Headlines about "Health plan costs - disease management"

Gathered from the web by the editors at BenefitsLink.com.
Specialty Drug Spending Accounted for 20% of Total U.S. Drug Expenditures in 2009
"Spending for specialty drugs has grown between 15 percent and 20 percent for the last several years ... -- despite the fact that such drugs are used by only 1 percent to 5 percent of the U.S. population, according to a recent report from the Pharmacy Benefit Management Institute.... The report -- the 2011-2012 PBMI Prescription Drug Benefit Cost and Plan Design Report -- projects the growth in spending on specialty drugs will continue to outpace non-specialty drug spending." (Human Resource Executive Online)

How Employers Can Address Challenges of Health Care Cost Containment
"There are two starting points. First, as an employer, you want to have your arms around your data. Maybe you've done a health risk questionnaire and you have medical claims data in such a way that you can stratify it to say that, of the eight greatest risk factors (such as smoking, lack of health screenings, poor diet, etc.) and the 15 most prevalent chronic conditions, these are the ones that are most prevalent in your population. From that, you can target those two or three greatest risk factors that will lead to the best improvement in health status and a lessening of the frequency and severity of chronic disease." (Smart Business)

Potential Savings Through Prevention of Avoidable Chronic Illness Among CalPERS Active Members
"In this report, we present estimates of the burden of preventable chronic disease on active members of the California Public Employees Retirement System and describe the distribution.... The estimates show that a 1 percent reduction in the prevalence of the common conditions included in the analysis could save the state $3.6 million per year." (Urban Institute)

Text of GAO Report Estimating Number of Americans with Pre-Existing Health Conditions at 36 Million to 122 Million
"Depending on the list of conditions used to define pre-existing conditions ..., GAO found that between 36 million and 122 million adults reported medical conditions that could result in a health insurer restricting coverage. This represents between 20 and 66 percent of the adult population, with a midpoint estimate of about 32 percent. The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions." (Government Accountability Office)

Performance Improvement in Health Care
"[The author] suggests that the federal government should first aim, by 2016, to hold the rate of increase in national health spending per capita to the annual projected growth in gross domestic product per capita plus 0.5 percentage points, and to maintain this rate through 2021. Achieving this target, [he] says, would reduce spending by $893 billion over 10 years." (The Commonwealth Fund)

Think Tank Proposes Plan to Improve Care for the Chronically Ill, Reduce Health Spending
"Noting the 'unprecedented opportunity' provided under the Affordable Care Act, the Health Information Technology for Economic and Clinical Health ... Act, and other recently enacted federal laws, the Commonwealth Fund Commission on a High Performance Health System today unveiled a community-based plan to enhance health and reduce spending by improving care for chronically ill patients and targeting quality improvement efforts to conditions that can yield the greatest benefit in a relatively short time. The 'Health Improvement Community' initiative proposed by the Commission has the potential to help those who most need more coordinated care and save $184 billion in health spending over the next 10 years." (The Commonwealth Fund)

International Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey
"An international survey of adults with complex health care needs found wide variations in the degree to which patients are engaged in their own care, from self-managing a health condition to actively participating in treatment decisions. Across countries, engaged patients reported fewer medical errors, higher care ratings, and more positive views of the health system as a whole." (The Commonwealth Fund)

The High-Value Health Care Project: Building an Infrastructure for Performance Measurement and Reporting
"The High-Value Health Care Project built the initial infrastructure for a nationwide performance measurement and reporting system. Project staff identified strategies for combining administrative and clinical data for use in measuring performance. They selected 22 measures of physician performance in preventing and managing chronic conditions; pilot-tested a methodology for combining information on those measures across health plans; and communicated with physicians about the findings. [The program results report is linked from the target page.]" (Robert Wood Johnson Foundation)

States Target Chronic Disease to Trim Health Care Costs
"'States are still in the middle stages of learning what works. But we are seeing some public health interventions that are having an effect.' Such interventions, including child immunizations, tobacco prevention efforts, cancer screenings and physical activity programs, could save as many as 2 million lives and $4 billion annually[.]" (amednews.com)

[Opinion] Will Health Reform Provide Coverage for Eating Disorders?
"[D]isparities in coverage for eating disorders across state laws and insurance plans emphasize the need for the federal government to adopt a national benchmark plan for [Employee Health Benefits] that includes comprehensive mental health." (Think Progress)

PPACA Commissions Rule Sparks Lobbying Push by Brokers
"The looming presidential election could have an impact on whether insurance producers will be able to get their commissions excluded from minimum medical loss ratio calculations under the Patient Protection and Affordable Care Act." (Business Insurance)

The Care Coordination Imperative: Responding to the Needs of People with Chronic Diseases
"Nearly half of all Americans live with at least one chronic condition, and care for these patients is complex, often involving a number of clinical, occupational, and social services. One study found that the typical primary care doctor has the potential to interact with as many as 229 other doctors, in 117 different practices. Another recent study found that the probability that a physician visit would result in a referral to another physician increased from 4.8 percent in 1999 to 9.3 percent in 2009, a 94 percent increase. The absolute number of ambulatory care visits that resulted in a referral more than doubled in this 10-year period." (The Commonwealth Fund)

When It Comes to Disease Management, Science Defies Logic
"Disease management guided by science targets the people who need it most, rather than rely on the faulty assumption that all patients with a particular disease are equal." (Employee Benefit News)

[Guidance Overview] Final Regulations Ease SBC Compliance Duties
"This post focuses on the changes made in the final regulation that apply to group, rather than individual health coverage, as follows: As mentioned, the compliance deadline was pushed out six months . . . . The SBC may be distributed electronically to plan applicants . . . . The SBC does not need to disclose health premium costs. . . . The SBC does not need to be a self-standing document but may be incorporated into a Summary Plan Description . . . ." (E Is for ERISA)

[Guidance Overview] Effect of New Michigan Health Insurance Claims Assessment Act on Group Health Plans
"Employer plan sponsors with Michigan employees should discuss payment of the HICA tax with their medical, dental, vision, prescription drug and wellness TPAs. Plan sponsors may want to review their service agreements with their TPAs to determine whether the plan sponsor has any obligation to reimburse the TPAs for the tax." (McDermott Will & Emery)

[Opinion] Living Well with Chronic Illness: A Call for Public Health Action
"Chronic disease has now emerged as a major public health problem and it threatens not only population health, but our social and economic welfare." (Institute of Medicine)

[Opinion] Cleveland Clinic: 'Why We Won't Hire Smokers'
"Job candidates are told that the offer is subject to a nicotine-free urine test. If a candidate tests positive for nicotine, the offer is rescinded, and he or she is offered a free tobacco-cessation program and may reapply in 90 days. . . . At Cleveland Clinic, we have a unique perspective on the burden of chronic disease. We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach." (USATODAY.com)

[Opinion] It Takes a CEO to Save the U.S. Health Care System
"Forget Washington and the political debate over Obamacare. The real battle for the future of health care is being fought in the world of business, where tens of thousands of companies have seen their financial well-being undermined by skyrocketing employee health costs." (Bloomberg L.P.)

Financial Incentives Raise Value-Based Insurance Design Program Stakes
"[The] programs are taking a bite out of the cost for four health conditions -- cardiovascular disease, cancer, diabetes and obesity -- that account for about three-quarters of the United States' health care costs." (LifeHealthPro)

[Guidance Overview] Health Reform: Fine-Tuning the Medical Loss Ratio Rules
"On December 2, 2011, the [HHS] released both a final rule and an interim final rule updating the medical loss ratio rule that it issued almost exactly a year ago. [DOL] simultaneously issued a technical release giving direction to employer-sponsored health plans governed by [ERISA] as to how to handle rebates provided by insurers who fail to meet the targets established under the MLR rule." (Health Affairs)

Four Ways to Create an HIV/AIDS Inclusive Workplace
"Bring in a local expert for a brown-bag lunch; hold a 'Red-ribbon Day' to promote awareness; conduct a one-day fundraiser to benefit a local HIV/AIDS clinic; promote regular testing." (Employee Benefit News)

Eating Disorders a New Front in Health Insurance Fight
"in the last few years, some insurance companies have re-emphasized that they do not cover residential treatment for eating disorders or other mental or emotional conditions. The insurers consider residential treatments not only costly -- sometimes reaching more than $1,000 a day -- but unproven and more akin to education than to medicine." (The New York Times; free registration required)

Medical Benefits to Manage Chronic Disease or Aid Recovery
"The article presents data on benefits for organ and tissue transplantation, physical therapy, durable medical equipment, prosthetics, diabetes care management, and kidney dialysis." (U.S. Bureau of Labor Statistics)

Economics Favor Retaining Health Coverage in Large Employer Plans, According to Benfield Report
"The Benfield report concluded, 'In addition to concerns over competing for valuable (and increasingly scarce) human capital talent, the math behind the decision is likely behind our finding that only 7% of jumbo employers are considering dropping active employee health care coverage in 2015 and beyond. An additional 7% of jumbo employers are considering dropping health care coverage, but will provide employee vouchers or supplemental compensation.'" (Wolters Kluwer Law & Business)

Pathways to Managing Cancer in the Workplace (PDF)
"This guide provides employers with practical ways to support employees who have cancer as well as those who are taking care of family members with the disease. The guide will assist employers as they implement a full spectrum of benefits and programs . . . ." (National Business Group on Health)

10 Tips for a Successful Chronic Care Management Program
"The key to success with any chronic care management program lies in effective coordination, coupled with powerful data analytics that allow employers to induce their employees to take an active role in their own health care." (Employee Benefit News; free registration required)

Health Care Payment Reform: Analysis of Models and Performance Measurement Implications
"Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services." (RAND)

National Business Group on Health Targets Cancer in the Workplace
Excerpt: "The National Business Group on Health has launched an ambitious, three-year initiative aimed at helping employers design benefit plans that reflect the latest scientific information and expert recommendations on cancer treatment and prevention." (Employee Benefit News; one-time free registration required)

Study Proves That Online Chronic Condition Program Offers Patients a Return on Investment and Enhances Ability to Self Manage Health Conditions
Excerpt: "The study, which took place over the course of five years, analyzed data of members who participated in HealthMedia? CARE? for Your Health, an online digital health coaching program designed to teach participants the skills they need to help manage any chronic condition." (Blue Cross and Blue Shield Association)

'Crowdsourcing' Offers New Way for Doctors to Seek Treatment Advice
Excerpt: "Crowdsourcing refers to the process of developing a group consensus by pooling ideas from a broad community, often over the Internet. Physicians can crowdsource by posting a medical question online and seeking input from thousands of medical professionals." (California HealthCare Foundation)

Engaging Large Employers Regarding Evidence-Based Behavioral Health Treatment
Excerpt: "[The project has several objectives; one objective is to] Develop an understanding of how knowledgeable large employers in the U.S. are in regards to behavioral health, collaborative care and the research supporting its effectiveness." (National Business Group on Health)

[Guidance Overview] HHS Releases Further Guidance on ERRP and Allows Plan Sponsors to Submit Early Retiree Lists (PDF)
4 pages. Excerpt: "[The] guidance provides more information on who is an early retiree for purposes of the program . . . ." (Buck Consultants)

[Guidance Overview] New Informal Guidance Issued on Various Health Reform Mandates
Excerpt: "On its web site, the DOL posted new frequently asked questions . . ., providing guidance on various new mandates. The DOL simultaneously issued DOL Technical Release 2010-02 addressing certain issues affecting the new internal appeals and external review requirements. Separately, the IRS issued Notice 2010-63 announcing that the IRS is seeking comments on the application of nondiscrimination rules to insured arrangements." (Proskauer Rose LLP)

For Chronic Care, Try Turning to Your Employer
Excerpt: "Your employer may seem like an unlikely choice. Chronic conditions account for 25 percent of all medical costs, studies show, and an employee with a longstanding illness can mean higher health care expenses and lower productivity to company bean counters." (The New York Times; free registration required)

Medical Home Approach to Care Can Improve the Sickest Employees' Health and Reduce Costs
Excerpt: "Last fall, Boeing announced the completion of a two-year pilot program in Seattle-area clinics for patients with chronic illnesses who get their health insurance through the company. The program . . . was based on the concept of the medical home, which puts patients at the center of a team of nurses and doctors who are paid extra to actively manage a person's health and health care." (Workforce Management; free registration required)

Innovations in Preventing and Managing Chronic Conditions
Excerpt: "Instead of waiting for workers to get sick, leading companies are shifting their focus from sickness to health, fostering work and community environments that help people lower risk factors -- smoking, diet, lack of exercise -- that lead to disease . . . . High-risk employees contribute disproportionately not only to health care cost, but also to absenteeism, disability and other costs." (Center for Studying Health System Change)

Lines Blurring between Wellness and Disease Management Services
Excerpt: "With wide acceptance of a link between lifestyle and the onset of chronic illness, disease management firms are incorporating wellness and health promotion into their traditional service model. Unlike a more fragmented approach in which wellness and disease management services are provided by separate companies, usually to different groups of plan members, an integrated approach puts all plan members together so they can access both services regardless of health status." (Workforce Management; free registration required)

Cancer Prevention and Care Management: Employer Opportunities
Excerpt: "Cancer in both employed and retired populations is a major expense for employers in terms of medical and pharmacy costs, disability costs, lost productivity and diminished quality of life. This Perspective examines the shortfalls in cancer care and explains how employers can adopt best practice designs and medical management programs that support cancer detection and treatment, including working with vendors to ensure best practice management and utilizing centers of excellence whenever possible." (Mercer LLC)

[Opinion] Ten Small-Scale Health Insurance Reforms for Pre-Existing Conditions
Excerpt: "In a reformed health care system, the chronically ill - along with their doctors, employers and insurers - should find lower-cost, higher-quality, more-accessible care in their economic self-interest. [Instead of suppressing the price system, [here] are 10 ways of dealing with this problem that make greater use of it.]" (National Center for Policy Analysis)

Value-Based Health Insurance Design Will Balance Costs for Drugs and Other Medical Services
Excerpt: "A value-based health insurance design program that promotes proven effective drugs for chronic medical conditions will, at the very least, keep costs balanced through reduced use of medical services, according to the results of a study published in the February 2010 Health Affairs. The study, Evidence that Value-Based Insurance can be Effective . . . ." (Wolters Kluwer)

[Opinion] American Benefits Council/HR Policy Association Comments on Interim Final Rules on Genetic Information in Health Insurance Coverage and Group Health Plans (PDF)
12 pages. Excerpt: "We are particularly concerned about the significant restrictions the Rules impose on employers' ability to effectively use HRAs and disease and case management programs to improve employee health." (American Benefits Council)

Estimates of Commercially-Insured Population at High Risk for Cardiovascular Events: Impact of Aggressive Cholesterol Reduction (PDF)
9 pages. (American Health & Drug Benefits via Milliman)

Childhood Obesity Weighs on Benefit Budgets
Excerpt: "Childhood obesity weighs heavily on the financial scales when it leads to increased health care utilization and higher costs for employers. Further, poor child health will decrease employee productivity as working parents often must leave early or be absent to care for their child." (BenefitNews.com)

[Guidance Overview] GINA Interim Final Regulations: Wellness and Disease Management Programs Impacted
Excerpt: "Title I of GINA, as interpreted by the interim final regulations, prohibits plans from ? Increasing group premiums or contributions based on genetic information; Requesting or requiring an individual or family member to undergo a genetic test (other than for certain limited exceptions, including a plan's right to condition payment for a medical service on medical appropriateness which may in turn depend on the genetic information of the individual); and Requesting, requiring or purchasing genetic information prior to or in connection with enrollment, or at any time for underwriting purposes. It is also important to note that unlike the other provisions of the HIPAA portability and nondiscrimination rules, GINA does apply to group health plans with fewer than two participants who are current employees. In other words, GINA does apply to a separate retiree medical plan." (Kilpatrick Stockton LLP)

The 'Next Big Thing' in Health Insurance Plan Design Offers Rich Benefits to Chronically Ill Members
Excerpt: "A startup health insurer aiming to incentivize behavior change for both healthy and chronically ill members will begin marketing its products to small employers in Fresno, Calif., this fall. Unlike traditional health plans, SeeChange Health's value-based benefit model seeks out both the chronically ill and the 'overlooked healthy (i.e., those at risk for developing a chronic condition) and offers them richer benefits in exchange for compliance in managing the condition." (AISHealth.com)

When HR Asks About Your Health
Employers want you to answer some personal questions. Should you? (CNNMoney.com)

Cisco Systems Links High Touch With Hi Tech to Engage Employees in Their Own Health
Excerpt: "Imagine attracting nearly 5,000 employees to a health screening in a heated competition to get their biometric numbers, hosting a secure messaging program where employees can conveniently communicate with their doctors via e-mail, or unveiling an on-site health center on YouTube. These are just a few of the many ways Cisco Systems, a leading provider of Internet technology solutions, is engaging its employees in managing and safeguarding their health for the long term." (Towers Perrin)

Budgetary Effects of Prevention Programs Need Clinical Data Over a Long Time Period
Excerpt: "Although preventive health measures will not necessarily save money on health care spending, over the long term, they at least will offset a large part of the costs of the prevention programs, according to a study published in the September 1 online journal Health Affairs. Health care reform proponents often claim that expanding coverage and preventive health measures will lower health care costs. The study researchers, from the University of Chicago's Medical School and the National Opinion Research Center, detail how an 'epidemiological' assessment over a period of 25 years, not the commonly used ten-year period, can more accurately project the actual costs of health care reform measures, because 'the positive effects of improved treatment often take decades to show clinically significant effects.'" (Wolters Kluwer)

Employers Balance Disease Management and Wellness Efforts to Cut Costs
Excerpt: "If employers focus only on employees with chronic conditions, 'they will get some savings a bit faster, but what they will not be addressing is that people who have those conditions in two to five years are people who have lifestyle problems today,' said Bruce Kelley, national leader of data services at Watson Wyatt Worldwide in Minneapolis.'We have seen some tendency to put more emphasis on the short-term (savings), but I can't think of a client who has abandoned the longer-term strategy' of fostering employee wellness, he said. Watson Wyatt data show that just 5% of the workforce -- those with complex chronic conditions and catastrophic cases -- spend about 50% of the health care dollars . . . ." (Business Insurance)

Chronic Conditions Crank Up Health Costs
Excerpt: "Nearly half of Americans have a chronic condition, and 75% of the $2.6 trillion spent annually on health care goes to treat patients with long-term health problems, says Kenneth Thorpe, a professor at Atlanta's Emory University and head of the Partnership to Fight Chronic Disease. . . . 'All of these diseases are accumulations of what's happened before in a person's life,' says Barbara Starfield, professor of public policy at Johns Hopkins University in Baltimore. 'We have to think about keeping people as healthy as possible so they don't get these diseases.'" (USA Today)

Using Clinical Information to Project Federal Health Care Spending
Excerpt: "Complications from chronic illnesses often do not emerge for many years. Current federal cost projection methods are constrained by ten-year cost estimates, which capture increases in near-term intervention costs but not changes in long-term costs. Current methods also cannot easily capture the cost implications of changes in disease progression. Type 2 diabetes is a prime example of a chronic illness with long-term health and cost consequences. We present results from an epidemiologically based model that projects federal costs for diabetes under alternative policies, and we discuss the potential changes in the federal budget process needed to capture the full impact of these interventions." (Health Affairs)

Study Raises Questions About Cost Savings from Preventive Care
Excerpt: "Preventive services for the chronically ill may reduce health-care costs, but they are unlikely to generate the kind of fantastic savings that President Obama and other Democrats have said could help pay for an overhaul of the nation's health system, according to a study being published Tuesday. . . . 'There's no free lunch here. Prevention will not pay for everything. But it's not as expensive as it looks at first blush,' said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, and one of four authors whose work is being published on the Web site of Health Affairs, a leading journal of health policy research." (The Washington Post; free registration required)

Healthcare Costs for Overweight and Obese Patients Grow
Excerpt: "Healthcare payers spent a lot more per person to treat those who were obese and overweight in 2006 than they paid in 2001. That's the message from a new federal report that ranked spending on adult patients categorized by body mass index. The increased spending per person is attributed to greater expense of managing chronic conditions, such as diabetes or high blood pressure." (HealthLeaders Media)

Prevention Efforts Provide No Panacea on Health Costs
Excerpt: "There is one idea for fixing the health-care system that lawmakers in both parties agree on: a bigger government role in disease prevention. Yet many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. 'It is not going to cut costs,' said Louise Russell, a research professor in the Institute for Health at Rutgers University who has studied the issue. 'We already do a lot more prevention than other countries. We are not healthier.'" (The Wall Street Journal)

Diabetes Disease Management Pilot Program Yields Big Cost Savings
Excerpt: "A diabetes disease management program conducted by the American Pharmacists Association Foundation is being made available to employers nationwide as a result of a series of successful tests. The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they've waived co-payments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said." (Workforce Management; free registration required)

Integrated Health Care Can Improve Chronic Illness Treatment
Excerpt: "Improving care for people with chronic illnesses will require addressing barriers such as fragmented care, poor transitions between care settings, and payment that does not recognize the value of better integration of services, according to a recent report from AARP. Other obstacles to improving care for those with chronic illnesses are 'poor information systems' that make it difficult for medical providers to track patients over time, to integrate care among different providers and different care settings, and to track medication adherence and prevent drug interactions." (Wolters Kluwer)

More Large Employers Offer Chronic Disease Management Programs to Reduce Health Care Costs
Excerpt: "Eighty percent of large U.S. companies this year are offering chronic disease management programs for workers in an effort to reduce health care costs, up from 51% last year, according to a new survey by Hewitt Associates . . . . Hewitt surveyed 343 large companies and found that more employers are targeting costly chronic diseases -- such as diabetes, heart disease, asthma and depression -- rather than workers' eating or exercise habits. Hewitt estimates that a company with 9,500 workers and 500 retirees younger than age 65 spends between $18 million to $22 million on health care just for those with diabetes." (Kaiser Family Foundation)

Health Plans Use Variety of Strategies to Identify and Ensure Compliance Among Diabetics
Excerpt: "On Jan. 15, United announced the launch of its Diabetes Health Plan with built-in preventive care incentives. As a value-based design, the plan eliminates copayments for many of the out-of-pocket expenses that discourage many diabetics from effectively managing their condition." (AISHealth.com)

In 'Sobering' Finding, Care Coordination Doesn't Save Money
Excerpt: "When it comes to finding ways to cut costs from the health-care system, an idea that's becoming popular among health-quality gurus, medical organizations and insurers is 'coordination of care.' . . . A study out in JAMA has some disheartening results. Among 15 randomized trials of care-coordination programs involving Medicare patients, only two showed significant differences in hospitalizations between those whose care was coordinated and a control group. And one of those two saw more hospitalizations among the coordinated group. Meantime, not one program ended up saving money. Ouch." (The Wall Street Journal)

Public Employers Focusing More on Disease Management, According to Survey
Excerpt: "A recent health care survey found the majority of public sector employers are working to control costs by implementing disease management and wellness programs, instead of introducing consumer-driven health plans (CDHPs). A news release from the the International Foundation of Employee Benefit Plans (IFEBP) said more than half of public employers who responded to the survey indicate they have implemented a disease management (69%) or a wellness program (65%)." (PLANSPONSOR.com; free registration required)

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