Category Archives: Healthcare Reform

UnitedHealth tries boutique-style health plan

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Harken Health members get free yoga at the clinic. (Phil Galewitz/KHN

By Phil Galewitz
Kaiser Health News

AUSTELL, Ga. — UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes. Services are delivered in stylish clinics with hardwood floors and faux fireplaces in their lobbies.

Harken Health is available only in Chicago and Atlanta, where it covers 35,000 members who signed up this winter on the Affordable Care Act’s insurance exchanges. UnitedHealth still sells traditional plans in those cities, too.

The plan spends twice as much on primary care as the average insurer,

Harken’s lush operation might seem puzzling for a cost-conscious company such as UnitedHealthcare, which said in November it lost hundreds of millions of dollars on its Obamacare plans in 2015 and threatened to drop out of the exchanges in 2017.

But it’s not crazy. Health care analysts say Harken demonstrates the insurer’s search for a better way to provide affordable care and attract more customers. Its mission is to prove that convenient, no-cost primary care, delivered with top-notch customer service, can lower hospitalization rates and overall health costs. Harken spends twice as much on primary care as the average insurer, according to the company.

“At the end of the day, United wants to know if this system can better control costs, as it’s a lot cheaper to prevent disease than treat one,” said Liz Frayer, an employee benefits consultant in Atlanta. Continue reading

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Workers’ Desire Grows For Wage Increases Over Health Benefits

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By Michelle Andrews
Kaiser Health News

Twenty-dollar bill in medicine bottleMore wages, less health insurance.

In a recent survey, one in five people with employer-based coverage said they would opt for fewer health benefits if they could get a bump in their wages.

That’s double the percentage who said they would make that choice in 2012.

“I do these surveys all the time, and it’s rare where you see things change that quickly,” said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, which conducted the survey of 1,500 workers with Greenwald & Associates.

Fronstin speculated that worker frustration with low wage growth may be driving the shift in attitudes.

Wage and salary increases have hovered around 2 to 3 percent in recent years, generally rising more slowly than cost increases of annual health care benefits.

Overall, two-thirds of people with employer-sponsored coverage reported that they were satisfied with their health insurance benefits in 2015, the survey found, lower than the 74 percent satisfaction figure in 2012.

Meanwhile, the percentage of people who would accept a smaller paycheck for better health insurance benefits was 14 percent last year, essentially unchanged from 15 percent three years earlier.

The growing willingness to trade health benefits for wages may be linked to some degree to the millennial generation’s growing share of the workforce, Fronstin said, referring to people born between roughly 1980 and 2000.

“The younger you are, the less important health insurance is to you,” Fronstin said.

As baby boomers retire and younger workers move in behind them, it may affect the mix of benefits that employers offer.

But as today’s “young invincibles” age, chances are they’ll see more value in their health insurance and the pendulum will swing back again, according to Fronstin.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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President’s task force aims to help end discrimination in mental health coverage

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headacheBy Jenny Gold
Kaiser Health News

Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President  Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”

Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them. Continue reading

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Medicare proposes expansion of counseling program for people at risk of diabetes

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GlucometerBy Mary Agnes Carey
Kaiser Health News

As the health law turned six Wednesday, federal officials proposed the expansion of a Medicare diabetes prevention program funded by the landmark measure.

The pilot program, developed and administered by the YMCA, helped Medicare enrollees at high risk of developing the disease improve their diets, increase their exercise and lose about 5 percent of their body weight.

Beneficiaries in the program, funded by an $11.8 million grant provided by the health law, attended weekly meetings with a lifestyle coach to develop long-term changes to their diet, discussed ways to get more physical activity and made behavior changes that would help control their weight and decrease their risk of Type 2 diabetes. Participants could also attend monthly follow-up meetings to help keep their new habits in place.

Compared to other beneficiaries also at risk of developing diabetes, Medicare estimated savings of $2,650 for each program enrollee over a 15-month period, more than enough to cover the cost of the program, according to the Department of Health and Human Services. Continue reading

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How to use your new Marketplace health coverage

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From Healthcare.gov

Congratulations on enrolling in 2016 health coverage! Now that you’re covered, here are a few tips to help you stay healthy and get the care you need.

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3 ways to use your health insurance to stay healthy

  • Find a doctor and get medical care: If you don’t have a doctor, check your plan to find one in your network. If you get medical services from a provider in your plan’s network, you’ll pay lower prices than you would without insurance. That can save you hundreds of dollars per year, even if you don’t meet your deductible.
  • Learn about your prescription benefits: Health plans help pay the cost of certain prescription medications. Some plans offer reduced prices on generic drugs even before you’ve met your deductible.
  • Stay healthy with preventive benefits: All health plans sold through the Marketplace cover a set of preventive services at no cost to you when delivered by a network provider. These include some screenings, check-ups, patient counseling, and wellness services.

If you’ve never had health insurance or if it’s been a while, you can get more information about using your coverage and improving your health using our Roadmap to Better Care and a Healthier You (PDF).

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California insurance marketplace wants to kick out poor-performing hospitals

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H for hospitalBy Chad Terhune
Kaiser Health News / NPR

California’s insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a novel proposal that is drawing heavy fire from medical providers and insurers.

Providers who don’t measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.

The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.

“The first few years were about getting people in the door for coverage,” said Lee, a key figure in the rollout of the federal health law. “We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don’t want to throw anyone out, but we don’t want to pay for bad quality care either.”

It appears to be the first proposal of its kind in the country. The exchange’s five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital “outliers” on cost and quality starting in 2018. Medical groups and doctors would be rated after that.

Providers who don’t measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.

By 2019, health plans would be expected to expel poor performers from their exchange networks.

The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.

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Coinsurance trend means seniors likely to face higher out-of-pocket drugs costs, report says

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By Michelle Andrews
Kaiser Health News

Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee, a new analysis found.

Fifty-eight percent of covered drugs in Part D drug plans are subject to “coinsurance” in 2016 rather than flat copayments, the analysis by Avalere Health found. The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs.

For beneficiaries, drug plans’ increasing use of coinsurance may mean higher out-of-pocket costs, among other things. If a drug costs $200, instead of making a flat $20 copayment, they may owe 20 percent of the cost, or $40. Continue reading

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Long-term care insurance: Less ban, more buck

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Mary Julia Klimenko, 69, in her office in Benicia, Calif., on Friday January 29, 2016. The therapist invested in a long-term care insurance policy, but her monthly premiums have nearly quadrupled over the past two years. Klimenko is furious with the choices she’s been given: pay the higher cost, reduce her costs by cutting her policy’s benefits, or drop the insurance altogether. (Heidi de Marco/KHN)

Mary Julia Klimenko, 69, in her office in Benicia, Calif., on Friday January 29, 2016. The therapist invested in a long-term care insurance policy, but her monthly premiums have nearly quadrupled over the past two years. Klimenko is furious with the choices she’s been given: pay the higher cost, reduce her costs by cutting her policy’s benefits, or drop the insurance altogether. (Heidi de Marco/KHN)

By Barbara Feder Ostrov
Kaiser Health news

Mary Julia Klimenko thought she was prudent 20 years ago when she invested in a long-term care insurance policy, one she believed would help pay for the care she’d need as she aged.

Now she wishes she’d banked the money instead.

Her monthly premiums have nearly quadrupled over the past two years, and Klimenko, now 69, is furious about the choices she’s been given: pay the higher cost, lower her premiums by cutting her policy’s benefits or drop the insurance altogether.

I have no choice. If I drop my insurance, I’ve thrown away all that money. If I pay less, they’re not going to cover what I need.

For now, the Vallejo, California therapist said she will pay the higher premiums, but she’s not sure how many more price hikes she can take.

“I have no choice. If I drop my insurance, I’ve thrown away all that money,” Klimenko said. “If I pay less, they’re not going to cover what I need.”

Long-term care insurance was supposed to help the middle class ease the financial burden of expensive in-home or nursing home care that now can top $90,000 a year.

Consumers were urged to buy policies in their 50s, because premiums rose the longer they waited. About 4.8 million people were covered by long-term care policies in 2014.

But insurers botched just about every aspect of the policies they sold in the early days of the industry, said Joseph Belth, a retired professor of insurance at Indiana University known as one of the insurance industry’s toughest critics.

They underestimated how long people would live and how long they’d need nursing home care — but overestimated how many people would drop their policies and how much interest insurers could earn on the premiums they banked.

Hemorrhaging money, many insurers left the business. Those that remain are in financial trouble on their long-term care policies. They’re charging far more for new policies, and sharply raising the premiums of old ones.

“The industry is a state of severe decline,” Belth said. “Companies … don’t see a way to successfully market the product and make money on it.” Continue reading

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Back from the brink, a rural Texas hospital shines

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By Sarah Varney
Kaiser Health News/PBS NewsHour

FREDERICKSBURG, Texas — Brad and Sheryl Kott didn’t think much of it seven years ago when their 13-year-old son, Quinn, complained his arm felt tingly. But later that day, Mr. Kott found Quinn — a friendly, energetic athlete — on the bathroom floor. His speech was garbled.

Read Related Story: Hospital Closures Rattle Small Towns

“We loaded him in the back of our pickup in the second seat, and we start heading to town to the emergency room right away,” Brad Kott recalled. “And on my way, my wife said, ‘I think he’s had a stroke.’”

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After the family arrived at Hill Country Memorial, the local hospital in Fredericksburg, the Kotts say Quinn’s medical care went terribly wrong. Quinn waited in a wheelchair in the emergency room for hours despite his drooping face and slurred speech, and his parents and former hospital administrators say, the ER doctor was inattentive, callous and at a point late in the evening, decided to send Quinn home.

As Brad Kott brought his son out to his truck in the parking lot, his wife refused to take their son home. She rushed back into the ER and demanded to see the doctor.

“I met the doctor coming down the hall, and I said, ‘Something is wrong with Quinn.’ And he shushed me,” Sheryl Kott recalled. “And I said, ‘No, don’t you tell me to shush. You’re the doctor. I’m the mom. There’s something wrong with my son and I need to know what’s wrong with my son, and we are not taking him home.’”

It wasn’t until the next morning that a pediatrician finally examined Quinn. He was rushed to a hospital in San Antonio, about 70 miles south, and died soon after. He had suffered a massive stroke.

For Dr. Michael Williams, then Hill Country Memorial’s chief executive officer, Quinn Kott’s death in 2009 was a crucible moment. Continue reading

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Hospital closures rattle small towns

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By Sarah Varney
Kaiser Health News/PBS Newshour

RICHLAND, Georgia — For years, Sybil Ammons was the director of nursing at Stewart County’s only hospital. Now, she’s the county coroner.

Across the country, more than 50 rural hospitals have closed over the last six years, and another 283 are in fragile financial condition.

Since the hospital here closed three years ago, Ammons says more than a dozen local residents were unable to get medical care quickly enough and were either harmed or died because of the delays. “We’ve had a stroke, several heart attacks,” she said, standing along Richland’s main street in this small town about 150 miles south of Atlanta. “We’ve had traumas out on the four-lane.”

Across the country, more than 50 rural hospitals have closed over the last six years, and another 283 are in fragile financial condition, according to the National Rural Health Association. With rural populations long in decline in the United States, small-town hospitals have lost customers and struggled to keep pace with the striking advancements in medical technology.

But the pace of closures has escalated in recent years, hastened by a series of budget control measures passed by Congress that reduced Medicare payments and by the Affordable Care Act, which is slowly restructuring the health care industry. The law rewards scale and connectivity — difficult goals for rural hospitals that are, by their geographic nature, low-volume and remote. Continue reading

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Are routine eye exams needed for seniors?

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Prevention Experts, Eye Doctors Disagree On Vision Tests For Seniors

Michelle Andrews
Kaiser Health News

eye diagramSome doctors and a key group of preventive care experts are not seeing eye to eye on seniors’ need for vision screening during primary care visits.

There’s not enough evidence to know whether giving seniors a vision test when they visit their primary care doctor will lead to earlier detection and treatment of cataracts, age-related macular degeneration or refractive problems that could require corrective glasses and contacts, according to guidelines published by the U.S. Preventive Services Task Force this month in the Journal of the American Medical Association.

The task force, an independent group of medical experts, evaluates the scientific evidence related to preventive services for patients that don’t have symptoms or signs of medical problems.

Under the health law, services that the task force assigns an “A” or “B” grade must generally be covered by health plans, including Medicare, without charging consumers anything out of pocket. In this instance — screening for impaired visual acuity in people age 65 and older — the task force assigned an “I” grade, saying the evidence was insufficient to assess the balance of benefits and harms of screening, the same grade it assigned screening in 2009 when it last reviewed the evidence.

An organization of eye doctors and surgeons criticized the task force recommendation. In an editorial published in JAMA Ophthalmology, Dr. David Parke II, chief executive officer of the American Academy of Ophthalmology, argued that the task force didn’t give enough weight to supporting evidence about the health and quality of life benefits of identifying and addressing visual problems early. Continue reading

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Have a quick question? Try the Insurance Commissioner’s new live chat.

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Question markFrom the Office of the Insurance Commissioner

This week is National Consumer Protection Week and the OIC is one of the many government agencies that helps protect consumers from financial harm.

A huge part of the work we do is helping and educating consumers about all things insurance, from answering questions to looking into complaints against insurance companies, providing help with filing appeals for claim and coverage denials and everything in between.

We recently launched a live chat feature to help consumers get answers to their quick questions about insurance and their rights. Consumers can chat with one of our consumer advocates Monday through Friday from 10 a.m. to noon and from 2 p.m. to 4 p.m. If your question needs more attention, we will direct you to the right place to get the help you need.

Consumers can reach us:

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Retail clinics add convenience but also hike costs, study

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minuteclinicBy Chad Terhune
KaiserHeatlhNews

Retail clinics, long seen as an antidote to more expensive doctor offices and emergency rooms, may actually boost medical spending by leading consumers to get more care, a new study shows.

Rather than substituting for a physician office visit or trip to the hospital, 58 percent of retail clinic visits for minor conditions represented a new use of medical services, according to the study published Monday in the journal Health Affairs.

There are more than 2,000 in-store clinics nationwide, and they handle about 6 million patient visits annually.

Those additional visits led to a modest increase in overall health care spending of $14 per person per year.

“This challenges the conventional wisdom that retail clinics save the health care system money,” said Dr. Ateev Mehrotra, a co-author of the study and an associate professor of health care policy at Harvard Medical School. “The increase in spending from new utilization trumps the savings we saw from replacing doctor visits and the emergency department.”

There are more than 2,000 in-store clinics nationwide, and they handle about 6 million patient visits annually, the study said.

They are popular with many consumers who like strolling in for care with no appointment, as opposed to waiting hours elsewhere, and they are open seven days a week.

These small clinics are typically run by nurse practitioners and treat infections, mild sprains and handle other preventive care such as immunizations. Continue reading

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Medicare plans score higher ratings and millions in bonuses

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Rayne Lowder, a nurse practitioner for Vantage Health Plan, talks with a Vantage Medicare patient at a clinic in West Monroe, Louisiana. (Courtesy Vantage Health Plan)

Rayne Lowder, a nurse practitioner for Vantage Health Plan, talks with a Vantage Medicare patient at a clinic in West Monroe, Louisiana. (Courtesy Vantage Health Plan)

By Phil Galewitz
Kaiser Health News

Vantage Health Plan executives saw an opportunity when they realized few of their female Medicare members were being screened for osteoporosis after they broke bones.

The test to identify women at increased risk for fractures is one of 40 measures that Medicare applies to produce its 5-star ratings comparing the private plans chosen by nearly a third of seniors over traditional coverage.

More than $3 billion is in play for insurers. Health plans earning at least four stars qualify for federal bonus payments. Those that don’t, lose out.

To improve its score, Vantage last year bought a $10,000 mobile ultrasound unit so it could give bone density screenings to its elderly women members in their homes. The proportion of eligible women tested soared from 13 percent in 2014 to 71 percent in 2015.

“The ten grand we spent on the ultrasound machine was more than worthwhile,” said Billy Justice, director of marketing and sales for Vantage, an insurer with 16,000 Medicare members in Louisiana.

Here’s why: Vantage lifted its overall star rating to 4 stars from 3.5 and set itself up for as much as $8 million in extra federal funding next year. By law, the bonus money must go to pay for extra benefits, which helps plans attract more members and in turn makes them more profitable. Continue reading

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