Wellness data is very “in” these days. Wearable technology such as FitBit allows individuals to track their fitness activity and apps let people track calorie consumption or weight loss.

The recent data released on Medicare doctor pay has unleashed a firestorm of controversy because of the amount of money some doctors made from treating Medicare patients — as much as $21 million in the case of one opthamologist. The Centers for Medicare and Medicaid Services released the data this week, for the first time in 35 years. The data had been held subject to the resolution of  an injunction, sought by the American Medical Association, which had been in place since 1979.

But it’s not all bad news. Think of this as another kind of wellness data. Essentially it is wellness data, a level up — data on the “wellness” not of the individual, but of the Medicare system as a whole.

The specific dollar amounts will be repeated and repeated as evidence of excess and even criminal activity on the part of some doctors. But the longer term takeaway is that data facilitates transparency. [To see exactly what reimbursements were state by state, check out this interactive map from USA Today.]

“Taxpayers have the right to understand what is being paid for and how it is being paid for,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicare Services.

In addition to it being a taxpayers’ “right,” having this full data transparency allows Medicare administrators to identify areas of excess and inefficiency and consumers to compare prices. It also allows all of us to consider broader questions about health care in the United States, for example, why some surgeries are performed more or cost more in one geographic area as opposed to another.

Shining the light on this data opens up the Medicare program to be improved, streamlined and  hopefully, made sustainable for generations to come.

The New York Times called it a “quiet sea change.” The Centers for Medicare & Medicaid Services calls it “Change Request 8458.” Regardless of what it’s called, a relatively unpublicized update to the Medicare policy manual made in January 2014 will have a profound impact on millions of Americans who suffer from chronic diseases that are progressive and for which certain types of care can only maintain a patient’s condition.

In other words, the update makes it clear that improvement is not necessary to receive Medicare coverage for skilled care.

The update was a long time coming. The process began back in 2011 when Glenda Jimmo, along with five other Medicare beneficiaries and seven national organizations (including the National Multiple Sclerosis Society, the Parkinson’s Action Network, and the Alzheimers Association) took Health and Human Services director Kathleen Sebelius to court for adopting “an unlawful and clandestine standard to determine whether Medicare beneficiaries are entitled to coverage.”

This standard reduced or outright denied coverage for services that were not actively making the patient better. Plaintiffs argued that people “not expected to improve” were being treated as “less worthy” of coverage. Proof was in language in the manual that described people in this category as needing “maintenance services only” or as patients who had “plateaued.”

Jimmo and the other Medicare recipients won their case in December 2013, leading to the manual updates in January 2014. An excerpt from the change order explained the intent of the change: “to clarify that coverage of skilled nursing and skilled therapy services… does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.”

This change marked a victory for Medicare recipients struggling to get coverage for care outside the bounds of purely “improvement-based” treatment. What’s most important is that people who have these conditions – Alzheimer’s, Multiple Sclerosis, and Parkinsons, just to name a few – need to know about this as it is hugely important to them and their quality of life.

>> Stay tuned later this week when the Extend Health blog gets a new name and look. <<

For a hint at what’s to come, check out our new look on Twitter – @OneExchange is the new face of the @ExtendHealth stream – tweeting all the healthcare, benefits & reform trends we’re known for.

The recent expansion of our Exchange Solutions business segment is a good opportunity to look back at the news from our private Medicare exchange over the past few years. Here are highlights from our early days to today.

Towers Watson Announces Expansion of Exchange Solutions Segment
1/23/2014

Towers Watson Acquires Liazon to Expand Private Benefit Exchange Offerings Through Multiple Channels
11/27/2013

Towers Watson Signs Agreement With Federal Government to Facilitate Public Exchange Enrollments
9/9/2013

Towers Watson Selects WageWorks to Administer Health Accounts on Towers Watson’s New Private Health Insurance Exchange
7/8/2013

Towers Watson Names Woody Sides Exchange Solutions Regional Vice President of Sales in the West
7/1/2013

California State Association of Counties Partners With Towers Watson
6/11/2013

Leading Health Insurers to Provide Health Plans on New Towers Watson Private Exchange for Active Employees
4/29/2013

Towers Watson Kicks Off “Ready for 2014: Road to Exchange Solutions” Road Show
2/26/2013

Fidelity® and Extend Health Partner to Help Retiring Employees Transition to Private Health Coverage
2/5/2013

Towers Watson Announces OneExchange, a Health Benefit Solution for Full- and Part-Time Employees, and Pre-65 and Medicare Retirees
1/31/2013

Towers Watson Announces Expansion of Exchange Solutions Segment
1/23/2013

Extend Health Wins Inc. Magazine Hire Power Award for Leading U.S. Job Creators
12/21/2012

Extend Health Survey: 74% of Seniors on Medicare Confident that Medicare Will Be There for Them for the Rest of Their Life
11/5/2012

Read the rest of this entry »

In a survey of 682 retirees who have Medicare supplemental plans purchased on the Extend Health private Medicare exchange, 70% reported that during the open enrollment period for 2014 they reevaluated their current plans. When asked why, the top reason by far was, “I just wanted to confirm that I have the best coverage” (63%). Another 22% cited premium increases as the reason they reevaluated.

Extend Health fielded the survey from December 8-10, 2013. The annual open enrollment period for the plan year 2014 ended December 7th.

Even though more than two-thirds of plan holders reevaluated their coverage, just 29% reported that after doing so, they either replaced or dropped one or more of their plans. The remaining 71% took no action and allowed their existing plans to automatically renew.

The percentage of retirees reevaluating their plans each year has increased since the last time we asked the question, while the percentage who replace or drop their plans has remained statistically the same. In a similar survey fielded by Extend Health two years ago, in December 2011 for the plan year 2012, 63% of respondents reported that they had reevaluated their plans and 31% said that after doing so they made changes.

These findings suggest that retirees purchasing plans on our exchanges are not taking their existing coverage for granted and are taking action to ensure that they coverage they have is right for them.

Questions and detailed responses from the survey are as follows:

During the annual open enrollment period for 2014, did you actively review and/or reevaluate your existing plans?

Yes 69.9%
No 30.1%

What was the most important reason prompting you to reevaluate your existing plans?

I just wanted to confirm that I have the best coverage 63.4%
My premiums increased 22.4%
My out-of-pocket expenses increased 5.2%
My current plan was no longer offered 3.8%
My benefits changed 2.4%
My prescription drugs changed 2.0%
My health status changed 0.8%

After reevaluating your existing plans, what action did you take?

I let my plans automatically renew 71.1%
I replaced one or more existing plans 28.1%
I dropped one or more of existing plans without replacing them 0.7%

October 15th marks the beginning of the Medicare Annual Enrollment Period (AEP) for 2014, which runs through December 7th. For seniors on Medicare, this is the time to evaluate current Medicare coverage — including the private Medicare supplemental plans they might be enrolled in — and decide whether to make changes or keep the coverage they have.

What might cause you to consider making changes? Extend Health fielded a survey this past weekend asking its customers who are currently enrolled in plans purchased on its private Medicare exchange whether they plan to re-evaluate or just keep the plans they have, and why.

Findings

Of the 449 respondents who completed the survey, 56.7% said they plan to reevaluate one or more of their existing plans and consider replacing one or more of them. Of those who will reevaluate, 23.8% cite their premiums increasing as their reason for reevaluating. However, 62.3% who said they will reevaluate their plans say they will do so simply because they want to confirm they have the best coverage available.

Not all respondents plan to reevaluate their plans: 37.5% said they plan to renew their existing plan or plans without going shopping. Among respondents who do not plan to reevaluate, 69.2% said it was because they are satisfied with their existing coverage.

Conclusion

Willingness to reevaluate plans indicates that Medicare retirees are actively engaged in gaining the best value and most fitting coverage for themselves, as opposed to simply deferring to the status quo and staying with existing plans.

Q1: The 2014 Medicare Annual Open Enrollment Period will begin on October 15, 2013. During the enrollment period, you have the option of renewing your existing private Medicare plans, purchasing new private plans (from your existing insurance provider or from a new provider) or dropping plans without replacing them. During the enrollment period, do you plan to:

Reevaluate one or more of my existing plans and possibly replace one or more of them

56.7%

Renew my existing or plans without reevaluating them

37.5%

Definitely replace one or more of my existing plans with a different plan

5.6%

Drop one or more of my plans without replacing them

0.2%

Q2: If you plan to reevaluate one or more of your existing plans, what is the most important reason prompting you to do so?

I just want to confirm that I have the best coverage 62.3%
My premiums increased 23.8%
My out of pocket expenses increased 6.6%
My prescription drugs have changed 3.0%
My current plan is no longer offered 2.6%
My benefits changed 1.7%

 

On Friday (10/12/12) the U.S. Department of Health & Human Services released the 2013 quality ratings for Medicare Advantage and Part D prescription drug plans. These star ratings summarize how well the plans performed on well-established measures of quality such as access to care, responsiveness, and beneficiary satisfaction. Plans can earn up to 5 stars, from one star for poor performance to 5 stars for excellent performance. Star ratings are reviewed each year and the results are published by CMS in the fall.

HHS Secretary Kathleen Sibelius said, “People with Medicare have more high quality choices and the performance of Medicare Advantage plans is improving,” and there are “more four and five star plans than ever before.”

Four & Five Star Plans
Plans 2012 2013
Medicare Advantage 106 127
Part D 13 26

To encourage people to enroll in higher quality plans, CMS is notifying people who have been enrolled in low performing plans (plans that received less than 3 stars for the past three years) that they can enroll in a new plan if they want to. Star ratings, in addition to cost and coverage, help consumers compare plans and choose the right one for their needs and budget.

5-star plans are allowed to market and enroll people throughout the year, and thousands of people “took advantage of this opportunity to join a top performing plan,”  according to Sibelius. People can switch to a 5-star plan at any time during the year, but they can only do so once each year.

In addition to better quality, HHS announced that Medicare Advantage benefits are increasing and premiums are holding steady. According to HHS data, average premiums fell 10% and enrollment increased 28%. Premiums for Part D prescription drug plans are expected to remain steady with last year at about $30 on average for 2013.

Related Stores:

Health plans “score” with Medicare’s 5-star rating system

New MA star ratings released by CMS

Preliminary CMS 2013 Medicare Advantage payment and policy guidelines

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

Coventry Health Care just recognized Extend Health for efficiency and customer satisfaction, including zero customer complaints in 2011. Here’s a brief snip from the press release.

“Extend Health Inc., a leading provider of health benefits management services, including the nation’s largest private Medicare exchange, received two first place awards from Bethesda, Maryland-based Coventry Health Care, Inc. (NYSE:CVH) for exceptional customer service performance by a partner in 2011.

  • Zero customer complaints reported to the Centers for Medicare and Medicaid Services (CMS) by seniors signing up for Coventry private Medicare supplement plans through Extend Health;
  • The lowest 90-day plan cancellation rate — called rapid disenrollment — which, at just 0.5 percent, was far less than the typical rate.”

Click here to read the complete news release.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

We just published the results of our latest retiree survey. We asked 504 retirees how satisfied they are with their individual Medicare coverage – and how it compares to the group insurance they had with their former employers. 85% said they are “very” or “somewhat” satisfied with their Medicare coverage. And 67% said they are as satisfied, or more satisfied, with Medicare than their previous employer-sponsored group health plans. Top reasons for overall satisfaction were (a) fewer billing and payment problems (37%), (b) better benefits (30%) and (c) lower cost (28%). You can see all the results in this press release.