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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cmonfils | December 22, 2011
December 12, 2011 (PLANSPONSOR.com) – The Texas Employees Retirement System expects to save about $20 million next year by shifting most of its retirees to a Medicare Advantage health-insurance plan.
Category: Health Insurance, Medicare, Texas |
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cmonfils | December 22, 2011
House Budget Chair Paul Ryan (R-WI) and Senator Ron Wyden (D-OR) have embraced a Medicare reform plan that in concept borrows heavily from one championed by former New Mexico Senator Pete Domenici and former Clinton budget chief Alice Rivlin.
Specifically, Wyden and Ryan are proposing to alter the earlier Ryan Medicare plan by:
http://healthpolicyandmarket.blogspot.com/2011/12/paul-ryan-and-ron-wyden-blow-medicare.html
Category: Health Care Legislation, Medicare |
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cmonfils | December 22, 2011
The feds’ decision to release Medicare claims data for quality measurement should help employers and individuals alike make more informed decisions down the road, advancing the goals of health care quality and value, a plan sponsor representative noted.
Category: CMS, Medicare |
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cmonfils | December 15, 2011
The CMS said in a proposed rule that it recommends delaying data collection (PDF) in a reform law provision intended to expose financial relationships between drug and device manufacturers, GPOs and providers.
The agency said in the proposed rule that manufacturers and GPOs should not be required to start collecting information about their financial relationships with physicians and teaching hospitals on Jan. 1.
http://www.modernhealthcare.com/article/20111214/NEWS/312149973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWdndGRWxiNUtpQzMyWmFwNW5nWUpidWk
Category: CMS, Health Care Legislation, Medicaid, Medicare |
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cmonfils | December 2, 2011
Now that the deficit-reduction supercommittee has failed to reach agreement, healthcare providers are dealing with the reality that things could get worse before they get worse.
A series of congressional hearings, intense lobbying efforts and countless closed-door meetings were not enough to help the 12-member Joint Select Committee on Deficit Reduction complete its task last week of delivering a proposal to Congress that identified ways to reduce the federal deficit by at least $1.2 trillion over the next 10 years. This summer’s Budget Control Act required that unless Congress could identify such savings, “sequestration” would kick in starting in January 2013, when $1.2 trillion in automatic, across-the-board cuts over 10 years will be split between defense and nondefense programs. The law limits the amount of healthcare savings by capping reductions to Medicare payments at 2%.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289960/cloudy-outlook
Category: Arizona, Health Care Legislation, Medicaid, Medicare, Pennsylvania, South Carolina |
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cmonfils | November 30, 2011
from Spencer’s Benefits Reports: The Equal Employment Opportunity Commission’s (EEOC) Age Discrimination in Employment Act (ADEA) exemption for coordination with Medicare applies only to retiree benefits, not the benefits of current employees, the EEOC Office of Legal Counsel staff confirmed in an informal discussion letter in response to an inquiry from a member of the public.
Category: Medicare |
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cmonfils | November 27, 2011
Several deficit-reduction plans have proposed combining Medicare’s separate deductibles for hospital and physician services, standardizing cost sharing across types of benefits, and establishing a new limit on annual out-of-pocket costs for beneficiaries. A new Kaiser Family Foundation study examines the potential implications of proposals to revamp Medicare’s cost-sharing requirements as a way of reducing federal spending.
Category: Medicare |
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cmonfils | November 20, 2011
Medicare Advantage (MA) and Part D plans are in the midst of marketing their 2012 products to consumers, analyzing how their products compare to competitors and determining how best to deploy sales force resources to maximize opportunities and win new business. With a slightly longer selling season for health plans and an abbreviated election period for consumers, plans are busy campaigning to retain members and prospecting for new ones.
Category: Medicare |
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cmonfils | November 14, 2011
This issue paper examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations on ACOs issued in October 2011 by the Centers for Medicare & Medicaid Services (CMS). Written by the Urban Institute’s Bob Berenson and Rachel Burton, this paper provides an overview of ACOs, the key complaints about CMS’ proposed regulations and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans. This paper is supported by the Robert Wood Johnson Foundation.
Category: Accountable Care Organizations, Health Insurance, Medicare |
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cmonfils | November 14, 2011
The Centers for Medicare & Medicaid Services (CMS) has announced the changes to the Medicare Part A and Part B premiums, deductibles and coinsurance paid by beneficiaries.1 These changes take effect on January 1, 2012.
Category: Medicare |
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cmonfils | November 7, 2011
Seniors will pay less than expected in Medicare Part B premiums next year, the Obama administration announced Thursday.
Monthly premiums for Medicare Part B, which covers doctors’ visits and outpatient procedures, will increase by $3.50, to $99.90, in 2012. Initially, government forecasters had projected a $10.20 premium bump, to $106.60, in seniors’ monthly fees.
Category: Medicare |
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