HealthLeadersMedia.com - Health Plan News & Analysis

Healthcare Costs Hit Record High, But Growth Rate Slows

Fri, 24 May 2013 12:28:00 GMT

The 2013 Milliman Medical Index pegs the annual cost of PPO coverage at 6.3% higher than last year. Physician and other professional services account for one third of annual healthcare spending.

Clock ticking on full Medicaid expansion funds

Fri, 24 May 2013 11:12:00 GMT

States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it's unclear whether they would be able to tap into the money before 2015. Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year's legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions.

Immigrant healthcare bills stump House group

Fri, 24 May 2013 11:09:00 GMT

WASHINGTON -- Differences over whether immigrants should be deported for failing to have health insurance or pay their healthcare bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul. Negotiators emerged upbeat from a closed-door meeting in the Capitol and said they remained on track to produce a bill by June. That, in itself, was significant, after the group of eight was on the verge of breakup. "We were all positive that we can move forward," said Rep. Raul Labrador of Idaho, a top Republican leading the bipartisan effort.

Some unions now angry about healthcare overhaul

Fri, 24 May 2013 11:05:00 GMT

WASHINGTON -- When President Barack Obama pushed his health care overhaul plan through Congress, he counted labor unions among his strongest supporters. But some unions leaders have grown frustrated and angry about what they say are unexpected consequences of the new law - problems that they say could jeopardize the health benefits offered to millions of their members. The issue could create a political headache next year for Democrats facing re-election if disgruntled union members believe the Obama administration and Congress aren't working to fix the problem.

CA picks 13 health plans for state-run insurance market

Fri, 24 May 2013 11:03:00 GMT

After weeks of negotiations, California said it has selected 13 health plans for a new state-run insurance marketplace where as many as 5 million people will shop for coverage next year. Officials at Covered California, the state agency implementing the federal Affordable Care Act, said Thursday that the winning bidders reflected a mix of large commercial insurers and smaller regional plans. The state also released some sample rates, illustrating how premiums will vary across health plans in this new market.

Insurance premiums after ACA kicks in remain a mystery

Fri, 24 May 2013 11:00:00 GMT

Whether health insurance rates under the Affordable Care Act will rise or fall is still a big unknown, as a recent congressional report made clear. Two large New Jersey insurers submitted widely divergent estimates for the future cost of insurance premiums -- one saying they could rise as much as 19 percent, another saying they could fall by up to 25 percent. In addition, one insurer said premiums for small businesses would rise by 16 percent. The costs were provided to Congress with the proviso that the estimates would remain anonymous.

IL Senate approves health insurance exchange

Fri, 24 May 2013 10:49:00 GMT

The Illinois Senate took a key step toward implementing the Affordable Care Act, also known as "Obamacare." Senators approved the creation of a "health insurance exchange." Starting next year, Americans must have insurance or face penalties. Under the Affordable Care Act, states have the option to create their own health insurance exchanges or partner with the federal government. A health insurance exchange is at the heart of the Affordable Care Act. It's a marketplace where people who don't otherwise have insurance -- like through an employer -- are supposed to be able to find it.

How the most powerful woman in healthcare finds balance

Thu, 23 May 2013 12:26:00 GMT

Since taking her post as Secretary of the Department of Health and Human Services (HHS) in 2009, Power Woman Kathleen Sebelius has arguably one of the most difficult jobs in the nation. Just named by Forbes as the 25th Most Powerful Woman in the world, she's not just at the center of one of the most controversial and immensely complicated pieces of legislation in this country – the Affordable Care Act – she's tasked with turning it into a reality. For Sebelius, this involves a nightmare of administrative challenges, particularly given that something on this scale and difficulty has never before been attempted in American history with the possible exception of Franklin Roosevelt's National Recovery Administration which the Supreme Court eventually ruled to be unconstitutional.

UC hospitals cancel surgeries, divert patients amid strike

Thu, 23 May 2013 12:23:00 GMT

A strike by University of California patient care workers Tuesday caused the cancellation of hundreds of surgeries, the closure of laboratory stations and the diversion of emergency room patients, officials said. The hospitals prepared for the two-day strike by postponing elective surgeries and hiring temporary workers, but services still were affected after thousands of employees took to the picket line at the medical centers in Los Angeles, Irvine, San Diego, San Francisco and Sacramento, where the UC Davis facility is located.

Latest from Parkland: All the good stuff happens in executive session

Thu, 23 May 2013 12:16:00 GMT

Parkland Memorial Hospital's board of managers met Wednesday for its monthly committee meetings, an all-day affair starting at 8 a.m. and ending somewhere around 3 p.m. The agendas promised lively discussions about: – The federal Affordable Care Act, which likely will bring dramatic changes to Dallas County's lone public hospital. – Review of recent "safety events" at the hospital, which actually describe mistakes that had the potential to harm patients. And, most importantly, an update on the hospital's efforts to satisfy a System's Improvement Agreement with the federal government, Parkland's on-going effort to retain its government funding. However, none of these discussions occurred during the board’s public session. They took place behind closed doors so that the media and members of the general public could not hear what anyone said.

Opinion: Health IT—Make sure policy umbrella is big enough for all

Thu, 23 May 2013 12:13:00 GMT

The growing trend toward incorporating health information technology (HIT) and patient-defined and patient-generated data into the healthcare delivery system is clear. From funding included in the American Recovery and Reinvestment Act of 2009 to provisions included in the 2010 Affordable Care Act, to the call for inclusion of patient-generated data in Stage 3 meaningful use, HIT implementation is an essential component of federal plans to improve healthcare quality and lower costs. The trend may be clear, but we still need a better comprehension of how broad the range of patient-generated data really is.

KY short 3,800 doctors even before Medicaid expansion

Thu, 23 May 2013 12:10:00 GMT

FRANKFORT, KY. — Kentucky needs 3,790 more doctors, including 183 additional primary care physicians, to meet current demand for care — and those numbers will grow when more Kentuckians get coverage through a Medicaid expansion and health benefit exchange under health reform. Those are some of the findings in a workforce capacity study report by Deloitte Consulting that was the subject of a briefing Wednesday held by the state Cabinet for Health and Family Services. The report is scheduled to be made available on the Kentucky Health Benefit Exchange website next week.

Fortunately, Angelina Jolie Isn't On Medicare

Wed, 22 May 2013 16:56:00 GMT

Most large private payers cover testing for a genetic marker indicating inherited breast cancer risk and will pay for associated prophylactic surgery. But Medicare has no national coverage decision for the test or for preventive mastectomy.

Uncompensated Care Faces a Double Hit in Some States

Wed, 22 May 2013 12:27:00 GMT

Hospitals in states that opt not to expand Medicaid are at a severe disadvantage to their counterparts in other states, not only because they will miss out on additional Medicaid-based reimbursement, but also because they will face the same cuts in disproportionate share funding as everyone else.

House Lawmakers Grill CMS Over Health Exchange Navigators

Wed, 22 May 2013 12:11:00 GMT

The role of navigators, expected to help millions of uninsured make their way through the health insurance market, came under fire Tuesday by members of Congress who raised questions about oversight and the role of the IRS in the implementation of healthcare reform.

Loophole in healthcare law could stick doctors with tab

Wed, 22 May 2013 11:05:00 GMT

A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills. A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims. Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation - but insurers are responsible only for the first month.

End of health price secrecy may be starting in Miami

Wed, 22 May 2013 11:02:00 GMT

When Medicare released thousands of health-care prices this month, one of the biggest criticisms was that these figures didn't represent what patients actually paid. Medicare, for example, pays hospitals on a set fee schedule, regardless of their prices. Health insurance plans typically negotiate a lower rate with a hospital than the sticker price that showed up in the new data. Those prices still remain secret — but that may change. Spurred by the release of the Medicare data, the chief executive of Mt. Sinai Medical Center in Miami has now pledged to release those negotiated rates that tend to be kept secret. Via MedCity News:

Humana CEO sticks with Medicare focus amid funding pressure

Wed, 22 May 2013 11:00:00 GMT

As the federal government squeezes payments for private Medicare plans, Humana Inc. (HUM), the big health insurer most tethered to the government health program, has no plans to shift gears. Instead, the Louisville, Ky., company is pressing ahead with efforts to grow Medicare membership, while making its plans work more efficiently through methods such as providing more intense care upfront for sicker patients. Like other companies running Medicare Advantage plans, which cover more than 14 million Americans, Humana has to find ways to make a good business by doing more with less.

House immigration talks hang on healthcare

Wed, 22 May 2013 10:56:00 GMT

House immigration negotiators have given themselves until the end of the week to hash out language on what kind of health benefits should be available to undocumented immigrants seeking U.S. citizenship, a crucial issue for the talks. If they can't resolve this issue, the four-year immigration negotiations could come to a crashing halt. Top Democrats said late Tuesday they do not think Republicans will walk away from the talks. It was only less than a week ago that the bipartisan House group announced it had reached a tentative agreement on a proposal "in principle" to be introduced in June.

WI hospitals reduce central-line infections

Wed, 22 May 2013 10:53:00 GMT

Painstaking work by Wisconsin hospitals in recent years has sharply lowered the occurrence of one of the most deadly types of infections: those from central lines used to deliver fluids, medication and blood to patients. Infections in intensive care units from central lines — tubes placed in a large vein in a patient's neck, chest or arm — were 56% lower last year than a national baseline established in 2008, according to a report by the Wisconsin Division of Public Health. That progress — which included a 21% reduction from 2011 — has stemmed from a series of initiatives since 2009 by the Wisconsin Hospital Association, as well as from projects by individual hospitals.