cmonfils | February 3, 2012
Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby boomers who are retiring and shifting from employer-sponsored health insurance to Medicare.
Category: CMS, Health Insurance, Medicaid, Medicare |
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cmonfils | February 3, 2012
One of the lesser publicized provisions of the Affordable Care Act creates “accountable care organizations” or “ACOs” ACOs are a new healthcare delivery model for Medicare beneficiaries that attempts to address the well known problem with the current , procedure-based Medicare billing system, which encourages multiple (and sometimes redundant and unnecessary) medical tests and procedures. It also organizes the delivery of medical care around a particular diagnosis or condition, as opposed to addressing the patient’s overall physical and mental well-being. Medicare has already limited reimbursements for multiple procedures but reports of unnecessary duplicate treatments – particularly with regards to imaging services .
http://www.erisawonk.com/
Category: Accountable Care Organizations, Medicare |
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cmonfils | February 3, 2012
Jan. 27 (Bloomberg) — Insurers offering Medicare health plans were overpaid by the U.S. as much as $3.1 billion in 2010 because the government miscalculated how sick beneficiaries were, federal auditors said.
Category: Medicare |
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cmonfils | February 3, 2012
Medicare Advantage premiums have fallen by 7 percent on average and enrollment has risen by about 10 percent since this time last year, HHS Secretary Kathleen Sebelius announced today.
The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall. Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012.
Category: HHS, Medicare |
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cmonfils | January 30, 2012
Many in healthcare, including leaders at the CMS Innovation Center, are betting on experiments with more coordinated services and value-based payments to show it’s possible to spend less for better outcomes. For two decades, the Medicare program has tried some of these ideas—and now a new federal report has some bad news about the results
http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219973/
Category: CMS, Health Care Legislation, Medicare |
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cmonfils | January 25, 2012
This study examined the consequences of adding a fitness-membership benefit on the self-reported health status of enrollees in Medicare Advantage plans. Using a quasi-experimental design, we found that persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking, and higher PCS scores than did persons who enrolled in the same plan before the fitness benefit was added and in matched control plans that never offered a fitness benefit. These patterns persisted in the analyses of 2-year follow-up responses for all measures except self-reported general health. Our findings suggest that there is an association between the adoption of fitness-membership benefits in Medicare Advantage plans and the enrollment of healthier Medicare beneficiaries.
Category: Medicare, Wellness |
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cmonfils | January 22, 2012
The offer of a fitness club membership is helping insurers including UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM) draw healthier and less costly patients to their Medicare programs, said researchers reporting in the New England Journal of Medicine.
Category: Health Insurance, Medicare, Wellness |
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cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
Sponsors and administrators of employer-sponsored health plans will spend lots of 2012 in implementing the health reform law, because there’s still a lot of uncertainty that will decide the fate of self-funded health plans in particular. Plans will have to raise annual limits on essential benefits (as defined by reform rules) to $2 million starting next Sept. 23. Plans won’t have to pay new fees to fund comparative effectiveness research in 2012. But 2012 will be the year plans learn the payment frequency of and the method used to calculate the fees they will start paying in 2013. Similarly, plans won’t have to start issuing summaries of benefits and coverage (SBCs) to all participants, but they will be waiting and watching for rules about the SBC to develop, so they know how to satisfy that requirement. (more…)
Category: Accountable Care Organizations, DOL, Health Care Legislation, HHS, Medicare, Plan Sponsor, PPACA, PPOs, Third Party Administrators |
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cmonfils | January 15, 2012
2013 may be the most significant year in health care policy ever.
But we have to get through 2012 first.
Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.
If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of Congress, we can still expect a serious effort to change the law. Then there is the granddaddy of all problems, the federal debt. The 2012 elections could well prepare the way for entitlement reform—particularly for Medicare and Medicaid. Even if Obama is reelected, the 2013 agenda will include a serious debate about Republican ideas to change Medicare into a premium support system and block grant Medicaid to the states.
Category: Health Care Legislation, Medicaid, Medicare |
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cmonfils | January 13, 2012
To view a PDF version of this article, please click here.
The Centers for Medicare and Medicaid Services (“CMS”) posted Version 3.3 of the User Guide, dated December 16, 2011 (the “Version 3.3”) on its website.
Version 3.3 includes the guidance that CMS has provided in various alerts since the previous User Guide was published as of August 17, 2011. A link to the User Guide is included in footnote 1, below. A summary of all of the changes to Version 3.3 are available on pages 6 and 7 of the User Guide; however, the following summarizes the most significant changes:
Category: CMS, Medicaid, Medicare |
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cmonfils | January 11, 2012
No, it’s not quite going down. But health care spending in 2010 rose at the second-slowest rate in the last half-century.
The Centers for Medicare and Medicaid Services reports that total health spending in the U.S. increased by 3.9 percent in 2010, just a notch above the slowest rate since the government started keeping track — 3.8 percent in 2009.
http://www.npr.org/blogs/health/2012/01/09/144923401/growth-in-u-s-health-spending-stays-slow-experts-cite-lagging-economy?ps=sh_sthdl
Category: CMS, Medicaid, Medicare |
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cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)
Category: California, CMS, Florida, Massachusetts, Medicaid, Medicare, New Hampshire, Transparency, Wisconsin |
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cmonfils | December 29, 2011
NEW YORK (CNNMoney) — This has been a volatile year for the stock market. But one sector has been consistently earning a windfall for investors: health insurers that provide private Medicare plans to seniors
Category: Medicare |
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cmonfils | December 29, 2011
To view a PDF version of this article, please click here.
Medicare expands resolution options to include a new Medicare repayment program for small settlements or judgments. This program will be available starting in February 2012 and applies to cases settling for $25,000 or less. Under this program, Medicare will provide final conditional payment amounts before settlement under certain circumstances. This program has the potential to revolutionize the settlement process for many Medicare beneficiaries, their counsel, and settling parties. The foundation of that process is to start the verification process early.
Category: CMS, Medicaid, Medicare |
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cmonfils | December 26, 2011
WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary.
Category: Medicare |
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