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First-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs

$157 million in funding will bridge clinical care with social services

The Department of Health and Human Services today announced a new funding opportunity of up to $157 million to test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical health care-related visits. Over time, these unmet needs may increase the risk of developing chronic conditions and reduce an individual’s ability to manage these conditions, resulting in increased health care utilization and costs.

The five-year program, called the Accountable Health Communities Model, is the first Centers for Medicare & Medicaid Services (CMS) Innovation Center model to focus on the health-related social needs of Medicare and Medicaid beneficiaries, including building alignment between clinical and community-based services at the local level. The goal of this model is that beneficiaries struggling with unmet health-related social needs are aware of the community-based services available to them and receive assistance accessing those services.

“We recognize that keeping people healthy is about more than what happens inside a doctor’s office, and that’s why, for the first time, we are testing whether screening patients for health-related social needs and connecting them to local community resources like housing and transportation to the doctor will ultimately improve their health and reduce the cost to taxpayers,” said HHS Secretary Sylvia M. Burwell. “The Accountable Health Communities model is yet another step towards building a health care system that results in healthier people and stronger communities and spends our health care dollars more wisely.”

Award recipients under this model, referred to as “bridge organizations,” will oversee the screening of Medicare and Medicaid beneficiaries for social and behavioral issues, such as housing instability, food insecurity, utility needs, interpersonal violence, and transportation limitations, and help them connect with and/or navigate the appropriate community-based services. For example, a patient who isn’t taking his medication because he or she lacks transportation to the pharmacy would be referred to federal, state or local assistance programs. Some bridge organizations will assist beneficiaries in applying for community-based services, such as the Low Income Home Energy Program, which can provide much-needed assistance with utility bills and allow beneficiaries to maintain their medication supply rather than having to choose between maintaining their health or paying their heating bill.

“For decades, we’ve known that social needs profoundly affect health, and this model will help us understand which strategies work to help improve health and spend dollars more wisely,” said Dr. Patrick Conway, CMS Deputy Administrator and Chief Medical Officer. “We will learn how health and health care improvements can be achieved through strong partnerships and linkages at the community level.”

The Affordable Care Act provides tools, such as the Accountable Health Communities Model, to move our health care system toward one that rewards doctors based on the quality, not quantity of care they give patients. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. In January 2015, HHS announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. More than 4,600 payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the entire health care system reach these goals.

Model Description

Thanks to funding provided under the Affordable Care Act, the Accountable Health Communities Model will support up to 44 bridge organizations, which will deploy a common, comprehensive screening assessment for health-related social needs among all Medicare and Medicaid beneficiaries accessing care at participating clinical delivery sites.

The model will test three scalable approaches to addressing health-related social needs and linking clinical and community services – community referral, community service navigation, and community service alignment. Bridge organizations will inventory local community agencies and provide referrals to those agencies as needed. They may also provide intensive community service navigation such as in-depth assessment, planning, and follow-up until needs are resolved or determined to be unresolvable for high-risk beneficiaries.

The pilot allows participants to assess community services and encourage partner alignment to ensure these services are available and responsive to the needs of beneficiaries. This continuous quality improvement approach includes organizing an advisory board and data sharing to inform a gap analysis and quality improvement plan.

To measure the effectiveness of the model on impacting total cost of health care utilization and quality of care, the primary evaluation will focus on reduction in total health care costs, emergency department visits, and impatient hospital readmissions.

Eligible applicants for the Accountable Health Communities model are community-based organizations, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and not-for-profit local and national entities with the capacity to develop and maintain a referral network with clinical delivery sites and community service providers. Applications will be due in early 2016 and CMS anticipates announcing awards in the fall of 2016.

To view a fact sheet on the Accountable Health Communities Model or for more information on the Accountable Health Communities Model, including the Funding Opportunity Announcement, please visit: https://innovation.cms.gov/initiatives/ahcm.

January 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Health Insurance Marketplace Open Enrollment Snapshot

Week 6: December 6 – December 12, 2015

More than 1.3 million consumers signed-up for health coverage through the HealthCare.gov platform between December 6 and December 12, the last full week before the deadline for January 1 coverage, bringing the total number of plan selections made since Open Enrollment began on November 1 to 4.17 million consumers.  Approximately 500,000 were new consumers, for a cumulative total of about 1.5 million new consumers since the beginning of Open enrollment.

“The unprecedented demand over the last several days continues to show that coverage through HealthCare.gov is something millions of Americans want and need,” said Department of Health and Human Services Secretary Sylvia Burwell. “We urge those who left their names with the Marketplace to come back to Healthcare.gov or the call center and complete their application for coverage starting January 1.”

Because of the unprecedented demand and volume of consumers contacting our call center or visiting HealthCare.gov, we extended the deadline to sign-up for January 1 coverage until11:59pm PST December 17. Hundreds of thousands have already selected plans on December 14 and 15 and approximately 1 million consumers have left their contact information to hold their place in line.

Similar to last year, each week, the Centers for Medicare and Medicaid Services (CMS) will release weekly Open Enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Marketplaces and State Partnership Marketplaces, as well as some State-based Marketplaces. These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity to date could fluctuate as plan changes or cancellations occur, such as in response to life changes like starting a new job or getting married. In addition, the weekly snapshot only looks at new plan selections, active plan renewals and, starting at the end of December, auto-renewals and does not include the number of consumers who paid their premiums to effectuate their enrollment.

HHS will produce more detailed reports that look at plan selections across the Federally-facilitated Marketplace and State-based Marketplaces later in the Open Enrollment period.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot

Federal Marketplace Snapshot

Week 6

Dec 6 – Dec 12

Cumulative

Nov 1 – Dec 12

Plan Selections (net)

1,326,946

4,171,714

New Consumers

38 percent

36 percent

Consumers Renewing Coverage

62 percent

64 percent

Applications Submitted (Number of Consumers)

1,604,633

6,147,257

Call Center Volume

1,511,082

5,383,321

Average Call Center Wait Time

22 minutes 44 seconds

9 minutes 55 seconds

Calls with Spanish Speaking Representative

89,262

338,906

Average Wait for Spanish Speaking Rep

19 seconds

14 seconds

HealthCare.gov Users

3,601,900

13,512,506

CuidadoDeSalud.gov Users

208,935

480,269

Window Shopping HealthCare.gov Users

1,357,120

4,718,633

Window Shopping CuidadoDeSalud.gov Users

21,249

80,195

 

HealthCare.gov State-by-State Snapshot

Consumers across the country continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visiting HealthCare.gov or CuidadoDeSalud.gov. Individual plan selections for the states using the HealthCare.gov platform include:

Week 6

Cumulative

Nov 1 – Dec 12

Alabama

88,108

Alaska

9,344

Arizona

94,928

Arkansas

26,608

Delaware

11,139

Florida

834,938

Georgia

229,552

Hawaii

8,060

Illinois

154,947

Indiana

73,943

Iowa

24,442

Kansas

50,000

Louisiana

88,175

Maine

37,210

Michigan

138,765

Mississippi

33,773

Missouri

129,536

Montana

25,103

Nebraska

43,944

Nevada

43,876

New Hampshire

21,277

New Jersey

121,592

New Mexico

22,440

North Carolina

280,080

North Dakota

9,344

Ohio

97,786

Oklahoma

58,621

Oregon

74,523

Pennsylvania

212,605

South Carolina

112,745

South Dakota

13,905

Tennessee

125,777

Texas

474,616

Utah

80,887

Virginia

178,465

West Virginia

15,615

Wisconsin

112,457

Wyoming

12,588

 

Glossary

Plan Selections:  The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected a plan. Each week’s plan selections reflect the total number of plan selections for the week and cumulatively from the beginning of Open Enrollment to the end of the reporting period, net of any cancellations from a consumer or cancellations from an insurer during that time.

Because of further automation in communication with issuers, the number of net plan selections reported this year account for issuer-initiated plan cancellations that occur before the end of Open Enrollment for reasons such as non-payment of premiums. This change will result in a larger number of cancellations being accounted for during Open Enrollment than last year. Last year, these cancellations were reflected only in reports on effectuated enrollment after the end of Open Enrollment. As a result, there may also be a smaller difference this year between plan selections at the end of Open Enrollment and subsequent effectuated enrollment, although some difference will remain because plan cancellations related to non-payment of premium will frequently occur after the end of Open Enrollment.

Plan selections will include those consumers who are automatically re-enrolled into their current plan or another plan with similar benefits, which occurs at the end of December.

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not include totals for effectuated enrollments.

New Consumers: A consumer is considered to be a new consumer if they did not have Marketplace coverage at the start of Open Enrollment.

Renewing Consumers: A consumer is considered to be a renewing consumer if they had 2015 Marketplace coverage at the start of Open Enrollment and either actively select the same plan or a new plan for 2016 or are automatically re-enrolled into their current plan or another plan, which occurs at the end of December.

Marketplace: Generally, references to the Health Insurance Marketplace in this report refer to 38 states that use the HealthCare.gov platform. The states using the HealthCare.gov platform are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 38 states that use the HealthCare.gov platform for the 2016 benefit year, including the Federally-facilitated Marketplace, State Partnership Marketplaces and State-based Marketplaces.

Applications Submitted:  This includes a consumer who is on a completed and submitted application or who, through the automatic re-enrollment process, which occurs at the end of December, had an application submitted to a Marketplace using the HealthCare.gov platform. If determined eligible for Marketplace coverage, a new consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

Call Center Volume:  The total number of calls received by the Federally-facilitated Marketplace call center over the course of the week covered by the snapshot or from the start of Open Enrollment. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative:  The total number of calls received by the Federally-facilitated Marketplace call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

HealthCare.gov or CuidadodeSalud.gov  Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadodeSalud.gov , respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.

December 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Health Insurance Marketplace Open Enrollment Snapshot

Week 5: November 29 – December 5, 2015

Heading into the final days before the December 15 deadline for January 1 coverage, more than 1 million new consumers signed-up for health coverage through the HealthCare.gov platform and about 1.8 million have returned to the Marketplace to renew their coverage for 2016. As expected, consumer interest in health coverage is increasing as we approach theDecember 15 deadline with over 800,000 people selecting plans during the fifth week of Open Enrollment. In total, 2.84 million consumers have made plan selections since November 1.

“I am pleased with the strong start to this year’s Open Enrollment,” Department of Health and Human Services Secretary Sylvia Burwell said.  “While we have more work to do, more than 1 million new consumers have signed up for affordable quality coverage through HealthCare.gov. And the average returning Marketplace consumer who has shopped and chosen a new plan will pay less in premiums after their tax credits this year than they were paying last year. Time is running out to sign up for a health plan that begins on January 1. With less than a week remaining before the December 15th deadline, we urge consumers to visit Healthcare.gov and get enrolled.”

This past week, there were more enrollments than over the same time period in the previous year – the third consecutive week that has occurred. The increase in new enrollments in this past week is particularly relevant.

Similar to last year, each week, the Centers for Medicare and Medicaid Services (CMS) will release weekly Open Enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Marketplaces and State Partnership Marketplaces, as well as some State-based Marketplaces. These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity to date could fluctuate as plan changes or cancellations occur, such as in response to life changes like starting a new job or getting married. In addition, the weekly snapshot only looks at new plan selections, active plan renewals and, starting at the end of December, auto-renewals and does not include the number of consumers who paid their premiums to effectuate their enrollment.

HHS will produce more detailed reports that look at plan selections across the Federally-facilitated Marketplace and State-based Marketplaces later in the Open Enrollment period.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot

Federal Marketplace Snapshot

Week 5

Nov 29 – Dec 5

Cumulative

Nov 1 – Dec 5

Plan Selections (net)

804,338

2,844,768

New Consumers

37 percent

36 percent

Consumers Renewing Coverage

63 percent

64 percent

Applications Submitted (Number of Consumers)

1,065,877

4,542,624

Call Center Volume

1,087,987

3,872,239

Average Call Center Wait Time

12 minutes 14 seconds

6 minutes 9 seconds

Calls with Spanish Speaking Representative

66,994

249,644

Average Wait for Spanish Speaking Rep

16 seconds

13 seconds

HealthCare.gov Users

2,787,997

10,823,257

CuidadoDeSalud.gov Users

94,855

263,646

Window Shopping HealthCare.gov Users

1,054,206

3,692,345

Window Shopping CuidadoDeSalud.gov Users

15,718

63,263

 

HealthCare.gov State-by-State Snapshot

Consumers across the country continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visiting HealthCare.gov or CuidadoDeSalud.gov. Individual plan selections for the states using the HealthCare.gov platform include:

Week 5

Cumulative

Nov 1 – Dec 5

Alabama

64,775

Alaska

6,068

Arizona

62,412

Arkansas

18,462

Delaware

7,730

Florida

598,279

Georgia

151,600

Hawaii

5,911

Illinois

97,551

Indiana

47,272

Iowa

16,495

Kansas

34,182

Louisiana

60,902

Maine

24,396

Michigan

89,673

Mississippi

23,224

Missouri

89,308

Montana

16,097

Nebraska

29,520

Nevada

31,173

New Hampshire

13,458

New Jersey

80,152

New Mexico

14,675

North Carolina

192,760

North Dakota

6,119

Ohio

62,181

Oklahoma

40,675

Oregon

49,825

Pennsylvania

146,975

South Carolina

78,238

South Dakota

9,456

Tennessee

88,007

Texas

317,094

Utah

53,872

Virginia

120,375

West Virginia

11,003

Wisconsin

75,938

Wyoming

8,935

 

Glossary

Plan Selections:  The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected a plan. Each week’s plan selections reflect the total number of plan selections for the week and cumulatively from the beginning of Open Enrollment to the end of the reporting period, net of any cancellations from a consumer or cancellations from an insurer during that time.

Because of further automation in communication with issuers, the number of net plan selections reported this year account for issuer-initiated plan cancellations that occur before the end of Open Enrollment for reasons such as non-payment of premiums. This change will result in a larger number of cancellations being accounted for during Open Enrollment than last year. Last year, these cancellations were reflected only in reports on effectuated enrollment after the end of Open Enrollment. As a result, there may also be a smaller difference this year between plan selections at the end of Open Enrollment and subsequent effectuated enrollment, although some difference will remain because plan cancellations related to non-payment of premium will frequently occur after the end of Open Enrollment.

Plan selections will include those consumers who are automatically re-enrolled into their current plan or another plan with similar benefits, which occurs at the end of December.

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not include totals for effectuated enrollments.

New Consumers: A consumer is considered to be a new consumer if they did not have Marketplace coverage at the start of Open Enrollment.

Renewing Consumers: A consumer is considered to be a renewing consumer if they had 2015 Marketplace coverage at the start of Open Enrollment and either actively select the same plan or a new plan for 2016 or are automatically re-enrolled into their current plan or another plan, which occurs at the end of December.

Marketplace: Generally, references to the Health Insurance Marketplace in this report refer to 38 states that use the HealthCare.gov platform. The states using the HealthCare.gov platform are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 38 states that use the HealthCare.gov platform for the 2016 benefit year, including the Federally-facilitated Marketplace, State Partnership Marketplaces and State-based Marketplaces.

Applications Submitted:  This includes a consumer who is on a completed and submitted application or who, through the automatic re-enrollment process, which occurs at the end of December, had an application submitted to a Marketplace using the HealthCare.gov platform. If determined eligible for Marketplace coverage, a new consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

Call Center Volume:  The total number of calls received by the Federally-facilitated Marketplace call center over the course of the week covered by the snapshot or from the start of Open Enrollment. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative:  The total number of calls received by the Federally-facilitated Marketplace call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

HealthCare.gov or CuidadodeSalud.gov  Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadodeSalud.gov , respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.

December 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC

Enhancing enterprise resource planning solution with new budgeting capabilities

CHARLOTTE, N.C. (Aug. 12, 2015) — Premier, Inc. (NASDAQ: PINC), a leading healthcare improvement company, today announced that it has acquired Healthcare Insights, LLC for $65 million in cash. Healthcare Insights is a privately-held,integrated financial management software developer that provides hospitals and healthcare systems with budgeting, forecasting, labor productivity and cost analytic capabilities.

“As the healthcare industry becomes more complex, value-driven, and data-dependent, the need for health systems to clearly understand their performance in every arena is a top concern,” said Keith J. Figlioli, Premier’s senior vice president of health informatics. “It is not enough to have financial, operational and clinical data. Health systems must understand how to translate that information into effective cost containment strategies, as well as superior clinical outcomes.”

The industry’s increased focus on cost is largely driven by the Affordable Care Act, which reduces overall reimbursement, and increasingly holds providers accountable for the total costs and quality of the care delivered. Coupled with the growing movement to value-based payments such as bundling or shared savings, healthcare providers need solutions that can help them understand cost drivers and opportunities for improvement in detail. Healthcare Insights is expected to enable Premier to offer a more complete solution that delivers additional value by adding budgeting, clinical financial management and productivity analytics to existing cost and quality applications, including the company’s enterprise resource planning (ERP) solution.

Thomas Johnston, Healthcare Insights’ chief executive officer, said, “This strategic combination will allow us to offer a more complete ERP solution with an end-to-end view of cost management. We expect this to increase our hospitals’ and health systems’ understanding of their clinical, operational and financial performance, and help them deliver more efficient, higher quality care.”

Founded in 2000, Healthcare Insights’ current customer base includes over 7,500 users across 200 facilities associated with 94 health systems, 49 of which do not currently have a relationship with Premier. KLAS, a leading research firm that provides ratings for more than 900 healthcare products and services, has ranked Healthcare Insights first place in budgeting for the past four years.

The Healthcare Insights acquisition, which was effective July 31, is currently projected to be modestly accretive to Premier’s fiscal 2016 revenue growth and adjusted EBITDA. Expected revenue and adjusted EBITDA contributions from the acquisition will be incorporated into Premier’s fiscal year 2016 guidance, which is scheduled to be announced on August 24, when the company reports fiscal fourth-quarter and full-year 2015 financial results.

About Premier, Inc.

Premier Inc. (NASDAQ: PINC) is a leading healthcare improvement company, uniting an alliance of approximately 3,400 U.S. hospitals and 110,000 other providers to transform healthcare. With integrated data and analytics, collaboratives, supply chain solutions, and advisory and other services, Premier enables better care and outcomes at a lower cost. Premier, a Malcolm Baldrige National Quality Award recipient, plays a critical role in the rapidly evolving healthcare industry, collaborating with members to co-develop long-term innovations that reinvent and improve the way care is delivered to patients nationwide. Headquartered in Charlotte, N.C., Premier is passionate about transforming American healthcare. Please visit Premier’s news and investor sites on premierinc.com for more information about the company.

August 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

U.S. Supreme Court Will Not Hear Challenge to Affordable Care Act’s Independent Payment Advisory Board at This Time

Goldwater Institute will renew challenge to price-setting board when it makes its first decisions

Washington, D.C.—Today the U.S. Supreme Court announced it would not hear a Goldwater Institute challenge to the Independent Payment Advisory Board created by the Affordable Care Act.

“This case is not dead; we’re simply in a holding pattern,” said Christina Sandefur, a senior attorney at the Goldwater Institute. “We will bring this challenge again once the Independent Payment Advisory Board takes action.”

The Independent Payment Advisory Board is a 15-member board created to set reimbursement rates for Medicare. In reality, it has the power to govern decisions about public and private health care, and to determine which procedures, treatments and drugs will and will not be covered by the government programs that pay for the medical treatment of more than 48 million Americans. IPAB’s decisions automatically become law and cannot be challenged in court. The ACA was written so that the Board cannot be repealed without an unprecedented congressional supermajority, and only during a short window in 2017.

These features are unique to the Independent Payment Advisory Board. Never in American history has another board been created with such broad authority to make law without Congress’s vote or the president’s signature, and that cannot be challenged in court or repealed.

This consolidation of power into one unelected agency was the main aspect of the Goldwater Institute’s challenge. But because the Board has not yet been appointed, or made any decisions, the Ninth Circuit Court of Appeals said the case was not ripe for review at this time.  Today, the Supreme Court did not disturb that ruling.

According to the ACA, as long as IPAB remains unstaffed, the Secretary of Health and Human Services wields the Board’s vast powers alone. And while the Board must act when Medicare costs rise higher than a designated percentage of inflation in a single year, nothing stops it from taking whatever action its members consider to be “related to the Medicare program.”

“We are disappointed we have to wait to bring this challenge before the Court—Americans are subject to IPAB’s limitless decision-making with no recourse,” said Sandefur. “Because the Board is completely insulted from constitutional checks and balances, without Supreme Court action now, it may be too late to decide the case later.”

Congressman Phil Roe (R-TN) has introduced legislation in the U.S. House of Representatives to repeal the Independent Payment Advisory Board. His bill has received dozens of co-sponsors, including several Democrats. Former Congressman Barney Frank (D-NY) has been a vocal critic of the Independent Payment Advisory Board and has also called for its repeal. Twenty-five members of Congress filed an amicus brief asking the Court to hear the Goldwater Institute challenge to IPAB.

Read more about Coons v. Lew here.

###

About the Goldwater Institute

The Goldwater Institute drives results by working daily in courts, legislatures and communities to defend and strengthen the freedom guaranteed to all Americans in the constitutions of the United States and all 50 states. With the blessing of its namesake, the Goldwater Institute opened in 1988. Its early years focused on defending liberty in Barry Goldwater’s home state of Arizona. Today, the Goldwater Institute is a national leader for constitutionally limited government respected by the left and right for its adherence to principle and real world impact. No less a liberal icon than the New York Times calls the Goldwater Institute a “watchdog for conservative ideals” that plays an “outsize role” in American political life.

March 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value

In a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.  This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.

To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network.  Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs.  HHS will intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare.  The Network will hold its first meeting in March 2015, and more details will be announced in the near future.

“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people.  Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” Secretary Burwell said. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.”

“We’re all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We’re on board, and we’re committed to changing how we pay for and deliver care to achieve better health,” Douglas E. Henley, M.D., executive vice president and chief executive officer of the American Academy of Family Physicians said.

“Advancing a patient-centered health system requires a fundamental transformation in how we pay for and deliver care. Today’s announcement by Secretary Burwell is a major step forward in achieving that goal,” AHIP President and CEO Karen Ignagni said. “Health plans have been on the forefront of implementing payment reforms in Medicare Advantage, Medicaid Managed Care, and in the commercial marketplace. We are excited to bring these experiences and innovations to this new collaboration.”

“Employers are increasingly taking steps to support the transition from payment based on volume to models of delivery and payment that promote value,” said Janet Marchibroda, Health Innovation Director and Executive Director of the CEO Council on Health and Innovation at the Bipartisan Policy Center. “There is considerable bipartisan support for moving away from fee for service toward alternative payment models that reward value, improve outcomes, and reduce costs. This transition requires action not only by the private sector, but also the public sector, which is why today’s announcement is significant.”

“Today’s announcement will be remembered as a pivotal and transformative moment in making our health care system more patient- and family-centered,” said Debra L. Ness, president of the National Partnership for Women & Families. “This kind of payment reform will drive fundamental changes in how care is delivered, making the health care system more responsive to those it serves and improving care coordination and communication among patients, families and providers. It will give patients and families the information, tools and supports they need to make better decisions, use their health care dollars wisely, and improve health outcomes.”

The Affordable Care Act created a number of new payment models that move the needle even further toward rewarding quality.  These models include ACOs, primary care medical homes, and new models of bundling payments for episodes of care.  In these alternative payment models, health care providers are accountable for the quality and cost of the care they deliver to patients. Providers have a financial incentive to coordinate care for their patients – who are therefore less likely to have duplicative or unnecessary x-rays, screenings and tests.  An ACO, for example, is a group of doctors, hospitals and health care providers that work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. In addition, through the widespread use of health information technology, the health care data needed to track these efforts is now available.

Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, and it does not matter whether these services help – or harm – the patient. In other words, providers are paid based on the volume of care, rather than the value of care provided to patients. Today’s announcement would continue the shift toward paying providers for what works – whether it is something as complex as preventing or treating disease, or something as straightforward as making sure a patient has time to ask questions.

In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments. The goals announced today represent a 50 percent increase by 2016. To put this in perspective, in 2014, Medicare fee-for-service payments were $362 billion.

HHS has already seen promising results on cost savings with alternative payment models, with combined total program savings of $417 million to Medicare due to existing ACO programs – HHS expects these models to continue the unprecedented slowdown in health care spending.  Moreover, initiatives like the Partnership for Patients, ACOs, Quality Improvement Organizations, and others have helped reduce hospital readmissions in Medicare by nearly eight percent– translating into 150,000 fewer readmissions between January 2012 and December 2013 – and quality improvements have resulted in saving 50,000 lives and $12 billion in health spending from 2010 to 2013, according to preliminary estimates.

To read a new Perspectives piece in the New England Journal of Medicine from Secretary Burwell: http://www.nejm.org/doi/full/10.1056/NEJMp1500445

To read more about why this matters: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-2.html

To read a fact sheet about the goals and Learning and Action Network:http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

To learn more about Better Care, Smarter Spending, and Healthier People:http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26.html

A blog from Secretary Burwell is here: http://1.usa.gov/1CYFKAk

Participants in today’s meeting include:

  • Kevin Cammarata, Executive Director, Benefits, Verizon
  • Christine Cassel, President and Chief Executive Officer, National Quality Forum
  • Tony Clapsis, Vice President, Caesars Entertainment Corporation
  • Jack Cochran, Executive Director, The Permanente Federation
  • Justine Handelman, Vice President Legislative and Regulatory Policy, Blue Cross Blue Shield Association
  • Pamela French, Vice President, Compensation and Benefits, The Boeing Company
  • Richard J. Gilfillan, President and CEO, Trinity Health
  • Douglas E. Henley, Executive Vice President and Chief Executive Officer, American Academy of Family Physicians
  • Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans
  • Jo Ann Jenkins, Chief Executive Officer, AARP
  • Mary  Langowski, Executive Vice President for Strategy, Policy, & Market Development, CVS Health
  • Stephen J. LeBlanc, Executive Vice President, Strategy and Network Relations, Dartmouth-Hitchcock
  • Janet M. Marchibroda, Executive Director, CEO Council on Health and Innovation, Bipartisan Policy Center
  • Patricia A. Maryland, President, Healthcare Operations and Chief Operating Officer, Ascension Health
  • Richard Migliori, Executive Vice President, Medical Affairs and Chief Medical Officer, UnitedHealth Group
  • Elizabeth Mitchell, President and Chief Executive Officer, Network for Regional Healthcare Improvement
  • Debra L. Ness, President, National Partnership for Women & Families
  • Samuel R. Nussbaum, Executive Vice President, Clinical Health Policy and Chief Medical Officer, Anthem, Inc.
  • Stephen Ondra, Senior Vice President and Chief Medical Officer, Health Care Service Corporation
  • Andrew D. Racine, Senior Vice President and Chief Medical Officer, Montefiore Medical Center
  • Jaewon Ryu, Segment Vice President and President of Integrated Care Delivery, Humana Inc.
  • Fran S. Soistman, Executive Vice President, Government Services, Aetna Inc.
  • Maureen Swick, Representative, American Hospital Association
  • Robert M. Wah, President, American Medical Association
January 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

National Health Expenditures Continued Slow Growth in 2013

Health spending continued to grow at a slow rate last year the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) reported today. In 2013, health spending grew at 3.6 percent and total national health expenditures in the United States reached $2.9 trillion, or $9,255 per person. The annual OACT report showed health spending continued a pattern of low growth—between 3.6 percent and 4.1– percent for five consecutive years. The report is being published today in Health Affairs.

The recent low rates of national health spending growth coincide with modest growth in Gross Domestic Product (GDP), which averaged 3.9 percent per year since the end of the severe economic recession in 2010. As a result, the share of the economy devoted to health remained unchanged over this period at 17.4 percent.

“This report is another piece of evidence that our efforts to reform the health care delivery system are working,” said CMS Administrator Marilyn Tavenner. “To keep this momentum going, we are continuing our efforts to shift toward paying for care in ways that reward providers who achieve better outcomes and lower costs.”

Total national health spending slowed from 4.1 percent growth in 2012 to 3.6 percent in 2013.  The report attributes the 0.5 percentage point slowdown in health care spending growth to slower growth in private health insurance, Medicare, and investment in medical structures and equipment spending.  However, faster growth in Medicaid spending helped to partially offset the slowdown.

Other findings from the report:

  • Medicare spending, which represented 20 percent of national health spending in 2013, grew 3.4 percent to $585.7 billion, a slowdown from growth of 4.0 percent in 2012. This slowdown was primarily caused by a deceleration in Medicare enrollment growth, as well as net impacts from the Affordable Care Act and sequestration.  Per-enrollee Medicare spending grew at about the same rate as 2012, increasing just 0.2 percent in 2013.
  • Spending on private health insurance premiums (a 33 percent share of total health care spending) reached $961.7 billion in 2013, and increased 2.8 percent, slower than the 4.0 percent growth in 2012. The slower rate of growth reflected low enrollment growth in private health insurance plans, the continued shift of enrollees to high-deductible health plans and other benefit design changes, low underlying medical benefit trends, and the impacts of the Affordable Care Act.
  • Medicaid spending grew 6.1 percent in 2013 to $449.4 billion, an acceleration from 4.0 percent growth in 2012. Faster Medicaid growth in 2013 was driven in part by increases in provider reimbursement rates, some states’ expanding benefits, and early Medicaid expansion.
  • Out-of-pocket spending (which includes direct consumer payments such as copayments, deductibles, spending by the insured on services not covered by insurance, and spending by those without health insurance) grew 3.2 percent in 2013 to $339.4 billion, slightly slower than annual growth of 3.6 percent in both 2011 and 2012.
  • Among health care goods and services, slower growth in spending for hospital care and physician and clinical services contributed to slower growth in national health care spending in 2013. However, faster spending growth for retail prescription drugs in 2013 partially offset the overall slowdown.
  • Hospital spending increased 4.3 percent to $936.9 billion in 2013 compared to 5.7 percent growth in 2012. The lower growth in 2013 was influenced by slower growth in both price and non-price factors (which include the use and intensity of services). Growth in private health insurance and Medicare hospital spending decelerated in 2013 compared to 2012.
  • Spending for physician and clinical services increased 3.8 percent in 2013 to $586.7 billion, from 4.5 percent growth in 2012. Slower price growth in 2013 was the main cause of the slowdown, as prices grew less than 0.1 percent. Growth in spending from private health insurance and Medicare, the two largest payers of physician and clinical services, experienced slower spending growth in 2013, while Medicaid growth accelerated as a result of temporary increases in payments to primary care physicians.
  • Retail prescription drug spending accelerated in 2013, growing 2.5 percent to $271.1 billion, compared to 0.5 percent growth in 2012. Faster growth in 2013 resulted from price increases for brand-name and specialty drugs, increased spending on new medicines, and increased utilization.
  • In 2013, households accounted for the largest share of spending (28 percent), followed by the federal government (26 percent), private businesses (21 percent), and state and local governments (17 percent).

Since 2010, the share of health spending financed by the federal government decreased—from 28 percent to 26 percent in 2013. At the same time, the share financed by state and local governments increased—from 16 percent in 2010 to 17 percent in 2013. These shifts resulted primarily from the June 2011 expiration of additional Medicaid funding provided by the federal government to the states through the American Recovery and Reinvestment Act of 2009.

The report includes all of the net impacts of the Affordable Care Act provisions as well as the budget sequester through 2013.  The Affordable Care Act provisions that exerted downward pressure in 2013 were:

  • productivity adjustments for Medicare fee-for-service payments
  • reduced Medicare Advantage base payment rates
  • increased Medicaid prescription drug rebates
  • the medical loss ratio requirement for private insurers

The Affordable Care Act provisions that exerted upward pressure in 2013 included:

  • early Medicaid expansion initiatives
  • a temporary increase in Medicaid primary care provider payments
  • reducing the size of the Medicare Part D donut hole
  • the implementation of prescription drug industry fees

The OACT report will appear at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

December 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Tatum Survey of Business Conditions Reveals Impacts of Affordable Care Act on CFO Business Strategies

Executive Survey Finds that Companies Report Increased Spending, but Minimal Workforce Changes as a Result of ACA Implications

ATLANTA, July 23, 2014 – Tatum, a leading professional and interim services firm offering hands-on strategic, financial and technology solutions that measurably improve business performance, today announced the results of its Survey of Business Conditions, based on the opinions of financial executives spanning a variety of industries and geographic locations.

Through its Survey of Business Conditions, Tatum CFO partners reflect monthly on 30-day business trends and projected business conditions for next 60 days. These responses are reflected in the Tatum Survey of Business Conditions, which shows little upward momentum going into the third quarter in terms of capital expenditure commitments and hiring.

This month’s survey also provided insights into the impact of the Affordable Care Act (ACA) on business costs and staffing models. The findings reveal some interesting statistics about how CFOs are contending with ACA implementation. Although this legislation has led to increased healthcare benefit costs, the survey found that the widely held belief that ACA would be an across-the-board headcount game changer did not hold true. When asked if the ACA has altered their company’s staffing model and approach to headcount management, only 18 percent of CFOs responded that their companies have done so as a direct result of ACA implementation. The majority, 65 percent of respondents, state that they have not altered their approach at this time.

The survey also asked participants to qualify the increase in healthcare benefit costs for their companies. Overall, less than half of all respondents (43 percent) reported that employee out-of-pocket expenses are up, and just one-third (33 percent) said employee contribution percentages are increasing. Additionally, respondents were asked about their overall healthcare cost management strategies (such as self-insured, insured, combination of self-insured and insured, use of exchanges, etc.), how they would describe them today and where they expect to be in three years after they’ve had more time to adapt to the new healthcare regulatory landscape. The responses show that insured arrangements are the most prevalent, with exchanges being the least utilized; with a sizeable shift anticipated with insured arrangements dropping and use of exchanges increasing.

“The Survey of Business Conditions gives us an unprecedented glimpse into the minds of senior finance leaders to see how market conditions impact their companies and their strategies for the future,” said Suzanne Donner, Managing Partner, Knowledge Management for Tatum. “The results from our latest survey may be surprising to some, showing that the vast majority of companies are not adjusting their staffing models in light of ACA implementation.“

“Healthcare is our largest industry practice,” Donner continued. “We see a rapidly-evolving landscape for our provider, payer and supplier clients – each of which is wrestling with their own issues and concerns – looking for new ways to collaborate, to organize and to be cost-effective that will work for them in their markets. We believe employers are correct to be cautiously evaluating their options while this all plays out.”

In addition to sharing insight into future business outlook and staffing practices, Tatum’s Survey of Business Conditions also serves as a way for the company to give back to the community. For each survey completed by respondents, Tatum also makes a contribution to Junior Achievement, the world’s largest organization dedicated to educating students about workforce readiness, entrepreneurship and financial literacy.

Tatum has made its Survey of Business Conditions, Second Quarter 2014 available for download at:

http://www.tatum-us.com/documents/SecondQuarterTatum_SoBCDetailReport.pdf

About Tatum

Tatum is a leading professional and interim services firm offering hands-on strategic, financial and technology solutions that measurably improve business performance. Tatum’s executive leaders and consultants help companies navigate critical points in the business lifecycle and execute their strategic initiatives. Our deep management and operational expertise, keen strategic consultancy and a focus on follow-through enable our teams to deliver solutions that drive sustainable impact. With a national footprint of offices in key markets, our firm is ready to mobilize locally anywhere in the country. Tatum is an operating company of Randstad US.

About the Tatum Survey of Business Conditions

The Tatum Survey has been keeping a finger on the pulse of the U.S. economy for over twelve years. Each month, Tatum conducts a survey of its executive and consulting professionals nationwide to gain insight on the business climate. The survey examines key indicators such as hiring and capital expenditures, looking at both the past 30 days and expectations for the upcoming 60 days. The survey captures the observations and opinions of CFOs, Controllers and CIOs in a broad base of industries and companies of all sizes. For additional details, please visithttp://www.tatum-us.com/knowledge-center/thought-leadership/survey-of-business-conditions/.

July 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Study: Health Insurance Exchanges Represent Immense Opportunity and Potential Risk for Health Insurers

Survey of 2013 Healthcare Mandate Summit Attendees Reveals Major Concerns, Though the Vast Majority Still Plan to Participate as Early as 2014

Bellevue, WA (PRWEB) February 20, 2013

Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by Edifecs, Inc., shows that health insurers recognize both the promise and peril of HIXs. At the recent 2013 Healthcare Mandate Summit, more than 95 percent of senior healthcare professionals surveyed said they plan to participate in at least one HIX. Of those, a surprisingly large majority—80 percent—will do so in 2014. However, the study also reveals skepticism among respondents that state or federal exchanges will be ready to launch by the October 1, 2013 deadline. And once HIXs are up and running, respondents fear potential disruption to existing IT infrastructure and the difficulties in reconciling premium, enrollment and payment records from the HIXs.

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The Congressional Budget Office projects that nearly 12 million Americans will buy health insurance via an HIX in 2014(1).

The potential upside for a health insurer participating in an HIX is significant. According to a November 2011 PwC Health Research Institute report, the 12 million people who buy insurance through an HIX in 2014 will together pay approximately $60 billion in premiums. By 2019, those figures will grow to 28 million consumers paying nearly $200 billion in premiums(2).

The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place February 4-6 in Austin, Texas. The report reveals that while HIX participation will be high and the country’s health insurers are confident they will be ready by the launch deadline, they also have reservations about how HIXs will be implemented and run.

Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:

    • Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the October 2013 deadline, 70 percent of respondents said they were “very confident” or “somewhat confident” that their organization would be ready.

 

 

    • There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.

 

 

  • Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.

 

“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said Jamie Gier, vice president of Corporate Marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

To download the report, visit http://www.edifecs.com/downloads/2013SummitSpecialReport_HIXs.pdf .

About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place February 4-6, 2013 in Austin, Texas. The results are from a survey of more than 125 senior healthcare professionals—each of whom self-selected which questions they chose to answer, and this accounts for the variation in sample size by question. All respondents are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates. Attendees represented a wide range of healthcare organizations, including commercial health insurers (68%), healthcare providers (11%), government entities and agencies (9%), and other healthcare industry organizations (12%).

The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.

The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Digital Overload of Healthcare Information and Looming Deadlines Driving New Challenges for IT Executives

Independent Study Commissioned by Level 3 Reveals Confidence Lacking in Network Security as Infrastructure Demands Continue to Increase

Broomfield, CO — Network security issues, vital infrastructure upgrades, Electronic Health Record (EHR) implementation and impending federal deadlines will guide priorities this year, according to an independent research study of 100 healthcare provider CIOs and senior IT executives commissioned by Level 3 Communications, Inc. (NYSE: LVLT). At the same time, healthcare CIOs and IT executives are less inclined to focus on mobile-enabled healthcare (mHealth) and slow to adopt cloud computing based on survey responses.

Research highlights and IT challenges for 2013 include:

—56 percent were only “somewhat confident” in their ability to prevent a privacy or security breach on their network
—76 percent of respondents are planning to upgrade their network infrastructure in the next two years
—24 percent reported they are using cloud-based computing, much lower than other industries
—Only 17 percent believe mHealth will have a significant impact on the healthcare industry
—80 percent agree that EHR-based systems will improve patient care
—More than 60 percent of respondents suggest EHR and Meaningful Use mandates are a “good idea” to support better quality patient care

Confidence in Security Lacking
The research study found that many healthcare organizations might not be prepared to deal with the scale of the security challenges headed their way, as more and more critical patient information is digitized. (Reference Exhibits 1 & 2.)

While 80 percent reported their organization had not experienced a security breach in the past 12 months, more than half (56 percent) of those respondents were only “somewhat confident” in their ability to prevent a security breach on their network. This indicates a strong lack of confidence for an industry that experiences a significant number of security breaches each year. In fact, a 2012 survey of 80 healthcare organizations from the Ponemon Institute found that 94 percent of the organizations had a least one data breach in the past two years, at an average cost of $2.4 million per data breach.

Security concerns are also a critical component of EHR implementations. Seventy-seven percent of respondents cited security breaches as either a major or moderate EHR implementation issue. The second top-rated concern with EHRs is patient safety, followed third by privacy issues. Security breaches and patients’ privacy issues were slightly more likely to be of “major concern” among large organizations, due to the sheer volume of patient information at risk. Lower on the list of EHR implementation concerns was penalty costs – 35 percent said security and compliance-related penalties were of little to no concern. (Reference Exhibit 3.)

“Patient privacy and the security of health records are weighing on the minds of healthcare CIOs,” said Karl Strohmeyer, Level 3 group vice president. “The ‘Future of Healthcare IT’ study reinforces that there is no room to take chances when patients’ privacy is at risk – ensuring the confidentiality of patient data should be a top priority. As more and more healthcare-related information is digitized and shared remotely, the need for secure networks and services to protect this data will continue to grow.”

Slow to Adopt Cloud Computing
Although many respondents recognized that cloud computing can offer cost-savings and capacity benefits, just 24 percent reported they are using cloud-based computing, which is a relatively low uptake compared to other industries.

Little Traction For mHealth
An even smaller percentage – 17 percent – believes mobile-enabled healthcare will have a significant impact on the healthcare industry, suggesting the healthcare IT industry may not yet be fully primed for a widespread move to mHealth technology and applications.

Telehealth Care Still Growing Trend
The survey results showed that telehealth is a growing trend, with two-thirds (67 percent) of organizations indicating that they currently have telehealth capabilities. The driving factor behind telehealth is patient care. Respondents believe these capabilities will offer both providers and patients better access to EHRs and, as a result, improve patient care. (Reference Exhibit 4.)

Additionally, more than one-third (37 percent) of respondents believe interconnectivity of healthcare facilities will have the greatest impact on the healthcare industry, and another one-quarter (27 percent) believes EHRs themselves will have the greatest impact.

Constant Infrastructure Upgrades In the Works
The study also showed that network infrastructure demands will continue to grow as healthcare organizations try to prepare for increased interconnectivity of healthcare facilities, security demands and other healthcare-related technology advancements. More than three-quarters (76 percent) of respondents are planning to upgrade their network infrastructure in the next two years driven by implementation of EHRs, interconnectivity between providers and facilities, and medical imaging demands. (Reference Exhibit 5.)

“The expansion of network infrastructure that we anticipate will allow healthcare organizations to store massive amounts of patient information securely,” said Strohmeyer. “Providers can access digitized information from any location in real time, ultimately resulting in substantial efficiencies in patient care. Interconnectivity and network security are essential to meeting the growing demands of the digital healthcare world.”

“EHR Deadline is Feasible”
The research also revealed that, despite feeling pressure to implement EHRs to meet new federal regulations under the Patient Protection and Affordable Care Act (ACA), most healthcare CIOs and senior executives support the efforts and believe ACA timeframes are feasible. More than 60 percent of respondents suggest EHR and Meaningful Use mandates are a “good idea” – due primarily to the fact that EHRs are expected to support better quality patient care with increased access to medical records and information by providers. In addition, 79 percent believe the 2015 EHR deadline is feasible.

Study Methodology & Demographics
Level 3 commissioned Corona Insights to conduct the “Future of Healthcare IT” study in November 2012. The 100-person respondent base was comprised of CIOs and other c-level and senior IT executives who are employed by hospitals, medical centers and physicians’ offices. The size of the organizations managed by these CIOs and executives range in revenues from $10 million to $1 billion.

To Learn More
To learn more about the research findings and Level 3’s solutions for the healthcare industry, please visit http://www.level3.com/en/solutions/industry/healthcare/.

About Level 3 Communications
Level 3 Communications, Inc. (NYSE: LVLT) provides local, national and global communications services to enterprise, government and carrier customers. Level 3’s comprehensive portfolio of secure, managed solutions includes fiber and infrastructure solutions; IP-based voice and data communications; wide-area Ethernet services; video and content distribution; data center and cloud-based solutions. Level 3 serves customers in more than 450 markets in 45 countries over a global services platform anchored by owned fiber networks on three continents and connected by extensive undersea facilities. For more information, please visit www.level3.com

February 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.