Wednesday, October 18, 2017
The White House and the Department of Health and Human Services announced it would no longer reimburse health plans for the subsidies they are required to make for low-income individuals purchasing coverage on the Affordable Care Act marketplaces—to the tune of around $7 billion a year. The notice comes just three weeks before the new enrollment period opens, but health plans already raised rates precipitously in many states in anticipation of the move, and California slapped a 12.4 percent average surcharge on the silver-tier plans that set the pace for tax credits. The cost-sharing reduction payments have long been in legal limbo; an appeal is still pending as to whether the funds were ever appropriated under the ACA. Washington, DC has joined 18 states suing the federal government over the move. (The Hill; HealthAffairs Blog; CNBC) An August Congressional Budget Office analysis finds repealing CSR payments will cause some insurers to withdraw from the individual market, leaving about 5 percent of people without options to buy individual coverage. Plans remaining in the market will likely pass the cost to consumers, raising the premium of a silver-tier plan by about 20 percent, but leaving other plan rates about the same because those plans set tax credit levels. More individuals will likely leave the higher-priced silver-tier plans and opt for lower premiums. When they do, they will actually realize net gains when they take the health plan tax deduction. When that happens, CBO projects it will increase the federal deficit by $194 billion over the next decade. (Kaiser Family Foundation; CBO analysis) With states announcing 2018 health premium rate hikes of as much as 57 percent, President Trump eased plan requirements in a bid to lower costs and heat up market competition. A new executive order calls for regulations expanding access to association health plans like those offered by chambers of commerce, professional or trade associations and others prior to passage of the Affordable Care Act. That move should expand options for individuals to buy plans just like ERISA-governed group health plans; although still subject to ACA reforms, they aren’t governed by state regulation. That’s a policy change supported by many Republicans. The order also expands the length of short-term health insurance coverage—which critics say will attract the most healthy and raise rates for those with pre-existing conditions—and directs the administration to revise rules so health reimbursement accounts can be used more broadly by individuals. (HealthAffairs Blog; HealthCare DIVE; National Public Radio; Marketplace)
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The 2018 corporate health plan enrollment period arrives with 96 percent of employer-based health plans covering telehealth visits like regular doctor visits. A National Business Group on Health survey finds usage rates are still low (only 2.5 percent of employees use telehealth now), but the service is still new, and employers are expected to encourage greater use. Employers like telehealth because employees use it rather than seeking higher-cost care at an urgent care center or emergency room. (U.S. News & World Report)
Fewer hospitalizations result when seniors get health monitoring
Seniors in affordable housing benefit from nurse-aided telemonitoring, experiencing one-third fewer hospitalizations and an 11 percent reduction in moves to higher levels of care. Lutheran Senior Services reported that 750 residents in nine subsidized housing communities consulted once a week with a parish nurse who monitored vital signs and feelings of isolation. The voluntary program also inspired 49 percent of participants to exercise more. (McNight’s Senior Living) Doctors say they feel new performance improvement and value-based reimbursement models represent change done to them, not with them. A survey by Harvard Business Review and Bain & Company finds doctors understand cost challenges, but they’re not convinced new payment models will result in better outcomes. More than 70 percent say they prefer the fee-for-service model, and a majority believe capitation reduces care quality. Organizations that are highly engaged in the process are more satisfied and committed to change. (Harvard Business Review) A study in the October issue of HealthAffairs finds that, while most emergency department frequent flyers taper off acute usage over the course of a year or so, a “small but nontrivial” portion continues frequent ED visits--some for more than a decade. A second study based on Colorado’s Bridges to Care initiative found that a coordinated, multi-disciplinary care program targeting frequent ED users successfully reduced ED visits and hospitalizations while increasing primary care visits by 123 percent. (HealthAffairs persistent ED use article; Health Affairs coordination program article) Float therapy is being tested as a nonpharmacological treatment in labs, but commercial float pools are becoming more common. In this broadcast, a doctor searching for an alternative to anxiety medications takes a test run in a float pool. Researchers use heavy concentrations of salt to lift patients into an effortless, stress-bending state of relaxation. Results can last up to 24 hours. (National Public Radio)
MarketVoices...quotes worth reading“As faith-inspired practitioners, a parish nurse can look at the whole person. Sometimes the healing is an emotional or spiritual thing as well as a physical one." – Susan Hutchinson, executive director of affordable housing for Lutheran Senior Services, quoted in McNight's Senior Living.
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