February 2017 Volume 19 Issue 2
Providing Current Information on

Health Insurance Industry Issues and Legislation

President Trump's First ACA Order Strong Words. Impact To Be Determined
President Trump's first executive order urges federal officials to "take all action consistent with law to minimize the unwarranted economic and regulatory burdens" of the federal health law. The impact of the order, as well as how far and how fast the administration will move to dismantle and replace the Affordable Care Act is still uncertain. That effort will have to overcome some big obstacles while avoiding potentially harmful unintended consequences.
Insurance Claims for Kids with Diabetes, Obesity-Related Conditions Skyrocketing
From 2011 to 2015, claims for Type 2 diabetes more than doubled among ages 0-22 year olds, according to a new study. Claims for obesity related diagnoses for infants and toddlers jumped by 94% while for those 19 to 22 rose by a whopping 154%. Prevalence of these conditions varied greatly by state with some of the results surprising the study authors.
Maryland's All-Payer Model Far Exceeding Expectations
Now entering its fourth year, Maryland's all-payer model has already surpassed the five-year hospital savings requirement set by the Centers for Medicare and Medicaid Services. As of August 2016, the State had realized $429 million in hospital savings, $99 million or 30% more than the target set by CMS. During this period, Maryland's hospital spending growth rate was 4% below the national average. Maryland has now submitted a progression report to CMS requesting permission to extend the model beyond hospitals. Could the all-payer model be the future of healthcare?
Pay for Performance Does it Pay?
An increasing number of providers, including Aetna, are adopting value-based pricing (another name for pay-for- performance). In a new KPMG survey, 44% of payers and providers responding reported having population health platforms in place that are being "effectively and efficiently utilized." Aetna appears to be all in for value-based contracting. Presently, Aetna's medical spend is tied 45% to value based pricing. Their goal is to grow that share to 75% or more by 2020. However, there are some skeptics. According to a systematic literature review, P4P has not demonstrated its ability to improve patient outcomes.
Three Star Preferred Provider Program Additions
Adkins & Associates
Houston, TX 77044

American Anesthesia Associates
Southfield, MI 48037

Anita Trubitt
Kailua, HI 96734

Beach House Center for Recovery
Juno Beach, FL 33408

Gary Chen, MD, Inc.
Los Angeles, CA 90015

Pineloch Medical Clinic
Houston, TX 77062

Relief Pain and Wellness
Humble, TX 77346

Savannah Keener
Palm Beach Gardens, FL 33410

South Georgia Toxicology, Inc.
Valdosta, GA 31605

Texoma Anesthesia Wichita Falls
Wichita Falls, TX 76310