Healthcare Business Week in Review: Infectious Disease Threats, Health Insurance, Bundled Payments

Monday, December 23rd, 2013
This post was written by Cheryl Miller

From antibiotic-resistant superbugs to salmonella to the seasonal flu, infectious diseases are disrupting lives throughout the country at an alarming rate, and driving up medical costs, and most states are unable to counter them, according to a report by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

The problem? Outdated systems and limited resources. In fact, 34 states scored five or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats.

One solution offered in this comprehensive analysis is to be more vigilant with vaccinations; only one-quarter of states vaccinated at least half of their population against the seasonal flu, which affects 20 percent of Americans each year. Details inside.

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

The analysis is the first such report to take a national look at the explanations insurers file with federal and state authorities to justify rate increases of 10 percent or more, as required by the ACA. Currently, insurers are only required to submit rate increase explanations for non-grandfathered plans, or those plans that became available after the enactment of the health reform law.

People whose existing healthcare insurance has been canceled because of the ACA will not be hit with tax penalties for failing to line up new coverage as required under the law, according to Health and Human Services Secretary Kathleen Sebelius. Under a “temporary hardship exemption,” they will be able to buy a bare-bones catastrophic plan regardless of their age.

Reducing health insurance premiums is one strategy employers are using to incent their employees to self-manage their health. Healthcare companies have grown increasingly creative in their use of economic and benefit-based incentives to drive engagement and participation in health and wellness programs, according to Healthcare Intelligence Network research.

Reducing joint replacement payments – specifically knees, which, at 600,000 annually, are the most commonly performed knee replacement procedure in the United States – is the aim of Florida Blue and Mayo Clinic’s knee replacement bundled payment agreement, first introduced in 2012. They have announced they are extending it, and their overall network agreement to include thousands of Florida Blue’s commercially insured members throughout the state who are now able to access Mayo Clinic as an in-network provider.

And lastly, there is no replacement for a little TLC, in the form of paraprofessionals or nurses visiting the homes of low income pregnant women and their children. Researchers from the University of Colorado School of Medicine found that these helpers, part of the Nurse-Family Partnership, helped improve the health and development outcomes for the children ages six through nine.

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