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News Items, by Subject

Health plan costs - misc

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State Efforts to Protect Consumers from Balance Billing
"In 2017 and 2018, states continued taking steps to protect consumers. Four states -- Arizona, Maine, Minnesota, and Oregon -- created balance-billing consumer protections for the first time, and two states -- New Hampshire and New Jersey -- substantially expanded existing protections. We now classify New Hampshire, New Jersey, and Oregon as states offering comprehensive protections against balance billing. As of December 2018, 25 states have laws offering some balance-billing protection to their residents, and nine of them offer comprehensive protections." (The Commonwealth Fund)
CMS Proposes Changes to ACA Premiums, Reducing Tax Credits
"CMS is proposing ... to seek to end the practice of silver loading, end automatic re-enrollment in individual exchange plans, and raise premiums by 1% ... In addition, the [2020 payment notice] proposes allowing individual, small group, and large group market health insurance issuers to allow mid-year formulary changes to encourage more use of generic drugs.... CMS also wants to raise the out-of-pocket maximum that those with employer-sponsored coverage would pay to $8200 annually, up $200. The maximum for family coverage would increase by $400." (American Journal of Managed Care)
[Opinion] Is the Drug Industry an Existential Threat to the Private Health Insurance Business?
"Because of the impact health insurance costs are having on take home income, we are at risk that the historical attractiveness employees and their families have had for employer-based health insurance will be lost. If the health insurance industry loses the support of employer-plan participants it will have lost the firewall that has made voters reluctant to support government-run health care.... [T]he primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs." (Bob Laszewski's Health Care Policy and Marketplace Review)
Stats That Could Make You Re-Evaluate Your Benefit Administration Strategy
"[1] Benefits account for 31.7% of total compensation costs, on average.... [2] Four out of five employees enroll in the wrong health plan.... [3] Nearly 90% of employees feel technology improves their understanding of benefits.... [4] 26% of employees report having left a job or rejecting a job offer due to the benefits offered.... [5] 37% of employers say the ability to integrate benefits technology with HR functions is the most valuable outcome of implementing a benefits administration platform." (Benefitfocus)
Long-Awaited 'Cross-Plan Offsetting' Case Increases Risk for Employers, Insurers
"[To recover disputed overpayments from an out-of-network provider,] an alleged overpayment relating to one health plan from one employer is 'offset' by modifying the amount which is paid by a different health plan of a different employer.... The court noted that nothing in the plan documents allowed UHC to conduct cross-plan offsetting.... Then, the court strongly hinted that the practice violated ERISA's fiduciary duty rules, including the requirement that plan assets of one plan be used for the 'exclusive purpose' of benefiting individuals covered by that plan." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (Quarles & Brady LLP)
Federal Appeals Court Sides with Out-Of-Network Doctors Against UnitedHealth
"[This] decision ... should act as a wake-up call to all self-insured health plans for potential rewards in the trillions of dollars in plan assets recovery for all self-insured ERISA plans nationwide, from cross plan overpayment recoupments and offsets done by all plan TPAs.... The appeals court [stated]: 'To adopt United's argument that the plan language granting it broad authority to administer the plan is sufficient to authorize cross-plan offsetting would be akin to adopting a rule that anything not forbidden by the plan is permissible.' " [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (AVYM Healthcare Revenue Consultants)
Lower-Wage Workers Pay More Than Higher-Wage Workers for Employer-Provided Medical Care Benefits
"In March 2018, private industry workers earning an average wage in the lowest 10 percent paid an average of $151.78 per month for medical care plans for single coverage. That was $25 more than the average monthly contributions of private industry workers with an average wage in the highest 10 percent ($126.82)." (U.S. Bureau of Labor Statistics [BLS])
[Opinion] High Prices Drive High Health Care Spending in the U.S., But So Too Do Other Factors
"[T]he prices that US providers negotiate with insurers are aberrantly high and that the level of providers' commercial prices differentially raises health spending in the US compared to other nations. However, it is crucial to note that the regulated prices US providers are paid by the Medicare and Medicaid program are not hugely out of sync with the regulated prices set in other countries." (Health Affairs)
ACOs Should Plan for Shorter Path to Greater Risk in CMS' Overhauled Medicare Shared Savings Program
"In an analysis of Medicare data for 560 [Medicare Shared Savings Program (MSSP)] ACOs to estimate where they would fall in CMS' new two-prong model, two out of three ACOs had the shorter window before they would be expected to take on greater risk." (FierceHealthcare)
Democrats Question Trump Administration's Use of ACA Marketplace User Fees
"As part of their inquiry, the Democrats are requesting a series of documents related to the Trump Administration's use of user fees collected, including: [1] The overall amount of user fees collected, as well as a detailed accounting of how these funds were spent in each year; [2] Detail on what capital investments have been made to improve the functioning of the Federal Marketplace in 2017 and 2018, as well as any plans for future investments; [3] A briefing on the Administration's outreach and enrollment expenditures for 2019 Marketplace plans." (Energy and Commerce Committee, U.S. House of Representatives)
CMS Administrator Commends Three Health Systems for Their Price Transparency
"Three health systems that have voluntarily taken steps to promote price transparency for their patients received kudos Thursday ... CMS Administrator Seema Verma named the three systems -- UCHealth in Colorado, Mayo Clinic in Minnesota, and University of Utah Health -- as exemplars, urging other hospitals to similarly go above and beyond the requirements laid out in revised price-transparency guidelines that took effect this month." (HealthLeaders Media)
Health Care in 2019: Five Key Trends to Watch
"Not only will the push to value-based care continue, it will accelerate.... 2019 will likely be the year where physicians more actively participate in these programs.... More than half [of consumers surveyed] expressed a willingness to receive care in a non-traditional setting if the care was less costly and more convenient.... [M]any health systems have embarked on integration efforts of their own to expand their networks, often across a broad geographic area ... [T]echnology is bringing profound change to the health care experience." (Health Affairs)
[Opinion] Not Your Grandmother's Risk Adjustment
"Developing an equitable risk-adjustment model in the ACA realm is a challenging endeavor, as is projecting a relative risk score for a participating health plan. This is primarily due to the dynamic population, the multitude of factors in the transfer formula and the budget neutrality requirement that necessitates the average risk being determined prospectively by the enrolling population." (The Actuary Magazine)
Outlook 'Stable' for Health Insurers in 2019 Despite ACA Uncertainty
"A robust job market bolstering employer-sponsored plans, Baby Boomers transitioning to Medicare Advantage, and ACA exchanges attracting new payers are good signs for health plans in the coming year." (HealthLeaders Media)
[Guidance Overview] CMS Finalizes Proposed Redesign to Medicare Shared Savings Program
"Low-revenue ACOs are permitted to stay in one-sided risk-sharing models for a longer period ... Any ACO determined to be experienced with Risk Models however, is required to take on risk immediately.... CMS is also cutting the shared savings rate that will be available for ACOs until they enter a Risk Model.... CMS finalized modifications to its calculation of the regional adjustment to an ACO's performance benchmark[.]" (K&L Gates)
[Guidance Overview] 'Pathways to Success' Update: CMS Issues Final Rule on Changes to the ACO Program
"On December 21, 2018, CMS issued the final rule for the redesign of the [Medicare Shared Savings Program (MSSP) which] includes the following: [1] Greater savings for one-sided risk models.... [2] Qualification as a low revenue ACO.... [3] Additional year of one-sided risk for new low revenue ACOs.... [4] High revenue ACO participation in BASIC Track Level E.... [5] Repayment mechanism for two-sided risk.... [6] Benchmarking methodology." (Sheppard Mullin)
Two Hundred Years of Health and Medical Care: The Importance of Medical Care for Life Expectancy Gains
"There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years.... [The authors] consider whether medical care productivity decreases over time, and find that spending increased faster than life expectancy, although the ratio stabilized in the past two decades." (National Bureau of Economic Research [NBER])
California Governor Cut Retirement Debt Bigger Than Pensions
"[As] Gov. Brown leaves office, ending what he called the 'anomaly' of retirees paying less for health care than current workers is part of one of his accomplishments ... The state no longer pays for Medicare Part B. And five more years of service are needed to receive state payment of retiree health care premiums, beginning with 50 percent after 15 years and increasing 5 percent a year to 100 percent after 25 years.... [T]he major part of Brown's retiree health care reform applies to workers hired before the reform, not just new hires. All workers are beginning to contribute to a pension-like investment fund to help pay future retiree health care costs." (Calpensions)
Workers with High Deductibles Curb Health Care Spending
"Those enrolled in plans with deductibles of at least $1,350 for self only and $2,700 for families were more likely to take costs into account when making health care decisions ... HDHP enrollees also were more likely to take preventive measures to preserve health, including enrolling in wellness programs." (Society for Human Resource Management [SHRM])
As Hospitals Post Sticker Prices Online, Most Patients Will Remain Befuddled
"As of Jan. 1, ... [CMS] required that all hospitals post their list prices online. But what is popping up on medical center websites is a dog's breakfast of medical codes, abbreviations and dollar signs -- in little discernible order -- that may initially serve to confuse more than illuminate.... To figure out what ... a trip to the emergency room might cost, a patient would have to locate and piece together the price for each component of their visit -- the particular blood tests, the particular medicines dispensed, the facility fee and the physician's charge, and more." (Kaiser Health News)
How Employers Are Controlling Health Care Costs
"[E]mployers are focusing on a short list of top priorities: [1] Concentrating on clinical conditions to reduce high-cost claims ... [2] Improving management of pharmacy costs ... [3] Encouraging greater use of high-performance networks, centers of excellence and telemedicine ... [4] Considering the addition of low-point-of-care cost plans as an option ... [5] Improving employee total wellbeing ... and connecting these efforts to corporate culture and the employee value proposition (EVP)." (Willis Towers Watson)
Activating Employees in Discussions of Health Care Trade-Offs: It Can Be Done
"[E]mployers must also consider trade-offs pertaining to which health care products and services their employer-sponsored health benefits will cover -- but notably, these decisions are often made with little or no input from employees. [A] recent case study ... explored how an employer could engage employees in an open and constructive dialogue related to both the population level and coverage-level trade-offs that must be considered when designing an organization's health care benefit." (Health Affairs)
2015 Medicare Current Beneficiary Survey Annual Chartbook and Slides
The MCBS 2015 Chart Book is now updated to include two new sections with information on the use and cost of health care services reported by survey beneficiaries. This release will supplement the information in Version 1 of the MCBS 2015 Chart Book which included information on beneficiaries' satisfaction with care, usual source of care, functional status, and health and well-being. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
ACA Strike-Down: Salvaging the BPCIA via Severability
"Should appellate courts uphold Judge O'Connor's decision, the [Biologics Price Competition and Innovation Act (BPCIA)] may have to be reauthorized. Although there would be tremendous pressure for Congress to reenact the BPCIA because the BPCIA has the potential to create savings in the billions of dollars for Medicare alone, a second look at the BPCIA would almost certainly result in renewed debate regarding its more controversial aspects and lobbying efforts by industry and consumer protection groups alike." (Foley & Lardner LLP)
Judge OKs CVS Plan to Keep Aetna Separate Pending Review
"CVS said it is currently operating Aetna's health insurance business separately from CVS's retail pharmacy and PBM business units, with Aetna maintaining control over pricing and product offerings. Aetna personnel will also retain their current compensation and benefits, and CVS will maintain a firewall to prevent the exchange of competitively sensitive information between the two companies." (AISHealth)
CMS Announces Reinsurance Funding for NJ, WI
"Combined, these two states will be receiving about $308 million in federal pass-through funding for state-based reinsurance programs.... [The total] estimated 2019 pass-through funding for all eight states is about $942 million ... Nearly 40 percent of this total funding will go to Maryland, which has the largest state-based reinsurance program." (Katie Keith, in Health Affairs)
IRS Unable To Recoup Nearly $1 Billion In Obamacare Subsidies
"All told, the Treasury Department paid out roughly $27 billion in Obamacare subsidies in the 2018 tax-filing season, with overages accounting for $3.7 billion of that. Only $2.7 billion was recaptured. The $1 billion left over is small compared to the overall federal budget, but it is 20 percent of the president's border wall funding request that's spurred the current government shutdown." (
Medical Debt and GoFundMe: Friends and Strangers Step in Where Insurance Lags
"Medical fundraisers now account for 1 in 3 of the website's campaigns, and they bring in more money than any other GoFundMe category.... Even for conventional treatments that are covered under most health plans, the copays and high deductibles have left many people with health insurance they can't afford to use." (National Public Radio [NPR])
Hospital Prices Are About to Go Public
"A federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1. The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say." (Atlanta Journal-Constitution)
Secrets Behind Comcast's Surprising Healthcare Success
"Comcast spends about $5,800 per person enrolled in its health plan. That number ... [is] just a hair above average employer spending. What's truly eye-popping are two things Comcast gets for its money: [1] Incredibly low employee cost-sharing. Employees only pay a $250 deductible on their care, compared to a $1,500 industry average. [2] Nearly flat cost growth.... Where other large employers see 3% year-over-year healthcare cost growth, Comcast's spending only goes up 1%. Clearly, Comcast is doing something right." (mpirica)
[Guidance Overview] Pathways to Success: An Overhaul of Medicare's ACO Program
"The rule is projected to achieve $2.9 billion in savings over ten years.... One key element of [this final rule] is a reduction in the amount of time that an ACO can remain in the program without taking accountability for healthcare spending.... [The] rule also increases flexibility for certain performance-based risk ACOs to encourage innovation and expand access to high-quality services that are convenient for patients, including telehealth services provided at a patient's place of residence." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of CMS Final Regs: Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017
957 pages. "The policies included in this final rule provide a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses). These policies are designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities, and promote regulatory flexibility and free-market principles. This final rule also provides new tools to support coordination of care across settings and strengthen beneficiary engagement; and ensure rigorous benchmarking." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Cutting Employee Hours to Avoid ACA Requirements Costs Employer $7.4 Million
"[T]he employees claimed that Dave & Buster's discriminated against them 'for the purpose of interfering with the attainment' of their right to health coverage under the health plan because they were covered under the restaurant's health insurance plan prior to the enactment of the ACA.... On December 7, the court gave preliminary approval to Dave & Buster's $7.4 million proposed settlement, which also bars Dave & Buster's management from taking adverse employment actions against employees for the purpose of denying them health coverage." [Marin v. Dave & Buster's, Inc., No. 15-3608 (S.D.N.Y. Dec. 7, 2018)] (Davis Wright Tremaine LLP)
Employer Health System Networks to Become More Exclusive
"These strategies are narrowing medical care provider networks and, in some cases, shutting out some health systems in favor of others for hip, knee, and spine surgeries; transplants; and cancer treatments. The strategies will place a significant hurdle to a worker's ability to choose the hospital or health system that they want but employers say they are guiding them to the higher-quality health systems with the best outcomes." (HealthLeaders Media)
$160,000 Tobacco Surcharge? Yes, If your Wellness Program is Noncompliant
"In a recent settlement, the DOL imposed over $160,000 in fines and penalties on an employer that failed to comply with wellness program regulations. The settlement included penalties against the employer for breaching its fiduciary duties, but individual employees who administered the wellness program could have been personally liable as well. This settlement significantly raises the stakes for failing to comply with the complex rules that govern wellness programs." (Kutak Rock LLP)
The HERO Health and Well-Being Best Practices Scorecard: 2018 Progress Report (PDF)
56 pages. "What will it take to uncover causal relationships that will allow us to confidently show how culture change, leadership influence, programming and other such factors can improve business performance and organizational and individual health and well-being? ... This progress report offers some of the most current and best examples of how a Scorecard, used with excellence in mind, can help inform practice improvements as well as fuel much-needed research." (Health Enhancement Research Organization [HERO], in collaboration with Mercer)
Digital Tools and Solutions for Diabetes (PDF)
18 pages. "The market for digital diabetes prevention and management solutions has continued to mature ... As employers refine the mix of programs and benefit strategies they offer their employees, NEBGH has developed this updated guide to reflect changes in the market and profile a current set of digital solutions available to employers in their efforts to help employees prevent and manage diabetes." (Northeast Business Group on Health [NEBGH])
Telehealth Is Reaching More Patients Than Ever, But It's Hindered by Parity Laws
"11 states have yet to pass telehealth parity laws.... [T]raction over the last year has occurred among groups other than doctors who want to serve patients virtually, such as nurses and social workers.... Payers, including Medicare, are hesitant to expand telehealth coverage too quickly -- lest utilization of telehealth services spike, sending costs through the roof[.]" (FierceHealthcare)
[Opinion] American Academy of Actuaries Comment Letter to IRS on Proposed Regs for HRAs and Other Account-Based Group Health Plans (PDF)
"Table 1 provides a simplified illustration of the impact on the individual market of shifting a share of the highest spenders in the group market to the individual market and highlights the potentially large increase in average individual market claims. This example underscores the need for nondiscrimination rules to limit the ability of employers to target integrated HRAs solely to particularly high-cost workers." (Individual and Small Group Markets Committee and Employee Benefits Committee, American Academy of Actuaries)
Cash Flow Dynamics and Family Health Care Spending: Evidence from Banking Data
"Bank transaction data reveal that in any given year, one in six families makes an extraordinary health care payment of roughly $2,000 in a single month ... Consumers increase health care spending by 60 percent in the week after receiving a tax refund, and the majority of these payments are made in person -- likely for care received on that day." (Health Affairs)
[Opinion] Evaluating the Administration's Health Reimbursement Arrangement Proposal
"[T]his new option would likely be particularly appealing to large employers with sicker workforces.... [S]ubsidizing community-rated individual market coverage could allow them to offer similar coverage at lower cost.... [T]he influx of sicker workers into the individual market would increase premiums, thereby increasing subsidy costs for the federal government and premiums for unsubsidized enrollees." (The Brookings Institution)
CMS Announces 2019 Pass-Through Funding For State Waivers
"CMS posted letters for Alaska, Hawaii, Maine, Maryland, Minnesota, and Oregon. Based on these letters, the estimated total pass-through funding for 2019 so far is about $634 million, more than half of which will go to Maryland. All these states except Hawaii used a Section 1332 waiver to adopt a state-based reinsurance program." (Katie Keith, in Health Affairs)
Health Insurer, Employer Groups Call on Congress to End Surprise Billing
"The groups -- which include powerful lobbyists like the Blue Cross and Blue Shield Association, America's Health Insurance Plans, the National Business Group on Health, and Consumers Union -- called on Congress to prohibit providers from billing patients for costs not covered by the health plan when the out-of-network visit isn't the patient's fault. But they also said Congress should ensure any policy enacted doesn't increase premiums or discourage providers from joining a health plan's network." (Modern Healthcare Online; free registration required)
Handling Health Claims: Traditional Carriers vs. TPAs
"[F]or the lion's share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But ... there are some services for which the carrier's network rates are egregiously high -- and for those services the TPA will simply apply Medicare reimbursement levels instead.... The projected impact of carving out administration to this more aggressive TPA would purportedly save clients in similar networks 4‑8% on total claims spend." (Frenkel Benefits)
Top Health Industry Issues of 2019: The New Health Economy Comes of Age (PDF)
54 pages. "The US health industry is looking less like a special case, an asterisk in the US economy, and is beginning to behave like other industries.... In the digital arena in 2019, life sciences companies will market digital therapeutics and connected devices targeting atrial fibrillation, hemophilia, substance abuse, birth control, depression, diabetes, epilepsy and other conditions. In 2019 the health industry will see value lines created by innovative providers and payers that have figured out how to subsist ... by serving almost entirely Medicaid or cash-strapped patients." (PwC)
How Carrier Negotiations Could Disrupt Your Health Insurance
"Often, these contract negotiations get resolved at the eleventh hour and the facilities never actually lose their in-network status. Sometimes, however, these contract negotiations can continue on beyond the expiration of the previous contract, which leaves the facility out-of-network until a resolution can be found. Members can become an unfortunate pawn in these negotiations.... [E]nsure that you are communicating with your employees so that they understand how their out-of-pocket expenses may be impacted." (Hill, Chesson & Woody)
Two Hundred Years of Health and Medical Care: The Importance of Medical Care for Life Expectancy Gains
"While common theories about medical care cost growth stress growing demand, [this] analysis highlights the importance of supply side factors, including the major public investments in research, workforce training and hospital construction that fueled a surge in spending over the 1955‑1975 span. There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years.... [S]pending increased faster than life expectancy, although the ratio stabilized in the past two decades." (National Bureau of Economic Research [NBER])
Cost of Employer Insurance a Growing Burden for Middle-Income Families
"After climbing modestly between 2011 and 2016, average premiums for employer health plans rose sharply in 2017. Annual single-person premiums climbed above $7,000 in eight states; family premiums were $20,000 or higher in seven states and D.C.... Average employee premium contributions across single and family plans amounted to 6.9 percent of U.S. median income in 2017, up from 5.1 percent in 2008. In 11 states, premium contributions were 8 percent of median income or more, with a high of 10.2 percent in Louisiana." (The Commonwealth Fund)
CMS Office of the Actuary Releases 2017 National Health Expenditures
"Hospital spending (33 percent of total healthcare spending) decelerated in 2017, growing 4.6 percent to $1.1 trillion compared to 5.6 percent growth in 2016.... Physician and clinical services spending (20 percent of total healthcare spending) increased 4.2 percent to $694.3 billion in 2017.... Retail prescription drug spending (10 percent of total healthcare spending) slowed in 2017, increasing 0.4 percent to $333.4 billion.... The 3.9 percent growth in healthcare spending was slightly slower than growth in the overall economy (4.2 percent) in 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Trends That Could Impact Health Plans, Hospitals, and Patients in 2019
"Convergence and collaboration between health systems and health plans will become more important ... Health systems will continue to focus more on the patient rather than the illness: ... Technology could help move patients to the center ... More patients could consider virtual health ... There will be more focus on population health." (Deloitte)
Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses: Highlights from the Proposed Rule
"Plan sponsors should review the proposed regulation and consider submitting comments to CMS (the comment deadline is January 25, 2019).... [T]he proposed rule raises operational questions that will need to be addressed by plan sponsors and PBMs. There will be pricing implications in the bids, and other actuarial considerations such as trend and Part D risk corridor projections.... [T]he provisions are likely to necessitate re-negotiation of contracts between plan sponsors and pharmacy benefit managers." (Wakely Consulting Group)
[Opinion] New Report by HHS, DOL and Treasury Department on Healthcare Reform
"The report asserts that educated consumer choice allows for improved quality and lower cost, comparing Lasik surgery costs (down by 25%) and cosmetic procedure costs (which grew at less than half the rate of general inflation) not typically covered by healthcare in contrast to overall healthcare costs (which grew at twice the rate of general inflation). It cites lack of cost transparency and distinguishes 'shoppable' versus 'non-shoppable' costs indicating that only 6% of costs are incurred in an emergency department and therefore more consumerism can be imposed." (Frenkel Benefits)
Sources of Health Care Spending Growth Are Hard to Identify
"[The NHE (National Health Expenditure)] is likely unable to measure true price growth with sufficient accuracy for us to be able to answer this important question: Are prices for health care growing faster or slower than overall inflation? If growth in prices is contributing to growth in the share of GDP devoted to health care, that has far different implications than spending growth resulting from new treatment options that people value and purchase." (Health Affairs)
[Opinion] Could Telehealth Increase the Price of Health Care?
"[T]he effect of telehealth on prices depends on: [1] how responsive suppliers (i.e., physicians and other health care providers) are to this changing dynamic; [2] the price of telehealth technology; ... [3] patients' perceived inconvenience cost of going to the physician; [and] [4] how third party payers (i.e., insurers) interact with the market." (Healthcare Economist)
[Guidance Overview] Review of 2018 Developments for Health and Welfare Plans (PDF)
23 pages. Topics: [1] Tax Reform Act; [2] Appropriations Act; [3] Short-term, limited duration insurance (STLDI) regulations; [4] Proposed legislation impacting account based plans; [5] State based laws; [6] DOL fiduciary update; [7] AHP regulations; [8] Wellness program rule reversal; [9] Proposed HRA regulations; [10] New contraception regulations; [11] Section 1557 update; [12] Adjusted limits for 2019; and [13] Forms and filings. (Alston & Bird)
Experiences Under the ACA Suggest Association Health Plans Could Harm the Small-Group Insurance Market
"[In] each of the past three years ... each regulation permitting non-ACA-compliant plans -- self-insurance and transitional plans -- was associated with a risk profile for the ACA-compliant market that was 10 percent to 14 percent higher than in states without such policies. Also, states that adopted both policies had risk profiles that were 15 percent to 20 percent higher than states with neither regulation.... Association health plans ... could have a much more pervasive effect on market segmentation. Unlike transitional plans, they can enroll new subscribers, and, unlike self-funding, they are feasible for groups of any size, or self-employed individuals." (The Commonwealth Fund)
Reforming America's Healthcare System Through Choice and Competition (PDF)
119 pages. "This report identifies barriers on the federal and state levels to market competition that stifle innovation, lead to higher prices, and do not incentivize improvements in quality. It recommends policies that will foster a health care system that delivers high-quality care at affordable prices through greater choice, competition, and consumer-directed health care spending." (U.S. Department of Health and Human Services [HHS], U.S. Department of the Treasury, and U.S. Department of Labor [DOL])
Economic Analysis of 'Medicare for All'
"As of 2017, the U.S. was spending about $3.24 trillion on personal health care -- about 17 percent of total U.S. GDP. Meanwhile, 9 percent of U.S. residents have no insurance and 26 percent are underinsured -- they are unable to access needed care because of prohibitively high costs. Other high-income countries spend an average of about 40 percent less per person and produce better health outcomes. Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents." (Political Economy Research Institute, University of Massachusetts Amherst [PERI])
Text of CMS Updated Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year (PDF)
9 pages. "This document updates two Tables in the 2017 Summary Report to reflect a recalculated default risk adjustment charge in the Utah small group market. The adjusted default charge allocation payments will be distributed to affected issuers in the Utah small group market after the additional default charge has been collected." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Study Charts Recent Spike in Telehealth Usage, Particularly Within Primary Care
"Proposals from CMS aimed at broadening reimbursement for virtual services have received positive reviews from telehealth advocates. Those proposals have also met skepticism from some doctors, however. A research letter in the latest issue of JAMA suggests both groups have a point: the benefits of reimbursement appear to vary depending on the subspecialty involved." (FierceHealthcare)
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