July 18, 2018
11:24 am
There is a consensus in this country that people who are struggling with illnesses and have a greater need for healthcare services should not be prevented from acquiring health insurance. Recent actions at the federal level, though, need to be addressed in order for that ideal to be met.
Risk adjustment payments provide financial stability to insurance providers that provide coverage to relatively high numbers of sicker, higher-cost consumers. Without those payments, premiums would become unaffordable for millions of Americans who buy their coverage through small businesses or on their own in the individual insurance market.
And that brings us to the current dilemma.
A federal district court judge ruled in February that the Department of Health and Human Service’s methodology for calculating risk adjustment payments was flawed and impermissible. Subsequently, on July 7, the Centers for Medicare and Medicaid Services (CMS) announced that payments under the risk adjustment program, including amounts already owed for the 2017 benefit year, would be suspended.
This is an issue that carries extraordinary ramifications. It will create more market instability – at a time in which we need just the opposite – and the potential for reduced coverage options for those who have the greatest need for healthcare access. Further, it could result in increased costs to taxpayers if the federal government has to increase premium subsidies.
An analysis by Change Healthcare, a major technology and analytics firm, found that the individual health insurance market attracts an extremely wide range of enrollees in terms of healthcare utilization. In fact, according to Change, the health plans attracting the sickest patients have health costs at least 450 percent higher than the plans with the healthiest clientele. Thus, the need for risk adjustment payments.
CMS has asked the district court judge to reconsider his ruling. We hope he will. Americans with serious healthcare needs should have affordable coverage.
April 17, 2017
4:53 pm
Now that most of us have filed our taxes for 2016, this is an opportune time to review our health planning with the same level of attention. There is a nationwide effort to make the day after Tax Day “National Healthcare Decisions Day” – a day in which we think about our long-term healthcare needs and make a plan for how we would like to be cared for in our final days. At one point or another, all families face challenges with advanced illness and must make decisions about end-of-life care, but too few of us have given thought to issues like designating power of attorney or creating advance directives and living wills. Advanced illnesses cause many challenges for families. One of the most difficult is when family members become the primary caregiver for their loved ones and are placed in decision-making roles that they never expected. Advanced care planning is a useful tool that can assist individuals in preparing for end-of-life care, and keeping family members and healthcare providers updated on their wishes.
For individuals faced with end-of-life care decisions, it is important to have conversations with their physicians about their treatment options and their wishes regarding advanced illness care. Studies indicate that patients and their families are interested in discussing their end-of-life options with their physicians. However, there is concern that physicians may lack the training or resources to engage in long-term conversations with their patients on end-of-life healthcare decisions. For instance, a recent survey of 736 physicians, link above, found that less than one-third reported any formal training on discussing end-of-life care with their patients and their families.
The Coalition to Transform Advanced Care (CTAC), a non-partisan organization, is collaborating with the AHIP Foundation on “The Advanced Care Project,” which offers suggestions for how healthcare professionals can help patients make their decisions about their end-of-life care needs. A combination of education and collaboration on advanced care allows for patients and family caregivers to develop their own care plan that is specifically designed to fit their needs.
Healthcare plans and providers are embarking on their own initiatives to assist and ensure that patients are able to make their own decisions about their healthcare. For instance, Aetna offers support to its members through its Compassionate Care Programs, in which individuals experiencing end-of-life care are assisted by nurse care managers who are available to provide resources to patients and their family members, as well as assist physicians in managing the care of the patient. The Franciscan Missionaries of Our Lady Health System in Louisiana is collaborating with the Louisiana Health Care Quality Forum in the Louisiana Physician Orders for Scope of Treatment (LaPOST) initiative on how a patient’s desires and goals into their treatment plan can be medically translated and applied to multiple healthcare settings.
SCAN Health Plan has constructed a new system to make it possible for patients and their families to understand the full array of care options available to them and to receive treatment that best fits their values, goals, and cultural preferences. This system is called the Program for Advanced Illness (PAI). A palliative-trained nurse case manager serves as the member’s personal advocate. The nurse will help members and their caregivers navigate care options that reflect patient’s goals and wishes, encouraging articulation and documentation of end-of-life requests while identifying healthcare proxies and making referrals to hospice. Additionally, the nurse will communicate with all medical staff and other parties to ensure everyone understands the critical decisions being made as well as following up with the family to offer bereavement services. More program details are available in the Viable Solutions compendium recently released by the Healthcare Leadership Council.
On National Healthcare Decisions Day, let us continue to have the conversation about how healthcare providers can best assist individuals in making their own decisions about their health care needs. Create an advance directive and talk to your family and friends about the importance of care planning. Visit www.nhdd.org for more information.
May 07, 2015
1:06 pm
It was very encouraging, to say the least, when Republicans and Democrats in Congress worked together this spring to pass legislation bringing much-needed reform to the Medicare physician payment system. It gives hope that bipartisanship can continue to reign long enough for Washington to take on an even bigger challenge – strengthening Medicare’s long-term financial solvency.
As Jim Pethokoukis wrote this week on the American Enterprise Institute’s blog, this effort won’t be helped if those running for president in 2016 distort the issue of Medicare sustainability with their rhetoric. One recently-announced candidate on the Republican side is, in fact, making opposition to Medicare reform a centerpiece of his messaging, saying “Washington has done enough lying and stealing. I’ll never rob seniors of what our government promised them and even forced them to pay for.”
That kind of statement – and it’s a sentiment heard all too often on both sides of the aisle – either ignores or obscures certain unavoidable facts:
• In blustering that you won’t “rob seniors” by improving Medicare, you’re essentially planning to rob younger generations, by forcing them to help finance a program that will be in far worse financial shape when it’s their turn to utilize its benefits.
• You can’t pretend demographic realities don’t exist. Today, that average senior who paid $500,000 in payroll taxes for Medicare and Social Security over his or her working life is receiving more than double that in benefits. At the same time, the ratio of working Americans to retirees is rapidly shrinking.
• Some of the more innovative and promising Medicare reform proposals have nothing to do with ‘robbing’ seniors, but rather providing them a choice of conventional fee-for-service Medicare or letting them enter a program similar to the popular Medicare Part D prescription drug program, in which private plans compete on the basis of cost, quality and value. The Congressional Budget Office has said, in fact, that this approach would reduce costs for both beneficiaries and taxpayers.
Congress has already made great strides this year in improving the way Medicare operates. The next step is to put in place the structural improvements to keep the program healthy for generations to come. I’m under no illusion that will happen in the upcoming 2016 campaign cycle. It would be nice, though, if we could at least have a productive, honest conversation on the subject.
May 06, 2015
10:27 am
Thanks to the healthcare industry’s success in containing per-capita Medicare cost increases, it’s easy to make the case that there’s no urgency to repeal the Independent Payment Advisory Board (IPAB). Current cost trends are not going to trigger IPAB’s power to recommend harsh cuts to Medicare expenditures, and the President hasn’t even appointed a nominee to the board.
That’s why this is exactly the right time to erase an ill-conceived idea off of the board. Better now than when its destructive consequences are on our doorstep.
U.S. Representatives Phil Roe (R-TN) and Linda Sanchez (D-CA), joined by 220 additional cosponsors, have introduced the Protecting Seniors’ Access to Medicare Act, a bill that would repeal the provision of the Affordable Care Act which created this board of political appointees with unprecedented powers. In addition to having the support of a majority of the U.S. House, over 500 national and local organizations representing healthcare providers, patients, employers and veterans have signed a letter urging Congress to enact IPAB repeal.
This critical mass of bipartisan support exists because IPAB is, quite simply, a bad idea. Not only does it shift congressional authority to an unelected board, but the legislation creating IPAB prohibits judicial or administrative review of the board’s actions. And with IPAB structured so that cuts to Medicare must be enacted within a one-year timeframe to meet spending targets, it means that long-term reforms to improve Medicare value and sustainability will take a back seat to short-term cuts to providers that will reduce beneficiaries’ access to care.
There is a need to make Medicare more cost-effective and there are ways to do it that warrant discussion. Granting sweeping powers, however, to a board that is not responsive to the public and taking actions that reduce patient access at a time when the Medicare-eligible population is rapidly increasing are approaches we shouldn’t be pursuing.
We’re fortunate that IPAB hasn’t yet been implemented. Congress should rapidly approve the Roe-Sanchez bill before it is.
May 01, 2015
2:25 pm
Last week, Dr. Vivek Murthy, the new U.S. Surgeon General was officially sworn into office. In his speech to the ceremony attendees, Dr. Murthy described his mission for a stronger and healthier America. He discussed roadblocks to better population health such as a culture focused on treatment rather than prevention, the spread of incorrect health information and unhealthy behaviors that are entrenched in society and difficult to change. Addressing these issues, he said, is a shared responsibility requiring partnerships involving diverse interests and perspectives.
The Healthcare Leadership Council is proud to be a part of that partnership. In fact, one of the Surgeon General’s first public appearances in Washington, DC was at a forum HLC hosted on anti-obesity initiatives. At that forum, he joined with HLC member companies – Weight Watchers, Takeda Pharmaceuticals, Health Care Service Corporation and the Cleveland Clinic – to discuss the steps that are being taken to help more Americans understand the importance of and how to achieve healthy body weight. Dr. Murthy spoke compellingly about the need to create a culture that encourages healthier lifestyles.
The good news is that important strides are being made in developing that culture. In communities throughout the country (note Oklahoma City’s collective million-pound loss spotlighted at the HLC anti-obesity event), we’re seeing successes in establishing improved health and well-being. Healthcare companies, including many of our HLC members, are taking innovative steps to incentivize better nutrition and exercise habits. Many of these success stories are detailed in our publication, The Future is Here: Transforming American Healthcare Through Private Sector Innovation.
The need for progress is great. As was mentioned several times at our recent event, the percentage of Americans classified as obese has nearly tripled since the 1960s. This is taking an enormous toll not only on our well-being as a society, but also on the economic sustainability of our healthcare systems. We need to learn from the successes that have been established, and then build on them. On that note, we’re certainly aligned with our new Surgeon General.
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