https://www.hctrends.com/rss/rss.aspx HCTrends.com - Resource Postings en-us All materials © Copyright 2002 - 2011, HCTrends.com 3723 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=FCFB5B56-34BF-4208-BBF9-89921070FC17 webmaster@hctrends.com This paper provides an overview of GINA and other legislation pertinent to wellness programs in order to alert program administrators to the special privacy and anti-discrimination issues that will dictate program design and implementation. At this early stage, no paper can be all inclusive, nor can we anticipate new legislation that might evolve from litigation brought under the new laws. It is our objective to inform the reader about the legal issues that impact wellness programs and to urge you to take steps to ensure your wellness program complies. 2011-08-18T06:22:17-05:00 3718 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=0D1DC818-B3ED-42CA-BE2E-02C6F98ECE1F webmaster@hctrends.com 2011-08-04T06:59:39-05:00 3717 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=CC978C61-9451-4378-B1B8-FFEB77D95611 webmaster@hctrends.com On June 26, 2011, Governor Scott Walker signed into law the biennial Budget Bill. The Wisconsin Budget Bill modified a provision in the Wisconsin Statutes that required that employers with insured group health plans (and self-funded public sector health plans) that offer dependent health insurance coverage to their employees must include coverage for certain adult dependent children up to the day before the child’s 27th birthday. Specifically, Wisconsin law now appears to follow the requirements of the federal health care reform law (the Patient Protection and Affordable Care Act (“PPACA”)), which requires that employers provide coverage to adult children of employees up to the day before the child’s 26th birthday. 2011-08-02T06:10:16-05:00 3712 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=8A9228A7-78FD-4CDB-81DE-3AFD6B16CDC5 webmaster@hctrends.com Health insurers can be doing more to come up with creative ways to pay providers and organize care - There were skeptics from the beginning, a handful of experts who stood back and watched warily as others celebrated the push for accountable care organizations. ACOs, a much-touted part of the Affordable Care Act, were the way to reduce costs and improve quality by way of a provider-centric system that’s buoyed by global capitation, proponents argued. ACOs were going to rescue health care. Then, in March, CMS published the regulations governing ACOs and, suddenly, everybody’s a skeptic, especially disappointed provider groups that had been pushing for them. “Part of the problem is that there are a lot of forces acting on CMS, not the least of which are analysts in the Office of Management and Budget and the Congressional Budget Office which, for some baffling reason, scored future savings for this program,” says Jeff Goldsmith, PhD, founder and president of the consulting company Health Futures. “That’s scary by itself.” There are indeed “many, many problems with the concept as drafted in the legislation, and the proposed regs have not helped at all,” agrees Alice G. Gosfield, principal of Alice G. Gosfield and Associates. This lawyer and health care policy expert calls all the optimism over ACOs downright absurd. Both Goldsmith and Gosfield are members of the MANAGED CARE Editorial Board. 2011-07-28T08:48:14-05:00 3711 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=24B5B658-569A-486E-8439-5D81FF25FE7E webmaster@hctrends.com Health care industry pundits believe the Patient Protection and Affordable Care Act (PPACA) of 2010 will restructure the way millions of Americans receive health insurance, but that it may do little to control costs. There is concern that one of the unintended consequences will be further consolidation of hospitals and physicians, which could result in still higher prices. Largely overlooked by many critics, however, are payment and delivery system reforms in the legislation that will lead to the further development of accountable care organizations (ACOs). If the payment reforms are fully implemented, ACOs have the capacity to significantly reduce costs and restructure health care delivery. Health plans must help lead the development of new organizational structures and develop core competencies such as data analytics, predictive modeling, risk adjustment and claims administration if ACOs are to succeed financially. Job #1 of ACOs is to reduce costs. Neither medical groups, hospitals, nor health plans have an effective business model or the required resources — acting separately — to do the job adequately. 2011-07-28T08:45:17-05:00 3710 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=E8672E14-5645-414A-8992-F17ABBF0D28B webmaster@hctrends.com In 2010, US health spending is estimated to have grown at a historic low of 3.9 percent, due in part to the effects of the recently ended recession. In 2014, national health spending growth is expected to reach 8.3 percent when major coverage expansions from the Affordable Care Act of 2010 begin. The expanded Medicaid and private insurance coverage are expected to increase demand for health care significantly, particularly for prescription drugs and physician and clinical services. Robust growth in Medicare enrollment, expanded Medicaid coverage, and premium and cost-sharing subsidies for exchange plans are projected to increase the federal government share of health spending from 27 percent in 2009 to 31 percent by 2020. This article provides perspective on how the nation’s health care dollar will be spent over the coming decade as the health sector moves quickly toward its new paradigm of expanded insurance coverage. 2011-07-28T05:09:39-05:00 3709 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=BA1CE49F-006F-4185-A398-A308F9EEEBF7 webmaster@hctrends.com Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets—Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin—average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation. 2011-07-27T08:55:14-05:00 3707 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=36EC7CAA-7C25-4DAC-A614-4290457C7815 webmaster@hctrends.com 2011-07-25T04:28:41-05:00 3705 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=C8725596-9083-45C4-8B2E-14D871C37994 webmaster@hctrends.com HHS Unveils Much-Anticipated Health Exchange Proposed Rule on 7/11/2011 - Health and Human Services Secretary Kathleen Sebelius announced the release of proposed regulations that will govern how states are to set up and run new marketplaces where individuals and small businesses can shop for health insurance. 2011-07-13T06:32:03-05:00 3702 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=E561EA45-18CA-4B65-8AA1-314DD1D664E7 webmaster@hctrends.com The rising tide of employee benefits costs is forcing employers to make tough decisions, often reducing disposable income for employees in order to maintain benefit levels. 2011-07-08T12:01:23-05:00