Headlines about "Health plan costs - healthcare delivery"
Gathered from the web by the editors at BenefitsLink.com.
Health Insurance, Health care and Labor Supply by Older Adults (PDF)
"Early workforce exits are publicly costly due to foregone payroll taxes and disability benefit payments, but also costly to workers, whose SSDI benefits are typically lower than their earnings, and who lose the additional contributions to retirement benefits and Social Security earnings credits associated with paid work. Despite a large literature that has shown the importance of health status and disability on work and retirement decisions of older workers, relatively little is known about the role of health care utilization in preventing or delaying workforce exit." (University of Michigan Retirement Research Center)
Effects of Pharmacy Benefit Carve-in on Utilization and Medical Costs (PDF)
"A study finds that plan sponsors offering health care benefits that include a carved-in pharmacy benefit are likely to experience significant medical cost savings over carving out the pharmacy benefit." (Benefits Magazine)
Senate Medical Loss Ratio Bill Aims to Give Agents and Brokers Some Relief
"U.S. Senator Mary L. Landrieu, D-La., chair of the Senate Committee on Small Business and Entrepreneurship, and Sen. Johnny Isakson, R-Ga., have introduced S. 2068, the Access to Independent Health Insurance Advisors Act, a companion bill and a shot in the arm for a medical loss ratio bill in the House that has many supporters but has gained no traction." (ProducersWEB.com)
[Opinion] A Discussion on Health Care Costs, Payers and Policy
Uwe Reinhardt writes: 'A second major factor accounting for high health spending per capita in the United States is the significantly higher prices Americans pay for virtually all health care services and products.My thesis on this issue . . . is that these much higher prices are the product of a deliberate strategy, hashed out in our political bazaars between the supply side of health care and state and federal legislators, always to keep the payment side of our health system fragmented and relatively weak vis ? vis the supply side of health care." (Physicians for a National Health Program)
Federal Health Care Spending Expected to Double Over Next Decade
"Total federal health care spending on mandatory programs, such as Medicare and Medicaid, will grow from $847 billion in the current fiscal year to $1.8 trillion in fiscal 2022, according to the CBO." (Wolters Kluwer Law & Business / CCH)
Health Care Innovation in the Context of Rising Health Care Costs
"AHIP's President and CEO Karen Ignagni gave [this] presentation on health care costs and innovation to the 9th Annual Healthcare Conference at Harvard Business School on [February 4, 2012]." (America's Health Insurance Plans)
5010 HIPAA Transaction Standards Deadline Extended, but Threat Remains, Says AMA
"Expressing serious concerns about the ability of physician practices and payers to make the conversion to the 5010 electronic transaction standards and ICD-10 (a new code set for medical diagnoses) in time, both MGMA and the AMA are calling for change. The two agencies say that the government needs to form a comprehensive contingency plan permitting health plans to adjudicate claims that may not have all the required data content, or the government needs to call an outright halt to the transition." (HealthLeaders Media)
University of Memphis Study Gauges Costs for Tennessee of Federal Health Care Reform
"Health care reform will reduce the number of uninsured Tennesseans by more than half and cut uncompensated care and bad debt by $2.3 billion, but the newly insured could put a strain on the state's health care system." (Memphis Commercial Appeal)
Studies Detail in Numbers U.S. Health System Problems and Effect of Health Care Reform
"Two new studies just out highlight the extraordinary problems now facing the United States health system, and some of the consequences that could befall the country if critical parts of health reform are stripped away." (Fisher & Phillips LLP)
States, Localities Seek Ways to Trim Health Care Costs for Employees and Retirees
"Officials in Providence, R.I., and Iowa propose changes in health benefits. New York City Mayor Michael Bloomberg says he'll use health care reserve fund dollars to make up a shortfall." (The Henry J. Kaiser Family Foundation)
Legal Considerations When Implementing On-Site Clinics
"The issues in implementing an on-site clinic may seem obvious: Finding a service provider; installing an appropriate facility; and addressing employee access during work hours. However, there are less obvious but equally important compliance concerns that arise when an on-site clinic is implemented." (Employee Benefit News)
[Opinion] The End of Health Insurance Companies
"Here's a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations -- groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients." (The New York Times; free registration required)
Cost-Controlled Health Coverage Called 'Global Payment'' Plans Gaining Ground
"In just three years, a new way of paying for medical care has spread rapidly across Massachusetts, and now more than 1.2 million people are covered by plans that put providers on a budget in an effort to restrain health spending. This means that about one in five Massachusetts residents are being treated by doctors working under these new cost-conscious arrangements, a Globe survey of insurers found . . . ." (The Boston Globe)
[Guidance Overview] Michigan Law Imposes Assessments on Health Claims Paid under Employer-Sponsored Plans
"Last September, Michigan enacted a law that imposes upon certain entities an assessment equal to 1% of their total paid claims1 under an ERISA group health plan, up to a cap of $10,000 per individual, effective for dates of service on or after January 1, 2012." (Miller & Chevalier Chartered)
Electronic Health Records Still Need Work
"America may be a technology-driven nation, but the health care system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue." (BenefitsPro)
Device Makers Urge Coverage of Weight-Loss Surgery
"Advocates say it will give obese patients a complete arsenal for fighting the condition that can spur a host of life-threatening illnesses and help save billions of dollars in health care costs for employers and the government." (Reuters via Employee Benefit News)
Early Induced Pregnancies Are Costing Your Health Plan
"That's not to say that some babies don't need to be induced before full term (40 weeks) because of medical reasons, but a growing trend shows that hospitals are electing this option because of revenue and doctors' schedules or because moms simply want to schedule their births." (Employee Benefit News)
Medical Debts Put Patients at Risk of Financial Collapse
"[Millions of Americans don't have the cash to cover their medical bills, but h]ospitals expect to be paid promptly and offer little leeway to insured patients. Unpaid bills go to collection agencies, damaging a person's credit history for years." (The Republic)
WellPoint to Increase Primary-Care Reimbursement
"Beginning in the summer, WellPoint will increase reimbursement for primary-care services -- offering those physicians a fee increase of around 10% with the chance of additional payments that could bolster what they receive for covered patients by as much as 50% -- in an attempt to lower acute-care costs, the WSJ reports." (The Wall Street Journal)
Health Insurance Deductibles Doubled in 7 Years, Study Finds
"A recent study by the Commonwealth Fund shows just how much more consumers are paying for employer-provided health insurance." (The New York Times; free registration required)
U.S. Financial Worries Rival Those of 1992, According to Gallup Poll
"Americans' worries about maintaining their standard of living (51%), being able to pay medical bills (43%) or losing their job (34%) in the next 12 months are among the highest Gallup has measured in the past 20 years, on par with the levels seen in 1991 and 1992, Gallup says." (LifeHealthPro)
One Year of Innovation: Taking Action to Improve Care and Reduce Costs (PDF)
"The Center for Medicare and Medicaid Innovation (the Innovation Center), is an important new resource for health care providers dedicated to improving how our health care system works. Its mission is to move quickly to identify, test, and spread delivery and payment models to help providers improve care while cutting costs." (U.S. Department of Health & Human Services, The Center for Medicare and Medicaid Innovation)
[Guidance Overview] Do Benefit Plan Recoupment Claims Trigger Internal Appeal Rights?
"The issue turns on the significance of a claim for refund or 'recoupment' by a group health plan after services have been rendered and benefits paid. In the end, the court in this case decides that the refund request does not trigger any additional obligations under the ERISA claims regulations." (Roy Harmon III, Health Plan Law)
America's 'Screwed Up' Health Care Spending
"Speaking at [a conference, the] co-director of the Emory Center on Health Outcomes and Quality in Atlanta explained that health care costs can be broken down into two simple areas: the change in the prevalence of treated diseases, such as hypertension and diabetes, and how much does it cost to treat those problems. To fix it simply, he says, there needs to be averting, detecting and managing chronic diseases." (Employee Benefit News)
More Employers Embracing On-Site Health Clinics
"A 2011 study by the professional-services company Towers Watson and the nonprofit National Business Group on Health found that 23% of the midsized and large U.S. employers they surveyed had on-site health clinics and that another 12% planned to establish an on-site clinic in 2012." (Massachusetts Institute of Technology)
Self-Insured Group Health Plans: Stop-Loss Insurance and Adverse Selection (PDF)
Published October 4, 2011. 'In the course of considering changes to its Stop-Loss Model Act, the National Association of Insurance Commissioners (NAIC) has received formal comments containing substantive inaccuracies regarding self-insured group health plans, stop-loss insurance, and how smaller self-insured group health plans may contribute to adverse selection in the health insurance marketplace. Similar comments have beenmade by federal regulators responsible for implementing the Affordable Care Act (ACA). This White Paper identifies and corrects several inaccurate comments in order to assist policy-makers at both the state and federal level to properly assess legislative/regulatory proposals related to self-insured group health plans." (Self-Insurance Insurance Institute of America, Inc.)
[Guidance Overview] IRS Acquiesces to U.S.Tax Court Holding that Gender Reassignment Surgery is Tax Deductible Medical Expense (PDF)
See pages 5-6. 'On November 2, 2011, the IRS announced its intent via a 'notice of acquiescence' that it would abide by the U.S. Tax Court'sdecision in O'Donnabhain." (Trucker Huss, APC.)
An Alabama County Commission Considers Employee Health Care Clinic to Reduce Costs
"Companies that run workplace clinics often tout returns on investment as high as 7 to 1, according to a 2010 study published by the center. However, returns of 2 to 1 are more common, according to one consultant quoted in the study." (Alabama Live LLC)
'Tiered' Insurance Confounds Consumers and Doctors in Massacusetts
"Massachusetts health insurers assign doctors and hospitals to tiers using a complicated formula of quality and cost measures. In short, the tiers are different because insurers don't use all the same quality measures, because they give the measures different weight and because insurers pay physicians and hospitals different rates." (The Henry J. Kaiser Family Foundation)
[Opinion] Bending the Health Care Cost Curve: New Era in American Health Care?
"Staying the course toward a high performance health system shows promise of at long last bending the health care cost curve. It offers a far more promising approach to containing health care costs than increasing deductibles, cutting benefits, and shifting more of the financial burden of health insurance premiums and medical bills to working families and elderly and disabled Medicare beneficiaries." (The Commonwealth Fund)
Is U.S. Health Spending Finally under Control?
"Now why is it reasonable to assume that excess cost growth will just have to decline to zero in the long run ? that is, to assume that health spending will not eventually growth faster than G.D.P. and perhaps even more slowly?" (The New York Times; free registration required)
Cost Containment: Overcoming Challenges (PDF)
"HealthLeaders Media's annual cost-containment survey shows that the revenue cycle is regarded as the top choice (30%) of leaders seeking the greatest return in efficiency and cost reduction. That area can provide the highest yields in efficiencies and cost reduction. But revenue cycle is very general as a priority. Significant numbers of healthcareorganizations are taking their revenue cycle operations to the next strategic level." (HealthLeaders Media)
Health Reform, Health Insurance, and Selection: Estimating Selection into Health Insurance Using the Massachusetts Health Reform
"We find that counties with larger increases in insurance coverage over the reform period face the smallest increase in average hospital costs for the insured population, consistent with adverse selection into insurance before the reform. Additional results, incorporating cross-state variation and data on health measures, provide further evidence for adverse selection." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
[Guidance Overview] Medical Loss Ratio Requirements Rules
"As of January 6, 2012, seventeen states have requested adjustments. Six states have received relief from application of the 80 percent MLR (Georgia, Iowa, Kentucky, Maine, Nevada, and New Hampshire).[See footnote 4] The relief allows each of these states to implement an MLR that is lower than 80 percent." (Epstein Becker & Green, P.C.)
[Guidance Overview] How to Handle Medical Loss Ratio Rebates: Guidance for Insured Plans Subject to ERISA
"Insurance companies will report data in June 2012, and pay rebates in August 2012. Plan sponsors with insured arrangements should be alert for communications from their insurance carriers during the summer of 2012, and should be prepared to address rebate distribution." (The Segal Group, Inc.)
[Guidance Overview] HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers
"[HHS] issued interim final regulations addressing standards for electronic funds transfers (EFTs) applicable to health care claims payments transmitted by health plans to health care providers." (Practical Law Company)
The Do-It-Yourself Health Savings Account
"[A two-part health-savings program, consisting of FSA assets plus additional assets held outside the FSA, probably makes sense for most participants in traditional health-care plans. Such a two-part plan would work as follows. Part 1: Flexible Spending Account: Fund an FSA with an amount that you think, with some degree of certainty, you'll be able to use on health-care expenses in the year ahead. Part 2: Supplemental Health-Care Account: Create a separate pool of liquid assets to cover any additional out-of-pocket costs that arise once you've exhausted your FSA funds." (Morningstar, Inc.)
Understanding Health Care Costs: The Employer-Sponsored Insurance System
"A new video looks at how the employer-sponsored health insurance system in the United States works -- and how healthcare dollars flow into and out of that system." (Milliman, Inc.)
20% of Health Care Dollars Spent on 1% of Population
"That indicates that more than $1 in every $5 healthcare dollars went to treat one out of every 100 people. The annual mean expenditure was $90,061 for those in that 1%." (HealthLeaders Media)
5% of Patients Account for Half of Health Care Spending
"Just 1% of Americans accounted for 22% of health care costs in 2009, according to a federal report released Wednesday. That's about $90,000 per person, according to the Agency for Healthcare Research and Quality.' (USA TODAY)
Uniform Rate Setting for Medical Provider Payments Offers Best Potential for Cost Containment
"Among the cost growth containment options considered are more aggressive limits on the tax exclusion for employer-based insurance, malpractice reform, targeted disease prevention policies, care coordination for those with chronic illnesses, lowering spending at the end of life, bundled payment mechanisms, strengthening the health insurance exchanges, the introduction of a public plan option in the health insurance exchanges, rate setting focused on the health insurance exchange markets, and all-payer rate setting." (Wolters Kluwer Law & Business / CCH)
'Value' in Health Insurance Acquires New Meaning
"The Patient Protection and Affordable Care Act is set to test whether value-based insurance design can be a viable tool for aligning out-of-pocket costs and the value of medical services. National reform will further encourage value-based insurance design in 2014, when it allows employers to reimburse employees up to 30% of health insurance costs if workers meet health and wellness goals. The current reimbursement rate is 20%." (California HealthCare Foundation)
[Guidance Overview] IRS Guidance on Mandatory Reporting of Value of Health Coverage on 2012 Forms W-2
"Importantly, health coverage is treated as applicable employer-sponsored coverage without regard to whether the employer or the employee pays for the coverage, or whether or not the value of the coverage is includible in the employee's income." (PricewaterhouseCoopers LLP)
Guidance Provided on Electronic Health Record Incentives
"[M]edical providers must comply with standards for use of the technology and properly account for the incentive payments in an area where accounting principles are in an infant stage. [Last] week, the Healthcare Financial Management Association (HFMA) published an issue analysis to provide clarity on accounting for incentive payments received under the Health Information Technology for Economic and Clinical Health . . . Act." (American Institute of Certified Public Accountants)
CMS Issues Final Round of Health Plan Waivers
"The waivers, announced Friday on a CMS website, apply to health insurance policies -- mostly for mini-med plans -- offered to the workers of 1,231 employers." (modernhealthcare.com; free registration required)
Health Reform Reporting Rule Clarified
"The latest guidance also reiterates numerous provisions in last year's guidance, including that the cost of coverage that is taxable to employees, such as for a child older than 26, must be reported on the W-2. It also reiterates that contributions employees make to flexible spending accounts are to be excluded from the health care cost figure." (Business Insurance)
[Guidance Overview] IRS Issues Revised Guidance on Form W-2 Health Coverage Reporting
"The revisions should help employers and advisors as they navigate the new reporting requirement, especially with respect to application of the requirement to EAPs, wellness programs, and on-site medical clinics. However, calculating the cost of coverage will continue to be a challenge, particularly for self-insured plans." (Thomson Reuters/EBIA)
[Guidance Overview] Federal Court Holds Plaintiff's Recovery of Medical Expenses Paid by ERISA Plan Are Recoverable
"The Defendants filed affirmative defenses including claims that the Plaintiffs' recovery was reduced or barred by the provisions of the Pennsylvania Motor Vehicle Financial Responsbility Law (MVFRL). The Plaintiffs argued that the defenses should be stricken since the medical bills were paid by a self funded ERISA plan which was making a claim for reimbursement. The Plaintiffs filed a Motion in Limine." (InjuryBoard)
How Does Growth in Health Care Costs Affect the American Family?
"Health care costs nearly doubled between 1999 and 2009, which left the average 2009 family with only $95 more per month than in 1999. If costs had matched the consumer price index's rise, the average family would have an additional $450 per month." (RAND)
Collaboration Reduces Costs of Health Care
"Experts say employers, hospitals, physicians and health plans are willing to work together because cost and quality problems have reached crisis levels. The goal is to cut spending that's wasteful and doesn't help patients. Sometimes there's an implicit threat that if a provider or health plan doesn't participate, the employer will buy health care elsewhere." (USA TODAY)
Evaluating Bundled Payment Contracting
"This healthcare reform briefing paper provides an overview of bundled payments and discusses recent developments, as well as an analysis of considerations in contracting for bundled payments." (Milliman, Inc.)
How $1 in Health Insurance Gets Spent
"Most of the dollar goes to medical care, not insurer profits. That's particularly true for Blue Shield of California, which pledged last year to cap its profits at 2 percent. But it's broadly true across the health-insurance industry." (The Washington Post; free registration required)
More Consumers Choosing High-Deductible Plans
"Not everyone enrolled in a high-deductible health plan is eligible for a paired health savings account, but even those who are often skip it. As of 2011, 38% of those with a high-deductible plan, or an estimated 7.3 million people, were eligible but did not open an account, according to the EBRI." (American Medical Association)
Firms Seek Medical Second Opinions
"Second-opinion medical services can be an effective benefits cost-containment tool for mid-market employers as treatment costs for complex cases such as cancer and back injuries are soaring." (Crain Communications Inc.)
Challenges of Remote Medicine Provide Solutions Many Employers Can Use
"For businesses operating in remote locations, solving [health care delivery] problems doesn't just affect productivity and the bottom line -- it can determine whether or not they stay in business." (The Institute for HealthCare Consumerism)
[Opinion] Paying for Unproven Medical Treatment: Crazy Medicine and Unsustainable Public Policy
"Everyone wants the best available care, especially for life-threatening diseases like cancer. But that doesn't mean Americans should pay exorbitant costs for treatments that can't be shown to be better than other, cheaper, options." (The New York Times; free registration required)
[Opinion] Empowering Patients as Key Decision Makers in the Face of Rising Health Care Costs
"For policymakers and the public, the basic question is not whether there should be rationing in health care: It already exists. Economics itself is an exercise in rationing among goods and services because limited resources cannot purchase unlimited goods. The crucial question is: Who should make the rationing decisions?" (The Cutting Edge News)
Can My Company Force Me to Take Health Insurance?
"Another reason the company requires you to take the health insurance is that if you do get sick, not being able to get care means you won't be able to work, you'll have high stress which makes the health situation worse, and even when you recover, you'll be buried under bills which will affect your performance level. They are looking out for their self interest as well as yours." (CBS Interactive Inc.)
Medical Care Visits Pick Up at End of Year Before New Deductibles Kick In
"It's an end-of-the-year crunch that has become a tradition of its own as people deal with the terms of their health insurance plans. For some, it's about taking advantage of one type of coverage before an employer switches plans. Others hurry to spend money set aside in a flexible spending account, which would otherwise be lost . . . ." (Chicago Tribune)
Top 12 Health Care Buzzwords for 2012
"This year's crop of healthcare buzzwords and catchphrases includes a handful of terms that are really oxymorons. . . . Innovators are looking at their systems and turning them upside down, contradicting old assumptions and turning volume-based care and payment systems into long-term wellness programs." (HealthLeaders Media)
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