Trends That We Are Reporting On Our Facebook Page

Almost 70 percent of Americans now have access to an accountable care organization for their health needs

Although growth slowed the number of ACOs still rose by about 16 percent; number of patients served rose 6 percent, said consultant Oliver Wyman.

Almost 70 percent of the U.S. population now lives in localities served by accountable care organizations, and 44 percent live in areas served by two or more, found new research by the Oliver Wyman consulting firm.

The total number of ACOs participating in Medicare programs has increased to 426, up from 368 in January 2014, the study found.

About 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, now receive their healthcare from ACOs participating in Medicare’s ACO programs.  https://www.facebook.com/TheMCIC

Source:  Oliver Wyman Study  http://www.oliverwyman.com/

What ‪‎Physicians‬ Earned in 2014 – New Results

“On average, specialists earned $284,000 a year while primary care physicians earned about $195,000, according to a new survey, which polled 19,500 physicians across 25 specialties.”

Orthopedists‬ earn an average of $450,000 a year. Cardiologists were earning a average total of $395,000 a year, the survey found.

On the lower end, pediatrics showed the lowest total compensation at $196,000, though exactly half said they felt fairly compensated. Also, 50 percent of pediatricians polled were women.

The average compensation for a self-employed male physician was $324,000, compared to $259,000 for female physicians.  https://www.facebook.com/TheMCIC

Source: Health Care Finance  http://www.healthcarefinancenews.com/

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Directories of Healthcare Payers and Provider Organizations From the Managed Care Information Center

Searching for contact information about managed care organizations, health systems and hospitals or such physician organizations as independent practice associations or physician hospital organizations visit our Directories of Health Insurers and Providers page at Health Resources Online.

https://www.healthresourcesonline.com/directories-of-health-insurers-and-providers.html
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“A small percentage of patients are responsible for the majority of healthcare spending in the United States,” study finds.

The top three percent of patients categorized as persistent high users accounted for 21 percent of total annual healthcare expenditure for a typical large business in Pennsylvania, found the study published this week in the American Journal of Managed Care.

Persistent high users incurred annual expenses of more than $38,000 compared to just $2201 for patients who never crossed the “high use” threshold, the study researchers said. While some patients experiencing acute issues or hospitalizations temporarily incurred high expenses, patients experiencing a higher burden of sustained chronic conditions were significantly more likely to be frequent users of healthcare services. https://www.facebook.com/TheMCIC

Source: Healthcare IT Analytics  www.http://healthitanalytics.com/

 

Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

From collaboration and consolidation to the inevitable acceptance of
a value-based system, the state of healthcare continues to stimulate
health plans,  providers and employers.

“Healthcare Trends & Forecasts in 2015: Performance Expectations for
the  Healthcare Industry,” HIN’s eleventh annual industry forecast,
examines the  factors challenging healthcare players and suggests
strategies for organizations  to distinguish themselves in the steadily
evolving marketplace.

For more information or to reserve your copy today please click on
this link: “Healthcare Trends And Forecasts in 2015”

In this yearly strategy playbook, Steven T. Valentine, president of
The Camden  Group, returns to give the industry outlook for healthcare
providers. Beginning  with his “pyramid of success” for population health
management, Valentine  outlines key impacts for physicians and
hospitals, including increasing  transparency in quality and pricing data;
emerging business roles for  physicians; shifting locus of care; and the
empowered and tech-savvy  healthcare consumer.

Offering the payor perspective is Dorothy Moller, managing director,
Navigant, who outlines industry “winds of change” and “seeds of
transformation” impacting health plans in the form of new roles for
existing stakeholders, mobile health and technology, and new players
on the healthcare field.

Now in its eleventh year of providing healthcare executives with a look
ahead to help shape strategic plans, “Healthcare Trends & Forecasts in
2015: Performance Expectations for the Healthcare Industry” covers
the following:

* Snapshot of provider trends, including inpatient utilization, pricing
and  quality transparency, and population health management;

* Provider milestones along the road to fee for value, including
accountable care and clinical integration;

* Report card on accountable care organization (ACO) performance;

* 15 key ACO infrastructure elements;

* Expectations for the patient-centered primary care delivery model;

* Impact of Medicare Chronic Care Management reimbursement in 2015;

* 16 factors in health system transition to a value-based reimbursement
system, including time frame, delivery systems and payment models;

* Responding to changes in locus of care, telehealth, retail health,
and direct primary care;

* Five payor strategies mirroring provider initiatives;

* 15 transformative payor challenges signaling a fundamental change
in the industry;

* Five questions payors must answer before negotiating the path to
value-based care;

* A dozen companies to watch that are introducing new technologies,
care delivery vehicles, care payment structures and consumer
engagement models;

* Eight payor survival strategies for weathering the ‘disruptive winds’
in the industry; and much more.

Reserve your copy today and please click here now: Healthcare Trends
And Forecasts in 2015

Focus On Data in Era of Value-Based Models of Reimbursement

“Despite the continued prevalence of the traditional fee for service reimbursement models as the primary method of payment, over time healthcare’s reimbursement will give way to value-based models of reimbursement.”

That prediction made by longtime friend and consultant Russell Foster surrounding the need for accurate data as value-based models of reimbursement continue to emerge has come true.

You know that valued-based reimbursement today is a significant focus. Payer reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses.

Payment Bundling, PHO Shared Savings, and Pay for Performance are all in the mix of emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

One major health payer’s 6,300 enrolled primary care physicians can earn bonus payments across six measure sets — a broad spectrum of measures from clinical and quality measures to prescribing Continue reading

Premiums For 2015 Silver-Level Health Insurance Plans Being Offered at Lower Rates in Many Geographic Areas Than 2014

Consumers in most of the geographic areas studied will be able to obtain 2015 silver-level health plan coverage at lower rates than were available in 2014 or at premium increases of less than 5 percent found a new study by the Urban Institute.

Observers had been concerned that large premium increases might kick in for year two of the ACA health insurance marketplace experience.

Often the researchers found that a different carrier from the 2014 health plan is offering the lowest priced silver option in a rating area for 2015.

The ACA’s incentives, centered on the silver plan premiums in an area, the study report said, resulted in “healthy competition over rates in many markets in 2014, particularly in urban areas. Markets generally saw a large number of competing carriers offering several plans.”

The Urban Institute report said national commercial plans, “particularly Blue Cross Blue Shield (BCBS) plans, as well as local carriers, entered the health insurance marketplaces in 2014.”

Plans previously providing coverage only for Medicaid beneficiaries and cooperatives also entered the marketplaces in a number of areas, the researchers said. “As a result of competition, premiums were surprisingly modest in many areas, particularly in comparison with benchmarks such as small group market premiums.”

The study analyzed non-group marketplace plans. “We focus on 17 states and the District of Columbia, which were the first to complete their rate review and approval processes,” the researchers said.

Overall, the study found that: Continue reading

What They Learned From the First ACA Open Enrollment Period in California

Affordability means different things to different people, target enrollment groups have unique interests and require tailored messaging, partnerships matter and are transformative, and, many consumers are new to insurance and need extensive education about health insurance terminology, are among the lessons learned by officials at the California Health Benefit Exchange called Covered California in a review of its first open enrollment period 2013-2014.

The new report, “Covered California Open Enrollment 2013-2014: Lessons Learned” looks at the experience from the first year California offered expanded health coverage through new Affordable Care Act subsidies and the expansion of Medi-Cal through the Covered California marketplace, the organization said.

More than 3 million state residents were enrolled in coverage during the first enrollment period — 1.4 million in health insurance through Covered California2 and more than 1.9 million in Medi-Cal, officials said.

“The report,” the organization said, “provides the first in-depth review of our efforts in the first year, including marketing, outreach and education, eligibility and enrollment support, consumer profiles, marketing research, and information about those we still need to enroll.”

The populous state faced “outsized challenges, making it unique among states establishing state exchanges. From the start, California focused on addressing these challenges in the design of the marketplace and in the state’s approach to reaching, educating and enrolling millions of uninsured and underinsured Californians, particularly those who struggle to afford the costs of health care and coverage.”

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The National Directory of Physician Organizations Database

Key contacts information on more than 1,370 physician organizations. including: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, management service organizations (MSOs) and primary care networks.

Get details here: The National Directory of Physician Organizations Database

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Covered California said it was also “mindful that its marketplace design and implementation would shape the broader health insurance market in California for those who were not eligible for subsidies through the exchange, many of whom had coverage before the initial open enrollment.”

Some 7.1 million state residents were uninsured, officials said, sometime during the year before implementation of reform.

Among the lessons learned:

* Many consumers are new to insurance and need extensive education about health insurance terminology, how to enroll in coverage and how to use insurance.

* Consumers need clear, straightforward information that explains how insurance works in plain language, without jargon. There is an ongoing need for a comprehensive,accessible, educational campaign to help answer common questions about Covered California’s products and promote the value of insurance. For 2015 open enrollment, advertising messaging is attempting to explain, in first-person testimonials, that health coverage means going to the doctor and getting the care you need.

* Affordability means different things to different people. Many consumers, even with financial assistance through federal subsidies, found cost to be a barrier to obtaining coverage. Future communications need to address the issue of affordability by emphasizing the value of having insurance and the financial security (protection from arge medical bills) that it provides. New advertising and marketing materials include testimonials from newly insured Californians explaining that insurance is a bill they don’t mind paying each month, with an emphasis on the peace of mind of having coverage and the financial security it brings for those able to purchase it.

* Target enrollment groups have unique interests, experiences and perspectives and require tailored messaging and customizable materials. Consumers in different age, income, gender and ethnic groups reflect different circumstances, knowledge and needs for information and support. Media messaging, marketing and collateral materials, assister training, and community outreach and enrollment efforts need to address the specific needs and interests of diverse communities. Community partners, grantees, agents and enrollment counselors need simple, updated fact sheets, fliers, brochures and other materials, including customizable materials for local events and target groups.

Covered California expanded its targeted support to local outreach and has developed, and will continue to develop, customizable, focused materials available to community partners and insurance agents for open enrollment in 2015.

* Most consumers relied on a variety of touch points, including in-person assistance, to successfully complete enrollment. Most consumers needed multiple touch points, whether pursuing self-service or an assistance pathway. They wanted to ask questions, get answers, identify the options and then consider, often in consultation with friends and family, the coverage most suitable for them. Covered California responded by shifting marketing and outreach messaging and encouraging Californians to take advantage of free, confidential, in-person assistance in local communities. More than 6,400 Certified Enrollment Counselors and more than 12,000 Certified Insurance Agents will be part of a comprehensive campaign for enrollment in 2015.

* The multi-channel marketing and media mix struck an effective balance between brand (awareness) and direct response (enrollment) and will continue to be tailored to specific target audiences. The large number of those eligible who enrolled is the strongest indicator that the community-level outreach, marketing and media campaigns, as adjusted in real time, were successful in accomplishing the two program goals: brand awareness and enrollment. Going forward, marketing and advertising will support the community outreach campaign targeting key demographic groups and segments. Building on brand awareness, advertising will be aimed at explaining how to enroll and motivating audiences to enroll by sharing the tangible ways having health coverage is improving the lives of real people.

* Partnerships matter and are transformative. At every stage of planning and implementation for the first open enrollment, Covered California relied on and collaborated with a multicultural and varied set of state and local partners who made the unprecedented effort possible. Covered California partners made real-time adjustments and accommodations as challenges surfaced and consistently helped in resolving and addressing those challenges. The partnerships reaffirm the power of shared commitment, collaboration and common effort.

Following is the link to the report: http://www.coveredca.com/resources/PDFs/10-14-2014-Lessons-Learned-final.pdf

 

 

 

Health Plan Member Satisfaction in 2014

Issues surrounding the time a member must wait after a pre-approval request has been submitted to their health plan before they hear from their provider, to concerns about having adequate health coverage, and health plan notices of changes in their coverage, networks or rates are having an impact on members satisfaction with their plan, found a recent study.

Some 41 percent of existing health plan members believe that they lack enough coverage for routine visits, serious illness or injury, health and wellness programs, routine diagnostics and drug coverage, found the study by market research firm J.D. Power.

Concerns over not having enough health coverage negatively impacts overall satisfaction by 133 points, more than any other coverage-related issue, according to the J.D. Power 2014 Member Health Plan StudySM.

The study, in its eight year, measures satisfaction among members of 136 health plans in 18 regions throughout the United States by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.

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In 2014, overall member satisfaction averages 669 (on a 1,000-point scale), the firm said.

Key Findings include:   Continue reading

More than 4000 Physicians Now Designated Patient Centered Medical Homes by Blue Cross Blue Shield of Michigan

Some 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year by Blue Cross Blue Shield of Michigan.

The doctors are members of 1,422 physician practices that combined care for more than 1.2 million BCBSM members in 78 of Michigan’s 83 counties.

The program, in its sixth year, continues to lead the nation in size and cost savings, BCBSM said.

The health plan said it recorded certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program.  Savings estimates for year four are expected later this year.

“Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices,” BCBM said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

Cigna’s Collaborative Care Now Includes Small Physician and Specialist Groups, Hospitals

Cigna said it has expanded its Cigna Collaborative Care to include health care professionals wherever they are in the health care delivery system.

The health insurer said it has developed a new suite of value-based initiatives called Cigna Collaborative Care that builds on the company’s Cigna Collaborative Care (CAC) initiatives.

The CAC is Cigna’s approach to achieving the same population health goals as accountable care organizations (ACOs): better health, affordabilityandexperience. The CACarrangements began first with large physician groups and integrated delivery systems. Now, the CAC expands value-based initiatives to include small physician groups, specialist groups, and hospitals, in addition to large physician groups, officials said.

Besides the large physician practices, the incentive-based Cigna Collaborative Care includes:

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The Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance explores emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

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  • Small physician groups including small private practices and unorganized physician groups. These arrangements represent an opportunity to help the 40 percent of Cigna customers with high-cost conditions and complex needs that are treated by small physician groups.7 Cigna has established arrangements on a pilot basis with small physician groups in select markets.
  • Hospital arrangements designed to promote quality, efficiency and safety for customers seeking hospital care. Research indicates that 25 percent of customers with high-cost conditions or complex needs are treated at a hospital each year.8 To date, Cigna has established arrangements with more than 150 hospitals, and continued development is planned for 2014.
  • Specialist groups focusing on the five specialties that account for 57 percent of medical spending – orthopedics, obstetrics-gynecology, cardiology, gastroenterology and oncology.9 Cigna launched orthopedic and maternity-focused arrangements in 2013, with continued development in 2014.

“The best way to achieve sustainable change in the health care system is to reach all stakeholders through personalized connections,” said Chief Medical Officer Alan M. Muney, M.D.

The CAC “enables us to engage health care professionals and customers in ways that are meaningful to them, which will help drive better health, affordability, and experience, he added”

Cigna said its CAC initiative is aimed at accomplishing the same population