If you need to quickly digest the 2,000-odd page health care reform bill passed by the House last week, you’re in luck. Towers Perrin has boiled down the key points — provisions that would have a significant impact on employers and could appear in final legislation — to a four-page cheat sheet. Stay tuned for updates as the Senate re-writes this bill.
On October 13, 2009, the Senate Finance Committee approved Senator Max Baucus’s (D-Montana) health care bill, the America’s Healthy Future Act, by a vote of 14 to 9. Senator Olympia Snowe (R-Maine) was the only Republican to vote with the committee’s 13 Democrats in favor of the bill. The Congressional Budget Office (CBO) estimated the cost of the bill at $829 billion over 10 years.
The bill will now be fully merged with Sen. Kennedy’s HELP bill with hands-on participation from Senate Majority Leader Harry Reid and key Administration officials. Some of the most contentious issues to be resolved in the merger include the fate of the HELP bill’s government option, the Finance Committee’s weak individual mandate penalties and new taxes and fees on the insurance industry.
The stated aims of the legislation are to lower costs, provide quality, affordable health care coverage, make purchasing health insurance easier, prohibit discrimination due to health factors and improve the way the health care system delivers care. However, many in Congress are divided on whether the bill can meet these objectives. Opponents of the bill have argued that it will increase costs for many Americans, rather than making health care more affordable.
Stayed tuned for MANY updates as this bill is vollyed about the Senate and House.
American’s with Disabilities Act (ADA) Amendments
Mental Health/Substance Use Parity
Michelle’s Law
Cuomo Speaks Out on Victory
Back in February 2008 I reported NY Attorney General, Andrew Cuomo was investigating United Healthcare and has subpoenaed 16 other health plans including Aetna, CIGNA, Humana, and Well Point a subsidiary of Empire Blue Cross Blue Shield to determine how they calculate UCR. UCR is the usual customary and reasonable payment made for medical services rendered outside of the insurance carrier’s network.
Yesterday United Healthcare agreed to close down two Ingenix databases used to determine usual and customary payment rates for services for out of network doctors and pay 50 M to establish a new database that will be run by an independent nonprofit. This much criticized database was run by Ingenix a subsidiary of United Healthcare.
Cuomo’s investigation found that the UCR determined by Ingenix database for claims led to underpayments by iurers anywhere from 10 to 28 percent. United wasn’t the only carrier using this database.
This is a huge victory for healthcare transparency for consumers. Under the agreement the new database will come with a web site that allows consumers to see how much they will be reimbursed for services in their area for out of network services
The NYS Health Accountability Foundations has published the 2008 Regional Health Care Report Card, which presents access, service and quality data for all hospitals and commercial managed care plans in New York, New Jersey, Connecticut, Vermont and Rhode Island.
Review reportcards for Insurance Carriers and Hospitals
The Institute of Medicine had reported in 1999 that up to 98,000 people had died in hospitals as a result of medical errors. Today the number is estimated to be 200,000+ and costing billions of dollars. Not to mention the medical errors that occur that don’t result in death but result in increased medical costs, cost of ongoing care and disability.
Medicare, Well Point, and Cigna are taking a stand by announcing plans to stop paying for care that’s triggered by a host of medical mishaps. Doctors will not be paid for surgical procedures on the wrong side, wrong person, wrong body part and or wrong site. Cigna is adding a list of “potentially non-reimbursable” mishaps that will mandate quality of care.
Effective April 1, 2008 Aetna adds the world renowned Memorial Sloan Kettering Cancer Center in NYC to all network based plans. “As one of the world’s premier cancer centers, MSKCC is committed to exceptional patient care, leading-edge research, and superb educational programs,” said John R. Gunn, Executive Vice President, Memorial Sloan-Kettering Cancer Center. “We are pleased that Aetna members will have the opportunity to access Memorial Sloan-Kettering Cancer Center on an in-network basis and we look forward to having a long-term relationship with Aetna for the benefit of its members who are or will be in our care.”
For more information click here
Aetna deserves praise for being out in front with the first-ever personalized search engine that mines information from Aetna’s vast data resources to deliver meaningful, personalized health and health benefits information to Aetna members. Aetna partnered with Healthline Networks to develop Aetna SmartSource. Aetna SmartSource is available online and can be accessed through Aetna Navigator®, Aetna’s member self-service website, the CareEngine-powered Personal Health Record (PHR), and Simple Steps To A Healthier Life®, Aetna’s online wellness program. Aetna will pilot Aetna SmartSource with several large, pre-selected customers throughout 2008.
Click here for more on SmartSource.
CIGNA expands their reach of retail clinics that allows members to receive care at addition retail sites in Arkansas and Texas. These additional retail sites will allow for members additional access to care at an affordable price.
Click here for the Healthcare Finance News article.
Will P4P initiatives transform behaviors by providers and hospitals to improve healthcare quality, costs and outcome targets? This is a loaded question that has many moving parts. I believe the P4P model will replace the fee for service model but will require a monumental effort on the part of insurance carriers, hospitals, physician, and legislators. The Common Wealth Fund reviews a case study with Partners Healthcare and Blue Cross Blue Shield of Massachusetts that centers on paying providers to adopt and implement EMRs and then using EMRs to evaluate patient outcomes. A must read for all interested in a Value Based Purchasing Model. Click here
