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

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.

Educating patients and families on palliative vs hospice care is critical

Medicare Spent $11,393 per Hospice Beneficiary in 2014

 

CMS recently released an analysis on hospice spending. Here are some key findings from the report:

 

In 2014, Medicare spent an average of $11,393 per hospice beneficiary.
There were 1.3 million hospice beneficiaries in 2014.
11% had a live discharge from hospice care in 2014.
In 2014, 1 in 3 beneficiaries had more than 60 days of hospice care.
13% had more than 180 days of hospice care in 2014.
South Carolina had the highest spending ($14,778) per hospice beneficiary.

 

 

Source: CMS, October 6, 2016

62% of Exchange Plans Will Be HMOs in 2017

 

 

McKinsey & Company recently released an analysis of 2017 exchange plan designs across the U.S.

Here are some key findings from the report:

 

HMOs will comprise 62% of all plans for 2017.
68% of consumers will have access to competitively priced managed plans only.
The lowest-price silver plan premium will increase 9% for managed plans in 2017.
82% of consumers will have access to both managed and unmanaged plans in 2017.
For unmanaged plans, the lowest-price silver plan premium increase will be 18%.
97% of national plans will be managed in 2017, up from 62% in 2014.

 

 

Source: McKinsey & Company, August 2016

Drug spending growth rate declines

Between May 2015 and May 2016, the growth in spending on prescription drugs dropped to 5.2%, down from 12.2% in 2014. Source: “CSHS Health Sector Economic Indicators Briefs: July 2016 Health Sector Economic IndicatorsSM Briefs,” Altarum Institute/Center for Sustainable Health Spending, July 2016, http://altarum.org/our-work/cshs-health-sector-economic-indicators-briefs  

Health care Premium Increases and Exchange Participation

    • Premium increases in the health insurance marketplaces created under the Affordable Care Act (ACA) will likely be higher in 2017 than in recent years. Kaiser Family Foundation analysis of proposed rates in states that make the information publicly-available shows an average premium increase in the benchmark second-lowest-cost Silver plan in 17 major cities of 9% in 2017, compared to an average increase of 2% in these cities in 2016.
    • Aetna CEO Mark Bertolini announced Tuesday (Aug. 2) that while the company is pleased with its overall second-quarter results, it will not enter exchanges in additional states in 2017 as planned and is revisiting its current position in 15 states.

“Buying Into” Medicare

Health care issuers are already interested in a proposal that would allow Americans age 55 and older to “buy into” Medicare, according to Chris Jennings, a longtime health policy expert and adviser to Democratic presidential nominee Hillary Clinton. Jennings spoke on a panel during the Democratic National Convention featuring several prominent health policy players, including former Senate Majority Leader Tom Daschle (D-SD), Center for American Progress President Neera Tanden, Families USA Executive Director Ron Pollack and former head of the White House health reform office Nancy-Ann DeParle.

Should wellness programs be sponsored by your employer

According to a recent survey, only 48% of employees had participated in an employer-sponsored program to help them improve their physical health. Source: “Employees Report High Satisfaction with Health and Well-being Programs, but More Personalization is Needed,” National Business Group on Health Press Release, July 20, 2016, https://www.businessgrouphealth.org/pressroom/pressRelease.cfm?ID=280

Can anyone create a understandable explanation of benefits (EOB)

According to a recent survey, 95.5% of respondents had received a medical bill from a doctor, hospital, or health care provider in the past 12 months. Of those, 60.5% rated their medical bills as confusing or very confusing. Their frustrations included the following:

  • The relationship between bills from provider and the statements from insurance company: 50.6%
  • Not sure if the total owed was correct: 49.4%
  • The amount owed was a surprise: 48.8%
  • Unexpected expenses that were thought to be covered by insurance: 46.1%
  • Not sure if the insurance company had paid yet: 43.2%
  • The bill arrived a long time after the date of service: 42.3%
  • The relationship between the bill and insurance deductible: 35.1%
  • Didn’t understand the language on the bill: 23.5%
  • Wasn’t sure if everything listed on the bill really happened: 22.0%

Source: “A BILL YOU CAN UNDERSTAND RESEARCH REPORT,” Mad*Pow, May 6, 2016, http://static1.squarespace.com/static/5715100cf8baf3c79d443859/t/5730e1c4f699bbe627603424/1462821330491/DesignChallenge_ResearchReport.pdf

What provider network does your health plan offer?

Over 60% of health insurers have changed network strategy since 2014, with 53% using tiered and 42% using narrow networks, according to a recent report. Source: “Journey to Value: The State of Value-Based Reimbursement in 2016,” McKesson, June 2016, http://mhsinfo.mckesson.com/rs/720-XWV-189/images/McKesson-Journey-to-Value-State-of-VBR-2016.pdf

July 11, 2016 | Categories: Benefits,healthcare,insurance | Tags: , , , | Comments (0)
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