iLoveBenefits: Industry News Blog

Patient spending increases as costs are shifted to deductibles and coinsurance

According to a recent blog in the Wall Street Journal by Kaiser Family Foundation’s Drew Altman, while worker’s wages increased 32% from 2004 to 2014, here’s what happend to patient spending during that time period:

  • patient spending on deductibles increased 256%
  • patient spending on coinsurance increased 107%
  • patient spending on copays decreased 26%

Source: “The Next Big Debate in Health Care,” The Wall Street Journal/Think Tank, June 30, 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

Putting a Positive Spin on a Critical Problem

53% of Exchange Consumers are Satisfied With Their Health Plan

Deloitte recently published their 2016 Survey of US Health Care Consumers. Here are some key findings from the report:

  • More than half (53%) of exchange consumers are satisfied with their health plan overall.
  • 54% of those with employer insurance and 74% of those with Medicare are satisfied.
  • 7 in 10 exchange consumers say they had no financial difficulty paying out-of-pocket costs last year.
  • 34% of exchange consumers feel prepared to handle future health care costs compared with 16% in 2015.
  • Nearly half of exchange consumers (45%) say they feel confident about being able to get affordable care.
  • 67% of exchange consumers looked online for help selecting a policy vs. 30% with employer coverage.

Source: Deloitte, May 11, 2016

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,

Congressional budget implications for health care

Congressional Recess Is Underway; Budget Decisions Still Unresolved

Both chambers of Congress have begun their Easter recess, allowing for a brief pause in legislative activity at the federal level. The Senate is scheduled to return from recess on April 4 and the House will return on April 11.

When Congress reconvenes, House leaders will make a decision about whether to proceed with the budget resolution that was approved on March 16 by the House Budget Committee. A key point of contention, which may result in changes to the committee’s version of the budget resolution, is the total amount of funding that will be allotted for the annual appropriations bills. Leaders of the House and Senate Appropriations Committee are eager to see this issue resolved, so they can take action in April and May on the 12 annual spending bills that will provide funding to support federal programs and agencies in fiscal year 2017.

The next stretch of the 2016 session also will include continued discussions by a series of House Republican Task Forces that are working to develop legislative recommendations on priority issues. One task force is charged with addressing health reform and others are focusing on national security, jobs and economic growth, poverty and opportunity, and constitutional authority. In January, House Speaker Paul Ryan (R-WI) stated that he expected these task forces to develop a complete agenda by the time Republicans choose their nominee for the presidential election.

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.

Race/Ethnicity for persons without health insurance

According to data from the January–September 2015 National Health Interview Survey, after adjusting for age and sex, the percentage of persons without health insurance coverage by race/ethnicity was:

  • 19.5% for Hispanic persons
  • 6.3% for non-Hispanic white persons
  • 10.0% for non-Hispanic black persons

Source: “Early Release of Selected Estimates Based on Data From the January–September 2015 National Health Interview Survey,” National Center for Health Statistics, Centers for Disease Control and Prevention, February 2016,

February 25, 2016 | Categories: Benefits,healthcare,insurance | Tags: , , | Comments (0)

4 in 5 expect that by 2021, patients will compare ratings before choosing a hospital

Survey: Most Patients Will Belong to Incentivized Health Plans by 2021

The Society for Healthcare Strategy & Market Development recently conducted a survey on healthcare leaders’ thoughts on emerging trends in healthcare. Here are some key findings from the report:

  • 99% agreed that by 2021 patients will demand a greater role in treatment planning.
  • 4 in 5 expect that by 2021, patients will compare ratings before choosing a hospital.
  • 89% said that most of their hospital’s insured patients will belong to incentivized health plans by 2021.
  • Most practitioners (88%) predict that at least a quarter of chronic disease patients will receive it remotely.
  • Two-thirds of practitioners predict that most chronic illness patients will receive primary care that includes some type of psychotherapy service.

Source: Society for Healthcare Strategy & Market Development, January 26, 2016

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

Health Benefits Cost $11,635 Per Employee in 2015

Mercer recently conducted the annual National Survey of Employer-Sponsored Health Plans. Here are some key findings from the report:

  • Total health benefits cost averaged $11,635 per employee in 2015.
  • Large employers experienced a 2.9% increase, while smaller employers experienced a 5.9% increase.
  • One fourth of all covered employees are now enrolled in a CDHP.
  • Employers predict that in 2016 their cost per employee will rise by 4.3% after making plan adjustments.
  • 24% of employers provided transparency tools in 2015, up from 15% in 2014.
  • 1 in 4 large employers encourage employees to track physical activity with a ‘wearable’ device.

Source: Mercer, November 23, 2015

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