Friday
Jun092017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Democrats home in on opioid crisis in bashing proposed Medicaid cuts

Health and Human Services Secretary Tom Price defended the White House’s proposed cuts to Medicaid in its 2018 budget blueprint before a pair of congressional committees on Thursday, parrying blows from Democrats furious over spending reductions they say President Trump pledged on the campaign trail never to approve. StatNews. June 8, 2017

 

If Insurance Market Crashes, Can Lawmakers Put The Pieces Back Together?

In his high-stakes strategy to overhaul the federal health law, President Donald Trump is threatening to upend the individual health insurance market with several key policies. But if the market actually breaks, could anyone put it back together again?

Kaiser Health News. June 8, 2017

 

Anthem Will Exit Health Insurance Exchange in Ohio

Anthem, one of the nation’s largest insurers and a major player in the individual insurance market created by the federal health care law, announced Tuesday that it would stop offering policies in the Ohio marketplace next year. NYTimes. June 6, 2017

 

Feds To Waive Penalties For Some Who Signed Up Late For Medicare

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the health law’s marketplaces. That decision can leave them facing a lifetime of enrollment penalties. Kaiser Health News. June 6, 2017

 

VA to adopt new electronic health records system in bid to improve care

Veterans Affairs Secretary David Shulkin said Monday the department will be overhauling its electronic health records, adopting a commercial product used by the Pentagon that he hopes will improve care for veterans and reduce wait times for medical appointments.

Stat News.  June 5, 2017

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Monday
Jun052017

In your member enrollment process leaving you exposed? 

By Claire Thayer, June 2, 2017

In September last year, the Government Accounting Office released a new study on findings from its undercover enrollment eligibility testing of federal and selected state marketplaces. As part of the study, GAO submitted 15 fake applications for subsidized coverage through the federal Marketplace in Virginia and West Virginia and through the state marketplace in California. GAO’s applications tested verifications related to (1) applicants’ making required income-tax filings, and (2) applicants’ identity or citizenship/immigration status. Through this extensive under cover testing process, GAO found that eligibility determination and enrollment processes continue to remain vulnerable to fraud.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, highlights some of findings presented in the GAO report: 


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.

Friday
Jun022017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

The Fate of 16.8 Million Medicaid Enrollees Rests On 20 GOP Senators From 14 States

The Senate is on the verge of debating legislation to repeal and “replace” the Affordable Care Act, and Medicaid is on the chopping block. Huffington Post, June 2, 2017

 

Trump Rule Could Deny Birth Control Coverage to Hundreds of Thousands of Women

The Trump administration has drafted a sweeping revision of the government’s contraception coverage mandate that could deny birth control benefits to hundreds of thousands of women who now receive them at no cost under the Affordable Care Act. The New York Times, June 1, 2017

 

Ohio Sues 5 Major Drug Companies For 'Fueling Opioid Epidemic'

The state of Ohio has sued five major drug manufacturers for their role in the opioid epidemic. In the lawsuit filed Wednesday, state Attorney General Mike DeWine alleges these five companies "helped unleash a health care crisis that has had far-reaching financial, social, and deadly consequences in the State of Ohio." NPR, May 31, 2017

 

How plan for California gov't health care might be funded

A pending state Senate bill would provide government-funded universal health care for California's 39 million residents. The bill faces a Friday deadline for passage out of the Senate if it is to be considered by the state Assembly. ABC News, May 31, 2017

 

Drug Rebates Reward Industry Players — And Often Hurt Patients

Medicare and its beneficiaries aren’t the winners in the behind-the-scenes rebate game played by drugmakers, health insurers and pharmacy benefit managers, according to a paper published Tuesday in JAMA Internal Medicine. Kaiser Health News, May 30, 2017

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 

Friday
Jun022017

Nine Things to Know About J.D. Powers 2017 Member Health Plan Study Results

By Clive Riddle, June 2, 2017

 

J.D. Powers has just released their 2017 Member Health Plan Study Results. J.D. Powers tells us this 11th annual study “measures satisfaction among members of 168 health plans in 22 regions throughout the United States by examining six key factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service. The study also touches on several other key aspects of the experience including plan enrollment and member engagement.” The study is based on responses from 33,624 commercial health plan members and was fielded in January-March 2017.

 

The study assigns scores to each plan based on the above criteria based upon a possible 1,000 point scale. Here are nine things to know about their findings:

 1.     J.D. Powers found that “Integrated delivery systems dominate rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—outperform traditional health plans on every factor measured in the study.”

 2.       Even though narrow networks have often been presented negatively in the media, the study found otherwise: “Regardless of product choice, members who were presented with lower-cost narrow network options were significantly more satisfied with their health plan versus those who were not offered such an option or did not know whether it was offered. However, just 33% of respondents say they were offered a narrow network option.”

 3.       J.D. Powers found that “the effect of payer-provider alliances is mixed: Aetna, Cigna, Anthem, and many other providers have begun to offer commercial products in collaboration with specific providers in the past few years.”

 4.       Satisfaction is highest among health plan members in the five regions: Maryland (723); East South Central (722); California (716); Michigan (716); and Ohio (714).

 5.       Satisfaction is lowest among members in the Colorado (676) and Northeast (682) regions.

 6.       The highest score achieved by any major plan was 794 (Kaiser in Maryland.)

 7.       Kaiser by far had the most regional top scores for major health plans with six: (California, Colorado, Maryland, Northwest, South Atlantic, Virginia)

 8.       The lowest score achieved by any major plan was a tie between Coventry (Aetna) in the Heartland region, and Blue Cross Blue Shield Montana in the Mountain region, both with 653. Given the regional average in the Mountain region (706) was higher than in the Heartland (693), the tiebreaker for Bottom performer would go to BCBS Montana.

 9.       UnitedHealthcare and subsidiaries by far had the most bottom regional bottom scores for major health plans with thirteen:  (Colorado, Delaware/WV/DC, East South Central, Florida, Maryland, Michigan, New Jersey, New York, Northwest, Ohio, Pennsylvania, Southwest, Virginia)

 

Here are the top and bottom performers of major health plans for each of J.D. Powers 22 defined regions with their respective scores, along with the average score for the region:

 

California

Top: Kaiser 780

Average: 716

Bottom: Aetna 683

 

Colorado

Top: Kaiser 725

Average: 676

Bottom: United 661

 

Delaware/WV/DC

Top: Highmark 712

Average: 691

Bottom: United 666

 

East South Central (AL, KY, LA, MS, TN)

Top: BCBS Tennessee 735

Average: 722

Bottom: United 684

 

Florida

Top: AvMed 733

Average: 702

Bottom: United 694

 

Heartland (AR, IA, KS, MO, NE, OK)

Top: Wellmark BCBS Iowa 723

Average: 693

Bottom: Coventry (Aetna) 653

 

Illinois-Indiana

Top: Health Alliance Medical Plans 723

Average: 708

Bottom: Coventry (Aetna) 666

 

Maryland

Top: Kaiser 794

Average: 723

Bottom: United 693

 

Massachusetts

Top: BCBSMass 707

Average: 703

Bottom: Cigna 664

 

Michigan

Top: Health Alliance Plan of Michigan 750

Average: 716

Bottom: United 672

 

Minnesota-Wisconsin

Top: Unity Health Plans 737

Average: 695

Bottom: Cigna 679

 

Mountain (ID, MT, UT, WY)

Top: SelectHealth 727

Average: 706

Bottom: BCBS Montana 653

 

New Jersey

Top: Horizon BCBS 712

Average: 705

Bottom: United 693

 

New York

Top: Capital District Physicians Health Plan 755

Average: 702

Bottom: Oxford (United) 658

 

Northeast (CT, ME, NH, RI, VT)

Top: BCBS Vermont 725

Average: 682

Bottom: Harvard Pilgrim 666

 

Northwest (OR, WA)

Top: Kaiser 751

Average: 697

Bottom: United 644

 

Ohio

Top: Medical Mutual of Ohio 720

Average: 714

Bottom: United 695

 

Pennsylvania

Top: UPMC 739

Average: 702

Bottom: United 672

 

South Atlantic (GA, NC, SC)

Top: Kaiser 791

Average: 707

Bottom: Aetna 696

 

Southwest (AZ, NV, NM)

Top: BCBS AZ 704

Average: 693

Bottom: Health Plan of NV (United) 661

 

Texas

Top: NA

Average: 710

Bottom: Aetna 686

 

Virginia

Top: Kaiser 769

Average: 702

Bottom: United 699

Friday
May262017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Top News From the Past Week as reported from key news services, and compiled by MCOL

 

Patient, Doctor Groups Say New CBO Score Reveals Health Care Bill's Flaws

Health care groups that represent doctors and patients are warning members of Congress that the House Republicans' plan to overhaul the Affordable Care Act would hurt people who need insurance most. NPR. Thursday, May 25, 2017

 

Senate to Start Drafting Health Care Bill Despite Policy Debates

Senate staffers will start to draft legislation that would repeal and replace significant parts of the Affordable Care Act next week, GOP senators said Thursday, despite the many differences among members of the caucus over policy. Morning Consult. Thursday, May 25, 2017

 

10 key points from the CBO report on Obamacare repeal

Here are some key facts and figures from the new CBO report on the American Health Care Act, the House-passed bill to repeal and replace Obamacare. CBO stressed the uncertainty of its estimates, given that it's hard to know which states would take up the chance to opt out of certain key parts of Obamacare. Politico Wednesday, May 24, 2017

 

Tab For Single-Payer Proposal In California Could Run $400 Billion

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. Kaiser Health News Tuesday, May 23, 2017.

 

Trump budget: $800 billion in Medicaid cuts

Donald Trump's budget that is expected to be unveiled on Tuesday will include $800 billion in cuts to Medicaid -- a move that underscores the President's resolve to significantly downsize the federal program even as Republican lawmakers are clashing over the issue in Congress. CNN Monday, May 22, 2017

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.