Archive for the ‘Healthcare Reform’ Category

President Trump Halts CSR Payments, Signs Executive Order on ACA Components

October 12th, 2017 by Melanie Matthews

The Trump Administration has called for the discontinuation of cost-sharing reductions (CSR) payments to health insurance companies based on a legal opinion from the Attorney General. President Trump also signed three executive orders directing the appropriate federal agencies to examine three Affordable Care Act (ACA) components: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).

“CSR payments are prohibited unless and until a valid appropriation exists,” said HHS Acting Secretary Eric Hargan, referring to the legal opinion from the Attorney General’s Office regarding CSR payments.

According to August 2017 estimates from the Congressional Budget Office and the Joint Committee on Taxation on the impact of ending CSR payments, the number of people uninsured will be approximately 1 million higher than under the baseline in 2018 but about 1 million lower in each year starting in 2020. In 2018, under the policy, the largest effect on coverage would derive from the drop in the number of insurers participating in the non-group market.

The CBO and JCT also estimated that by 2020, the effect on coverage would stem primarily from the increases in premium tax credits, which would make purchasing non-group insurance more attractive for some people. As a result, a larger number of people would purchase insurance through the marketplaces, and a smaller number of people would purchase employment-based health insurance.

President Trump also signed Executive Orders that direct the:

  • Secretary of Labor to consider expanding access to AHPs;

  • Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost STLDI; and

  • Departments of the Treasury, Labor, and Health and Human Services to consider changes to HRAs.

Each of these components will be subject to the federal government’s rulemaking process and will not have an impact on this year’s open enrollment period under ACA.

Industry reaction was mixed to the Executive Orders:

  • “Health plans remain committed to certain principles. We believe that all Americans should have access to affordable coverage and care, including those with pre-existing conditions. We believe that reforms must stabilize the individual market for lower costs, higher consumer satisfaction, and better health outcomes for everyone. And we believe that we cannot jeopardize the stability of other markets that provide coverage for hundreds of millions of Americans. We will follow these principles – competition, choice, patient protections and market stability – as we evaluate the potential impact of this executive order and the rules that will follow. We look forward to engaging in the rulemaking process to help lower premiums and improve access for all Americans,” said Kristine Grow, Senior Vice President, Communications, America’s Health Insurance Plans (AHIP).

  • The American Hospital Association (AHA) said while the “Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections. No one can predict future health care needs with complete certainty and such plans could put patients at risk when care is needed most.”

    In addition, said the AHA, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options. And, regarding consolidation, respected economic studies demonstrate that the hospital field’s trajectory has resulted in both cost savings and quality improvements. The AHA is encouraging the Administration to achieve the goal of ensuring that individuals and small businesses have affordable, comprehensive healthcare coverage options without sacrificing critical consumer protections by stabilizing the individual and small group markets.

2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Infographic: Medicaid’s Role in Behavioral Healthcare

May 19th, 2017 by Melanie Matthews

Medicaid restructuring as proposed in the American Health Care Act could limit states’ ability to care for people with behavioral health conditions, according to a new infographic by the Kaiser Family Foundation.

The infographic details how Medicaid currently enables people with behavioral health needs to access care and how reduced federal spending could limit behavioral health coverage and services.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Infographic: A Look Back at Healthcare Steps in Trump’s First 100 Days

May 15th, 2017 by Melanie Matthews

In the first 100 days of his administration, President Donald J. Trump has taken a number of actions that could impact healthcare, including filling a Supreme Court seat and taking steps to repeal the Affordable Care Act, according to a new infographic by AJMC.

The infographic examines some of the most notable healthcare-related happenings in Trump’s first 100 days in office.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: What Millennials Want From Healthcare

April 24th, 2017 by Melanie Matthews

Millennials are the healthcare wildcard for policy makers, insurers, healthcare providers and employers, according to a new infographic by Benenson Strategy Group.

The infographic explores whether Millennials will redefine healthcare based on their unique experiences, attitudes and viewpoints or engage more predictably with the healthcare industry based on a lifecycle model.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: U.S. Public Opinion on Healthcare Reform

April 7th, 2017 by Melanie Matthews

Both Democrats and Republicans give top priority to lowering out-of-pocket costs for healthcare as a key tenet needed in healthcare reform, according to a new infographic in the Visualizing Health Policy series by the Kaiser Family Foundation and the Journal of the American Medical Association.

The infographic details other health reform priorities by the U.S. population in general and by political affiliation.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

American Health Care Act Fails to Deliver for U.S. House of Representatives’ Vote

March 27th, 2017 by Melanie Matthews

The American Health Care Act, designed to repeal and replace parts of the Affordable Care Act (ACA), was pulled from a vote by the U.S. House of Representatives on Friday, March 24th, by House Speaker Paul Ryan.

With mounting opposition to the bill from the House Freedom Caucus and Democrats, the bill did not have the votes to pass.

Healthcare industry groups, including the American Medical Association, the American Hospital Association and AHIP had also voiced concern over key aspects of the legislation (see Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’).

The White House has indicated it will now take a wait and see approach to health reform.

What’s your take on the failure of the American Health Care Act to achieve the support of the U.S. House of Representatives and the Trump Administration’s steps to repeal and replace the ACA? What aspects of the ACA are working? What needs to be fixed? Share your thoughts in our comments section below.

Infographic: Comparing the Affordable Care Act and the House Republican Bill

March 8th, 2017 by Melanie Matthews

Comparing the Affordable Care Act and the House Republican BillRepublicans in the U.S. House of Representatives released on Monday legislation to repeal and replace the Affordable Care Act (ACA).

A new infographic by the New York Times compares the key features of ACA with what has been proposed by the House Republicans.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you’d like featured on our site? Click here for submission guidelines.

5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve “MACRA-readiness.”

  • The first component for success is perhaps the most important, and that’s having a culture of provider support. A willingness to explore new options. This component is free, so if you don’t have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you’ve got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That’s important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don’t have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I’ve experienced teams that didn’t work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You’ve got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn’t mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Infographic: Effects of President Donald Trump’s Healthcare Reform Proposals

January 25th, 2017 by Melanie Matthews

There are four options under President Donald Trump’s Affordable Care Act repeal and replace, according to a new infographic by NEJM Catalyst.

The infographic examines the impact of each of these options on: the number of uninsured, the number of individuals in poor health; the annual average out-of-pocket expenses for the individual market; and the impact on the federal deficit.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you’d like featured on our site? Click here for submission guidelines.