Posts Tagged ‘ACA’

Providers, Patients Outline Healthcare Priorities to New HHS Secretary

February 16th, 2017 by Patricia Donovan

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents’ minds.

As Rep. Tom Price settles into his new role as secretary of the Department of Health and Human Services (HHS), organizations representing physician practices, nurses, patient groups and actuaries are making their healthcare priorities known to the newly confirmed administrator.

Concerns range from the future of the Affordable Care Act, which President Trump pledged to repeal in a January 2017 executive order, to specifics of new physician reimbursement programs resulting from MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

In a news release from the American Association of Nurse Practitioners, America’s leading nursing organizations called on the Trump administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. Representing over 3.5 million nurses, the organizations affirmed their shared commitment to advancing patient-centered healthcare and healthcare policies that reflect five key areas ranging from ensuring patients access to healthcare with affordable coverage options regardless of preexisting conditions to creating greater efficiency in the Medicare system.

On the patient side, I Am Essential, a coalition of more than 200 patient groups, asked Price to preserve key ObamaCare protections, including one that guarantees coverage for those with pre-existing conditions.

In its letter, the coalition said certain ObamaCare provisions have provided improved access to care to millions living with chronic and serious health conditions.

“While it is not a perfect law,” the letter stated, “The ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.”

The letter concluded with the following statement: “As you make any changes, we urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious health conditions.”

Meanwhile, a letter from the Medical Group Management Association (MGMA), which represents more than 18,000 U.S. healthcare organizations in which 385,000 physicians practice, asked the new administrator to “significantly reduce the regulatory burden on physician practices and improve the quality and efficiency of healthcare delivery in this country.”

Focused on the federal payor’s new Quality Payment Program resulting from MACRA, the MGMA requested the following from Price, who worked in private practice as an orthopedic surgeon for nearly twenty years prior to launching his political career:

  • A reduction in the cost and reporting burden of the Merit-Based Incentive Payment System (MIPS);
  • A careful review of the eligible Advanced Alternate Payment Program (APM) risk standard and contend there is significant inherent risk in moving from fee-for-service to risk-bearing arrangements, including substantial investment and operational costs, as well as misaligned financial incentives between the payment systems; and
  • Legislative relief from the Federal Physician Self-Referral Law, which MGMA referred to as “a regulatory monster of mind-numbing complexity.”

MGMA represents physician groups of all sizes, types, structures and specialties, and has members in every major healthcare system in the nation.

And finally, the American Academy of Actuaries released three new issue briefs examining a number of key public policy considerations policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act.

The three papers, which address high-risk pools, selling health insurance across state lines, and association health plans, are available on the academy’s site.

“Differences in a reform’s structure can have wide implications for stakeholders and for how it interacts with other reforms that have been or may be adopted,” said Academy Senior Health Fellow Cori Uccello. “For example, high-risk pools can be structured in different ways, with different implications for access to coverage, premiums, and government spending. Further, how regulatory authority is defined for both cross-state insurance sales and association health plans affects whether insurers would compete on a level playing field.”

Value-Based Reimbursement Dominates Healthcare in 2016 and 11 More Industry Trends

December 15th, 2016 by Patricia Donovan

MACRA-Ready: 9 percent said they would participate in an Advanced Alternative Payment (APM) model in 2017.

ACA anxieties aside, value-based reimbursement wielded the most influence over the business of healthcare in 2016, according to the thirteenth annual industry trends snapshot by the Healthcare Intelligence Network (HIN).

Value-based reimbursement also topped the list of lucrative business development areas for 18 percent of respondents, HIN’s industry survey found, followed by chronic care management (14 percent), integration of behavioral healthcare and primary care (11 percent), and telehealth (11 percent).

Sixty-nine percent of respondents consider themselves well positioned to succeed under value-based reimbursement models in the year to come. Additionally, 60 percent report that 2016 was a better year business-wise than 2015.

However, preoccupation with new models of care delivery and payment did not eliminate worry over the post-election fate of the Affordable Care Act (ACA), which President-elect Trump has vowed to repeal or replace. At least 10 percent referenced either the election, ACA uncertainty or the incoming presidential administration when identifying the greatest business challenges they expect to face in 2017.

The annual Healthcare Trends & Forecasts survey, administered in November 2016, captured year-end feedback from more than 100 hospitals, health plans, physician organizations, long-term care providers and others, pinning down the trends impacting the industry in the year to come.

A Look Back: Best and Worst Business Decisions of 2016

Community partnerships, training for integrated care and value-based payments, and participation in CMS Bundled Payment for Care Improvement (BPCI) were among the most successful business decisions of 2016, respondents reported. However, many cited lack of preparation for bundled payments and care delivery transformation, lack of communication, and lack of focus on quality as regrettable 2016 business decisions.

This 2017 roadmap for healthcare also identified the following metrics:

  • Respondents’ pace of MACRA participation for 2017:
    • Eight percent will test MACRA’s Quality Payment Program by submitting partial data in 2017 without fear of negative payment adjustments;
    • Six percent will participate for part of the calendar year;
    • Nine percent said they would participate for the full calendar year; and
    • Nine percent said they would participate in an Advanced Alternative Payment (APM) model in 2017.
  • Growth, hiring and recruitment, and sales and services were the three business areas most impacted by the 2016 economic climate.
  • Healthcare wearables, palliative care and health insurance exchanges had the least impact on respondents’ 2016 business operations.

Download the complimentary HINtelligence report, “Healthcare Trends for 2017: ACA Anxieties Aside, Majority Well-Positioned for Value-Based Reimbursement.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 14th, 2016 by Patricia Donovan

The people have spoken: the future of the ACA is healthcare's most pressing concern for 2017.

The people have spoken: the future of the Affordable Care Act is healthcare’s most consuming concern for 2017.

If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting.

That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the ongoing Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

“The change or replacement of Obamacare might affect us significantly, including changing our USA market priority over other markets,” contributed one respondent.

“We don’t know what ACA repeal implications will mean for us,” offered another.

Other respondents identified “changes to our government structure and the unknown impact” as well as “lack of clarity post-election” as their most pressing concerns for the year ahead.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Given Trump’s ambitious healthcare agenda, much is at stake for industry stakeholders. But is it possible for the incoming administration to unravel the ACA, when the public already has been exposed to many of its provisions? And if repeal is possible, how long might the process take?

Greg Mertz, managing director for Physician Strategies Group, LLC, advises healthcare organizations not to panic about the ACA’s demise. “A ‘“repeal and replace’ means that Trump admits Obamacare can’t go away. Nothing will happen quickly, and whatever happens will be less dramatic than many expect,” predicts Mertz, who points to Trump’s lack of specifics as to what might replace Obamacare as further evidence.

“House Speaker Paul Ryan, R-Wisconsin, has already put forward his plan for healthcare reform, so I would think his ideas will be a pivotal part of what eventually gets passed,” continues Mertz. “However, Congress still decides what happens, so whatever Trump proposes will be mired in hearings, staff work, and debate for at least the next year. This means that we limp along with a broken program as we argue what is better.”

Also based on Ryan’s healthcare proposals, Travis Ansel, senior manager of strategic services for Healthcare Strategy Group, is advising providers to brace for more Health Savings Account (HSA)-related payment woes. “Ryan’s plans for Medicare, which have loomed over the industry for five years, bring with them increased patient payment obligations,” Ansel explains. “Expect more and more employer-based coverages to shift to HSAs as well. We can expect payors to raise insurance premiums across the board as the Republican-led Congress unwinds the ACA.”

Ansel pointed out that major payors were forced to shift their business models and infrastructure to compete in an ACA-focused market. “The quick shift back will be a reality these payors are not prepared for and not prepared to succeed under,” he concludes.

As payor margins suffer, adds Mertz, pressure will be placed on commercial insurers to raise reimbursement to offset the gap. “Employers will howl and the feds will be pressured to control costs, especially big pharma.”

Where Mertz does expect activity is within the Health Insurance Exchanges created by the ACA. “The insurance exchanges are in trouble already, so we would expect that providers that were seeing significant numbers of exchange-insured individuals would have likely seen a drop in those numbers regardless. I think the number of uninsured will increase in the short-term, as many will decide that paying the penalty is better than paying the premium.”

As to what healthcare might look like under the Trump administration, Mertz thinks the industry will see tax credits or vouchers. “However, I seriously doubt we’ll see a government-sponsored alternative, which I think we would have seen with (the Democratic presidential nominee) former U.S. Secretary of State Hillary Clinton.”

On the provider side, Mertz expects that while physicians will see little impact, hospitals will see a rise in charity care, and no major increase in income.

For a post-election roadmap to the challenges and opportunities facing healthcare in the year ahead under GOP leadership, don’t miss Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a live webcast on Thursday, November 17 at 1:30 Eastern.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Infographic: A Comparison of ACA Marketplace and Employer Health Plan Costs

October 16th, 2015 by Melanie Matthews

Healthcare premium costs for lower-income enrollees in the ACA Marketplace are similar to those with employer coverage, according to The Commonwealth Fund.

A new infographic by The Commonwealth Fund examines the premium levels of marketplace and employer plan enrollees, as well as deductible levels for these segments.

A Comparison of ACA Marketplace and Employer Health Plan Costs

2014 Performance Measures for Individual, Small-Group and Large-Group Risk-Based Plans

Commercial Health Plan Market Metrics provides a snapshot of the rapidly evolving commercial risk health insurance market, by assessing the impact of the individual mandate, exchanges and other Affordable Care Act initiatives. Filled with charts and statistics applying metrics such as membership, premium revenue and claims expenses, it measures which plans made profits—and how profitable they were—in various segments of this market during the first full year of ACA implementation.

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Infographic: Assessing the Affordable Care Act

October 29th, 2014 by Melanie Matthews

There are a number of measures that could be used to evaluate the effectiveness of the Affordable Care Act, according to the Commonwealth Fund.

To date, the ACA’s implementation has been associated with significant progress, reflected in a new infographic by the Commonwealth Fund. The infographic looks at the ACA marketplaces and health insurance enrollment and uninsured trends since the ACA’s implementation.

Asessing the Affordable Care Act

Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower CostsPursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs shares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a healthcare system for the nation that improves the experience and quality of care while at the same time controlling costs.

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Infographic: Top 10 States with Low Uninsured Rates Post-ACA

August 6th, 2014 by Melanie Matthews

The uninsured rates in states that did expand Medicaid has dropped substantially in comparison to the states that did not expand Medicaid, according to a new infographic by LifeHealthPro.

The infographic looks at the top states with lower rates of uninsured post Affordable Care Act.

Top 10 States With Low Uninsured Rates Post ACA

Public Exchanges Data: Premium Analysis and Carrier Participation for 2014Now that open enrollment is over, Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 takes a look at how it all played out. This report offers a highly detailed overview of where carriers participated, the types of products they offered and how their prices stacked up against their competitors.

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Infographic: Public Opinion of the Affordable Care Act

June 20th, 2014 by Jackie Lyons

Nearly 60 percent of individuals want Congress to improve the Affordable Care Act (ACA) rather than repeal it, according to a new infographic produced by the Journal of the American Medical Association.

This infographic also illustrates the barriers to obtaining health insurance, and the effects of the ACA since its rollout in 2010.

Want to know more about healthcare trends and effects of reform? Plunkett’s Health Care Industry Almanac 2014 provides a complete market research report, including forecasts and market estimates, technologies analysis and developments at innovative firms. This resource provides vital insights into how the healthcare industry is evolving and effects of healthcare reform.

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Narrow Networks Top Payor Product Innovations List for 2014

June 17th, 2014 by Patricia Donovan

If recent market data is any indication, employers are gravitating toward narrow networks in greater numbers. For instance, a March 2014 Wells Fargo Insurance survey of more than 70 insurance companies placed narrow networks among the top three employer product innovations in 2014, along with are accountable care organizations (ACOs) and increased wellness programs.

In just one example, Harvard Pilgrim HealthCare this week introduced ElevateHealth℠, a partnership with Dartmouth-Hitchcock and Elliot Health System that is a non-profit, high-performance, defined-network product offering access to premier hospitals and providers in New Hampshire.

With its emphasis on care coordination within the network, ElevateHealth insurance premiums on average offer 10 percent savings compared with Harvard Pilgrim’s similar full-network plans, the insurer said.

And last month, UnitedHealthcare announced it would cut 2 to 4 percent of the physicians in its Medicare Advantage network in some Virginia service areas.

In theory, narrow networks—and their close cousins, tiered, tailored and high performance networks—sound like a good thing: health insurance products that group providers into tiers based on their cost or efficiency of care, then steer patients to choose these providers through lower premiums or cost sharing.

In practice, however, some consumers served by narrow networks are balking at the difficulty of obtaining appointments with network providers. Earlier this month, the Wall Street Journal reported that insurers in several states are expanding hospital and physician networks for plans sold through the Affordable Care Act’s health insurance exchanges amid gripes from patients and state officials about limited provider choices.

Anthem Blue Cross, Blue Shield of California, Health Net and WellPoint are among insurers that have substantially expanded provider networks in its exchanges, the article stated. And more providers are slated to join Harvard Pilgrim HealthCare’s ElevateHealth’s network beginning in July.

Earlier this year, industry thought leaders analyzed what the proliferation of narrow networks means for healthcare. Steven Valentine, president of The Camden Group, talked about the impact on both providers and consumers.

“First of all, we anticipate an increase in the number of covered lives,” Valentine said during HIN’s annual healthcare trends forecast. “Providers are going to see an increase in patient volumes, especially primary care providers. And especially providers in states that have opted to stay in Medicaid.”

However,” he continued, “Many of the qualified health plans have narrow networks, so patients are probably going to be confused about which doctors are in their networks and probably will shift around until they can find the right place for them.”

Providers in networks with bronze plans will probably have much higher increases in patient volumes, he predicted. “And other providers will probably see some shifting until patients can figure out where they need to go.”

Regardless of the confusion, Valentine expects the trend of narrow networks to continue. “We clearly see narrow networks operating in conjunction with tiered benefit plans; that is, a lower premium, a more narrow network. We’ve clearly seen that in some of the exchanges as we look at the various medal options that are available. Narrow networks are here to stay; they are not going to go away.”

Catherine Sreckovich, managing director in the healthcare practice at Navigant, concurs. “I agree 100 percent. We’re going to see [narrow networks] more and more. And to the extent there continues to be competition in the exchanges and more health plans trying to get involved, this trend will continue.”

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Nurse Practitioners Slowly Gain More Access to Patients; Could Relieve Anticipated Physician Shortage

June 5th, 2014 by Cheryl Miller

Patients are slowly gaining access to care provided by advanced practice registered nurses (APRNs) as a number of states have taken steps to loosen restrictions on highly educated nurse practitioners (NPs).

Minnesota became the 19th state, plus the District of Columbia, tooffer patients full and direct access to NP service. According to the American Association of Nurse Practitioners (AANP), it is an important step that improves access to care and more effectively uses NPs to meet the state’s growing healthcare needs. Officials state the following in a press release:

This comes at a time when the changing demographics of health care, especially primary care, necessitates that states make full use of the nurse practitioner workforce. The nursing community is committed to addressing these challenges in future sessions to ensure that patients have a choice of health provider and receive full access to the health services they need.

Maryland was one of the first states to loosen existing restrictions, according to a story from the Robert Wood Johnson Foundation (RWJF). In 2010 the state replaced its requirement for lengthy collaborative agreements between NPs and physicians with less cumbersome “attestation statements” that identify a physician who is willing to collaborate when clinically necessary but do not require physician signatures.

The law eliminated situations where patients were left without care if their physician died, retired, or left the state. NPs can now open practices and serve larger patient populations. This has helped with the primary care shortage in Maryland.

And the shortage is not limited to Maryland. As the Healthcare Intelligence Network reported in a previous news story in 2013, the RAND Corporation predicted that as more Americans seek health services once newly insured under the Affordable Care Act (ACA), physician shortages could worsen, and reach as high as 45,000 by 2025.

And the recent Veterans Affairs problem that is making headlines around the world has been attributed to a shortage of primary care physicians (PCPs), as documented here in the New York Times.

Expanding the role of nurse practitioners and physician assistants could help eliminate the anticipated shortage of PCPs over the next decade, the RAND report suggested.

Other states that have taken steps to ease NP restrictions in recent years include the following:

  • In Utah, state Medicaid officials agreed to recognize and reimburse NPs for primary care services for beneficiaries.
  • Oregon’s governor signed a law that allows NPs and clinical nurse specialists to dispense prescription drugs.
  • In Iowa, the state Supreme Court ruled that NPs can supervise fluoroscopy, a high-tech X-ray, without physician supervision.
  • In 2011, North Dakota scrapped a requirement that NPs work in collaboration with physicians.

But these changes are not without their controversy. Some feel that it goes too far, that the supervision of a physician should be maintained. According to this editorial in the Times-Herald Record, “though well intentioned, such proposals underestimate the clinical importance of physicians’ expertise and overestimate the cost-effectiveness of nurse practitioners.”

Other areas of healthcare pose the same challenge. In Minnesota, a state law allows dental therapists to work under the supervision of dentists and perform many of the tasks they do, something that has been opposed nationally and in most other states.

But the field of NPs is also changing. First created in 1965 to meet the growing demand for basic pediatric care, by 2015 all new NPs will need to be trained at the doctorate level as a Doctor of Nursing Practice, and 104 new DNP programs are in development, according to a new infographic from Maryville University Master of Science in Nursing Online.

Infographic: Health Insurance Costs Under the ACA

April 2nd, 2014 by Jackie Lyons

Under the Affordable Care Act (ACA), a 40-year-old making $40,215 per year would have moderate assistance from the government to pay their health plan premium, according to a new infographic from JAMA and the Kaiser Family Foundation.

This infographic estimates what Americans will pay for health insurance under the ACA according to their income and location.

You may also be interested in this related resource: Quality Care, Affordable Care: How Physicians Can Reduce Variation and Lower Healthcare Costs. This resource offers a practical, hands-on guide to getting a variation-reduction program in place that will engage physicians. It offers a unique take from a physician leader who has personally led a highly successful program, and explains in plain language how to take advantage of his experience.

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.