December 26, 2016
With the end of the year just around the corner, we are taking a moment to look back at the most popular posts on the OneExchange blog this year.
Most-read topics included benefits administration, telemedicine, disease management programs, and types of benefits being offered, including student loan repayment, workplace perks such as snow days, and changing PTO policies. We also got to know more about exchange innovator Sherri Bockhorst, a managing director of Willis Towers Watson’s group exchange business.
Here are some interesting tidbits from the top 10 posts:
On workplace perks: “New parents no doubt perked up (pun intended) when companies offered such benefits as unlimited parental leave (Netflix) and $4,000 in “baby cash” for the birth of a newborn (Facebook).”
On telemedicine: “The average telemedicine visit costs between $40 and $49…. This compares favorably with a visit to a primary care doctor ($110) or a trip to the emergency room ($865).”
On biosimilars: “The potential benefit [from the FDA approving more biosimilars] is huge… biosimilars could result in over $44 billion in savings on biologics between 2014 and 2024.”
Read on for the complete list of the top 10 blog posts in 2016:
- Little Known Rule Allows Some Seniors To Change Medicare Advantage Plans When Plans Drop Their Doctors
September 26, 2016
Some of the fastest-growing Medicare costs stem from doctors using new medical devices for testing and treatment in their offices, recent data shows.
According to a Wall Street Journal analysis, four of the top 10 fastest-growing Medicare services from 2012 to 2014 involved new medical devices being used by doctors in their offices, instead of in care settings where they might typically be used.
The appeal to doctors of using these new devices is clear: because of the way Medicare payments are structured, their use can be very lucrative. There is also the convenience factor for both doctors and patients. And in an era when technology offers sophisticated medical innovations small enough for use in doctors’ offices, it’s easy to see how doctors are tempted to use cool new devices.
But the consequences of doctors using more medical devices in their offices is an uptick in Medicare spending, to the tune of $135 million, according to Medicare billing records. While that amount of money is a drop in the bucket of total Medicare spending, if the trend continues, it could result in meaningful increases.
So while in-office testing and treatment has its advantages, it’s a trend that bears watching from a cost-benefit point of view.
To read the article in the Wall Street Journal, click here.
A trend toward coinsurance over copays results in Medicare beneficiaries paying higher out-of-pocket prices for their prescription drugs. It also makes it harder for seniors to predict costs because drug prices fluctuate.
Unlike copays, which are flat rates, coinsurance rates are based on a percentage of total costs. Coinsurance was previously limited to higher cost specialty drugs, but its adoption in other drug tiers now is increasing.
According to an analysis from Avalere Health, reported in a recent article in Kaiser Health News, more than half (56%) of drugs covered under the Part D Medicare benefit will use a coinsurance model in 2016. Medicare Advantage plans are also making the change, but at a much lower pace. Just 26% of drugs offered through Medicare Advantage plans will require coinsurance in 2016.
Rising pharmacy costs have been a concern not just for seniors on Medicare, but for health care consumers and providers generally. Pharmacy Benefit Managers (PBMs) have been working to manage the rising cost of drugs to avoid passing on higher costs to employees.
August 2, 2016
The doctor is in. But in this case, “in” could mean in your home.
A recent article in Kaiser Health News highlighted the first-year results of a pilot program, called Independence at Home, run by the Centers for Medicare and Medicaid (CMS) to test whether in-home care provided by 17 medical practices for Medicare beneficiaries could improve outcomes for people with multiple chronic conditions while saving money. The answer? According to the CMS, “Yes.”
In fact, the CMS analysis found that participants saved more than $25 million in the first performance year, an average of $3,070 per person. In addition, all 17 participating practices improved quality in at least three of the six quality measures; four practices met all six quality measures.
Doctors going to their patients, as opposed to having them come into the office, saved Medicare $13,600 per patient in Portland, Oregon and $12,000 per patient in Washington, D.C. While this method of delivering care seems antiquated, it has proven to be effective at saving money. The savings comes, at least in part, from reduced emergency room visits and hospital readmissions, and the ability to monitor patients’ chronic illnesses before they worsen.
“House calls go back to the origins of medicine, but in many ways I think this is the next generation,” said Dr. Patrick Conway, head of the CMS Innovation Center, which oversees the program.
Congress has authorized the program through October 2017. It remains to be seen whether the program will be re-authorized with support to extend it nationwide.
For the complete article in Kaiser Health News, click here.
May 24, 2016
According to Kaiser Family Foundation data, just 23% of employers with over 200 employees offered retiree health benefits last year. But that statistic doesn’t tell the whole story.
Rather than exiting retiree benefits, a growing number of employers are looking to other avenues to provide benefits to retirees, including private Medicare exchanges.
According to John Barkett, director of policy affairs for Willis Towers Watson, the private exchange option is appealing to employers for a variety of reasons. In a recent article for Business Insurance Barkett said, “[A private Medicare exchange] allows employers to make coverage available with predictable costs and in an affordable way.”
Barkett noted that an exchange also allows employers to offset the cost of the benefit for both themselves and retirees by creating and making contributions to tax-advantaged health reimbursement accounts (HRAs) on behalf of retirees.
While traditional employer-sponsored retiree health coverage continues to decline, data from Willis Towers Watson shows that this alternate approach is on the rise. One third of U.S. employers surveyed by Willis Towers Watson reported that they have already transitioned to a private Medicare exchange for retiree benefits and two-thirds are considering it by 2018.
For the complete article in Business Insurance, click here.
It’s official. Over the next 2 years, CMS will be phasing in changes to how payments are calculated for group Medicare Advantage plans that provide health coverage to employers’ retirees. This is according to a recent ruling from the Centers for Medicare and Medicaid Services (CMS).
The changes are designed to stop substantial overpayments for providing Medicare-covered benefits. Even though CMS will require more competitive bids from employers and their carriers, the agency has said it also still expects the plans to offer comprehensive supplemental benefits.
John Barkett, senior director of policy affairs at Willis Towers Watson, was interviewed by Cort Olson for an article in Employee Benefit News (EBN) on this topic. According to Barkett, the changes have been a long time coming.
“MedPac has been pointing this out for a while, and this year in their annual rule making process, it was cited that employers are not competitively bidding for their Medicare payments,” said Barkett.
Barkett noted that employers were against the changes because they will negatively affect both employers and retirees. The only silver lining for employers is that CMS decided to phase the new rules in over two years rather than one year as was initially proposed.
(MedPAc stands for the Medicare Payment Advisory Commission, an independent U.S. federal body formed to advise Congress on the Administration of Medicare.)
For the complete article featuring John Barkett in EBN, click here.
For the complete article on the Medicare Advantage ruling, click here.
Little Known Rule Allows Some Seniors to Change Medicare Advantage Plans When Plans Drop Their Doctors
May 4, 2016
Medicare Advantage plans are an attractive alternative to original Medicare or original Medicare plus private supplemental Medicare plans for some seniors. However, Medicare Advantage plans have some limitations. While the plans can drop care providers and providers can drop out of plans anytime they want, in the past seniors were allowed to change plans just once a year, with some exceptions. This meant some seniors had to change doctors to continue receiving care.
However, in 2013, the Centers for Medicare and Medicaid Services (CMS) issued rules giving Medicare Advantage plan members a “special enrollment period” based on what the CMS called a “significant” change in their provider networks. The rules went into effect last year and so far, CMS has allowed more than 15,000 people to change plans based on changes in their providers.
But two obstacles stand in the way of more seniors taking advantage of the option. First, CMS is not publicizing the benefit, so many members don’t know about it. Second, CMS has not clarified what it means by a “significant” change.
In a recent article in Kaiser Health News, Medicare Deputy Administrator Sean Cavanaugh offered an explanation for what CMS looks for in granting special enrollment periods: “What we’re looking for is whether their selection of a plan was based on a network and the presence of certain physicians and that their [the plan member’s] selection would’ve been different.”
Cavanaugh further advised members to call CMS’ help line, 800-Medicare, to request permission to leave their plans because they lost their doctors. But he cautioned that members are being allowed to switch plans only “in rare situations.”
Still, for employers with retirees who currently have Medicare Advantage plans or are considering one, the new rule is important to know about: it could provide a pathway for retirees to maintain their long-standing relationships with their care providers.
To read the complete article in Kaiser Health News, click here.
A Medicare policy enacted in January of this year will help seniors decide the care they want at the end of their lives.
The policy, referenced in a Centers For Medicare and Medicaid Services (CMS) press release as “advance care planning,” for the first time establishes a separate payment and billing rate for physicians who have conversations with their patients about their wishes at the end of their lives.
By creating a separate designation, Medicare makes it more feasible for physicians to take time out of their already strapped-for-time schedules to have these conversations. Doctors can now bill $86 for a counseling session up to 30 minutes long with their patients on the care they would like to receive at the end of life.
For employers and plan sponsors, this new policy could directly benefit their Medicare-eligible retirees. More broadly, it has implications both for assuring quality of care and for controlling health care costs.
A whopping 28% of Medicare spending, estimated in 2011 to be almost $544 billion, happens in the last six months of a patient’s life. Much of that comes from measures meant to extend quantity of life, but that do not assure quality of life. Feeding tubes, breathing machines, and eleventh hour surgeries or treatments end up costing $170 billion in those last months.
While some people may still opt for these extreme measures to prolong life, everyone benefits from sitting down with their physician to have the conversation about the care they wish to receive.
To learn more about the new policy, read this article in Kaiser Health News.
“Health insurers increasingly are moving away from traditional fee-for-service models toward value-based care under alternative payment arrangements,” according to John Barkett, director of policy affairs at Willis Towers Watson.
In January of 2015, the Department of Health and Human Services (HHS) announced the intention to have 50% of Medicare payments go to providers in alternative payment arrangements by 2018. This marks a seismic shift in how care is delivered and will inevitably change the way providers operate.
As the guest host of a recent Wharton Business Radio show on SiriusXM, Barkett discussed the topic with Seth Frazier, chief transformation officer of Evolent Health, a software and consulting services company that helps health systems transition to value-based care.
(If you are a SiriusXM subscriber, you can listen to the full interview here. If you are not a subscriber, read on for highlights from the interview.)
In their discussion, Barkett and Frazier first offered some background on value-based care and how it is different. Frazier explained that the current system is organized to reimburse by volume. However, as new models emerge that reimburse based on other metrics such as outcomes, quality, and value, the system is transitioning from “paying for volume” to “paying for value.”
Barkett noted that this is not the first time this transition has been attempted, though it is likely to be more successful this time. He recalled a previous attempt at Duke University in the 1990s.
“Thinking back to my policy class days, we discussed the cardiac intervention at Duke University,” said Barkett. “They found a great way to serve patients recovering from cardiac surgery that reduced readmission rates. However, they scrapped the program because it was losing too much money. They couldn’t share in the savings their program created. So why are we talking about this now, when Duke failed decades ago?”
Frazier explained the unique domestic and international circumstances that are driving a renewed look at payment models in the United States. Domestically, health care costs account for a disproportionate share of the GDP, and the growth in the cost of health care is outstripping growth of the GDP. This negatively impacts U.S. businesses global competitiveness, the federal government’s funding of Medicare and support for Medicaid, and state governments’ overall budgets. Internationally, in rankings of health care outcomes by country, the U.S. is “not at the top of heap.” The combination of cost and quality concerns is motivating U.S. private sector leaders and government entities to take action, making change “inevitable.”
So what steps should be taken to achieve this transition? Frazier outlined what providers can do to transition to a value-based path:
1) Physician alignment: Communicate clearly and align physicians currently employed by, as well as those affiliated with, your health system with your goals.
2) Revenue opportunities: Identify specific revenue opportunities connected with population health through federal government programs or through relationships with private payers, or with Medicaid.
3) Infrastructure: Understand what infrastructure is needed to support and share relevant medical information.
4) Business plan: Put together a cohesive business plan around the strategy, with goals and priorities.
Ultimately, Frazier concluded, changing the business model is the key: health systems need to get paid for value, not just providing more services.
Barkett and Frazier agreed that we will have to wait until 2018 to see if the ambitious targets of HHS are met. Even if the targets aren’t met, the shift to quality, not quantity, should result in better health outcomes for patients and cost savings for providers.
February 23, 2016
I’m Sherri Bockhorst, managing director with Exchange Solutions, Willis Towers Watson’s private exchange business segment.
It’s my mission to support employers’ strategic business needs as well as help them meet their employees’ needs around their health care, finances and family situations.
At the end of the day, I’ve found that employers and employees are after the same thing: They want better health, productivity and protection from risk.
I help support the strategic direction of our group exchange for active employees through product design and development, forming strategic alliances with value-add third parties and raising the level of awareness and understanding across exchange-space participants including employers, employees, insurance carriers, and others.
My health insurance roots
Most of my career has been focused on supporting large employers in the health care space. I have worked with employers under many different circumstances, including companies that needed to figure out how to provide benefits in a high-turnover environment, or how to work successfully with their unions.
My passion for my current job is based on seeing how a comprehensive exchange solution can be configured to solve each employers’ unique needs in a way that provides many options for the employer and a range of plan choices to meet the diverse needs of employees.
Exchanges like ours take the best practices that we’re figured out for large employers with the resources for a completely custom solution and package those leading-edge solutions so employers without the same resources can deploy a similarly configured approach.
We take the best thinking from our years of experience working with large employers – levers like high-performing networks, optimizing pharmacy costs, promoting and supporting consumerism, choice from the right mix of plans so employees and retirees can pick the best one for their personal needs, and integrated well-being and incentive design – and make it more accessible to smaller groups. Because why should these levers only be available to employers with a 100,000-employee workforce? The same solution could make sense for employers of any size.
At the same time, many employers aren’t necessarily ready to adopt the full depth of our solution. Account-based health plans are a good example; initially employers may want to make them available while continuing to offer more traditional options, like PPOs. Not all employers will be on a total replacement track, but having access to them is likely to be of interest.
All of those levers are embedded into OneExchange. So if and when employers are ready to change gears and adopt new strategies to achieve their goals, they can dial our exchange levers up or down at the pace that’s right for their organization.
Where I see health insurance going
Right now we’re continuing to see exchanges evolve and change, and that makes a lot of sense, given how this space is developing as a new way for employers to deliver health benefits.
With employer adoption, we’re learning more about what employees will purchase, what kinds of choices and products they gravitate toward and how much they need to talk to individuals or want other types of on-demand decision support.
So that brings us back to where we started in terms of employers and employees ultimately wanting the same thing. Exchanges are fine-tuning the many ways their offerings can support the common ground between employers’ and employees’ goals – both where they are now and where they want to be over time.
As exchanges become more ubiquitous – and I believe this will happen within the span of my career – private exchanges will contribute greatly to the environment that will create transparency and choice for individuals and operate as a robust channel for delivering higher value employee benefits programs for employers.
To reach me for comment on an article or a presentation, contact Melanie Meharchand, Director of PR and Social Media for Exchange Solutions, Willis Towers Watson.