iLoveBenefits: Industry News Blog

Health care hiring slows

Healthcare, an engine of employment through the recession, shed 6,000 jobs in December with payroll declines in ambulatory care and hospitals.

The drop comes at the end of a year in which healthcare hiring flagged, adding a below average number of jobs, new figures from the Bureau of Labor Statistics show. Healthcare added 271,000 jobs last year to bring the industry’s total to 14.57 million. Hiring fell about 2% below the annual average since 1990.

http://www.modernhealthcare.com/article/20140110/NEWS/301109951?AllowView=VDl3UXk1TzRDL1NCbkJiYkY0M3hlMEtvajBVZEQrYz0=&utm_source=link-20140110-NEWS-301109951&utm_medium=email&utm_campaign=mh-alert

The trend in hospitals is down, the trend in outpatient employment is up. In good times, there was likely over hiring. Now as times get leaner for the health care industry they will need to adjust like every other industry. They will need tools such as Lean Six Sigma and other process tools to address the need for greater productivity.

This is what Health Exchanges can be . . .

Instead of focusing on the issues and challenges that some exchanges are experiencing, if America understood the success of the California Exchange they would begin to grasp the promise of what can be. . .

Thousands of Consumers Apply for Health Insurance through New Covered California Marketplace

First Week of Open Enrollment Reveals Strong Demand for Coverage; Nearly 1 Million Unique Visits to Website; Service Center Calls Surge

SACRAMENTO, Calif. — Covered California™ received tens of thousands of enrollment  applications during the first week consumers could officially apply for health  insurance at the agency’s online marketplace, as well as those newly eligible  for Medi-Cal coverage.  “We’ve started strong,” said Executive Director Peter V.  Lee. “The amount of interest and number of applications we’ve received in the  first week underscores the demand among Californians for quality, affordable  health care.”

Website    and Call Center Weekly Report: Oct.1-5
Service    volumes
Unique    visits to CoveredCA.com 987,440
Call volume 59,003
Average    wait time 15:08    *
Average    handling time 16:48
Applications 43,616
Partially    completed 27,305
Applications    completed with household eligibility determined 16,311
Number    of Californians determined eligible for coverage 28,699
Small    Business Health Options Program businesses registered as of 10/8/2013 430
*Average    wait time was reduced to less than four minutes by Friday, 10/4/2013.

For the initial week of operations, reflecting Tuesday  through Saturday (Oct. 1-5), Covered California’s website, www.CoveredCA.com, had 987,440 unique visits.  Online, 16,311 households completed their eligibility process and were  determined eligible for subsidies, Medi-Cal or to enroll in an individual  private plan. These household applications contained 28,699 individuals who  completed eligibility determination. An additional 27,305 households had  partially completed their online application.

At Covered California Service Centers, 59,003 calls were  logged over the five-day period. “It’s just the beginning, but these numbers are truly  exciting and encouraging,” Lee said. Consumers were equally excited about being  able to enroll online in Covered California health insurance plans that provide  quality and value, and uniform benefits, without worry about pre-existing  conditions.

Paul Torrigino of Sacramento enrolled in a Bronze plan for  about a dollar per month and said, “Oh my gosh, the insurance has been going up  for the last few years like crazy. All our money was going to pay for medical  insurance.”

In San Diego, the Gedankens are receiving premium  assistance of $1,300 a month on their Silver plan — roughly half the cost  they’re paying now.

And Aura Lee Sanchez from Sacramento said when she enrolled,  “It felt fantastic to finally get coverage!”

“With almost three months to enroll for coverage effective  Jan. 1, the fact that thousands of Californians and hundreds of our small  businesses are stepping forward in our first week is a testament to the need  for the Affordable Care Act,” said Peter Lee.

Subsequent weekly statistics will be based on a Sunday-through-Saturday  schedule. Total enrollment for October will be released in November.

“Covered California is committed to sharing information and  will continue to report weekly on the numbers of visits to our website and the  number of consumer calls to our Service Centers,” Lee said.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California will help individuals determine whether they are eligible for premium assistance that will be available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses will be able to purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit www.CoveredCA.com.

Federal subsidies – was this what you expected – affordable health care

Following on our post this morning on an article from the Wall Street Journal questioning whether young adults will purchase health care coverage, check out the following chart which offers a snapshot of the likely cost breakdown for a 26-year-old in Portland, Oregon, including the availability of premium subsidies.

WSJSubsidy

– See more at: http://www.ahipcoverage.com/2013/07/25/chart-of-the-day-subsidy-ceiling/#sthash.Bsj7Ohcc.dpuf

Improving access to care at potentially lower price points

Take Care Clinics expand scope

Walgreen Co. is broadening its clinics’ scope of care–and not everyone is pleased. Nurse practitioners and physician assistants at roughly 370 of the chain’s Take Care Clinics will perform tests, make diagnoses, write prescriptions and provide other assistance. Walgreen’s decision follows a move by CVS Caremark Corp. to start monitoring chronic conditions at most of its 640 MinuteClinics, the Associated Press reports. The drugstores argue the move provides more people with access to health care and that they will work with physicians as part of a team treating patients, but critics say it can lead to fragmented care. (Associated Press)

FASB made companies prepare for this in the 1990s – but government not so much

Retiree Health Care: Biggest Retirement Bill Coming Due

According to a report from Pew Center on the States on pension and retiree health care funding in 61 cities-the most populous one in each state plus all others with populations over 500,000, the cities had set aside just 6 percent of $126.2 billion in projected costs for what are known as Other Post-Employment Benefits, primarily retiree health care, leaving $118.2 billion in unfunded liabilities in fiscal year 2009.

Los Angeles led the 61 cities with 55 percent of its retiree health care promises pre-funded in fiscal year 2009. Next were Denver (51 percent); Washington, D.C. (49 percent); Louisville (40 percent); Sioux Falls (37 percent); and San Antonio (31 percent).

Some cities have begun tackling their retiree health care liabilities by pre-funding a portion of their expenses. Of the 27 cities with some assets set aside, five contributed more than 90 percent of the annual sums recommended by their actuaries in both fiscal years 2009 and 2010: Anchorage, Charlotte, Los Angeles, Sioux Falls, and Virginia Beach. Eight contributed more than half of their full annual payments in both years, and 14 contributed less than half.

Source: Pew Center on the States
http://www.pewstates.org/research/reports/a-widening-gap-in-cities-85899442341?p=1

The world shares many common health care challenges

I am often asked to compare the United States to other regions of the world. While absolute costs are significantly different, the rates of increase, the budgetary challenges and desire for higher value care are common concerns across the globe. Here are a few examples published by the Commonwealth Fund:

A new series of International Innovations profiles approaches to solving shared health system challenges. These include:

A new issue brief by David Squires, senior research associate in the Fund’s international program, explains high health care spending in the U.S. compared with other countries.

D. A. Squires, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, The Commonwealth Fund, May 2012.

The Commonwealth Fund–supported research of Naoki Ikegami and Gerard Anderson found that Japan has been able to maintain access to care and avoid rationing while also taking advantage of the latest medical technology by applying a standardized fee schedule for nearly all health care goods and services and by combining hospital and physician fees.

With the cost of care in the US costing significantly more…is it worth it?

U.S. cancer care shows better survival rate
A study in Health Affairs revealed that the U.S. spent $598 billion in cancer care between 1983 and 1999, with a mean cost of $61,000 per patient. Researchers found that U.S. cancer patients lived an average of 11.1 years after the disease was diagnosed, while Europeans lived 9.3 years. “Our findings bear on the larger question of whether higher U.S. health care spending is worth it, suggesting — although not confirming — that it is,” researchers added. HealthDay News (4/9)

Then there is this:

The poor performance of the United States in life expectancy and other major health outcomes, as compared with its global peers, reflects what the nation prioritizes in its health investments. The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society. In this report, the IOM assesses both the sources and adequacy of current government public health funding and identifies approaches to building a sustainable and sufficient public health presence going forward.

Read the Report >>

Health care is our destiny

This from John Goodman:

Have you ever read an article in which the writer compares the incomes of the top 1% to the bottom 99% over the last decade, say? Or the comparison might contrast the top 10% to the bottom 90%?

The problem: the author is encouraging you to think that the people in the top 1% at the beginning of the decade are the same people who are in the top 1% at the end of the decade. But they aren’t. People move in and out of this category with surprising frequency. Yet if they aren’t the same people, what’s the point of the comparison?

A similar thing happens in health care. I frequently see writers say that a small number of people spend most of the health care dollars. True. But the small number this year are not the same people as the small number last year, or the year before.

As in the case of the income comparisons, readers can be misled into thinking that our health care problems boil down to how to take care of a small number of people. Not so.

Read more here: http://healthblog.ncpa.org/persistence/comment-page-1/#comment-106463

Socioeconomic status predictor if rural hospital utilization

Low-income adults ages 18 to 64 accounted for 56 percent of the 8 million visits made to rural hospital emergency departments in 2008.  [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #116: Emergency Department Visits in Rural and Non-Rural Community Hospitals, 2008.]

Prostate cancer vaccine Provenge subject of lawsuits at federal level

Jan.09, 2011
For the second time in as many months, the Centers for Medicare and Medicaid Services (CMS) finds itself named in a lawsuit related to the agency’s handling of the prostate cancer immunotherapy sipuleucel-T (Provenge).

Judicial Watch, a Washington-based public interest group, has sued HHS to gain access to documents related to the CMS decision to conduct a one-year national coverage analysis to assess whether the therapy is “reasonable and necessary,” thus qualifying for Medicare coverage.

According to a Freedom of Information Act request filed in last November, Judicial Watch wants access to “all records concerning CMS’ national coverage analysis of the vaccine Provenge, including but not limited to the criteria being used to analyze Provenge.”

The legal action apparently has evolved from a suspicion that the national coverage analysis is the first step toward cost-based healthcare rationing.

In a statement posted on the Judicial Watch website, representatives of the organization noted that sipuleucel-T “costs $93,000 to administer the three necessary treatments. Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost. Yet, multiple press reports suggest that cost is the major factor in the unusual decision by CMS to undertake a review of the treatment which could signal a move by the Obama administration to begin implementing healthcare rationing based on the cost of treatments.”

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