Category Archives: Health-care Policy

Administration warns employers: Don’t dump sick workers from plans

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Ban_signBy Jay Hancock
KHN

As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere.

Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued this month.

Brokers and consultants have been offering to save large employers money by shifting workers with expensive conditions such as hepatitis or hemophilia into insurance marketplace exchanges established by the health law, Kaiser Health News reported in May.

Image courtesy of Xm1702 under Creative Commons license. 

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Humana and Multicare launch accountable care program

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image003MultiCare Health System and Humana Inc. will launch a new accountable care partnership for Humana’s Medicare Advantage members in South King County and Pierce County, the companies announced this week.

Accountable care partnership will provide Humana membership with more coordinated care that will emphasize preventive services, the companies said.

Humana offers Medicare Advantage HMO plans, a prescription drug plan and Medicare supplement policies to Medicare recipients in the Tacoma area.

MultiCare is made up of five hospitals including Allenmore HospitalAuburn Medical CenterGood Samaritan HospitalMary Bridge Children’s Hospital and Tacoma General Hospital as well as outpatient specialty centers, primary and urgent care clinics.

The not-for-profit health care organization has more than 10,500 employees and a comprehensive network of services throughout Pierce, South King, Thurston and Kitsap counties.

Humana aims to work closely with doctors and hospitals through its Accountable Care Continuum, the companies said.

For a Primer on Accountable Care Organizations go here.

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Shop around before automatically renewing your health plan

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Marketplaces Will Automatically Renew Consumers’ Plans But Take A Look First

Shopping CartBy Michelle Andrews
KHN

So far, the open enrollment period on the federal and state marketplaces—which started Nov. 15 and continues until Feb. 15 for 2015 coverage—is proceeding much more smoothly than last year. But people remain confused about plans, premiums and provider networks. Here are answers to several readers’ questions.

Q. I understand the federal marketplace will renew my coverage automatically this year. That seems really simple. Is there any reason I shouldn’t do it?  Continue reading

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Is there really a looming doctor shortage?

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Question markSome Experts Dispute Claims Of Looming Doctor Shortage

By Julie Rovner
KHN

You hear it so often it’s almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years.

But is that really the case?

Many medical groups, led by the Association of American Medical Colleges, say there’s little doubt. “We think the shortage is going to be close to 130,000 in the next 10 to 12 years,” says Atul Grover, the group’s chief public policy officer.

While few dispute the idea that there will be a growing need for primary care in the coming years, it is not at all clear whether all those primary care services have to be provided by doctors.

But others, particularly health care economists, are less convinced. “Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,” wrote an expert panel of the Institute of Medicine (IOM) in a report on the financing of graduate medical education in July. “The committee did not find credible evidence to support such claims.” Continue reading

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Minimum wage a health issue? States take a broader view of health disparities.

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Minnesota_population_map_croppedBy Michael Ollove
Stateline

MINNEAPOLIS, Minn.— For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation?

The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short.

This year, proponents seized on a new strategy: They convinced the legislature to ask the Minnesota Department of Health to analyze the health impact of the state’s minimum wage of $6.15 an hour, which is among the lowest in the country.

The department’s subsequent analysis revealed that health and income levels were inextricably linked. Whether it was rates of adequate prenatal care, infant mortality, diabetes, suicide risk, or lack of insurance, the results for poorer Minnesotans were vastly inferior to residents with higher incomes.

In fact, Minnesotans living in the highest income areas of the Twin Cities region lived eight years longer than those living in the poorest.

The report virtually ended the debate. The legislature voted to phase in an increase in the minimum wage to $9.50—one of the highest in the country—with automatic subsequent increases indexed to the rate of inflation. Continue reading

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Wall Street is ‘bullish’ on 2015 Obamacare enrollment

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bullish-enrollment-obamacare-570By Julie Appleby
KHN

A group of Wall Street analysts predicted Friday that enrollment in health law insurance plans will be higher than the 9 million projected by the Obama administration because insurers are aggressively courting new customers and more small businesses are likely to send workers to the online exchanges in 2015.

Health sector analyst Carl McDonald of Citi Investment Research said he expects about 11 million people to enroll in individual health plans, based on his firm’s survey of clients in October.

“I’m more optimistic,” McDonald said at the 19th annual “Wall Street Comes to Washington” roundtable, sponsored by the Jayne Koskinas Ted Giovanis Foundation for Health and Policy.

More aggressive outreach by insurers and fewer glitches with the online marketplaces will create a “robust 2015,” agreed Ralph Giacobbe, an analyst at Credit Suisse. Continue reading

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Seniors’ obesity-counseling benefit goes largely unused

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ScaleBy Phil Galewitz
KHN

Three years ago, the Obama administration offered hope to millions of overweight seniors when it announced Medicare would offer free weight-loss counseling.

Officials estimated that about 30 percent of seniors are obese and therefore eligible for counseling services, which studies have shown improve the odds of significant weight loss.

But less than 1 percent of Medicare’s 50 million beneficiaries have used the benefit so far. Experts blame the government’s failure to promote the program, rules that limit where and when patients can go for counseling as well as the low fees for providers.

Since November 2011, about 120,000 seniors have participated, including about 50,000 last year, according to federal data.

“It’s very disappointing,” said Dr. Scott Kahan, an obesity medicine specialist at George Washington University.

“It’s a huge lost opportunity,” said Bonnie Modugno, a registered dietician in Santa Monica, Calif., who advises doctors how to provide weight loss counseling.

By  comparison, about 250,000 seniors last year used Medicare’s tobacco cessation counseling benefit, which started in 2005 and offers greater flexibility about how providers can offer it. Nationally, 9 percent of seniors smoke, while 30 percent are obese. Continue reading

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Boeing’s new accountable care health plans with UW Medicine and Providence-Swedish take off – Puget Sound Business Journal

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boeing-logoThe accountable care plans aim to lower costs for both employees and the company by incentivizing employee wellness and creating a more coordinated system to provide health care. By creating contracts directly between the employer and the health systems, the goal of these new systems is to reduce costs and confusion that often come from dealing with third parties while also improving care.

via Boeing’s new health plans with UW Medicine and Providence-Swedish take off – Puget Sound Business Journal.

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New Medicaid rule could hinder shift away from nursing homes

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A younger man holds an elderly man's handBy Christine Vestal
Stateline

For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes.

In fact, the number of people living in skilled nursing facilities has declined significantly over the last decade, despite a marked increase in the ranks of the elderly in the U.S.

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care.

While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes.

Under the rule, for example, elderly people with dementia who enter assisted living facilities should not be subjected to constraints, such as locked exits, unless they are at risk for wandering.

But if they share living space with other residents with dementia who do need to be prevented from wandering, it will be difficult to allow them to leave the building whenever they want without jeopardizing the safety of others.

“The goal was completely laudable,” said Martha Roherty, director of the National Association of States United for Aging and Disabilities, which works to help elders and people with disabilities live in their communities for as long as possible.

“Unfortunately, what’s happened is that it is limiting individuals’ choice of what and where to receive (long-term care) services rather than broadening it, especially as it relates to seniors,” she said. Continue reading

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Big changes for 2015 workplace plans: Watch out for these six possible pitfalls

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sixBy Jay Hancock
KHN

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans — where most working-age folks get coverage — are changing too.

Rising costs, a looming tax on rich benefit packages and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” said Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”  Continue reading

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Small business plans now available on the SHOP marketplace

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Small business owners: SHOP coverage is now available online at HealthCare.gov.

Start your SHOP application 

Need help? You can contact a SHOP-registered agent or broker in your area or call 1-800-706-7893 (TTY: 711), Monday – Friday 9am – 7pm ET.

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More states adopting law allowing terminal patients to try experimental treatments

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One dye showing 2By Michelle Andrews
KHN

Earlier this month, Arizona voters approved a referendum that allows terminally ill patients to receive experimental drugs and devices. It’s the fifth state to approve a “right-to-try” law this year.

Supporters say the laws give dying patients faster access to potentially life-saving therapies than the Food and Drug Administration’s existing “expanded-access” program, often referred to as “compassionate use.”

Supporters say the laws give dying patients faster access to potentially life-saving therapies. Critics charge such ‘right-to-try” acts are  feel-good laws that don’t address some of the real reasons patients may not receive experimental treatments.

But critics charge they’re feel-good laws that don’t address some of the real reasons patients may not receive experimental treatments.

The legislatures in Colorado, Louisiana, Michigan and Missouri also passed right-to-try laws this year as part of a nationwide effort spearheaded by the conservative Goldwater Institute, which hopes to get right-to-try laws on the books in all 50 states.

The measures generally permit a patient to get access to an experimental drug after it’s passed through phase 1 of a clinical trial, the initial testing in which a drug is given to a small group of people to evaluate its safety and side effects. Continue reading

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