Thursday, June 29, 2017

32.51% ...

... of Medicare Advantage members as of June 2017 are enrolled in a contract with a 4.5-or-higher Star Rating. Only 0.89% are enrolled in contracts with a 2.5 Star Rating.

Wednesday, June 28, 2017

Memorial Hermann to cut 350 positions

By Alex Kacik  | June 28, 2017

Houston-based health system Memorial Hermann will cut 350 jobs, the organization announced Wednesday, citing escalating costs, declining reimbursements and a softened local economy.

The move is part of an overriding strategy to adapt to an uncertain healthcare environment by becoming more cost-efficient and consumer-focused, the organization said, adding that the cuts won't impact direct patient care. Memorial did not specify which of its 25,000 total employees would be losing jobs.

The news comes not long after Memorial Hermann's CEO Dr. Benjamin Chu abruptly resigned after about a year at the helm. He plans to transition to a public policy role.

Memorial Hermann is currently in the credit review process with both Moody's Investors Service and Standard & Poor's, but it does not expect the transition to lead to any material credit action, executives said.

"Our greater (credit) concerns rest with changing economic conditions in Houston, a result of the prolonged energy recession," Dennis Laraway, the system's executive vice president and chief financial officer, told Modern Healthcare last week.

Alex Kacik is the hospital operations reporter for Modern Healthcare in Chicago. Aside from hospital operations, he covers supply chain, legal and finance. Before joining Modern Healthcare in 2017, Kacik covered various business beats for seven years in the Santa Barbara, California region. He received a bachelor's degree in journalism from Cal Poly San Luis Obispo in Central California.

http://www.modernhealthcare.com/article/20170628/NEWS/170629880?utm_source=modernhealthcare&utm_medium=email&utm_content=20170628-NEWS-170629880&utm_campaign=dose

Insurance claim denials cost hospitals $262 billion annually

By Dave Barkholz  | June 27, 2017

ORLANDO, Fla.—Hospitals across the country lose approximately $262 billion per year on denied claims from insurers, sparking huge cash-flow issues and recovery costs, according to new data.

Payers initially deny about 9% of hospital claims, putting about $5 million in payments per hospital at risk, said Jason Williams, vice president of analytics for Change Healthcare, which collected the data.

Although hospitals ultimately will secure payment for 63% of initially denied claims, it costs $118 per claim on average to recoup the money, not to mention the cost to hospitals of foregoing the payments while they claw back the funds, Williams said.

"Even if they're ultimately paid for 63% of the claims, that's not great," said Williams, speaking on the sidelines of the national educational forum held each year by the Healthcare Financial Management Association.

Change Healthcare merged with McKesson's healthcare information technology business in March. The company analyzed about $3 trillion in claims in 2016 as part of its Healthy Hospital program.

Hospital claims denials happen for a host of reasons, ranging from providers not obtaining authorization for procedures to faulty input of codes, Williams said.

If hospitals cannot secure a denied claim, they're left eating the cost or billing the patient for the services, which can alienate that patient and ding satisfaction scores on the unlikely bet that the hospital can collect the funds, according to Williams.

Hospitals can try to avoid claim denials by automating their revenue-cycle workflow and collecting data that flag where claims are being denied, Williams said.

"The key is avoiding the denial in the first place," he said.

Dave Barkholz is Modern Healthcare’s Southern Bureau Chief stationed in Nashville. He covers hospitals, doctors, suppliers and governance across the Southeast. A winner of numerous national journalism awards, Barkholz started his career at Modern Healthcare in 1984 covering the investor-owned hospital companies. He spent the past 10 years in Detroit at Automotive News, a sister Crain publication.


Medicaid remains sticking point in Senate ACA repeal bill

By Mara Lee  | June 27, 2017

Facing rebellion on the left and the right, Senate Majority Leader Mitch McConnell on Tuesday delayed a vote on the Senate replacement for the Affordable Care Act.

McConnell hoped to bring the Better Care Reconciliation Act to the Senate floor for debate and a vote this week, so public outcry during next week's congressional holiday wouldn't weaken senators' resolve to repeal the ACA.

But after senators from Maine, Nevada, Utah and Wisconsin all said they would vote against a motion to begin debate, McConnell pulled the bill for continued intraparty negotiations. The announcement came during a closed-door GOP lunch.

After the lunch, McConnell told the press: "We're going to continue discussions in our conference on the differences we have. We're still working toward getting 50 people in a comfortable place."

The decision comes just one day after the Congressional Budget Office revealed its analysis of the Senate bill, saying the plan would cause 22 million to lose their health coverage by 2026. The House's American Health Care Act had a similar impact with 23 million projected to lose their coverage.

"We're optimistic we're going to get to a result that's better than the status quo," he said.

All the Republican senators were invited to the White House Tuesday to talk about replacing Obamacare.

The Senate bill does more to drive down exchange premiums than the House bill, thanks to its proposed subsidy system for individual insurance policies, which shifts subsidies to Bronze plans rather than Silver plans.

Senate Republicans say people are unhappy with the individual market and rising premiums under Obamacare.

"While the schedule may have changed a little bit, one thing that hasn't changed: Obamacare is collapsing. It's a failed system that needs to be replaced," said Sen. John Thune of South Dakota.

Thune said the Senate approach to regulating the individual market will "bring affordability to people suffering under the curse of high premiums, high deductibles and high out-of-pocket costs."

The CBO analysis of the Senate bill determined that premiums will drop for those who don't qualify for subsidies, but premiums will rise for individuals over the age of 50 who currently qualify for subsidies. In addition, fewer people will qualify for subsidies.

Other analysts say that deductibles and out-of-pocket costs will rise, not fall, thanks to their changing actuarial value.

The CBO predicted that virtually no low-income people who currently qualify for very low deductibles and co-pays will buy policies under the Senate proposal's regime, since their out-of-pocket costs would rise too high.

But Senate Republicans say the current system is unsustainable.

Sen. John Barrasso of Wyoming, a physician, said he had a constituent visit his office this morning complaining she and her husband pay twice as much for their policies now, with $6,500 deductibles, than they did before Obamacare. That policy "wasn't good enough for the Democrats," but it was good enough for her, he said.

One of the sticking points among Republicans is how to rework the Medicaid program, which some states expanded under the Affordable Care Act. Lawmakers in those states are wary of rescinding the benefits to their constituents and facing a tougher road to re-election.

Barrasso said covering childless adults gets away from Medicaid's original purpose and that states need the flexibility to design their own programs.

The bipartisan National Governors Association sent a letter to the Senate saying it opposes the proposal to withdraw more than $770 billion in federal Medicaid funding over 10 years by ending enhanced support for the expansion population and constraining the growth in the federal contribution.

Those cuts are why Republicans can repeal taxes on health insurers, earners making more than $200,000 annually and investment income, among others, without increasing the deficit.

Providers will feel the impact of Medicaid cuts far greater than changes to the individual market. Dr. Atul Grover, executive vice president of the Association of American Medical Colleges, said that his member hospitals, which are 5% of all hospitals, cover 24% of Medicaid patients.

Although the Senate bill preserves and increases disproportionate-share hospital funding in non-expansion states, that won't make up for the Medicaid cuts. If Congress rolls back Medicaid support and millions are pushed off the program, "We're not going to turn these patients away," Grover said. "That's not who we are."

Mara Lee covers developments in health care policy in Congress and around Washington. This is her second time covering the Hill. In a previous life, she covered Midwestern delegations for Scripps and Gannett newspapers in Indiana and Michigan. Over her 20-year-plus-career, she’s spent more time outside the Beltway, both as a business reporter for The Hartford Courant and nine years in Ohio, mostly at the Dayton Daily News. She won an award for coverage of Oxycontin addiction Ohio in 2003, as well as for Census, business and breaking news coverage in Ohio and Connecticut. She’s a Virginia native, and graduated from the University of North Carolina-Chapel Hill. Twitter handle: MaraRhymesSarah


Providers ramp up pressure to scuttle Senate repeal bill

By Harris Meyer  | June 27, 2017

Healthcare industry groups opposed to Senate Republicans' Obamacare replacement bill plan to step up their lobbying of GOP senators now that Majority Leader Mitch McConnell has delayed a vote until after the July 4 recess.

McConnell announced Tuesday afternoon he was delaying a vote to proceed on the Better Care Reconciliation Act until senators return from the recess on July 11. He was stymied when GOP senators from Maine, Nevada, Utah and Wisconsin all said they would oppose a motion to begin debate. Under the Senate's budget reconciliation rules, he needs the support of 50 of the 52 GOP senators to pass the bill.

"The delay is good in the short run, but this bill isn't dead and probably will come back," said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents safety-net insurers. "We will continue to educate lawmakers about problems we see with the bill and its effect on low-income people and states."

On Tuesday, CEOs from 50 of her organization's members were in Washington meeting with their home state senators and representatives.

Arizona's two GOP senators, Jeff Flake and John McCain, face pressure from the state's providers and its Republican governor to protect the state's Medicaid expansion, which covers nearly 400,000 low-income adults.

"We're happy there's a delay," said Greg Vigdor, president of the Arizona Hospital and Healthcare Association. "We think the Senate bill is flawed policy, and we'll use the extra time to understand it better and urge our senators to oppose it."

It's expected that McConnell will try to negotiate changes with Republican moderates and conservatives who have expressed doubts about the bill, which was written by McConnell and his staff behind closed doors and unveiled last Thursday.

McConnell has nearly $200 billion over 10 years in enhancements to dole out to win over moderates concerned about the Congressional Budget Office's politically damaging report Monday. That report estimated the bill would lead to 22 million more Americans without insurance in 2026. The CBO also said that people buying coverage in the individual market would face significantly higher out-of-pocket costs under the bill, though some people would pay lower premiums.

Since the CBO scored the bill as saving $202 billion more than the House bill, McConnell could richen the bill's coverage provisions by that amount and still comply with Senate budget reconciliation rules.

Moderate Republicans like West Virginia's Shelley Moore Capito and Ohio's Rob Portman may press for a slower phase-out of the ACA's Medicaid expansion and additional billions in funding for substance abuse treatment for their drug-ravaged states. Conservatives like Utah's Mike Lee and Kentucky's Rand Paul want more rollbacks of ACA insurance rules, which they argue would bring down premium costs.

The majority leader is dancing on a knife edge. If he adds costly coverage enhancements to please the moderates, he risks losing the support of conservatives. If he relaxes insurance rules and weakens consumer protections, he could lose the moderates.

Murray said her organization is urging senators not to accept temporary grants for substance abuse treatment as a trade-off for phasing out Medicaid coverage.

"We don't want senators to think they've taken care of the problem by accepting a grant," she said. "Forty percent of medication-assisted treatment is paid for by Medicaid, and we want to make sure people have Medicaid coverage entitling them to treatment, not a limited pot of money."

Two moderates, Maine's Susan Collins and Nevada's Dean Heller, have said they can't support the Senate bill in its current form, while Paul has said the same thing from the conservative side. Heller, who faces a tough re-election campaign in 2018, is seen as a bellwether. If McConnell can win him over, many political observers think the bill will pass. But Heller has staked out a tough public position against cutting Medicaid.

For McConnell, the silver lining to the delay is it gives balky GOP senators time to publicly justify a switch from opposition to support, said Rodney Whitlock, a Republican healthcare lobbyist and former Senate staffer.

The downside is that during the recess break, Republican senators are going to hear a lot of fierce opposition to the bill—particularly to its restructuring and funding cuts in Medicaid—but not a lot of support. And the bill's provision locking people out from buying insurance for six months if they have a lapse in coverage will be a hard sell with the public, he warned.

"It will be harder and harder on members to hear all that from people and then come back to Washington and feel they're doing the right thing" by voting for the bill," Whitlock said.

Republican leaders want to pass their bill to repeal and replace the ACA as quickly as possible to so they can move on to tax and budget legislation. The Senate has 15 more working days before its long August recess. They have said that the end of July is the absolute deadline for the bill.

If McConnell makes changes to win over wavering senators, the bill will have to be evaluated again by the CBO and scored on its cost and coverage impact.

In addition, its provisions still have to be vetted by the Senate parliamentarian for whether they comply with budget reconciliation rules. That process could knock out nonbudgetary provisions such as insurance regulatory changes and bans on federal funding for Planned Parenthood and abortion coverage that are strongly supported by conservatives.

The bill's path looks rocky, but healthcare industry leaders aren't relaxing their guard, knowing McConnell is a savvy and determined legislative leader. They're particularly focusing their efforts on Senate GOP moderates who have expressed strong concerns about the bill's Medicaid provisions and coverage losses.

"We assume they'll make another run at the bill, just like when the House bill initially went down," Murray said. "We won't let up the pressure."

Harris Meyer is a senior reporter providing news and analysis on a broad range of healthcare topics. He served as managing editor of Modern Healthcare from 2013 to 2015. His more than three decades of journalism experience includes freelance reporting for Health Affairs, Kaiser Health News and other publications; law editor at the Daily Business Review in Miami; staff writer at the New Times alternative weekly in Fort Lauderdale, Fla.; senior writer at Hospitals & Health Networks; national correspondent at American Medical News; and health unit researcher at WMAQ-TV News in Chicago. A graduate of Northwestern University, Meyer won the 2000 Gerald Loeb Award for Distinguished Business and Financial Journalism.


Colonial Life Report Encourages Bigger View Of Employee Benefits

Business Wire

Research shows employers can create stronger benefits plans by avoiding health care reform distraction

COLUMBIA, S.C.--(BUSINESS WIRE)-- Employers can create more competitive and cost-effective benefits programs by taking a broader view and avoiding the distractions of health care reform legislation, according to a new white paper released today by Colonial Life.

Big-Picture Benefits” uses industry and internal company research to illustrate solutions available to employers that help control rising insurance costs, protect their workers’ financial wellbeing and offer greater choice for today’s increasingly diverse workforce.

“Health insurance is a major employer expense, but a competitive employee benefits plan includes far more than that,” says Steve Hesler, assistant vice president, product development at Colonial Life. “Employers who want to attract and retain the best talent can take active steps today rather than waiting to see what does or doesn’t change down the road.”

Rising costs create financial burden

As health care premiums continue to rise — up more than 300 percent since 19991 — employers are increasingly shifting costs to employees, through a higher share of premiums, higher coinsurance or higher deductibles. However, that heavier burden increases employees’ already-fragile financial state, the report points out. The average deductible for employer-sponsored health plans surged 13 percent in 20161 while workers’ wages increased only 2 percent.2

That comes at a time when nearly half of surveyed Americans say they couldn’t cover a $400 emergency expense or would have to sell something or borrow the money. And close to a third went without some medical care in the past year because they couldn’t afford it.3

Redesigned programs close gaps, offer choices

Employers who pair voluntary benefits with a high-deductible health plan find they can reduce employees’ financial exposure while expanding their benefits program. Employees can select and pay for the coverage they want, or employers can fund it — often at the same or lower cost than before with the premium savings from the higher-deductible health plan.

The increased choice of voluntary benefits also creates greater flexibility and customization demanded by today’s increasingly diverse workforce, the report says. Research shows there are large gaps between what employees list as “must-have” benefits compared with what employers offer, especially for accident, critical illness and hospital confinement insurance.4In fact, one recent study showed a third of employees tend to enroll in every type of coverage offered.5

“A strong benefits program is one of the most important tools employers have to compete for and keep their talented workforce,” Hesler says. “Those who broaden their vision beyond major medical coverage to include voluntary benefits will be ideally positioned to both manage the bottom line and give their business a competitive edge.”

Download a copy of the “Big-Picture Benefits” white paper at ColonialLife.com.

1 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2016.
2 Bureau of Labor Statistics, Employment Cost Index, April 2017.
3 Board of Governors of the Federal Reserve System, “Report on the Economic Well-Being of U.S. Households in 2014,” 2015.
4 MetLife, 14th Annual U.S. Employee Benefit Trends Study, 2016.
5 Customer Benefits Analytics and Lodestar Advisory Partners, 2016 Employee Benefits Enrollment Study.

About Colonial Life
Colonial Life & Accident Insurance Company is a market leader in providing financial protection benefits through the workplace, including disability, life, accident, dental, cancer, critical illness and hospital confinement indemnity insurance. The company’s benefit services and education, innovative enrollment technology and personal service support more than 86,000 businesses and organizations, representing 3.7 million of America’s workers and their families. For more information visit www.coloniallife.com or connect with the company at www.facebook.com/coloniallifebenefitswww.twitter.com/coloniallife and www.linkedin.com/company/colonial-life. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

Colonial Life

Jeanne Reynolds, 803-678-6274
jdreynolds@coloniallife.com

Source: Colonial Life

https://insurancenewsnet.com/oarticle/new-colonial-life-report-encourages-bigger-view-of-employee-benefits

Worldwide cyberattack: Here's how to protect yourself

by Selena Larson   @selenalarsonMay 15, 2017: 9:09 AM ET
Europol: Ransomware preying on 'poor digital hygene'
One of the biggest-ever ransomware attacks continues to take computers hostage.
Friday's attack largely hit businesses and large organizations: U.K. hospitals, a Spanish telecom, FedEx (FDX), the Russian Interior Ministry, and more. And it's expected to cause more problems on Monday. Researchers recorded infections in tens of thousands of machines, and Europol estimated Sunday that the attack had spread to about 150 countries.
Ransomware is a type of malicious software that takes over a computer and locks the user out, preventing them from accessing any files until they pay money. This particular program, called WannaCry, asks for about $300, though the price increases over time.
Experts are advising infected users not to pay the ransom, because it is unlikely they will get their files back.
Businesses and large organizations are mostly at risk of this attack because of a flaw in a Windows protocol that many businesses use to share files.
WannaCry takes advantage of a vulnerability discovered by the NSA and made public by hackers in April. Microsoft (MSFTTech30) released a patch for the vulnerability in March. But computers and networks that didn't update their systems are still at risk.
On Friday, a security researcher inadvertently created a "kill switch" to help stop the spread of this ransomware. However, a hacker could rewrite the code to omit the kill switch and start trying to infect new machines with a new version of it.
Businesses sometimes take longer to install critical updates and patches, often to avoid impacting any older software they are running. In a surprise move over the weekend, Microsoft released a patch for versions of Windows it no longer supports -- because many businesses and organizations use legacy technology as critical infrastructure.
Matthew Hickey, cofounder of security firm My Hacker House, created a virtual inoculation for companies to use to prevent ransomware while they work on patching. The tool is called WCRYSLAP and can be found here.
"It gives you a little piece of the virus so that when your machine gets infected, the virus sees you already have an infection and quits. It stops the damage being caused," Hickey told CNNTech.
The tool doesn't stop the worm from spreading, but it prevents files from getting encrypted. Businesses need to patch to be completely protected, but Hickey's solution works for organizations that might need more time to upgrade.
Though the worm is primarily affecting business, individuals with PCs running Windows should still take a few precautions.
First, install any software updates immediately and make it a regular habit. Turn on auto-updaters where available (Microsoft offers that option). Microsoft also recommends running its free anti-virus software for Windows.
If you don't already have a backup routine, start now: Regularly save copies of all your files. That way, if your machine gets infected and your photos and documents are encrypted, you don't need to worry about losing them.
Finally, always stay alert. Don't click on links that you don't recognize, nor download files from people you don't know personally.
The cyberattack highlights how critical infrastructure and major organizations can be harmed by outdated software and technology. So while your own machine is clean, basic services that impact your life could still be at risk.
Heather Kelly contributed reporting.
CNNMoney (New York)First published May 15, 2017: 8:35 AM ET