Despite instability, individual health plans will persevere
Will the individual insurance market survive? Sources say yes, despite a media glut of double-digit premium increase notices and announcements that big health plans are exiting ACA marketplaces. Fewer choices affect individuals with federal subsidies, but rate hikes will hit those who pay their own premiums hardest. Bottom line: Analysts say there are enough people in the "gig economy" to assure a future customer base for individual plans to prosper. (Kaiser Health News)
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High-cost claims get real: $18M in six months for Member X
The risk of covering individuals, regardless of pre-existing conditions, proved too great for Wellmark Blue Cross Blue Shield. The plan announced it was exiting the 2018 insurance marketplaces in Iowa and South Dakota, citing high-cost claims across the pool. One individual member with a genetic disorder filed claims averaging $3 million a month; across the pool, that breaks down to $500 in cost for every member of the 2017 exchange. (
HealthPayer Intelligence
)
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Innovation & Transformation
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Opponents to a national patient identifier appear to be softening their stance. Congress recently provided funding for the Office of the National Coordinator for Health Information Technology to work with the industry on patient ID and matching initiatives. ONCHIT is now directed to "examine accurate and timely record matching so that all EHR systems are collecting the information necessary for a fully interoperable system that protects patients from identity mismatch errors, but also considers patient privacy and security." Supporters say the need is great for a universal patient identifier system to solve interoperability issues. (
HealthData Management)
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Tennessee pharmacists to provide medication therapy management
Members of Tennessee's Medicaid program may now receive medication therapy management directly from pharmacists. The two-year pilot allows pharmacists to enter collaborative practice agreements with patient-centered medical home physician practices. They can be reimbursed directly for helping the sickest patients. "This is not an expansion of services. This is what we've been doing our entire careers. It has not been utilized near to the full degree of its potential," says Tenn. Sen. Ferrell Haile, the bill's sponsor and a pharmacist. (
Pharmacist.com)
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Are clinician mobile devices secure?
The answer is "not likely." Mobile devices are widely used by clinicians, health care executives and staff, and they're more easily lost or stolen than laptop or desktop computers. In a recent survey of 410 security professionals, two-thirds say they doubt their organizations can prevent a breach to mobile devices; more than a third say they improperly secure their company's smartphones and tablets. That's troubling, especially after last month's WannaCry ransomware attack that targeted vulnerable systems worldwide. "Security professionals identified the risk of mobile devices, but focus and resources assignment seem to be waiting for actual catastrophes to validate the need to properly prepare their defenses," one researcher says. (MobiHealthNews; report)
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Skip the line: Boutique access to doctors for 40K a year
Those who can afford $40K to $80K a year are opting for boutique doctors and high-dollar hospital wards designed by a veteran of Louis Vuitton and Nordstrom. Patients like the "asset manager" approach, 24-hour access, same-day appointments and quick reach to top-notch doctors worldwide. Doctors enjoy the ability to focus on and spend time with patients, as well as a calmer pace and more money, while administrators say high-dollar patients help fund treatment for all. (
The New York Times)
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New York plays health plan hard ball: Health plans that leave New York's health insurance exchange will be banned from the state's Medicaid program and from contracting with any state agencies. Gov. Andrew Cuomo said insurers doing business in the state must also guarantee the ACA's 10 essential health benefits are included in plans--no matter what changes are enacted in Washington. (
NYup.com)
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Nevada takes shot at Medicaid for all:
Nev. Gov. Brian Sandoval hasn't signed it yet, but the state's legislature passed a bill allowing residents to buy into Medicaid using ACA tax credits. The four-page bill includes no cost estimates for the state and no permission to use federal funds. (Los Angeles Times)
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CIOs: Mobile solution for workflow, clinical gains? Not yet.
Secure mobile phone use with access to clinical support tools is still a work in progress; less than a third of clinicians can receive alerts on a mobile device if a patient's vital signs change. A survey of CIOs says 95 percent worry about mobile data security. And 45 percent give their organizations a failing grade for successfully adopting mobile technologies to improve workflow. (
spok infographic)
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MarketVoices...quotes worth reading
“There is a horrific death spiral going on with the [non-subsidized] part of the market right now, because rate hikes are limited for those getting help from the government, but not for those paying the full premiums."—Robert Laszewski, insurance industry consultant, in
Kaiser Health News
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Copyright 2009-2017,
H2R Minutes
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