iLoveBenefits: Industry News Blog

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.

Medicare hospice palliative and curative care will be allowed for the first time

CMS announced the new Medicare Care Choices Model which will allow beneficiaries who qualify for the Medicare hospice benefit to receive palliative and curative care at the same time, which isn’t permitted under current Medicare payment rules. Under the five-year demonstration, CMS said participating hospices will provide services that are currently available under the Medicare hospice benefit for home care and respite levels of care, but cannot be billed separately under Parts A, B and D. For each beneficiary, CMS will pay a $200 to $400 monthly fee. Services will start next year for the first round of hospices and then in January 2018 for the rest. 

July 27, 2015 | Categories: Benefits,healthcare,Medicare | Tags: , , | Comments (0)

Independent Payment Advisory Board will be triggered for the first time

July 2015, implementation of the Independent Payment Advisory Board will be triggered for the first time in just two years, based on projections included in the annual report issued by Medicare’s trustees. That controversial ACA panel would be required to recommend cuts if Medicare exceeds spending growth thresholds. Conservatives have pilloried the board as potentially a means to ration care for seniors, and the House voted earlier this year to repeal it.

How Does Medicare Spend its Money

Latest Medicare Payment Composition Data

Here are some key findings from the new 2013 Medicare spending data released by CMS:

  • Over 950,000 health care providers collectively received about $89 billion in Medicare payments in 2013.
  • This includes $17 billion for drugs administered and $72 billion for medical services.
  • Spending on psychiatry rose 9.3%, to $853 million.
  • $32 million was spent on sports medicine, for an increase of 56%.
  • Sleep medicine spending increased, as 100 new practitioners in the specialty received $7.2 million.
  • Spending on general practice decreased by 7.6% to $380 million.

Source: Centers for Medicare and Medicaid Services, June 2, 2015

June 9, 2015 | Categories: Benefits,Cost,insurance,Medicare | Tags: , , , | Comments (0)

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

Accenture Survey: Majority of Seniors Want to Access Healthcare From Home

An Accenture survey regarding senior attitudes toward digital healthcare tools found that:

  • 67% of seniors want to access healthcare service from home.
  • 66% of seniors do not think available technology is sufficient for them to access healthcare from home.
  • Currently 25% of seniors use electronic health records portals regularly to manage their health.
  • Of those that currently use these portals, 57% use them to access lab results.
  • More than 60% of seniors are willing to wear a health tracking device to monitor vital signs.
  • Over 66% of seniors prefer to use self-care technology rather than managing health independently.

Source: Accenture, March 2, 2015

Reimbursement is beginning to change in important ways

Effective January 1st, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers who actively manage care delivery for Medicare patients who have two or more chronic conditions. According to a recent health care provider survey, 76% of respondents planned to organize and structure to meet Medicare’s chronic care management program requirements within the next six months.



5% of Seniors Admitted to Hospital within 1 Week After ER Release

Study: Close to 5% of older ED patients are hospitalized within a week A study in the Journal of the American Geriatrics Society revealed close to 5% of seniors who visit the emergency department are hospitalized within a week of being released. Old age was among the predictors of hospitalization, and end-stage renal disease, chronic kidney disease and congestive heart failure were the conditions tied to the highest likelihood of admission. News (1/23)

Everyone’s destiny is health care . . . we need to improve this . . . for ourselves

Survey: 68% of older U.S. adults have multiple chronic conditions A survey from The Commonwealth Fund of 15,617 older adults in the U.S. and 10 other countries showed 68% of Americans had two or more chronic conditions and 53% were taking four or more medications, which were higher rates than reported in some other countries. Other countries had better rates of same-day care than the U.S., but Americans had faster access to specialist care. The findings were published in Health Affairs. Health Affairs Blog

How much will you need in retirement to cover health care expenses

According to projections in a recent report, in 2014, a man would need $64,000 in savings and a woman would need $83,000 if each had a goal of having a 50% chance of having enough money saved to cover health care expenses in retirement. Source: “Needed Savings for Health Care in Retirement Continue to Fall,” Employee Benefit Research Institute (EBRI) Press Release, October 28, 2014,

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