Week of December 7, 2009

The Senate began to slog its way through amendments (see below) last week in a process that promises to get harder, not easier. In the meantime, the debate continues as to whether the Senate bill would do anything significant to slow rising health care costs, and a Bloomberg story points out that a number of economists and analysts are doubtful that it will. The White House defends the bill’s ability to slow costs, but some analysts predict that Congress will need to make many more tough decisions to have a real impact. According to Bloomberg, a group of Senators that includes Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising costs with an amendment that would include new requirements on providers to try to wring more costs out of the system. Anyone concerned about the rising cost of health care should be engaged in the process by reaching out to their Senators to urge a greater focus on bending the cost curve.

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Federal

The Senate debate on health care reform actually consists of three simultaneous debates. The first is public on C-SPAN, and it’s going slowly as Republicans are pressing for 60 votes as often as they can while Democrats try to speed things up. Nothing of any great moment has been passed or decided. The second debate is the one Majority Leader Harry Reid is conducting behind closed doors as he tries to garner 60 Democratic votes for some acceptable form of a public option. Once this is accomplished, most observers believe Reid will immediately file cloture to cut off debate on the bill itself. If successful at getting 60 votes, he will go straight to final passage, which would require 51 votes. This could happen before Christmas. The third debate is the one Reid is having with House Speaker Nancy Pelosi over whether to have a conference at all. If the Senate can pass a bill the House can accept “as is,” then there will be no need for a time-consuming conference that could unravel the bill. Thus, Reid is checking in with Pelosi frequently to see what he needs to be able to pass a bill and avoid a conference.

Since returning from its Thanksgiving break last week, the Senate has slowly been making its way through a number of amendments. Key votes so far include: approved an amendment that would require first-dollar coverage (no cost sharing) for certain preventive services; approved an amendment stating that nothing in the bill reduce guaranteed benefits under Medicare; defeated a motion that would have sent the bill back to the Finance Committee for the purpose of removing proposed cuts to Medicare; defeated an amendment that would have removed the CLASS Act provisions from the bill; defeated a motion that would have sent the bill back to the Finance Committee to eliminate the proposed Medicare Advantage funding cuts; approved an amendment requiring that nothing in the bill shall eliminate benefits “guaranteed by law” to Medicare Advantage enrollees (protects only benefits also covered by traditional Medicare and does not protect extra benefits and services provided by MA plans); and defeated an amendment that would have placed limits on how much attorneys can earn from medical malpractice lawsuits.

States

ALL STATES: The National Governors Association (NGA) has announced an initiative outlining preparations for federal health care reform. Titled “Rx for Health Reform – Affordable, Accessible, Accountable,” the 2009-2010 initiative is led by Vermont Governor and NGA Chair James Douglas. It will focus on: providing governors with the information needed to transition to a new health care system; developing state-based system improvements and cost containment measures, including tools necessary to develop delivery system enhancements, looking at what is required under federal legislation, and highlighting other reforms the states could undertake to create a more efficient and effective health care system; and preparing states for implementing insurance market reforms, state-based exchanges, new mechanisms to support delivery system reform, and other national health reforms. The NGA’s Health Care Task Force includes Governor Douglas and West Virginia Governor Joe Manchin, both serving as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon Governor Ted Kulongoski.

CALIFORNIA: The California Medical Association (CMA), the second largest medical association after Texas, has announced its opposition to the “Patient Protection and Affordable Care Act,” the health care reform bill being debated in the Senate. The CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health care reform proposal in 2007. In other news, Republican Governor Schwarzenegger has appointed State Senator Abel Maldonado to serve as Lieutenant Governor, but Democrats in the legislature have vowed not to confirm the Republican Senator because they view him as a viable state-wide candidate who could be elected easily to the position. Maldonado still must be confirmed by the legislature, which has 90 days to act.

COLORADO: The Colorado Medical Society (CMS) continues to seek support for a bill that would define the practice of medicine as including medical necessity determinations and utilization reviews performed by health plan medical directors. As currently drafted, the proposal would potentially expose medical directors to disciplinary action by the state Board of Medicine when medical necessity or utilization review decisions are challenged. Several discussions have been held with the executive director of CMS to ascertain the nature of the problem the association is trying to address, particularly since the organization as a whole may not be supporting the bill.

ILLINOIS: Illinois’ fiscal situation is “grim and getting worse.” Illinois has a reported $12 billion structural budget deficit. Comptroller Hynes said Illinois had nearly $4.6 billion in unpaid bills at the end of September, a record development for the first quarter of any fiscal year. This, despite the state having borrowed $2.25 billion in short-term loans, which must be repaid before the end of FY2010. Hynes identified two factors that have had a major impact on the deteriorating fiscal position: the steep decline in economy-driven revenues, such as personal and corporate income taxes and sales taxes, and record lapse-period spending. Hynes predicted fiscal pressures would continue well into FY2011 and warned of record and prolonged payment delays for most categories of state programs and operations, including health care and social services. There will be increasing pressure on health care programs as the economic stimulus funds expire and the amount of money demanded by utilization increases continue to be realized. There are already significant payment cycle delays on portions of the State employee health plan. The budget situation will dominate discussions in the General Assembly, which reconvenes in January.

KANSAS: At the request of Kansas Congresswoman Lynn Jenkins, the Kansas Health Policy Authority recently announced that it estimates the health reform bill passed by the U.S. House would provide health insurance for 240,000 Kansans without coverage and possibly save the state treasury up to $25 million a year. It estimated the U.S. Senate Finance Committee bill would insure an estimated 190,000 Kansans and reduce state costs by $25 million to $50 million a year. The Authority also concluded that the House bill would provide more federal matching dollars for Medicaid and likely would allow a reduced package of benefits for Medicaid beneficiaries added to the state rolls as a result of health reform. Current Kansas Medicaid eligibility is among the strictest in the nation, with benefits generally available only to the oldest and youngest of the state’s poor. Childless adults of working age are not eligible and parents are enrolled only if they earn less than about 27 percent of poverty guidelines. Exceptions are made for pregnant women.

MICHIGAN: State House Democrats announced a plan last week to cut auto insurance rates through tighter restrictions on auto insurance companies and the medical portion of those claims, affecting subrogation and coordination of benefits for Aetna and Cofinity®. Generally, the proposal requires auto insurance companies to offer low-cost auto insurance to low-income drivers with good driving records. The bill also would: allow the state insurance commissioner to deny rate changes by auto insurance companies before they take effect; prohibit auto insurance rate increases for those with good driving records; prohibit auto insurers from using certain types of rating factors; and limit fees paid to doctors and hospitals for treating auto accident injuries. Michigan is the only state that requires all auto insurance policies to give unlimited medical coverage for injuries suffered in auto accidents. The proposal would change that requirement and allow motorists to buy maximum medical coverage as low as $50,000. This means that rate-regulated provider groups would likely have group policies pay auto claims rather than wait for adjudication of the claim in court, as they would not want their fees limited. In addition, the allowance of low medical coverage on auto claims would affect Aetna’s subrogation and coordination of benefit activities with both auto carriers and Aetna enrollees.

MISSOURI: The Department of Insurance recently released its 2008 HMO Annual Report showing that the entire managed care market is declining. The report shows that the number of people enrolled in either an HMO or a major medical health insurance plan decreased 15 percent since 2006. PPO plans are gaining the most enrollment, and POS plans remain more popular in certain areas than HMO plans. Total premiums for managed care coverage continue to rise with the industry reporting a 7.5 percent increase from 2004 to 2008. The medical cost ratio for all HMOs operating in Missouri, covering only Missouri business, was 82 percent in 2008, compared to the nationwide industry number of 83.6 percent.

NEW JERSEY: The legislature returned from its extended recess and took action on legislation to establish a medical home demonstration project for the Medicaid population. Upon federal approval, the state Medicaid program would set out a three-year demonstration project with an annual evaluation and reporting requirement by the Division of Medicaid Assistance Services to the Governor and legislature. On the Senate side, Aetna offered support for legislation requiring chain restaurants to provide nutritional information for food and beverages on their menus. Similar legislation is currently making its way through the Assembly and will likely receive a full vote in both chambers prior to the end of the session.

NEW YORK: The legislature passed another deficit reduction plan, trimming spending and using unspent funds to plug a $2.7 billion dollar budget deficit. A large percentage of the revenue used to fill the gap came from federal stimulus money that was originally designated for the 2010 budget and cuts to the Medicaid trend factor. After intense lobbying and coalition efforts, the legislature did not pass the Governor’s proposed 0.25 percent increase to the patient services assessment or “sick tax”. In addition, the Senate did not pass the Marriage Equality Act, effectively defeating the bill for the year. The legislature will return to face a multi-billion dollar deficit again in January, and it is likely that increases to health insurance taxes will be back on the table.

UTAH: The Department of Insurance remains committed to pursuing legislation to expand the Utah Health Exchange Network Portal to include a master patient index that providers could access to obtain coverage eligibility information. The bill contains a number of troubling provisions, including a monthly batch reporting requirement on health plans. The proposal also includes a July 1, 2010 effective date allowing no time to update and test affected internal systems.

Unless you have been totally away from the news you know about influenza A (H1N1) flu that has been in the headlines. Though cases have been reported to be mild it has hospitalized many who have contracted the flu. And, has you know a hospital stay can be costly if you don’t have the right health plan. Blue Cross Blue Shield North Carolina (BCBSNC) has some of the best plans you can find.

 

Health insurance or not the best thing is to avoid influenza A (H1N1) flu. Since most people come in contact in the work place the CDC has issued some common since rules to either prevent catching this flu or prevent spreading it to others.

 

Businesses and employers, in general, can play a key role in protecting employees’ health and safety, as well as in limiting the negative impact of the outbreak on the individual, the community, and the nation’s economy. This interim guidance is meant to inform and educate management and employees about appropriate precautions and work practices to minimize the risk of potential employee exposure, illness, and the spread of pandemic influenza A (H1N1) flu in the workplace through general prevention and preparedness strategies

Prevention of Illness in Well Employees

Spread of this pandemic influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their eyes, mouth, or nose.

What can employers do to protect employees?

Encourage sick workers to stay home and away from the workplace, and provide flexible leave policies. Encourage infection control practices in the workplace by displaying posters that address and remind workers about proper hand washing, respiratory hygiene, and cough etiquette. Provide written guidance (email, etc.) on pandemic influenza A (H1N1) flu appropriate for the language and literacy levels of everyone in the workplace. Employers should work closely with local and state public health officials to ensure they are providing the most appropriate and up-to-date information (e.g., the CDC H1N1 Flu website http://www.cdc.gov/H1N1flu/). Provide sufficient facilities for hand washing and alcohol-based (at least 60%) hand sanitizers (or wipes) in common workplace areas such as lobbies, corridors, and restrooms. Provide tissues, disinfectants, and disposable towels for employees to clean their work surfaces, as well as appropriate disposal receptacles for use by employees. One study showed that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.  To reduce the chance of spread of the pandemic influenza A (H1N1) virus, disinfect commonly-touched hard surfaces in the workplace, such as work stations, counter tops, door knobs, and bathroom surfaces by wiping them down with a household disinfectant according to directions on the product label.

What can employees do to reduce the spread of novel influenza A (H1N1) flu in the workplace?

Stay home if you are sick. If you have symptoms of influenza-like illness, stay home for 7 days after symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Following these recommendations will help keep you from infecting others and spreading the virus. Employees who are well but who have an ill family member at home with pandemic H1N1 flu can go to work as usual. These employees should monitor their health every day, notify their supervisor and stay home if they become ill. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers can be used if soap and water are not available. Avoid touching your eyes, nose, or mouth. Germs spread this way. These employees should monitor their health every day and should notify their supervisor and stay home if they become ill

The CDC has issued these guidelines in an effort to prevent the spread of the influenza A (H1N1) but it never hurts to be prepared. Direct Marketing Associates in Asheville NC has friendly, experienced and award winning agents that can help you choose the right health plan whether it is individual, family or business. Contact them today.

December 9, 2009

This Week in Health Reform —Legislative Overview

Senate

Less than two weeks after the debut of official legislative language, the Senate began official debate on its $848 billion health care reform bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on November 30. The bill, which is estimated to cover 94 percent of Americans, passed its first hurdle before the Thanksgiving holiday when Senate Democrats received the needed 60 votes on the “motion to proceed” to debate.

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More than 60 amendments have been filed to the Senate health care reform legislation in its first week of debate. Some of the notable amendments include one by Senator Barbara Mikulski (D-MD), which was adopted by a vote of 61-39. The amendment would eliminate co-payments for many preventive services for women – and would require that insurers provide full coverage for ****** and cervical cancer screenings. Senator David Vitter (R-LA) also included a stipulation to the amendment that would preclude the most recent controversial recommendations on ****** cancer screenings by the U.S. Preventive Services Task Force from being used for insurance coverage determinations. Additionally, Senator Ben Nelson (D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related amendment that will mirror the one passed in the House version of the bill last month. The amendment would prohibit the use of federal funds for abortions.

Senator Thomas Carper (D-DE) is leading efforts in the Democratic caucus on the creation of a public health insurance option that is built around a state-by-state “trigger” option. Carper has spent weeks working with members of the Democratic caucus, as well as some moderate Republicans on the amendment that he is hoping will appease a broad range of individuals concerned about the government-run health insurance plan, also known as the “public option”.

Majority Leader Harry Reid (D-NV) still has significant work to do in uniting his divided Democratic caucus. Reid has stated that he will keep Senators in Washington on weekends throughout December to ensure that key legislative issues are worked out before a final bill can be brought to the Senate floor. As detailed above, Reid will have to balance trying to appease the progressive members of his party with a robust government-run health insurance plan with corralling the moderate and conservative Democrats who have been vocal on issues such as abortion and cost-containment measures.

House

The House of Representatives remains quiet on health care reform legislation after passing its portion of the bill in November. Its main focus during the next few weeks before the holiday recess will be on a financial regulation package to be brought up by the House Committee on Ways and Means.

As overall medical costs continue to increase by double digits annually, medical costs for individuals in account-based consumer-driven health plans (CDHPs) went down 26% over four years, while levels of care for their preventive medicine, chronic disease management and evidence-based treatments were higher than their counterparts in traditional PPO and HMO health plans, according to a new multi-year study of health care claims experience of 655,000 CIGNA customers.

The Fourth Annual CIGNA Choice Fund Experience Study is the latest evidence that more than any health reform proposal currently on the table, these innovative free market plans have been consistently proven to deliver actual quality, accessible health coverage at substantially lower costs.

“The empirical data is in and it’s undeniable: when health plans provide incentives for people to be engaged, their health care quality goes up and costs go down,” said CIGNA President and Chief Operating Officer, David M. Cordani. “CIGNA’s study shows that the incentives offered by consumer-driven plans — such as lower premiums, freedom of choice, and the ability to build up health savings — result in an immediate and sustained improvement in health care quality and lower costs.”

Key findings of the Fourth Annual CIGNA Choice Fund Experience Study include:

Immediate and sustainable cost savings: CDHP medical costs are 14% less than traditional plans the first year, cumulative cost savings rise to 19% in the second year, 23% in the third year and 26% in the fourth year.

Higher levels of care: People with CIGNA Choice Fund received recommended care at compliance rates that were similar or better than those covered by traditional CIGNA health plans. Key indicators such as use of preventive care, evidence-based care and disease management program participation were measurably better among those in CIGNA CDHPs than those in PPOs and HMOs.

Less cost for those with chronic conditions: Medical cost trend was substantially less for CIGNA Choice Fund customers with hypertension (27% less), joint disease (21% less), and diabetes (15% less), than for individuals with either of those diseases in traditional CIGNA health plans. According to the study data, these cost savings were achieved without sacrificing care.

According to Cordani, if the share of Americans enrolled in a CDHP rose from a current 18% to 50%, and the results of the CIGNA study were applied, the U.S. could achieve $350 billion dollars in savings over 10 years.

Chris Policinski, President and CEO of Land O’Lakes, Inc., noted: “Offering consumer driven health plans to Land O’Lakes employees is helping to keep health care costs in check, while maintaining or improving care quality. For Land O’Lakes, this approachsupports our commitment to employees, while at the same time ensuringthat we remain highly cost efficient.”

Customer: Engagement is Key

One of the nation’s premier agricultural cooperatives, Land O’Lakes, Inc., offers both CIGNA Choice Fund CDHP and traditional health plans. The company confirms that its employees are increasingly electing to enroll in the CDHP for cost savings — with eight of 10 employees choosing CDHP over traditional managed care plans.

“Since January 1, 2007, when our first CDHP was offered, our company and employees have saved more than $10 million in health plan costs,” said Land O’Lakes Director of Benefits and HR Operations Pamela Grove. “From 2006 to 2007, our health care trend decreased from 13% to negative 5% – a decrease of 18% year over year. Our employees are making smart choices: increasing their use of preventive care and the CIGNA 24-hour nurse line, as well as opting to use less-costly urgent care facilities or convenience care clinics rather than heading to the emergency room for non-emergency events.”

“We attribute this enormously successful enrollment to honest and open communication with employees coupled with consumer-focused information and tools,” said Grove. “That’s a strategy that we will continue to focus on and, so far, it has produced very impressive results.”

Individuals Making the Most of their Health Benefits

Noting the solid clinical compliance among those enrolled in CIGNA Choice Fund plans, CIGNA Chief Medical Officer, Jeffery Kang, M.D. said: “America is a land of smart shoppers, and what our study shows is given the right plans, tools and information, people will make rational, wise and successful health care decisions.”

Individuals enrolled in CIGNA Choice Fund plans continued to receive recommended care at the same or higher levels as those enrolled in traditional plans in an evaluation of compliance with 400 evidence-based measures of health care quality. In fact, first year Choice Fund customers had higher statistical compliance with 11% of evidence-based measures than their counterparts in traditional plans, and 16% higher for Choice Fund customers enrolled for multiple years.

Moreover, individuals with chronic illnesses covered by CIGNA Choice Fund plans are more engaged and more likely to comply with and complete their plan disease management programs. Disease management program follow-through and completion rates are 22% higher among those in CIGNA Choice Fund plans than their counterparts in traditional CIGNA managed care plans.

Preventive care visits for first-year CIGNA Choice Fund customers were an average of 16% greater when compared to traditional plans, with CDHP preventive care visits continuing at higher rates than those in traditional plans in the second year.

The trend in pharmacy costs for new CIGNA Choice Fund customers who also have their pharmacy benefits with CIGNA was cut by more than half when compared to those enrolled in traditional plans.

“CIGNA’s mission is to improve people’s health, well-being and sense of security;” said Dr. Kang. “During the past four years, CIGNA Choice Fund studies have consistently demonstrated that CDHPs are part of the solution for creating a more affordable, accessible, sustainable and high quality healthcare system.”

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