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
|
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 |
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 |
