iLoveBenefits: Industry News Blog

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

Innovations to Reduce Non-Urgent Use of Emergency Services

The Agency for Healthcare Research and Quality (AHRQ) announces the August 17 issue of the Health Care Innovations Exchange (

  • The featured Innovations describe how an ambulance provider redesigned its emergency medical services system to create new care and referral pathways for 911 callers not facing true emergencies; a community paramedic program that significantly reduced unnecessary 911 calls from a local shelter and enhanced access to primary care for shelter residents; and a city EMS program that used a multipronged strategy to reduce unnecessary ambulance transports and ED visits, connecting non-emergent patients to primary care.
  • The featured QualityTools include resources for reducing inappropriate emergency department use and tools to support community paramedicine programs.
  • The featured Perspective, Convening a Learning Community to Reduce Non-Urgent Use of Emergency Services, describes the collaborative work of the Innovations Exchange Emergency Services Learning Community, based on an interview with its champion and expert faculty.

Emergency Doctor’s Perspectives on Getting and Paying for the Care of their Patients

As you look at this survey keep in mind who they are asking and how they are responding. For example, 8 out of 10 are seeing patients…who are foregoing or delaying medical care. While it seems to say that 80% of physicians are seeing at least one patient who is delaying health care, it is not providing the detail about how many patients on the whole are delaying medical care…

And what percent of patients understand their health insurance coverage and how it works?

According to a recent nation-wide survey of emergency physicians:

  • 96% said that emergency patients do not understand what their health insurance policies cover for emergency care
  • 8 in 10 are seeing patients with health insurance who have forgone or delayed medical care because of high costs
  • 62% say most health insurance companies provide less than adequate coverage for emergency care visits
  • Over 60% have had trouble finding in-network specialists to care for patients in the last year
  • A quarter of them say they have trouble finding in-network specialists on a daily basis

Source: “Insurance Companies Mislead Patients By Selling “Affordable” Policies That Cover Very Little,” American College of Emergency Physicians News Release, May 9, 2016,

E-health comes of age as a business issue

I can get my $1 Coke and my $1 dollar burger, but where’s my $1 salad?

80% of consumers say they wish “doing healthier things didn’t cost so much”

According to a recent consumer survey by Cigna:

  • 75% fear health costs could ruin prospects for secure retirement.
  • 44% worry health costs will limit ability to pay for child’s college.
  • 42% of consumers note hospitalization as their number one health cost concern.
  • 19% of consumers note health costs for a spouse or partner as their number one health cost concern.
  • 16% of consumers note costs of medications as their number one health cost concern.

Note: “Health and Financial Well-being: How Strong Is the Link?” was conducted electronically via a panel by MRops Data Collection from August 7 – 21, 2014 with 1,847 women and men 25-64.

Florida – average weighted silver plan premiums to increase by 13.2% in 2015

The Florida Office of Insurance Regulation announced that the average weighted silver plan premium in the state will increase by 13.2% in 2015.  According to the release, the “average monthly premium for a Silver plan ranges between $938 and $1,452 for a family of four earning $51,000.  Even with a federal subsidy, that could mean an out-of-pocket cost of $500 or more per month to have coverage that still requires Florida families to pay about 30% of expenses out-of-pocket for deductibles, copayments, and coinsurance.”


PricewaterhouseCoopers LLP’s Health Research Institute (HRI) released an analysis that finds health insurance premiums in the individual market will rise, on average, by 7.5% in 2015.

New Service Offers Real Price Transparency

CHEYENNE, Wyo., July 18, 2014 /PRNewswire/ — A new service aimed at simplifying the way doctors are paid for providing medical care is now inviting healthcare providers to sign up. This service, called, provides an integrated technology platform that allows medical professionals to register and list their services for prospective patients. Prospective patients have access to web-based and mobile technology that allows them to search these physician offerings by location and price. They have opened up an online registration tool through their website

Read more here:


Health care spending continues its torrid growth

The Altarum Institute released its monthly indicators for the health sector, which found that national health spending in February 2014 grew 6.7 % over a year earlier, the highest rate of growth since the recession started.  A portion of the growth is attributable to newly insured individuals, but much of the acceleration in growth happened in 2013, before coverage took effect.  By January, the health spending share of GDP reached an all-time high of 17.7 percent.

Self care is beginning to come of age

The rise of the empowered patient
A woman who diagnosed her own rare genetic disease represents today’s “empowered patient,” said cardiologist Dr. Eric Topol, who interviewed her at the Future of Genomic Medicine conference. Kim Goodsell identified the cause of her irregular heartbeat and other symptoms as a type of Charcot-Marie-Tooth disease, and she pressed her physicians for genetic testing. One of her doctors subsequently listed her as a co-author of a case study he is preparing to present to the Heart Rhythm Society, saying she did the majority of the work. San Diego Union-Tribune (3/7)

Does this improve outcomes or provide incremental revenue?

Is point-of-care ultrasound the new stethoscope?
A new paper espouses the benefits of hand-held ultrasound devices over the iconic stethoscope, arguing the convenience and power of ultrasound will improve diagnosis. Writing in the journal Global Heart, Drs. Jagat Narula and Bret Nelson of the Mount Sinai School of Medicine question why sonography isn’t used more widely. However, Dr. Reid Blackwelder, president of the American Academy of Family Physicians, says the stethoscope remains valuable and warns wider use of sonography could bring additional costs — both for equipment and the tests that might follow the initial assessment. CBS News (1/24), (1/23), USA Today (1/24)

So, I am not against advances, but is there evidence that the outcomes are better than with a stethoscope? I know it will be more expensive. The article talks about it leading to more tests, too.

On the other hand, how about personal medicine and getting these devices as apps with sophisticated computer software that links to a ‘benchmark’ database to inform patients of potential next steps? Does that lower the number of office visits and procedures vs. putting the technology only in the hands of the clinician?

Older Posts »