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Doing More Harm Than Good

Several healthcare groups, including the American Hospital Association and Blue Cross and Blue Shield plans, have joined coalitions that oppose “Medicare for All” plans, according to The New York Times.

Three things to know:

1. While 2020 presidential hopefuls incorporate Medicare for All into their platforms, hospitals, physicians, drugmakers and insurers are lobbying against the idea and proposed legislation.

2. In June 2018, the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created a coalition to combat Medicare for All proposals. The lobbying group, the Partnership for America’s Health Care Fund, also includes the American Medical Association, the AHA and Blues plans, according to the NYT.

3. The AHA’s president and CEO, Rick Pollack, recently cautioned against Medicare for All proposals in a Feb. 22 blog post, writing that such legislation “could do more harm than good to patient care.”

Source: Morgan Haefner, Becker’s Hospital Review.

Drug Coverage Proposal

Improvements in the cost of medications for Medicare-eligible customers may not be too far off. The Centers for Medicare and Medicaid (CMS) has proposed some new ways to lower drug costs for those in the Medicare program, and with drug coverage through a stand-alone prescription drug plan or with a Medicare Advantage plan that includes drug coverage.

One provision in the proposal targets e-prescribing and would require the person’s plan “to adopt a provider Real Time Benefit Tool by the start of 2020.

“‘RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs,’ CMS stated.

Another provision of the CMS proposal is that drug coverage Explanations Of Benefits (EOBs) that people receive from their plans will be tasked with including drug pricing information and lower cost therapeutic alternatives as part of these EOBs to give customers the information in hand that can also potentially help them lower their out-of-pocket costs for their particular medications.

This is not a comprehensive list of the provisions of the CMS proposal which could become a set of new rules in the near future. However, we do want to get info about these two particular provisions out there, so everyone can have confidence in any changes to come and know there will be tangible things for American households coming that can help lower their drug costs.

Source: Kyle Murphy, “HealthPayer Intelligence.”

New Hampshire is Next!

“The CMS on Monday, May 7th, gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

“The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

“‘Today’s announcement by the CMS … is a transformative step towards a more thriving workforce,’ Gov. Chris Sununu said in a written statement. ‘Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs—we are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.'”
Source: Steven Ross Johnson, Modern Healthcare.

CMS Encourages Innovation!

On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

New to Medicare: Some DNA Tests

“The CMS announced Friday that it will cover diagnostic laboratory tests using gene sequencing technology for Medicare cancer patients.

“The CMS said the tests — called next generation sequencing — can help patients and their oncologists make better treatment decisions as well as help more patients enroll in clinical trials. Patients with recurrent, metastatic, relapsed, refractory or stages III or IV cancers will be eligible to get the tests covered under Medicare, according to the agency.

“‘We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways,’ said CMS Administrator Seema Verma in a statement. ‘That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve.’

“The CMS’ decision to cover such tests comes shortly after the FDA’s recent approval of Foundation Medicine’s genomic profiling test called FoundationOne CDx. The CMS worked with the FDA to review the effectiveness of the test.” Source: Maria Castellucci, Modern Healthcare.

CMS: “Patients Over Paperwork”

CMS Administrator, Seema Verma,  has announced the initiative to ease the burden of records and reporting management in medical pracctices.  Nationally, medical providers and staff typically spend a disproportionate amount of time on maintaining medical records in comparison to actual patient care.

“On a typical day, primary care doctors spent about 27% of their time on “meaningful patient care” and about 49% on administrative activities, he said, according to a 2016 study published in Annals of Internal Medicine.”

The new initiative, “Patients Over Paperwork,”  seems to be set to review current regulations and eliminate those that may not be adding to quality of care, or possibly unnecessary altogether.  The coming steps to be taken have the potential, in the long run, to lower today’s healthcare costs, increase efficiency and benefit both the healthcare industry and the people in America directly.  Source:  Medpage.

Update: Large Employer Insurance

“Consumers who get health insurance through their jobs won’t see rate hikes in the double digits like those on the Obamacare exchanges, but they’ll still see the cost of health care go up.

“Large employers estimate that the employee share of health insurance costs next year will be $4,400, up from $4,200 this year, according to a new report from the National Business Group on Health. On average, employers will continue to cover about 70 percent of the total costs, which they project will increase by 5 percent to $14,156.

“As the price of insurance continues to go up, more companies are looking into different kinds of plans. If your company doesn’t offer a high-deductible health insurance plan, it probably will soon.

“The plans, which shift some costs from the company to the worker and encourage consumers to shop around for health care, are becoming far more common. In 2018, nine in 10 large employers will offer at least one high-deductible health plan, up from 84 percent last year, according to NBGH.”  Source: Beth Braverman, Financial Times.

Guideline:  Large Employers have 50 or more full-time equivalent employees (working 30 or more hours per week).

Currently almost 4 out of every 10 companies have only high-deductible health plans as their only plans available for employees.  This trend is predicted to continue across America, with about 97% of large employers making a high-deductible health plan an option for employees to keep their premium cost lower.

The National Business Group on Health has also found trends in large employers offering plans with tele-medicine available and providing onsite health centers for treatment of minor medical issues.

 

Anthem ’18 ACA Only in 5 IN Counties

Anthem has confirmed that in Indiana, next year, it will only be offering Affordable Care Act individual/family plans in 5 counties.  The 5 Northwest Indiana Counties include:  Newton, Jasper, White, Benton, and Warren.

Current Anthem individual/family plan customers will be able to continue with their current coverage through December 31, 2017.  These plans will terminate effective January 1, 2018.

All Indiana residents with an individual/family plan that is terminating will receive notification via US Mail in early September.

Anthem Will Not Offer ACA Plans in Indiana in ’18

Just Anounced:  Anthem will not be offering Affordable Care Act plans on the federal exchange in Indiana in 2018.  At this time it appears that it will only be offering off-exchange (subsidy in-eligible) plans in 5 counties: Benton, Newton, White, Jasper and Warren.

Additionally, MD Wise has announced they will not be offering ACA plans in Indiana in 2018.  It will instead be focusing on its Medicaid business.

The loss of these insurers in 2018, in the ACA market, will affect about 76,800 Hoosiers.

Source: Indy Star.

Insurance Companies Have Deadline

“The federal deadline for insurers to file rate proposals with the federal government is June 21. Many insurers had been hoping that the Trump administration would say for certain whether it would continue to pay cost-sharing reduction (CSR) subsidies for covering low-income enrollees.

“No such assurances from the administration appear to be coming, leaving insurers with a difficult choice.

“Next week’s filings will give the most comprehensive look yet at what the ObamaCare markets could look like next year. It’s not clear whether the Trump administration will make the requests public, though sometimes individual states will release the information for their insurers.

“Still, early filings already show several insurers requesting double-digit rate increases. Some have already announced they won’t participate in the law’s marketplaces next year, leaving an unprecedented 47 counties with no options on the exchanges for 2018.

“‘We’ve seen so far pretty high premium increases in a number of states. Some of that seems to be because of uncertainty insurers are facing over CSR payments and individual mandate enforcement,’ said Cynthia Cox, an insurance expert with the Kaiser Family Foundation.”  Source: The Hill.