lists of all kinds, featured a couple of its recent lists on health care innovation:

If you’re looking for an easy way to stay current on healthcare innovation trends and initiatives, Health Policy Publishing has a new monthly newsletter, Healthcare Innovation News, dedicated solely to this topic, with feature articles contributed by leading national experts and executives in the field; Thought Leader insights; Industry Briefs; profile of a key individual involved with healthcare innovation initiatives; plus more.

Readers can get a free sample issue of the 12-page monthly Healthcare Innovation News publication here. And, if you’re simply wanting to stay in the loop on news and other general announcements pertaining to healthcare innovation, the bimonthly Healthcare Innovation Bulletin, also available from Health Policy Publishing, is accessible for free here, at any time.

Wednesday
Jul092014

One in 5 million Americans now covered by Medicaid

By Claire Thayer, July 7, 2014

The Affordable Care Act (ACA) has had a huge impact on Medicaid enrollment and spending since the expansion of Medicaid eligibility to include almost all adults with incomes at or below 138% of the federal poverty level effective January 1, 2014. The Kaiser Family Foundation recently released, Medicaid Moving Forward, a concise fact sheet summarizing current enrollment, spending and other trends for the Medicaid program.  Lots of data is packed into this fact sheet, here are a few of the important highlights:

Who Does Medicaid Cover?

  • Over 66 million Americans now receive their health coverage through the Medicaid

  • Medicaid and Children’s Health Insurance Program (CHIP) cover more than 1 in every 3 children

  • In June 2013, over 28 million children were enrolled in Medicaid and 5.7 million were enrolled in CHIP

  • The ACA expanded Medicaid to nearly all adults under age 65 with income at or below 138% FPL, effective January 1, 2014.

  • As of June 2014, 27 states, including DC, were expanding Medicaid, three states were actively debating the issue, and 21 states were not moving forward

What does Medicaid Cover?

  • inpatient and outpatient hospital services;

  • physician, midwife, and nurse practitioner services;

  • early and periodic screening, diagnosis, and treatment (EPSDT) for children up to age 21;

  • laboratory and x-ray services;

  • family planning services and supplies;

  • federally qualified health center (FQHC) and rural health clinic (RHC) services;

  • freestanding birth center services (added by ACA);

  • nursing facility (NF) services for individuals age 21+;

  • home health services for individuals entitled to NF care;

  • tobacco cessation counseling and pharmacotherapy for pregnant women (added by ACA);

  • non-emergency transportation to medical care

How do Medicaid Beneficiaries Get Care?

  • Most Medicaid beneficiaries obtain care from private office-based physicians & other health professionals.

  • Safety-net health centers and hospitals also play a major role in serving the Medicaid population.

  • Over half of Medicaid beneficiaries nationally, mostly, children and parents, are enrolled in comprehensive managed care organizations (MCO) that contract with states on a capitation, or risk, basis to deliver Medicaid services

  • A smaller but still significant number of beneficiaries are enrolled in Primary Care Case Management (PCCM) programs

How much does Medicaid cost and how is it financed?

  • In FY 2012, Medicaid spending on services totaled about $415 billion

  • Administrative costs accounted for 5% of overall program spending.

  • Two-thirds of all spending on services was attributable to acute care

  • 30% of all spending on services was associated with long-term care.

  • Supplemental payments to hospitals that serve a disproportionate share of Medicaid and uninsured patients, known as “DSH,” accounted for about 4% of spending

  • Medicaid payments for Medicare premiums and cost-sharing on behalf of dual eligible beneficiaries totaled 3.5%.

Source: Medicaid Moving Forward, The Henry J. Kaiser Family Foundation, June 17, 2014.

Additional Issue Briefs that might be of interest:

Katherine Young and Lisa Clemans-Cope and Emily Lawton and John Holahan, Medicaid Spending Growth in the Great Recession and Its Aftermath, FY 2007-2012, The Henry J. Kaiser Family Foundation, Issue Brief, July 3, 2014.

Samantha Artiga and Robin Rudowitz, Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers, The Henry J. Kaiser Family Foundation, Issue Brief, January 29, 2014.