“In an effort to slow health care spending, more employers are looking at capping what they pay for certain procedures — like joint replacements — and requiring insured workers who choose hospitals or medical facilities that exceed the cap to pay the difference themselves.
But a study out Thursday finds employers might be disappointed with the overall savings. While the idea, known as “reference pricing,” does highlight the huge variation in what hospitals and other medical providers charge for the same services, the report says, it does little to lower overall health care spending.
“It’s zeroing in on a piece of the health spending puzzle that is critical, the unreasonably high negotiated prices paid by health plans … but it’s not going to get you there if you need to save a lot of money,” said co-author Chapin White.”
“With the second Obamacare open-enrollment beginning on November 15th, the enrollment system’s testing begins with insurance companies this week.
Of course, last year the enrollment system testing was a real mess resulting in a humiliating Obamacare launch for the administration.
Up until now I wasn’t expecting any major problems with HealthCare.gov’s consumer enrollment system given all of the lessons learned and the new people running things.
But apparently, the administration is pretty worried about what could happen.”
“CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act’s health insurance provider fee, and says that the fee itself should be incorporated into plans’ capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status. Medicaid Health Plans of America President Jeff Myers said CMS’ recently released frequently asked questions document provides certainty for plans, particularly in states that hadn’t yet agreed to cover those fees.
Myers said the plans are gratified CMS decided to move forward with the FAQ, and the release of the FAQ and the 2015 Managed Care Rate Setting Consultation guide suggest that CMS would like to play a more involved role in rate setting for managed care. Since plans have been asking for more transparency around rate setting, CMS’ involvement could be a net positive, Myers said. The Government Accountability Office has also said that CMS’ oversight of the rate-setting process needs improvement.”
“Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology’s annual report on electronic health-record adoption, released Thursday.
While standards and services have been established to support information-sharing, “practice patterns have not changed to the point that healthcare providers share health information electronically across organization, vendor and geographic boundaries,” the report argued.
Information-sharing is seen as a key component in the move from a fee-for-service approach in U.S. healthcare to a quality of care approach, so signs that the sharing isn’t happening could spell trouble for progress toward that shift.”
“Faced with the rising costs of generic prescription drugs, health insurers increasingly are turning to tiers and preferred lists on their formularies to keep costs down. Those strategies previously were used only for brand-name and specialty drugs. Experts say those approaches will increase out-of-pocket costs for patients and could make them less likely to adhere to drug regimens.
For years, insurers have encouraged patients to choose generic drugs because they were less expensive than their brand-name counterparts, and most prescription drugs currently used are generics.
But over the past year the cost of generic drugs has skyrocketed, including for products that have been on the market for many years. A study by Pembroke Consulting comparing CMS data for average generic drug acquisition costs between July 2013 and July 2014 found that half of the generic drugs listed rose in cost, with the median increase nearly 12%. Some drug prices saw extreme increases. For instance, the per-unit price for a 500 mg capsule of tetracycline, a common antibiotic, increased from $0.05 cents to $8.59, a more than 17,000 % increase.”
“Health Reform: Wal-Mart says it’s cutting health benefits to part-timers and boosting worker premiums. If a retail empire built on low prices can’t find a way around ObamaCare’s added costs, we are all doomed.
The world’s biggest retailer announced this week that its health costs will be about 48% higher for the current fiscal year than it had expected in February. As a result, it’s cutting 30,000 part-timers from its health benefit plan, raising worker-paid premiums by 19% and trimming its co-payment for health costs above the deductible.
“We had to make some tough decisions,” benefits director Sally Wellborn told the Associated Press. But to hear President Obama tell it, Wal-Mart just didn’t shop around.
That, at least, was what he said when the general manager of the Indiana-based Millennium Steel asked Obama last week about the company’s double-digit premium hikes.
Obama’s response: “The question is whether you guys are shopping effectively enough.””
“If the Congressional Budget Office is close to the mark, in the second open-enrollment season we will see about a doubling of the 7 million people enrolled in the Affordable Care Act insurance marketplaces. Open enrollment, which begins Nov. 15, is three months this year, or half as long as last year, and the remaining eligible uninsured are a more difficult-to-reach population. Here are the biggest challenges this time around:
First, the overwhelming reason the remaining uninsured cite as to why they have not already gotten coverage is that they believe they could not afford it. The message that most needs to reach the uninsured is that there are tax credits available to help make coverage more affordable. For a 30-year-old making $25,000 per year, the ACA tax credit would reduce the average cost of the most commonly selected “silver plan” from $2,877 per year to $1,729. Eighty-five percent of those who got coverage in the new insurance exchanges qualified for credits this year, but in our Kaiser Family Foundation survey of the uninsured in California, 73% of those eligible for assistance did not know they could get help.”
“Consumers keep price top of mind when they purchase prescription drugs and they’re unafraid to buy against the big labels, a new Morning Consult poll found.
Nearly three quarters of respondents said if given the choice between a brand name drug and a generic version, they’d be more willing to choose the generic version. What’s more, 65 percent of respondents disagreed that brand name drugs were more effective than generic drugs.”
“There are obvious benefits to getting health insurance at work. For one, employer-sponsored insurance is not taxed, meaning that every dollar of compensation provided as medical coverage stretches further. Individual market plans, meanwhile, are purchased with post-tax dollars. The only way to get in on the tax exemption is to buy coverage at work.
But for low-wage workers, Obamacare has introduced a new and big drawback to the employer insurance. Namely, anybody who gets access to affordable coverage at work is barred from getting subsidies through the new exchanges. This is even true for people who don’t buy insurance at work; just the act of getting offered employer coverage blocks individuals from using getting financial help.”
“Some health insurers are having trouble finding doctors and hospitals to accept low rates under Gov. Tom Corbett’s Medicaid expansion plan, leading one company to quit the program and another to reduce participation.
Highmark Inc., the state’s largest health insurer, said it won’t participate in Corbett’s Healthy PA program because it couldn’t sign enough doctors to its network. Healthy PA is an alternative to Medicaid expansion under the Affordable Care Act, proposed by Corbett and approved by the federal government in August, in which private insurers provide coverage to Medicaid recipients.”