On August 22, 2012 CMS Announced 500 primary care practices that will participate in the Comprehensive Primary Care (CPC) demonstration project in a new partnership between payers and primary care providers. Backed by the ACA, the goal of this multi-payer initiative is to deliver better coordinated, higher quality, patient-centered care, and to reduce costs.

The CPC’s goal was to enroll about 75 primary care practices in several regions spanning eight states: Arkansas, Colorado, New Jersey, New York, Ohio & Kentucky, Oklahoma, Oregon. Practices were chosen in a competitive process based on several criteria.

  • Use of health information technology
  • Ability to demonstrate recognition of advanced primary care delivery by accreditation bodies
  • Service to patients covered by participating payers
  • Participation in practice transformation and improvement activities
  • Diversity of geography, practice size and ownership structure.

The chosen practices are to begin delivering health care services under the program in the fall of 2012, and are projected to serve over 300,000 people with Medicare. For more details and a complete list of participating primary care practices visit the CMS Innovation web site and read the CMS press release.





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

The road map for state exchange health plans in 2014 was just released. Posting it here to make the whole report available.

Essential Benefits Package (IOM Oct 6 2011)

The U.S. Department of Health and Human Services (HHS) announced a new program called the Bundled Payments for Care Improvement initiative. As part of the Affordable Care Act’s ongoing efforts to improve health care and lower costs, this new initiative will bundle “payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement.” The program will incentivize health care providers (hospitals, doctors, clinicians, etc.) to work together to reduce costs and provide better care while patients are in the hospital as well as after they are discharged.

“Patients don’t get care from just one person – it takes a team, and this initiative will help ensure the team is working together,” said HHS Secretary Kathleen Sebelius. “The Bundled Payments initiative will encourage doctors, nurses and specialists to coordinate care. It is a key part of our efforts to give patients better health, better care, and lower costs.”

At this time, the program is voluntary and participants can choose from four broad approaches. This gives them the flexibility to decide which services and episodes of care they wish to bundle together. Participants will also propose a target price for an “episode of care.” Total payments will be compared to the target price and the providers will share in the savings.

The initiative is based on a previous CMS demonstration project that bundled payments for heart bypass surgery which saved the participating providers $42.3 million, and saved patients $7.9 million in coinsurance. It also improved patient care and lowered mortality.

According to CMS Administrator Donald Berwick, M.D. “All around the country, many of the leading health care institutions have already implemented these kinds of projects and seen positive results.” That may be true, but, even if the hospitals and other providers are interested, will the financial incentives be enough to get them to participate? I guess we’ll just have to wait and see.

For more information visit the CMS Innovation Center or donwload their Fact Sheet.

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

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Governor Sam Brownback of Kansas announced on Tuesday that his state would return a $31.5 million “Early Innovator” grant received in February to “design and implement the Information Technology (IT) infrastructure needed to operate Health Insurance Exchanges” as mandated by the ACA.

The U.S. Department of Health and Human Services (HHS) awarded grants to seven states, including Kansas, so they could lead the way on, “building a better health insurance marketplace, one that allows individuals and small-business owners to pool their purchasing power to negotiate lower rates. Using these new funds, the Early Innovator states will develop Exchange IT models that can be adopted and tailored by other states.” Of the seven states that received a grant, Kansas is the second to reject it. Oklahoma returned its $54 million grant in April.

In his statement justifying the return, Governor Brownback said, “There is much uncertainty surrounding the ability of the federal government to meet its already budgeted future spending obligations. Every state should be preparing for fewer federal resources, not more. To deal with that reality Kansas needs to maintain maximum flexibility. That requires freeing Kansas from the strings attached to the Early Innovator Grant. The early innovator grant does not address the most important issue in health reform, which is slowing the rate of cost growth in health care.” Others have indicated that the decision may be due, at least in part, to political pressure from special interest groups.

Note that Governor Brownback does not provide any suggestions for how health care growth costs might be slowed, although it does say Kansas will search for solutions that will work for the state. Extend Health would argue that state exchanges will play a critical role in cost containment by introducing consumer empowerment and carrier competition to the market – helping consumers to find and pay for health care plans that cover only their specific needs at a cost they can afford.

The governor’s statement is available here.
You can read the HHS press release announcing the “Early Innovator” grants here.

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

McKinsey & Company in Shanghai _3417

Image by !/_PeacePlusOne via Flickr

According to a recent study released by McKinsey & Company report titled How US Health Care Reform Will Affect Employee Benefits, 30 percent of employers will “definitely or probably” drop health insurance for their employees. This is a far cry from earlier projections, such as the Congressional Budget Office’s estimate that only 7 percent of employees will have to switch from employer-sponsored insurance (ESI) to subsidized-exchange policies in 2014.

McKinsey’s survey of 1,300 employers found that the impact will be much greater than those original estimates. Here’s a summary of their key findings:

  • 30 percent of employers will “definitely or probably” stop offering ESI
  • 45 to 50 percent of employers will “definitely or probably” seek ESI alternatives
  • 50 to 60 percent of employers with “high awareness of reform” will pursue ESI alternatives
  • 30 percent of employers would still benefit economically by dropping coverage even after compensating employees with other benefits or increased salaries
  • 85 percent of employees would not quit their jobs if ESI was no longer offered

McKinsey’s findings also indicate that to remain competitive for top talent, employers that drop ESI are expected to make up for it by increasing other benefits like salaries, vacation, retirement, or health-management programs. However, McKinsey believes that employers won’t have to compensate employees for 100 percent of the lost insurance value.

Interestingly, the survey shows that employers that are considering dropping ESI are doing so because they realize ESI may not be the most efficient way to provide health coverage for their employees after 2014. But the report also points out that most employers will probably find solutions somewhere between the extremes of completely dropping ESI and continuing their current offerings:

“For employers and insurers, success after 2014 will require a better understanding of employee and employer segments, and the development of the right capabilities and partnerships to manage the transition.”

Not everyone agrees with the findings of this thought-provoking report. The Obama administration, for instance, has pointed out the McKinsey’s research is at odds with that from the Congressional Budget Office, Rand Corp., and the Urban institute. One thing is for sure: the McKinsey report is a must read if you are interested in the potential effects of health care reform on employer-sponsored health care benefits. You can download the report from McKinsey Quarterly.

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

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This week we released results of a survey of 460 seniors 65 and older.  The survey shows that 70% of respondents believe the Patient Protection and Affordable Care Act (PPACA) will reduce their Medicare benefits, despite the fact that the bill does not cut Medicare benefits and instead adds some, including a yearly free checkup and other free preventive care services.

We conducted the survey from December 10-17, 2010. The results are consistent with surveys from other third parties throughout 2010 showing that many Americans, including seniors, have strong opinions about the overall health care bill without knowing what is in the bill and that often contradict how they feel about its individual provisions, including the AP-GfK Poll on health care reform from January 2011;  the KFF/Harvard Poll on health care reform from January 2011; and the National Council on Aging on health care reform from July 2010 .

The survey also revealed the following views of seniors on the impact of the health care law:

  • 72% expect reductions in their choice of Medicare Advantage or Medigap insurance plans
  • 64% expect reductions in their choice of Part D prescription drug plans
  • 87% expect increases in the cost of their Medicare insurance premiums
  • 84% expect increases in their prescription drug premiums
  • 82% expect increases in their out-of-pocket prescription drug expenses.

More detailed survey results are available in the Extend Health Medicare Conference Report for 2010.

Latest Kaiser Family Foundation tracking poll comes in with some surprising results. The headline news – that 22% of respondents think PPACA has been repealed, and another 26% aren’t sure – isn’t the finding of most interest for us at Extend Health. We know that the law has never been liked by retirees on our advisory panel, but we’re surprised to learn just how unpopular it is with older Americans in the latest Kaiser poll. Unfavorable views among people 65 and older are at their highest level since the bill passed: 59%, a 19% increase since the low of 40% last December. Favorable/unfavorable ratings over all age groups are much more evenly divided, with 43% favorable, 47% unfavorable. We’re curious about readers’ opinions on this recent rapid uptick in unfavorability among Medicare-eligible individuals. The level of anti-reform rhetoric has always been high, so that doesn’t seem to be a likely cause of a sudden increase.  Is this latest poll result related to the repeal vote in the House of Representatives? If so, what’s the relationship? Are seniors reflecting a fear that reform will diminish or eliminate benefits they’ve come to depend on? That their medical costs will rise as a result? Comments welcome – we’re interested in your take on these latest results.

HHS announced today the award of “early innovator” grants to seven states (actually, six states and a consortium of five New England states) to help them design and implement the IT infrastructure for state insurance exchanges. According to HHS, “Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state consortium led by the University of Massachusetts Medical School will receive a total of approximately $241 million.” (The New England consortium includes  Connecticut, Maine, Massachusetts, Rhode Island, and Vermont.) Grant amounts range from $6 million for the Maryland Department of Health and Mental Hygiene, to a high of  nearly $55 million for the Oklahoma Health Care Authority. Learn more about grant amounts and the states’ proposals here.

Extend Health is the only partner included in today’s announcement of Microsoft’s new turnkey solution for state health insurance exchanges. Our exchange platform is an integral piece of the solution; you can read the full press release here. Read the rest of this entry »

Titled The Public’s Health Care Agenda for the 112th Congress and fielded just before the repeal vote, the latest Kaiser Family Foundation/Harvard School of Public Health poll results are out today.  Unfavorable views on PPACA, which had been dropping in recent months, took a sharp turn upward to 50% (from a low of 40% in November) while favorable views dropped to 41% – with sharp divisions in opinion along party lines.

Paradoxically, many provisions of the reform bill are viewed favorably by a majority of respondents, including reducing payments to Medicare Advantage plans (56% favorable vs. 35% unfavorable), the 50% discount on drugs in the Part D doughnut hole (85% favorable vs. 14% unfavorable) and increasing Medicare premiums for some higher-income seniors (53% favorable vs. 45% unfavorable). Majorities favor provisions that will expand coverage, but are opposed to individual and employer mandates.

Recommended reading, especially the Chartpak.