Extend Health helped over 150,000 choose Medicare plans during AEP

We just put out a press release announcing some results from the 2011 Medicare annual enrollment period. In addition to helping more than 150,000 people evaluate and choose Medicare plans, we were able to submit 99% of enrollment applications to carriers within 24 hours, thanks to our back-end integration with carriers.
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Washington Extension

Medicare News

Medicare Advantage plans that offer gym memberships to enrollees may have the same effect as cherry picking healthy beneficiaries, according to a new study in the New England Journal of Medicine. The authors found that enrollees in plans with gym memberships are healthier and have fewer mobility limitations than enrollees in plans without fitness benefits. The study did not address whether the plans were purposefully trying to attract and retain healthier enrollees, which is prohibited by law.

Gradually increasing the Medicare eligibility age to 67 would save the Federal government $148 billion over ten years, according to a new Congressional Budget Office report, or about a 5 percent annual reduction in Medicare spending. Although most seniors losing access to Medicare would have employer-based coverage, they would face higher premiums and pay more out-of-pocket for health care.

ACA Update

The White House released a report showing that 28 states have taken concrete steps toward establishing a health insurance exchange—half with clear authority to set up an exchange and half with executive orders or studies authorizing exchange work. Another 22 are still studying their options. The report highlights the actions of ten states and summarizes the authority and funding for exchange development in each state.

Wisconsin Governor Scott Walker will officially return a $37 million Early Innovator grant from the Federal government. He has also directed the state health agency to cease work on a state-run health insurance exchange and will rescind the creation of the state Office of Free Market Health Care. Kansas House Republicans are pressuring Governor Sam Brownback to cancel the state’s $135 million contract with Accenture to design a computer system to track social service applicants. Though Governor Brownback has put a moratorium on health insurance exchange work until after the Supreme Court decision, Republicans saw Accenture’s project as laying the groundwork for an exchange. New Hampshire’s Senate voted unanimously to establish a health insurance exchange, with backers citing the need to keep state control over if the ACA is implemented. New Hampshire’s House is opposed to ACA implementation.

The US Department of Health and Human Services faces pushback on its essential health benefits proposal. Patient advocates are asking for an additional 45 day comment period, after the initial deadline of January 31, 2012. Republicans are criticizing the use of sub-regulatory guidance rather than the traditional rulemaking process, accusing HHS of sidestepping regulatory requirements for cost-benefit and unfunded mandate analyses.

On the Hill

The House and Senate conference committee assigned to negotiate a longer-term solution to the payroll tax break and Medicare physician payments will convene on January 24^th. The House returned to Washington, DC on January 17^th and the Senate returns on the 23^rd. Current law expires on February 29^th, at which point Medicare’s payments to physicians would fall by nearly one-third.

Other News/Reports

The Congressional Budget Office found that Medicare demonstration programs—used to explore new ways to deliver and pay for Medicare—rarely reduce Medicare spending and in fact are often more costly. Value-based payment experiments struggled to overcome Medicare’s fee-for-service payment incentives while trying to increase the quality and efficiency of care delivered, and only successfully decreased spending by negotiating lower payment rates. CBO concludes that effective demonstration programs focus on transitions in care settings, gather timely data on care utilization, encourage close interaction between physicians and case managers, and target interventions to high-risk enrollees.

Visit Extend Health — the nation’s largest private Medicare exchange.

How to accurately and fairly measure health care providers

In keeping with its mandate to inform the public of the measures it’s considering for adoption, the Centers for Medicare & Medicaid Services (CMS) has compiled a list of 367 new ideas on how to accurately and fairly measure doctors, hospitals and other health care providers. The proposed measures came from a variety of sources, including the CMS, CDC, industry groups, companies, health care organizations, universities, research groups and others. After a thorough review, CMS is expected to adopt about 60 of the measures.

A key goal of the Patient Protection and Affordable Care Act (ACA) is to shift reimbursements from being based on the quantity of services delivered to being based on improved efficiency, lower costs and improved quality of care provided. These new measures will be assessed and selected based on their ability to help CMS in their efforts to achieve this goal.

In addition, the ACA requires a federal “pre-rulemaking process” for selecting quality and efficiency measures. In compliance with this requirement, CMS submitted the entire list of proposed measure to the NFQ organization Measures Application Partnership (MAP) for their review.  MAP has studied the proposed measures to determine which ones it believes will accurately and fairly measure health care provider performance.” Their pre-rulemaking report is posted online and indicates which measures it does and does not endorse.

The new measures under consideration for 2012 are spread across 12 out of 23 CMS programs. In the chart below (from the CMS list of measures) you’ll find the number of measures being considered listed by program. It’s interesting to note that most of the measures are concentrated into just a few of the programs.

• 153 measures (more than 40%) fall under the CMS program Physician Quality Reporting System
• Other programs with many new measures include Medicare and Medicaid Incentive Program for both eligible professionals and for Hospitals and CAHs, and Hospital Inpatient Quality Reporting
• None of the measures are related to the Medicare Shared Savings Program, Health Insurance Exchange Quality Reporting, or Medicare Part C and Part D Plan Rating Programs.

CMS Program	No. of new measures
End Stage Renal Disease Quality Improvement	5
Hospice Quality Reporting	6
Hospital Inpatient Quality Reporting	22
Hospital Value-Based Purchasing	13
Inpatient Psychiatric Facility Quality Reporting	6
Inpatient Rehabilitation Facility Quality Reporting	8
Long-Term Care Hospital Quality Reporting	8
Medicare and Medicaid EHR Incentive Program for Eligible Professionals	92
Medicare and Medicaid EHR Incentive Program for Hospitals and CAHs	39
Physician Quality Reporting System	153
Prospective Payment System (PPS) Exempt Cancer Hospital Quality Reporting	5
Physician Feedback/Value-Based Modifier Program: Value-Based Payment Modifier	10

Sources:

http://capsules.kaiserhealthnews.org/index.php/2012/01/measuring-quality-368-new-ideas-for-2012/

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69495

http://www.cms.gov/QualityMeasures/15_MultiStakeHolderGroupInput.asp

Health Care Trends to Watch: How insurance carriers are evolving to prepare for ACA

At Extend Health we like to keep an eye on trends in the health care and insurance industries, and lately one big trend is erosion of the clear boundaries between providers and payers – specifically, insurance carriers who are positioning their businesses to cope with the cost-control challenge they face as MLR requirements of the Affordable Care Act (ACA) start to kick in.

The trend of hospitals expanding into regional super-providers, buying up physicians groups and ancillary service providers, has been going on for some years now. But recently there has been a spate of activity among carriers who are expanding into new areas, buying companies or forming partnerships to offer new services both to patients and providers. Carriers are also investing in ways to educate patients and increase compliance with preventive and wellness measures, improve patient care coordination among their provider networks, and help patients find the services they need. A few examples follow:

• Aetna recently announced Whole Health, a new insurance plan available to employees of small businesses. Employees who are covered under the plan receive lower co-pays if they get their care through Arizona’s Banner Health Network, Aetna’s ACO partner on the plan. The Whole Health plan is built on the ACO model of care, using electronic medical records (EMR) technology to allow providers to share patient information and data so they can better coordinate care. Employees will also have access to technology in the form of on-line tools that will help them do a better job of managing their health.

• UnitedHealthcare (UHC) purchased XLHealth Corp., a Baltimore-based provider of programs for managing Medicare beneficiaries with chronic conditions such as diabetes. XLHealth’s model includes a variety of interventions enabled by health information technology to address the needs of its Medicare membership. For example, XLHealth members may be provided with advance home monitoring tools used to gauge their health status on a daily basis.

• UHC also recently opened a consumer storefront, dubbed a “comprehensive health benefits store” in Flushing, New York. The store is meant to serve as a prototype for future consumer-support centers around the country. The center gives UHC plan members access to customer service representatives who can explain benefits, resolve claims issues, and help with other insurance-related matters. Specially-trained staff will also be available to help both UHC plan members and nonmembers find and apply for state and federal financial aid for such things as prescription drugs, food stamps, and heat and electric subsidies. Visitors to the center will be able to use available computers and iPads to find and print health-related information, and a health-screening kiosk will measure blood pressure, pulse and body mass index. Finally, the center will host an ongoing series of free-to-the-public seminars on topics such as nutrition and exercise, disease management, and financial planning.

• Taking another tack, Humana has acquired Anvita, a health care analytics firm – a move that will allow Humana to give actionable clinical data to health care organizations, which they can use to improve patient outcomes and reduce costs. Humana will offer Anvita’s suite of software to hospitals and physician practices within its network.

• Humana also recently bought a company that employs care managers for seniors with chronic illnesses. SeniorBridge, a clinical care company based in New York, provides in-home care for chronically ill patients. According to SeniorBridge, its beneficiaries have fewer unnecessary hospitalizations, falls, and emergency department visits.

• CareFirst BlueCross BlueShield in Ohio has teamed up with Cardinal Health on a clinical pathways program for Rheumatoid Arthritis (RA). The partnership engages nearly 70 rheumatology practices who will participate in a “treat-to-target” approach to RA care – testing different treatment options until a patient’s symptoms are in remission. The goal of the program is to find ways to standardize the way rheumatologists treat RA patients.

Many of these programs are targeted at Medicare beneficiaries for several reasons, not the least of which is the funding and support provided by the ACA-instituted Center for Medicare and Medicaid Innovation (CMI). Seniors are also a good target for finding care improvements and cost efficiencies – older people generally need more health care services, and are far more likely to suffer from one of the 15 chronic conditions that account for 44% of total U.S. health care expenses.

There are many other examples; these are just a representative few. Looming MLR target requirements, along with the economic downturn, are making it imperative that carriers push for efficiency. It’s encouraging to note that so many carriers are looking for ways to improve efficiency by also improving patient care, enlisting both providers and consumers in improving health and managing chronic conditions.

Visit Extend Health — the nation’s largest private Medicare exchange.

The Washington Extension

Medicare News

HHS is proposing changes to its quality rating methodology for Medicare Advantage and Part D prescription drug plans for 2013. Plans receive bonus payments based on quality scores. Updated quality ratings would reflect measurements of plan enrollees receiving high-quality hospital care, coordinated care, and medication reviews. The quality scores would also reflect statistically significant improvements in individual quality measures. Public comments are accepted until January 13, 2012.

ACA Updates

HHS released a bulletin proposing minimum requirements for essential health benefits that most health plans in the individual and small group markets must cover by 2014. Rather than list specific benefits, HHS proposes to allow states to choose a benchmark plan that reflects one of the three largest plans by enrollment in the small group market, State employee benefit plans, or national FEHBP plans, or base the benchmark plan on the state’s largest non-Medicaid HMO. Health plans must offer benefits that are “substantially equal” to the benchmark plan, as well as any necessary additions to meet the ten health benefit categories required by the ACA. HHS proposes this approach for 2014 and 2015 and will reevaluate for future years. Public comments are accepted until January 31, 2012.

Alaska will contract with Boston’s Public Consulting Group for exchange planning consultation. PCG already provides operational support for Massachusetts’ exchange. Democrats in Ohio proposed legislation creating a state-run health insurance exchange, though Republicans—including the governor and lieutenant governor—claim that their actions are premature due to continued uncertainty about the law. Republicans in Michigan’s Senate removed authorization for use of federal funding to begin exchange planning in the state, despite Republican Governor Rick Snyder’s support for an exchange. Lawmakers prefer to wait until after the Supreme Court decision about the constitutionality of the ACA but state health officials fear that delay would make exchange preparedness by January 2013 impossible.

On the Hill

A bicameral, bipartisan conference committee will begin working on a longer-term fix for Medicare’s payments to physicians, which were frozen through March 1, 2012 to avoid a 27% payment decrease at the end of 2011. Members of the committee include chairmen of the House and Senate committees of jurisdiction, as well as freshmen members.

The House is recessed until January 17^th and the Senate is scheduled to return on January 23^rd.

Reports/Other News

Major health insurance companies increasingly derive revenue from government programs like Medicare and Medicaid, rather than from commercial business, according to a new report by Bloomberg Government.  Commercial business now accounts for less than half of the combined revenue of WellPoint, UnitedHealth Group, Aetna, Humana and Cigna. Average operating profit margins have also increased in 2011 relative to the 18 months before the ACA was passed, largely due to expansion into the public sector, according to the report.

Visit Extend Health — the nation’s largest private Medicare exchange.

Happy Holidays!

Happy Holidays to all our readers. Thank you for your support in 2011.
We’ll be away for the next week, but we look forward to seeing you back here
for an exciting 2012 . . . there’s sure to be much to write about!

CMS selects thirty-two organizations to participate in Pioneer ACO Model

On Monday, December 19^th, 2011 the Department of Health and Human Services (HHS) announced its list of 32 organizations that were selected to participate in the Pioneer Accountable Care Organization (ACO) Model, which begins January 1, 2012.

Launched by the CMS Innovation Center, the Pioneer ACO Model initiative will test the impact of different payment arrangements on helping organizations improve patient care and reduce Medicare costs. HHS estimates that this initiative could save up to $1.1 billion over five years.

Out of 80 applicants, 32 organizations were selected based on their experience offering coordinated patient-centered care, and for operating in an ACO-like manner.  An ACO is a group of health care providers and suppliers that work together to deliver high-quality care and reduce costs.

A complete list of the organizations selected can be found in “Pioneer Accountable Care Organizations Model: General Fact Sheet.

During its first two years, the Pioneer ACO Model will test a shared savings and shared losses payment arrangement. The shared savings would be determined by comparison with CMS established benchmarks. In the third year, ACOs that showed savings over the first two years could move to a population-based per-beneficiary, per-month payment model.

CMS will determine which beneficiaries are aligned with each ACO. Generally, each ACO must have 15,000 beneficiaries, but those located in a rural area are allowed to have only 5,000. In addition, beneficiaries must be enrolled in original, fee-for-service Part A and Part B Medicare. To make sure beneficiaries receive high-quality care, CMS has set strict quality measures that it will monitor.

The Pioneer ACO Model is just one of several ACO initiatives. For more information on those programs, visit www.cms.gov/aco.

Wyden-Ryan: The Devil is in the Details

Last week Sen. Ron Wyden (D-OR) and Rep. Paul Ryan (R- WI) released a 12-page white paper outlining their plan to overhaul Medicare in an effort to reduce long-term Federal health care spending while preserving the promise of comprehensive health care benefits to our nation’s retirees.  The plan would, in effect, convert Medicare from a defined benefit program to a defined contribution program.  Beneficiaries would receive a fixed amount of money – “premium support” – that would be put towards the cost of their insurance plan.  CMS would certify plans to be eligible for sale on a Medicare exchange, much the same way Medicare runs the Medicare Advantage and Part D programs today.  Original Medicare would be offered as one of the plans on the Medicare exchange.

The release of this plan is sure to reverberate around Washington.  The last time Rep. Ryan released a plan to overhaul Medicare, it was criticized to great effect by Democrats, who argued that the amount of premium support offered to beneficiaries would grow too slowly and become inadequate over time.  The last time Sen. Wyden introduced a bipartisan plan to overhaul a portion of the health care system, his Republican co-sponsor, Sen. Robert Bennett (R-UT), lost his re-election primary bid to a Tea Party-backed candidate.  Meanwhile, Governor Mitt Romney has recently released a plan similar to the Wyden-Ryan plan, ensuring a protracted, national debate during the 2012 election campaign season.

While plans like Wyden-Ryan are receiving bipartisan support for the time being, the devil, as they say, is in the details.  And for now Wyden-Ryan is short on details.  We at Extend Health have over seven years’ experience introducing defined contribution plans to Medicare-eligible retirees on behalf of over 150 employer sponsors.  To the Congress that might one day debate such a plan, we offer the following advice:

Will insurers be compelled to guarantee issuance of a health insurance policy?

This may seem like an obvious point, but it’s a deal breaker for every one of Extend Health’s clients:  seniors must be able to purchase any policy offered on an exchange without fear of being denied coverage.  Without guaranteed issue, the most vulnerable beneficiaries will have the hardest time finding coverage.  Wyden-Ryan specifically outlines this as a feature of their plan, and we would expect any final version of a plan to maintain this requirement.

What is the right level of funding?

Much of the debate will center on the amount of funding offered to beneficiaries as premium support.  Will the amount be enough to purchase a private plan such that the beneficiary is no worse off – or perhaps better off – than they were under original Medicare?  The answer to this question will be determined by the specifics of the policy:  what determines the rate of growth of the voucher; what amount of geographic adjustment will be factored in; what amount of health risk adjustment will be factored in; can cost-containment strategies introduced by policymakers or plan administrators assist in keeping plan costs down.  Policymakers will work with economists at the Congressional Budget Office who, in “scoring” a detailed plan, will officiate whether or not seniors are better off.

From our experience, providing employer sponsors with this style of actuarial analysis has been imperative to ensuring they make the right decision on a retiree health solution.  Extend Health actuaries have spent the last seven years refining analyses that demonstrate how retirees choosing plans on a private Medicare exchange can collectively find greater value for their employer’s dollar than the employer can through a group plan.  Without the analysis, plan sponsors are making important contribution decisions in the dark.  We encourage lawmakers to use such analyses when making the case to their constituents for defined contribution.

Will plan choices be easy to understand?  

Competition only produces value to the customer if the customer can easily understand the meaningful differences between products.  If you’ve ever had to choose between even two health insurance options, you know how difficult this can be. 

At Extend Health, we believe no retiree should decide on a plan without understanding the meaningful differences between insurance products in four areas:  costs (premium vs. out-of-pocket); plan benefits; provider network; and customer service.  In fact, we believe this is the whole point of operating an exchange in the first place.  We have spent the last seven years building out technologies that make comparing plans along these lines as simple as possible, both for a customer looking at plans online and for a benefit advisor assisting a customer over the phone.  Congress should ensure that by engaging with a Medicare exchange, beneficiaries will be able to easily comprehend the tradeoffs when choosing one plan over another. Without such a capability, the exchange won’t provide a transparent, competitive marketplace where consumers can maximize the value of their health care dollar.

 

Related articles

• Wyden-Ryan Medicare plan merits close look (mysanantonio.com)
• A game changer on Medicare’s future? (cnn.com)
• Wyden has history of bold health care proposals – WSB Atlanta (wsbtv.com)
• Ryan and Wyden Medicare proposal overview and news roundup (brycewilliams.wordpress.com)

Ryan and Wyden Medicare proposal overview and news roundup

Overview:

Paul Ryan (R-WI) and Ron Wyden (D-OR) released their proposal to overhaul Medicare this week. It is not at the bill stage yet, as the authors hope to cut down on the political rhetoric and start a serious national dialogue about the future of Medicare. Ryan and Wyden have not asked the Congressional Budget Office to review their proposal yet, so it is not known how much their plan would save compared to current Medicare.

Here is a brief overview of some of the plan’s key points:

People over 55 would see no change to their benefits. They would be free to opt into a private plan when the Medicare Exchange is established in 2022.

The “premium support” system would ensure affordable coverage by empowering seniors to choose either traditional Medicare or private plans. And there would be more help for low-income seniors who need it, and less for wealthier seniors who don’t need the assistance.

Medicare plans could be purchased on an insurance exchange established by congress.

Strong consumer protection would include:

• All participating plans would have to offer benefits that are at least equal to traditional Medicare plans.
• Risk-adjusted premium-support payments would guarantee affordable coverage for those with the greatest health needs.
• Plans could neither refuse coverage for pre-existing conditions, nor charge rates that discriminate based on health status.
• CMS would oversee all plans to ensure transparency and fairness.

Competition would drive program growth. Competitive bidding would force providers to reduce costs and improve quality. Competition between private and traditional Medicare plans would incentivize both to develop better delivery models and ways to care for patients.

Employees in small businesses with up to 100 workers could use their employer’s contributions to purchase their own health insurance, and the cost of free choice options would be fully tax deductible to the employer. In addition, allowing workers to keep the same insurance when they retire would ease their transition into Medicare.

Medicare spending would be capped to GDP plus one percentage point.

Read the full report:  http://budget.house.gov/UploadedFiles/WydenRyan.pdf

 

News Roundup:

Here’s a roundup of news articles written this week about the Ryan/ Wyden proposal, with reactions and opinions from across the political spectrum.

Bloomberg BusinessWeek: Bipartisan Medicare Plan May Spur More Compromise, Ryan Says

The Washington Post: Interview with Rep. Paul Ryan

Politico: Ryan-Wyden under ‘no illusion’ their plan will pass tomorrow – Looming shutdown? W.H. says to pass a short-term CR – Essential benefits, politically speaking

Boston.com: Clipboard: The “Ryden” Medicare proposal

Chicago Tribune: White House blasts new Medicare plan by GOP’s Ryan

Reuters: Republican Ryan backs new bipartisan Medicare Plan

Forbes: Ron Wyden and Paul Ryan’s Bipartisan Plan for Health Care and Medicare Reform

The Wall Street Journal: A.M. Vitals: Ryan, Wyden to Introduce Proposal for Changing Medicare

Time: Wyden-Ryan: A Move Toward Health Care Sanity

The Washington Post: What Wyden-Ryan hath wrought

The Wall Street Journal: The Wyden-Ryan Breakthrough

Kaiser Health News: Wyden And Ryan Join Forces On New Medicare Overhaul Plan

The Hill: Paul Ryan moves away from controversial Medicare reform plan

The New York Times: Lawmakers Offer Bipartisan Plan to Overhaul Medicare

Visit Extend Health — the nation’s largest private Medicare exchange.

The Washington Extension

Medicare News

Senator Ron Wyden (D-OR) and House Budget Chairman Paul Ryan (R-WI) introduced a plan to reform Medicare beginning in 2022, including premium support, a Medicare Exchange, and a cap on annual Medicare spending. The members tout their plan as increasing choice for seniors, spurring innovation, and lowering health care costs through competition among private plans and traditional Medicare. The plan also expands health care options for small businesses by allowing employees to use employer contributions to purchase their own health care. The reforms draw from ideas that Mr. Ryan and Mr. Wyden have previously backed. Though key details are omitted from the plan, critics of premium support have questioned its ability to lower costs, provide adequate premium support amounts, and protect low-income beneficiaries. Political reactions are divided largely along party lines, with Democrats asserting that the plan will undermine Medicare and Republicans cautiously supporting it as worthy of consideration.

ACA Update

The early retiree health insurance fund—established by the ACA to help employers maintain coverage for non-Medicare eligible retirees until 2014 when exchanges are running—will accept its last claim on December 31, 2011. The $5 billion fund has already exhausted $4.5 billion. According to Democrats, the rapid exhaustion is due to the program’s popularity with employers, though Republicans assert the premature shut-down proves the inaccuracy of cost estimates when the ACA was passed.

Minnesota has posted multiple exchange prototypes for employers and individuals to test drive, including websites from Ceridian, Curam Software, MAXIMUM/Connecture, Getinsured.com, and Deloitte. The functionality of the websites range from Deloitte, with actual plan search capability, to MAXIMUM’s, which appears to have only demonstration videos posted. Minnesota is asking for public feedback on the modules to influence its vendor selection process and development of an online interface.

On the Hill

Congress must act before the end of the year to avert a nearly 30% Medicare pay cut to physicians, and may pair short-term relief from the cuts with extension of the payroll tax holiday and unemployment benefits, also set to expire at year-end. The extension could be as short as two months, but will still require Congress to come up with $40 billion to pay for the bill. A House-passed bill earlier in the week offset the extensions in part by reducing the Medicare subsidy that certain higher-income beneficiaries receive, thereby increasing premiums and reducing government spending.

Both Senate committees with jurisdiction over health care—Finance and Health, Education, Labor and Pensions—held hearings on widespread prescription drug shortages reported across the country. Witnesses at the hearings cited quality control issues, manufacturing delays, supply disruptions and price changes as problematic in ensuring a constant supply of drugs.

HHS is expected to release information about essential health benefits that plans offered through health insurance exchanges will be required to cover. Look for the release here or here. The Institute of Medicine, at the HHS Secretary’s request, released a report earlier in the year recommending criteria and methods for determining and updating essential benefit requirements.

Reports/Other News

Seniors age 50+ and near retirement are more concerned about their ability to afford health care expenses (24%) than current retirees (17%), according to an Allstate-National Journal Heartland Monitor poll. Three-quarters of near-retirees believe they will have to work after retirement and over half say they will retire later than their parents.

The Government Accountability Office released a report on “job lock” due to employer-sponsored health insurance, finding that workers with health insurance from their employer are less likely to change jobs, leave the labor market, become self-employed, or retire when eligible, compared to workers with alternative sources of coverage. Experts surveyed generally agreed that broader access to health insurance in the ACA may help mitigate job lock, but opinions differed about the extent.

The Washington Extension will return in 2012. Happy Holidays!

Visit Extend Health — the nation’s largest private Medicare exchange.