Anthem disclosed in February 2015 that hackers had infiltrated its systems beginning in February 2014 using malware installed through a phishing email.
Anthem Inc. on Wednesday announced that it had reached a multistate settlement that resolves a months-long 2015 data breach that exposed the personal information of 78.8 million customers nationwide.
Calling itself "a victim of a sophisticated state-sponsored criminal attack group," the Indianapolis-based health insurer said it had cooperated with state attorneys general throughout the investigation before agreeing to the settlement.
Anthem disclosed in February 2015 that the hackers had infiltrated its systems beginning in February 2014 using malware installed through a phishing email.
"The company is pleased to have resolved this matter, which is the last open investigation related to the 2015 cyber-attack," Anthem said in a media release. "Anthem does not believe it violated the law in connection with its data security and is not admitting to any such violations in this settlement with the state attorneys general."
The breach gave hackers access to Anthem's data warehouse, where they stole names, dates of birth, Social Security numbers, healthcare identification numbers, home addresses, email addresses, phone numbers, and employment information.
Anthem will also adhere to more stringent data security and good governance provisions designed to strengthen its practices going forward.
The settlement already cost Anthem $115 million to establish a class action settlement fund for credit monitoring and payments of up to $50 for customers.
Stakeholders say legislation to support coverage parity is needed for continued post-pandemic access to telehealth services.
A coalition of Illinois healthcare providers and patient advocates want the state's general assembly to make permanent the temporary regulatory "flexibilities" that were authorized for telehealth services during the COVID-19 pandemic.
In a letter this week to every member of the Illinois General Assembly, the Coalition to Protect of Telehealth praised Gov. J.B. Pritzker and the state's Department of Healthcare and Family Services for a March 19 executive order that "temporarily lifted longstanding barriers to service access via telehealth for commercial health plans and Medicaid."
Among other things, the executive order expanded the definition of telehealth services and access points for consumers, loosed restrictions on physician licensing, and barred private insurers from charging copays and deductibles for in-network telehealth visits.
"In response," the stakeholders wrote, "healthcare providers rapidly invested in new technology, adjusted clinical workflows and educated staff, patients, and clinicians on telehealth delivery."
However, unless state lawmakers make the executive order permanent, the coalition wrote that "providers and professionals will not have the certainty they need to continue to invest in and utilize new care delivery tools, and Illinois residents will abruptly lose access to the telehealth services they have relied on during the pandemic."
Thirty-six states had coverage parity policies in place before the pandemic, and 16 states payment parity for commercial health plans. Illinois requires neither.
For Medicaid, 21 states have coverage parity policies and 28 states had payment parity. Illinois offers limited Medicaid coverage for telehealth services and has no laws that direct the Medicaid program to treat telehealth and in-person services the same.
A federal report this summer found that 47% of Medicare fee-for-service primary care visits in Illinois were provided via telehealth in April, compared with an average of less than 1% before the COVID-19 public health emergency.
Medicare Advantage plans reported that telehealth use among beneficiaries rose by 52% this spring, and that 91% of seniors reported a favorable experience with telehealth. As in-person visits have since resumed, and while telehealth use has tapered somewhat, it still accounted for 20% of all visits by the start of June.
The stakeholders also laid out for lawmakers a 10-point plan that they said should be model telehealth reform legislation that would guarantee coverage and payment parity with in-patient services.
The Coalition to Protect Our Telehealth includes: AARP Illinois; American Nurses Association-Illinois; Association of Community Mental Health Authorities of Illinois; Health Care Council of Illinois; Illinois Association for Behavioral Health; Illinois Critical Access Hospital Network; Illinois Health and Hospital Association; Illinois Health Care Association; Illinois Occupational Therapy Association; Illinois Primary Health Care Association; Illinois Psychiatric Society; Illinois Society of Advanced Practice Nursing; Illinois State Medical Society; The Kennedy Forum; and LeadingAge.
A new study found that 27% of U.S. personal healthcare expenses were attributable to risk factors such as obesity and smoking.
Modifiable health risks such as smoking, obesity and high blood pressure have been associated with more than $730 billion in U.S. healthcare spending, according to a study published Wednesday in The Lancet Public Health.
The study, conducted by researchers from theInstitute for Health Metrics and Evaluationat the University of Washington School of Medicine, and wellness advisors Vitality Group, looked at the $2.7 trillion spent on U.S. healthcare in 2016, and determined that 27% of the spending was attributable to five modifiable risk factors, including; overweight and obesity, $238.5 billion; high blood pressure, $179.9 billion; high fasting plasma glucose, $171.9 billion; dietary risks, $143.6 billion; and tobacco smoke, $130.0 billion.
"Given that U.S. healthcare expenses are almost double that of other developed nations, we set out to understand how much of these expenses could be attributed to modifiable risk factors," said study author Francois Millard, chief actuarial officer at Vitality.
"While the relationship between lifestyle risks and medical conditions is understood, this is the first study to offer a comprehensive analysis of health spending related to such risks," he said. "This can help inform how we as a society invest our resources and why health should be part of all policy discussions, not just those related to sickness."
Researchers used IHME's Disease Expenditure Study 2016to estimate U.S. personal healthcare spending by condition, age, and sex and merged these estimates with population attributable fraction estimates for 84 modifiable risk factors from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017to produce estimates of spending by condition attributable to these risk factors.
Modifiable, treatable risks were strongly linked to costly medical conditions – including cardiovascular disease, cancers, diabetes, and chronic respiratory diseases. That spending increased significantly with age, with the greatest proportion of spending associated with people aged 65 years and older (44.8%).
"Looking at risks allows U.S. to better understand where these costs start, since unmanaged risk factors often lead to more serious health conditions later in life," said study senior author Joseph Dieleman, a health economist and associate professor at IHME.
"While we can't draw conclusions about possible reductions in spending from this research, the findings illustrate the huge costs tied to poor diets, high blood pressure, smoking, and obesity," Dieleman said.
"Moving forward, it's crucial to focus on preventing and managing these key risks before they turn into costly diseases, so that more people have the chance to live a long and healthy life."
Private buyers of healthcare say they're open to government reforms and new payment strategies.
A solid majority (71%) of the nation's employers are holding firm or accelerating health benefit strategies for their workers, even as the coronavirus pandemic and the ensuing economic downturn disrupts business as usual, according to a new poll from the National Alliance of Healthcare Purchaser Coalitions
Employers are even more receptive to healthcare reforms on a variety of issues including drug price regulation (94%), hospital price transparency (90%), surprise billing regulation (81%) and hospital rate regulation (79%).
Half of employers (50%) said a Medicare public option could be very or somewhat helpful, while 21% felt it could be very or somewhat harmful. When asked about Medicare for All, 46% of employers indicated that would be very or somewhat harmful," the survey found.
The online poll was conducted in August and September with 165 employers that are members of coalitions affiliated with the National Alliance.
"Employers are maxed out as to what they and their employees and family members can shoulder for healthcare costs and they continue to be concerned about the sustainability of privately-sponsored healthcare," said National Alliance President and CEO Michael Thompson.
"Looking forward, they are working to shift market dynamics to get better value for their healthcare dollars through delivery-based strategies such as advanced primary care and centers of excellence, and there is also an increasing openness to government action," he said.
The survey also found that:
Caregiving benefits such as leave (30%) and protected time to support employee caregiving (28%) have tripled since the start of the COVID-19 pandemic.
Some employers are considering expanding allowances for emergency day care (13%) and home tutoring or teachers (12%).
Respondents said these market forces present a significant threat: drug prices (90%), lack of transparency (73%), hospital prices (71%), surprise medical bills (58%), and overuse of low-value services/waste (53%).
The top delivery and payment reform strategies employers include reducing waste and inappropriate care (61%) and narrow networks (47%).
Strategies over the next two years include hospital quality transparency (44%), hospital pricing transparency (43%), regional centers of excellence (39%), and advanced primary care (36%).
The most prevalent medical and pharmacy drug strategy employers now use is medication therapy management (49%). One in three will be considering strategies in medical and pharmaceutical drug transparency and pass through pricing (33%) the next two years.
Health and wellbeing strategies now being implemented include flexible work week (65%), total person health and wellbeing (63%), navigation and advocacy services (55%), and enhanced mental health support (49%).
Most employers are encouraging community volunteerism (71%) and engagement in community improvement (70%), and 58% said they are offering anti-racism education and cultural competency training (52%).
Over the next two years, 40% said they are considering programs for transparency and education for healthcare disparities, and access to aggregate health data by race/ethnicity.
Elizabeth Mitchell, president and CEO of Pacific Business Group on Health, said the survey illustrates that "rising healthcare costs continue to burden our businesses and employees, and they are crowding out jobs, wages, and in the age of COVID, our economic recovery."
"The results of this survey reinforce employers' justified concerns about how high drug and hospital prices, surprise medical bills and continued overuse of low-value healthcare services threaten the health and economic security of American businesses and workers," Mitchell said.
"Employers well understand that healthcare is broken and that they can no longer wait for the system to fix itself."
The pandemic virtually shut down elective procedures for much of 2020, but that may not be the case in 2021.
Thanks to the coronavirus pandemic, the use of healthcare services took a nosedive in 2020. But a new analysis suggests that the lull may be over in 2021.
A new analysis from consultants Willis Towers Watson projects that the costs of healthcare benefits in 2021 are likely to increase above and beyond non-pandemic projections as care deferred in 2020 is pushed into the future.
"COVID-19 has played havoc with all previous projections of health care utilization levels," said Trevis Parson, chief actuary, Willis Towers Watson.
"In 2020, we may see a reduction in national healthcare expenditures on a per capita basis for the first time since 1960," Parson said. "However, this reversal in trend is highly likely to be only temporary, despite the continued uncertainty about the virus, as previously deferred care returns in 2021.”
Examining medical claims, Willis Towers Watson looked at four potential future patterns of COVID-19 infection and their impact on the care delivered to COVID-19 and non-COVID-19 patients.
The analysis found employer healthcare costs in 2020 will likely come in between 3.3% and 8.8% lower than originally expected because of the pandemic, as system capacity shifts and a fear of contracting the virus in medical settings continue to depress volumes.
In 2021, however, costs are expected to rise again, between 0.5% and 5.0% above non-pandemic projections due to continued care for COVID-19 patients and delivery of previously deferred non-COVID-19 care, Willis Tower Watson said.
When 2020 and 2021 are combined, the study shows cost reductions of between 2.8% and 3.8% from non-pandemic levels across the four patterns.
Parson said the impact of COVID-19 on employer plans will differ based on geographic factors.
"Employers need to pay special attention to the impact of COVID-19 on their healthcare spend," he said. "The pandemic is driving significant volatility, which demands effective measurement."
Parson said broader changes to the healthcare system are likely to result, which will challenge employers as they look to drive value to employees through their health care plans.
"Employers will need to understand the rapidly changing health care market landscape and the shifting needs and risk profiles of their workforce," he said.
The appointment comes as the pediatric health system contemplates staff cuts and relocating services in the face of the COVID-19 pandemic and declining birth rates.
Veteran healthcare executive Bess Musser has been named vice president of revenue services at Children's Minnesota, the Twin Cities-based pediatric heath system announced Monday.
"I look forward to joining Children's Minnesota and hitting the ground running during a critical time as the organization focuses on growing and enhancing its current revenue cycle performance," Musser said in a media release. "I am thrilled to have the opportunity to put my expertise to work for an organization that is so vital to our community."
Musser duties will include implementing strategies to improve revenue cycle performance, in partnership with leaders and teams across the organization.
In addition, she will manage the system-wide process for the end-to-end revenue cycle functions, including patient access, health information management, patient financial services, billing, coding, regulatory compliance, accounts receivable, and budgeting and reporting.
Musser comes to Children's Minnesota as the state's largest pediatric hospital contemplates major reforms that could include staff cuts and a relocation of services from St. Paul to Minneapolis.
In aninterview this month with the Minneapolis Star Tribune, Children's CEO Marc Gorelick, MD, said the changes were part of a broader plan to transition some services to virtual care, and improve supplies acquisitions and financial services.
"It's been a long time since we've had significant layoffs at Children's," Gorelick told the newspaper, adding that the redesigns are not entirely motivated by COVID-19 but by long term trends.
"One of them is declining birthrates. One of them is increased emphasis on value-based care" contracts that change reimbursements from health insurers," Gorelick said.
Messer joins Children's Minnesota after 20 years at University of Minnesota Physicians, working in various capacities that focused on operational improvement initiatives, including the transition to integrated electronic health-practice management.
Before that, Musser was a senior consultant at McGladrey & Pullen, LLC.
"Beth is known for her ability to innovate across the revenue cycle and for her drive to challenge the status quo to advance the organization," said Brenda McCormick, CFO at Children's.
The Washington State-based health insurer self-reported the breach, which was discovered 2015 and may have affected more than 10.4 million beneficiaries over nearly nine months.
Premera Blue Cross will pay the federal government $6.85 million to settle potential violations of the Health Insurance Portability and Accountability Act Privacy and Security Rules for a nearly nine-month-long data breach that may have exposed the personal information of more than 10.4 million people, the Department of Health and Human Services Office of the Inspector General announced.
OCR Director Roger Severino said the settlement is the second-largest payment to resolve a HIPAA investigation in OCR history and should serve as a warning.
"If large health insurance entities don't invest the time and effort to identify their security vulnerabilities, be they technical or human, hackers surely will," Severino said. "This case vividly demonstrates the damage that results when hackers are allowed to roam undetected in a computer system for nearly nine months."
PBC self-reported the breach on March 17, 2015, stating that hackers had accessed its IT system, using a phishing email to install malware that gave them access to PBC’s IT system in May 2014.
The hack went unreported for nearly nine months until January 2015, and resulted in the disclosure of protected health information of more than 10.4 million people, including their names, addresses, dates of birth, email addresses, Social Security numbers, bank account information, and health plan clinical information.
OCR's investigation found systemic noncompliance with HIPAA rules at PBC, including failure to conduct an enterprise-wide risk analysis, and failures to implement risk management, and audit controls.
More than 1,600 Medicare Advantage and Part D prescription plans will cap insulin monthly copays at no more than $35.
Medicare Advantage premiums in 2021 will be 34.2% lower than they were in 2017, with a monthly average that will be the lowest since 2007, the Trump administration announced Thursday.
In addition, Trump officials said that more than 1,600 Medicare Advantage and Part D prescription plans will cap insulin monthly copays at no more than $35.
"Historically low premiums, massive savings on insulin, and more supplemental benefits represent the welcome fruit of the creative, patient-oriented policies that this administration has made its calling card. Medicare beneficiaries will feel the difference – in their health as well as their pocketbook," she said.
The announcement comes weeks before the annual open enrollment period for Medicare. About 26 million people are projected to enroll in Medicare Advantage. The trending lower Medicare Advantage premiums have saved beneficiaries nearly $1.5 billion since 2017, CMS said.
In addition:
The Medicare Advantage average monthly plan premium is expected to decrease 11% to $21 in 2021 from an average of $23.63 in 2020. In some states including Alabama, Nevada, Michigan, and Kentucky, beneficiaries will see average premium decreases of over 50% since 2017.
Beneficiaries will have about 2,100 more Medicare Advantage plans operating in 2021 than in 2017, a 76.6% increase. Beneficiaries can choose from more than 4,800 Medicare Advantage plans during 2021 open enrollment.
The average number of Medicare Advantage plan choices per county will increase from about 39 plans in 2020 to 47 plans in 2021, a 78.5% since 2017. The number of plan options in rural counties has increased to 2,900 in 2021 from about 2,450 in 2020, an 18%.
The projected Medicare Advantage enrollment for 2021 would be a 44% increase since 2017.
Starting in 2021, beneficiaries with End Stage Renal Disease can enroll in a Medicare Advantage plan.
The average basic Part D premium will be approximately $30.50 in 2021. Part D premiums have decreased by 12% since 2017, saving beneficiaries nearly $1.9 billion.
Part D continues to be an extremely popular program, with enrollment increasing by 16.7% since 2017.
Since 2017, beneficiaries have saved approximately $3.4 billion in combined Medicare Advantage and Part D premium costs.
Delaney succeeds Joseph Iannotti, MD, who served as interim CEO and president for the $1.8 billion Florida region since June.
Conor Delaney, MD, has been named president and CEO of the five-hospital Cleveland Clinic Florida region, effective Oct. 15, the health system announced this week.
Delaney succeeds Joseph Iannotti, MD, Ph.D., who served as interim CEO and president for the $1.8 billion Florida region since June. Iannotti will return to his roles as Chief of Staff, and Chief Academic and Innovation Officer for the Cleveland Clinic Florida region.
"I am incredibly excited to join the Cleveland Clinic Florida team and contribute to our mission of providing patients access to Cleveland Clinic care, while helping grow research and education throughout the region," Delaney said in amedia release.
Delaney is a colorectal surgeon and professor of surgery with more than 30 years of experience in healthcare. He joined Cleveland Clinic in 1999 as a fellow and began his career at Cleveland Clinic in 2000 on the clinical associate staff.
Delaney now serves as chairman of Cleveland Clinic's Digestive Disease and Surgery Institute, with oversight of the departments of Colorectal Surgery, Gastroenterology, Hepatology, Nutrition and General Surgery throughout Cleveland Clinic.
The institute has more than 240 staff physicians, more than 80 advanced practice providers, and 140 residents and fellows, who perform 48,000 surgical cases and 90,000 endoscopic procedures each year.
Delaney earned his medical degree from University College Dublin Medical School. In 1992. He became a fellow of the Royal College of Surgeons in Ireland and earned his master’s degree in surgery in 1994.
His doctorate degree is from the University of Pittsburgh. He holds the Victor W. Fazio, M.D., Endowed Chair in Colorectal Surgery.
Weston-based Cleveland Clinic Florida includes five hospitals across the southeastern corner of Florida, outpatient venues, and a newly opened Cleveland Clinic Florida Research and Innovation in Port St. Lucie, north of Palm Beach.
"Dr. Delaney's accomplishments and leadership experience will further advance our mission and expand our capabilities throughout Florida," said Cleveland Clinic CEO and President Tom Mihaljevic, M.D. "He brings a remarkable dedication and commitment to providing the highest level of quality and safe care for our patients."
Iannotti has been serving as interim CEO since the departure in late June of Wael Barsoum, MD, an orthopedic surgeon, who left the health system he led for six years to become president and chief transformation officer at privately held HOPCo, which operates orthopedic practices, specialty hospitals, ambulatory surgery centers, medical risk management.
At the time of Barsoum's departure, Cleveland Clinic was hemorrhaging red ink and cutting staff and services because of the COVID-19 lockdown, but Barsoum told local media that was not why he stepped aside.
"I am choosing to leave for another job," he told the South Florida SunSentinel in June. "It has nothing to do with Cleveland Clinic cutting costs. I’m just ready for a change."
Baroum, an orthopedic reconstruction specialist, remains on staff at Cleveland Clinic Florida Professor of Surgery in the Cleveland Clinic Lerner College of Medicine.
University of South Florida researchers estimate COVID-19 has caused "2 million years of lost life."
The United States recorded 200,000 deaths from COVID-19 this week, but a new study this week suggests that the grim milestone does not fully reflect the effect of the disease.
A study by researchers at the University of South Florida and published in the Journal of Public Health suggests that measuring "years of life lost" is a better metric than deaths, because it accounts for the range of ages of the people who've died from COVID-19.
"While death counts are a vital initial measure of the extent of COVID-19 mortality, they do not provide information regarding the age profile of those who died," said lead author Troy Quast, professor of health economics in the USF College of Public Health.
"By contrast, years of life lost tell us the extent to which deaths are occurring across age groups and can potentially help healthcare providers and policymakers better target clinical and governmental responses to reduce the number of deaths," he said.
Using a tool is often used to determine the effects of non-communicable disease, drug misuse and suicide, the researchers found that for every U.S. COVID-19 death, an average of nearly 10 years of life had been lost.
The USF researchers obtained data from the Centers for Disease Control and Prevention that report COVID-19 death counts by sex, age and state from Feb. 1 to July 11, during which there had been roughly 130,000 COVID-19 deaths reported.
They compared the ages at death to life expectancies by age and gender from the U.S. Social Security Administration and to population data from the U.S. Census Bureau and calculated that COVID-19 had caused 1.2 million years of life lost during that timeframe.
While the analysis only covered the period through mid-July, if past trends were to have continued, that figure at this point would approach 2 million, Quast said.
Researchers adjusted for the higher rate of pre-existing conditions among COVID-19 deaths by reducing expected life expectancy by 25%.
Close to 80% of U.S. COVID-19 deaths are among people ages 65 and older. Another significant factor is pre-existing medical conditions. Men have more pre-existing medical conditions than women and accounted for 55% of deaths attributed to COVID-19
Measuring COVID-19 deaths has been difficult due to evolving diagnostic criteria, testing supply constraints and the uncertainties that occur in over-burdened intensive care units. Quast says it's vital to continue monitoring years of life lost due to COVID-19 to help policy makers and health care providers better understand the extent of the outbreak.
