iLoveBenefits: Industry News Blog

National Health Spending Increased 4.3% in 2016

December 12, 2017

The CMS Office of the Actuary recently released national health expenditures for 2016. Here are some key findings from the report:

• In 2016, overall national health spending increased 4.3%.
• Retail prescription drug spending increasing 1.3% to $328.6 billion in 2016.
• Private health insurance spending increased 5.1% to $1.1 trillion in 2016.
• Medicare spending grew 3.6% to $672.1 billion in 2016.
• Spending growth for Medicaid slowed in 2016, increasing 3.9% to $565.5 billion.
• Out-of-pocket spending grew 3.9% to $352.5 billion in 2016.

Source: CMS Office of the Actuary, December 6, 2017

26% of Californians Were Covered By Medicaid/CHIP in 2015

Some simply amazing data. How can this be?

Kaiser Family Foundation recently updated state fact sheets on Medicaid spending. Here are some key findings from the report on Medicaid in California:

• In FY 2015, Medicaid spending in CA was $85.4 billion.
• 26% of people in CA were covered by Medicaid/CHIP in 2015.
• 4 in 5 Medicaid enrollees in CA are in families with a worker.
• 34% of Medicaid spending in CA is for Medicare beneficiaries.
• One-fifth of state general fund spending in CA is for Medicaid.
• 58% of all federal funds received by CA is for Medicaid.

Source: Kaiser Family Foundation, January2017

Seeing Medicare and Medicaid Patients

According to a recent survey, 73.1% of physicians do not limit the number of Medicare patients they see, and 63.7% of physicians do not limit the number of Medicaid patients they see. Source: 2016 Survey of America’s Physicians: Practice Patterns & Perspectives, The Physicians Foundation, September 21, 2016.

1 in 3 Adults Have Not Planned for Long-Term Care Needs

The Associated Press recently published their 2016 Long-Term Care Poll on attitudes and preparedness for long-term care. Here are some key findings from the report:

·         4 in 10 American adults over age 40 expect to rely on Medicare to pay for their long-term care needs.

·         One-third say they have done no planning at all for their own long-term care needs.

·         More than three quarters would prefer to receive care for themselves in their own home.

·         67% would prefer for their loved ones to receive care in a home setting.

·         Half of older Americans support government-administered long-term care insurance programs.

·         72% support state paid family leave programs to help Americans providing care to a loved one.

Source: Associated Press, June 1, 2016

Medicaid programs educating beneficiaries

A new AHIP Issue Brief provides background information about the Medicaid program and explains how health plans work with the states to deliver care for Medicaid beneficiaries.

Our issue brief provides an overview of the federal-state Medicaid partnership, who is covered by Medicaid and the benefits they receive, the role of Medicaid health plans, research findings on the value offered by Medicaid health plans, and the key issues health plans face under the Medicaid “mega reg” that CMS is expected to finalize at some point this spring.

The brief also highlights key areas where Medicaid health plans are demonstrating strong leadership:

  • By offering integrated health care delivery systems, Medicaid health plans promote access to coordinated, quality care and prevent overutilization of services that are both unnecessarily costly and potentially harmful for their enrollees, including dual eligibles.
  • By conducting outreach and health education efforts that encourage Medicaid beneficiaries to receive needed preventive care, Medicaid health plans help to reduce unnecessary hospital admissions.

By helping to manage chronic conditions through patient-centric disease management programs, Medicaid health plans are improving health outcomes while also reducing the costs of providing health care to beneficiaries with complex health care needs.

US Healthcare Spending $3 Trillion

U.S. Healthcare Spending was $9,523 Per Capita in 2014

Health Affairs recently published a study on national health spending trends in 2014. Here are some key findings from the report:

  • U.S. health care spending increased 5.3% to $3.0 trillion in 2014.
  • Health spending was $9,523 per capita in 2014, 4.5% higher than in 2013.
  • The share of gross domestic product used for health care was 17.5%, up from 17.3% in 2013.
  • Retail prescription drug expenditures increased by 12.2% in 2014.
  • Medicaid spending growth increased at a rate of 11%, compared to 5.9% in 2013.
  • The federal government’s share of health spending increased from 26% in 2013 to 28% in 2014.

Source: Health Affairs, November 2015

NCQA Health Insurance Plan Ratings 2015–2016

Using a new methodology, NCQA has announced their Health Insurance Plan Ratings 2015–2016. NCQA studied 1,358 health plans and rated 1,016: 491 private (commercial), 376 Medicare and 149 Medicaid. The ratings align with the CMS Star Ratings of Medicare Advantage plans, and incorporate health outcomes and consumer satisfaction data. Click to continue.

Patrick Conway on lower hospital ED use

Patrick Conway will be one of the Novembe 2015 Cracking the Code on Health Care speakers in Rochester, NY

CMS official links lower hospital, ED use to support for primary care
A 2% decrease in hospital admissions and emergency department visits can be linked to increased CMS support for primary care, the agency’s chief medical officer, Patrick Conway, told the National Quality Forum’s annual conference. He highlighted several population health and coordinated care projects, initiated by hospitals and physician practices, that have reduced costs and improved quality of care. HealthLeaders Media

Use of copays do not reduce Medicaid members use of ERs

JAMA internal Medicine published a study conducted by Johns Hopkins Researchers showing that Medicaid copayments do not significantly reduce Medicaid recipients’ use of emergency rooms.  “Our study suggests they will need to look at other strategies besides requiring copayments. There was little evidence that cost-sharing would have any impact on the use of emergency rooms by poor people, who often have few other health care options,” said the lead author of the study.

AHRQ Finds Hospital Readmission Rates High Among Medicaid “Super-Utilizers”

Medicaid “super-utilizers” accounted for half of all 30-day hospital readmissions for the Medicaid population in 2012, with a readmission rate nearly six times as high as that for other Medicaid patients, a new statistical brief from AHRQ concludes. Super-utilizers, or patients who had four or more hospital admissions annually, are a relatively small group of patients who account for a disproportionately large share of hospital services and costs. The authors examined data from AHRQ’s Healthcare Cost and Utilization Project and found that the 30-day all-cause readmission rate among super-utilizers was 52.4 percent compared with 8.8 percent for other Medicaid patients. Medicaid super-utilizers’ hospital stays also were longer and more expensive. The two most common reasons for hospitalization among these patients were mood disorders, and schizophrenia and other psychotic disorders.  Medicaid is the largest public health insurance program in the United States, with more than 67 million beneficiaries. The statistical brief is titled, “Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012.”

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