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Fast Company just published my latest post on medical hotspotting on the Fast Company Co-Exist blog. Here’s a snip; follow the link to read more.

Medical hotspotting traces its roots to a law enforcement strategy that involves mapping where crimes are committed in a given region and then applying extra police resources in areas considered hot spots. Advocated by former New York Police Commissioner William Bratton in the mid-1990s, the approach was credited as an important element in reducing crime in New York City by 60%.

A happy and healthy Thanksgiving to all – see you back here next week.


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November 23, 2011

Extend Health just got a very nice mention today on A Musing Healthcare Blog in an article titled “In Good Companies, Volume IV.” Check it out!

Thanks for the kind words DJK!

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

After nearly three months of hearings and negotiations, the supercommittee has failed to reach a $1.2 trillion deficit reduction deal. Jeb Hensarling (R-Texas) and Sen. Patty Murray (D-Wash.) announced late this afternoon that “after months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline.”

The supercommittee was supposed to present its plan for reducing the federal deficit by this Wednesday, but it would have had to have a deal ready by today to give the CBO time to calculate the financial impact on the deficit before the announcement.  Failure to meet the deadline triggers $1.2 trillion in automatic “across-the-board” spending cuts starting 2013, half of which will come from national security. Not willing to let congress off the hook for their promise to make those cuts, President Barack Obama said today, “I will veto any effort to get rid of those automatic spending cuts to domestic and defense spending.”

Plenty of people are talking about what happens next. Read More >

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

The Washington Extension

November 18, 2011

Medicare News

CMS has calculated that seniors saved more than $1.2 billion on their prescription drugs due to changes in the Affordable Care Act. This is an average of $550 per person. More than 22.6 million Medicare beneficiaries have used a least one Medicare preventive benefit, newly free-of-charge in the ACA.

ACA Updates

Oregon’s Insurance Administrator is joining the HHS office charged with implementing the ACA as an advisor to states establishing exchanges. Teresa Miller has been recognized for her creation of a detailed and transparent rate review process for health insurance in Oregon.

The Supreme Court scheduled 5.5 hours of oral argument on the ACA for March—a modern-day record for length of time devoted to a case. The time will be divided between the individual mandate (2 hours), Medicaid expansion (1 hour), whether the Anti-Injunction Act bars the court from considering the constitutionality of the individual mandate until 2014 (1 hour), and severability, or whether the entire law is unconstitutional if just one section is determined so (1.5 hours).

North Dakota legislation to create a health insurance exchange was defeated by state House Republicans. The legislature doesn’t meet again until January 2013, essentially ruling out any chance for the state to establish its own exchange before the initial federal deadlines. North Dakota estimated its exchange would cost $39.6 million to implement, and an additional $10.2 million every two years to operate. The operating costs would have been paid for by assessing taxes on insurance companies.

The Illinois legislature is hung up on whether the exchange should adopt an active purchaser model with power to negotiate rates with insurers. The governor’s office is concerned that the state could lose more than $90 million in federal grant funding if legislation is not enacted soon. Illinois already passed legislation authorizing an exchange, but needs to fill in details such as the structure of the governing board, funding mechanism and other powers.

Minnesota’s exchange task force began work to shape that state’s health care marketplace, where 300,000 Minnesotans could gain coverage. Former Republican Governor Tim Pawlenty proposed implementing a state exchange well ahead of the ACA, though Republican lawmakers now oppose exchanges and are so far absent from the task force. Business, insurance and consumer groups all broadly support exchange implementation in Minnesota.

South Carolina’s Department of Health and Human Services (HHS) chief recommended the state pass on establishing a health insurance exchange. The study—presented to an exchange study committee established by the governor—finds that “ill-defined and unfinished” federal regulations would hamper the state’s progress, South Carolina’s HHS department is already at full capacity implementing Medicaid, and encourages development of private exchanges in the state. The committee must issue recommendations to the governor by the end of November.

On the Hill

A deficit reduction compromise is appearing unlikely, as the deadline looms less than a week away. Interest groups and legislators are warming to the idea of sequestration—automatic cuts in 2013 that take effect if no compromise is reached. Kaiser Health News is documenting the long wish list from the health care sector as the Super Committee continues negotiations.

Reports/Other News

Walmart released a request for information seeking partners to help it build a “national, integrated, low-cost primary care healthcare platform that will provide preventative and chronic care services” for millions of Americans. The company subsequently retracted part of the RFI, stating that it is not building such a platform and the statement of intent was incorrect.  The RFI seeks vendors to provide chronic care, diagnostic, and preventative services; health and wellness products; and select acute care services. Other vendor responses may address proposed ownership/operating models for delivering low-cost care, financial models, information systems and data sharing models, integrated delivery systems, and care delivery and support models.

HHS released a health plan “finder” tool for small businesses. The new website allows small employers to search for available insurance by ZIP code and sort by out-of-pocket limits and average cost. Users can view descriptions of the plan options and filter products by various measures, including doctor choice, maternity coverage, mental health or prescription coverage, and company.

A Gallup/Healthways poll found that adults receiving health insurance from their employers continues to decline, falling to 44.5% in the third quarter of 2011. Employer-based health insurance has declined steadily since 49.8% when this poll was initiated in 2008.

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

Harvard law professor Einer Elhauge put up this OpEd yesterday in the New York Times outlining an interesting argument for the constitutionality of the ACA’s individual mandate clause. Here’s a snip:

But the argument that the commerce clause does not authorize the insurance mandate is beside the point. The mandate is clearly authorized by the “necessary and proper clause,” which the Supreme Court has held gives Congress the power to pass any law that is “rationally related” to the execution of some constitutional power.

I’ve argued before that the law can work without the individual mandate, given the right conditions including annual enrollment periods, affordable, standardized plans and guaranteed issue among others. I’m looking forward to hearing the arguments on both sides as the Supreme Court date gets closer.

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

The Surpreme Court decided today that it will hear arguments on the constitutionality of the Affordable Care Act (ACA). Twenty six states are challenging the ACA, claiming congress exceeded its power to regulate interstate commerce by requiring Americans to purchase insurance. In what is sure to be one of the most visible court cases in a long time, a ruling is expected by the end of June.

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

In his latest blog post for Fast Company magazine, Bryce discusses the opportunity health care reform offers insurance companies to compete for new customers. Can insurers adapt quickly enough to take advantage of this tremendous market opportunity? To find out, read “Can Health Insurance Become Customer-Friendly And Web-Savvy?

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

Opponents of the ACA have been fighting to strike it down ever since it was passed into law. While some of the uproar against health care reform may have diminished over time, criticism is expected to pick up again as the Supreme Court considers taking up the case against it.

This recent article “Follow the Money: How Industry Is Lobbbying to Preserve Reform Law” takes an interesting look at who’s for the new health care law and who’s against it . . . and who’s keeping quiet.

Author Dan Diamond asserts that the health industry has remained quiet on the repeal of health care reform because “health insurance companies, device manufacturers, and many provider associations have strong financial motives to keep the ACA in place.”

One of the common allegations from opponents is that the ACA imposes restrictions that are tantamount to a government takeover of the health care system. Despite those assertions, Diamond suggests that the health care industry is staying quiet because it is “hedging its bets” and doesn’t want to “alienate an administration that holds huge sway over their bottom lines.”

To support his position, the author sites data on lobbying efforts and campaign contributions. Whether he’s right or not, it makes for some interesting reading. We’d be interested in your comments on Diamond’s argument, as well as on the issue of the health care industry’s stake in preserving the ACA. What happens to the insurance industry, for example, if the Supreme Court strikes down the individual mandate but keeps the rest of the law in place?

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

We have been tracking efforts across the health care industry to reduce costs and provide better health care. We’ve noticed that insurance carriers are getting more involved in the delivery of health care benefits to accomplish these goals. Here are three articles that discuss this trend and the various approaches being taken.

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

The Washington Extension

November 4, 2011

Medicare News

Part B premiums will rise from $96.40 to $99.90 per month for 2012, significantly less than projected, but the first increase for most Medicare beneficiaries since 2008. Medicare law prevents Part B premiums from rising in years with no Social Security cost-of-living adjustment, for most seniors. This has been the case for the past three years due to the sluggish economy. Although HHS initially projected a larger in Part B premium increase, lower-than-expected medical utilization has kept costs down.

Quality ratings for Medicare Part D prescription drug plans are changing this year, as HHS incorporates criteria to stress clinical outcomes. In addition to measuring the length of hold time on phone calls, the quality scores will also reflect whether patients with various chronic conditions take their medications. For 2012, 24% of plans have four or five stars; about half have three stars; and 28% have only one or two stars. The Centers for Medicare and Medicaid Services recently proposed to expel Part D plans that score below three stars (out of five) for three consecutive years.

ACA Updates

The Kaiser Family Foundation released a new monthly tracking poll, showing higher rates of dissatisfaction with the Affordable Care Act (ACA), especially among Democrats. Although public opinion has shifted over time, this is the widest margin between people who have a favorable view (34%) and those with an unfavorable view (51%). A growing share of respondents (44%) also expects that the law will have no impact on their lives.

Ezra Klein summarizes health insurance exchange progress in terms of gubernatorial executive action, despite legislative stalemates or outright opposition. After exchange implementation action failed in more than a dozen state legislatures, five states’ governors are taking action on their own, with even more pursuing grant money from the Federal government despite legislative opposition. The National Conference of State Legislatures tracks exchange implementation action across the country.

On the Hill

Capitol Hill is dominated by Supercommittee stalemate, with little to no agreement on a path forward and less than three weeks until mandatory and automatic across-the-board spending cuts take effect. Medicare reform proposals will be instrumental in reaching a $4 trillion deficit reduction goal, but disagreements abound as members consider policies both large and small.

Reports/Other News

Reuters reports on the growing number of employers using “sticks”, with or instead of “carrots”, to incentivize healthier lifestyles among their employees. Many employers initially offered free weight loss or tobacco cessation programs; however, few employees participated. Employers are now turning to penalties in the form of premium increases, sometimes coupled with free programs to improve health. Most recently, Wal-Mart announced it would require smokers to pay an extra $260-$2,340 per year for health care coverage, but continue to offer free smoking cessation programs. A Thomson Reuters/NPR poll recently found that 85% of respondents believe individuals with healthy behavior should pay lower premiums; 59% say smokers should pay more for health insurance; and 31% say overweight or obese people should pay more than normal weight individuals.

As consumers become responsible for more out-of-pocket health care costs, the Government Accountability Office (GAO) found a challenging environment for consumers trying to compare providers’ prices. This is due to the difficulty in predicting health care services ahead of time, myriad insurance benefit structures, billing from multiple providers, and contractual obligations that prohibit sharing of negotiated billing rates. The agency reviewed various price transparency initiatives, and found that two insurers worried that consumers might associate high prices with better quality. Generally, the price transparency initiatives—offered by states, insurers and providers—struggled to provide price estimates that truly reflected what consumers would pay out-of-pocket.

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