Monday, March 2, 2015

ACA 101: What You Need To Know

**Editing Note: This is an in-person briefing, not a webinar (as previously noted) and registration is closed.**

On Friday, March 6, from 11 a.m.-12:30 p.m. Eastern the Kaiser Family Foundation and the Alliance for Health Reform are hosting a briefing to review the Affordable Care Act (ACA).

Speakers will answer and discuss critical ACA questions, such as:
  • What are the key provisions of the ACA? 
  • How did the ACA extend coverage to the uninsured? 
  • How does the ACA impact private and public insurance coverage, marketplaces and employer-sponsored coverage? 
  • What is the role for states? 
  • What are the requirements on employers and individuals? 
  • How was Medicaid changed by the ACA and then the Supreme Court? 
  • How is the Children’s Health Insurance Program (CHIP) affected?
Moderated by KFF’s Diane Rowland and the Alliance’s Ed Howard, Friday’s discussion will include:
  • Jennifer Tolbert, director of state health reform, Kaiser Family Foundation, will provide a broad overview of the key provisions in the ACA, including private and public coverage provisions, quality and delivery system reforms;
  • Sabrina Corlette, research professor and project director at the Center on Health Insurance Reforms, Georgetown University’s Health Policy Institute, will address the changes in private insurance, requirements on individuals, the creation of marketplaces and the implications of the King v. Burwell Supreme Court case on subsidies;
  • Paul Fronstin, director of the Health Research and Education Program, Employee Benefit Research Institute, will explain employer-sponsored coverage and requirements; and
  • Charlene Frizzera, senior advisor, Leavitt Partners, and former CMS acting administrator, will address the Medicaid and CHIP provisions in the ACA
Here's a link to registration information.

Changing How We Pay for Health Care: Value-Based Reform

Dr. Jack Cochran and Charles Kenney wrote an article on The U.S. Department of Health and Human Services’ recent announcement to move the Medicare program toward value-based payments.

Posted today in The Health Care Blog and originating from a February post on the Kaiser Permanente blog, the authors noted that this effort "is among the most promising recent developments in health care. While changing the way we pay for care will not be easy, we believe that shifting away from fee-for-service to value-based payments could be a catalyst to a better, more affordable health care system in our country."

Also included was an excerpt from NBCH's Value-based Purchasing Guide.
According to the National Business Coalition on Health, a nonprofit organization of “purchaser-led health care coalitions … dedicated to value-based purchasing of health care services through the collective action of public and private purchasers,” the impact would be significant. The coalition takes this position:
 As the business community has learned over the past several decades, maintaining workforce health and preventing illness – particularly chronic conditions – improves productivity and competitiveness, and can lower health care costs over time.
Value-based purchasing can help shift the paradigm of why employers offer health benefits from seeing it as an employee recruitment and retention tool, to seeing it as a chance to improve population health and increase productivity, and ultimately the employer’s bottom line.
The authors concluded that this may be the tipping point in our nation’s complex, often difficult, health care journey. What do you think?

Friday, February 27, 2015

Millenson in Forbes: How Mayo's "Dr. Google" Deal Disrupts Medicine

In his latest column in Forbes, health care quality consultant Michael Millenson examines the implications of Google joining with the Mayo Clinic to provide consumers with medical information, which he says quietly signals a powerful disruption for all of medicine.

Now when people search their health questions on Google they will get relevant medical facts up front that have been reviewed by teams of doctors including expert clinicians at Mayo Clinic for quality and accuracy.

Millenson writes:
Recommending a Google search “as the first stop for those needing health information,” in the words of a Mayo physician executive, represents a true paradigm change.
But there’s much more going on here than search. From the Fitbit to medicine’s front lines, information technology is forcing a new doctor-patient relationship with new rules for new roles.
If information is power, digitized information is distributed power. While “patient-centered care” has been directed by professionals towards patients, collaborative health – what some call “participatory medicine” or “person-centric care” ­– shifts the perspective from the patient outwards.
Genuine collaborative health will require incorporating information technology into relationships that harmonize both those views

Google image of medical conditions on mobile phone

Thursday, February 26, 2015

Kaiser Family Foundation: A Guide to the Supreme Court Argument in King v. Burwell

The Kaiser Family Foundation has released new materials examining the policy implication and legal arguments in the U.S. Supreme Court’s King v. Burwell case.

The Supreme Court is set to hear oral arguments on March 4. A new Policy Insight from the Kaiser Family Foundation's Larry Levitt and Gary Claxton explores the policy implications for consumers and insurance markets if the Court were to side with the plaintiffs in the challenge to the Affordable Care Act’s consumer subsidies. 

A second issue brief by KFF’s MaryBeth Musumeci, a policy analyst and an attorney, explains the legal arguments underlying the case.

At issue in the case is whether the federal government can provide premium and cost-sharing subsidies to consumers who buy insurance in states that do not establish their own ACA Marketplace and instead rely on a Federally-facilitated or Partnership Marketplace. In 2015, roughly 7.5 million people who have signed up for coverage in the 34 states that use the federal Marketplace qualify for subsidies, or 87 percent of all people who picked a plan in such states.

The new Policy Insight, Insurance Markets in a Post-King World, explains that a Court decision to cut off such subsidies would cause millions to go without coverage, make the vast majority of consumers who were receiving subsidies exempt from the ACA’s individual mandate, and disrupt insurance markets by leaving insurers with a sicker pool of people to cover and limited ability to generate enough premium revenue to cover health costs. In some cases, insurers may choose to exit the individual market in affected states rather than face significant losses, according to the analysis. Governors, state legislatures and Congress would face pressure to take steps to preserve subsidies, but there are political and logistical challenges to doing so quickly.

The issue brief, Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell, walks through legal aspects of the case, from who the plaintiffs are to what each side is seeking from the Court and how this legal challenge differs from other ACA cases already decided by the Court. It also explains the legal test that the justices are likely to apply in the case and the potential actions the Court could take.

For more on health reform and the King v. Burwell case, visit

The Leapfrog Group Releases Maternity Care Report

This week The Leapfrog Group released its Maternity Care Report, an in-depth examination of hospital quality and safety for early elective deliveries, episiotomies and high-risk deliveries, with data analysis by Castlight Health.

Though the analysis of hospitals nationwide demonstrates substantial progress in recent years, it also reveals significant room for improvement on maternity care standards. In fact, less than a third of hospitals meet Leapfrog’s standard for high-risk deliveries of very low birth weight babies, while rates of episiotomies are still too high at 35 percent of birthing hospitals.

The report is the first in a series of six reports examining key quality and safety measures at hospitals nationwide based on data from the 2014 Leapfrog Hospital Survey of 1,501 U.S. hospitals.

Several NBCH-member coalitions have focused on preventing medically unnecessary early elective deliveries. The Midwest Business Group on Health received a grant from NBCH and the United Health Foundation to convene health care stakeholders in Illinois and develop a community action plan to reduce the high number of early inductions and C-sections performed. And the Virginia Business Coalition on Health Foundation also has a program focused on education to ensure babies are born full term.

Health Affairs: Engaging Health Care Consumers: The Lowe’s Experience

Image result for health affairs

Worth reading and NBCH's recent study with Benz Communications is noted...

A recent post for the Health Affairs blog by Bob Ihrie, senior vice president of compensation and benefits for Lowe's, and Dr. Alan Spiro, chief medical officer for Accolade, outlined Lowe's evolution to better engage employees through its population health and benefits program.

Time will tell, but it appears that employers are not giving up on providing health insurance to their employees — even with the availability of health care exchanges. That’s at least what the results of a new study sponsored by the National Business Coalition on Health (NBCH) suggest.
Brian Klepper, CEO of the NBCH, speculated in his recent Health Affairs Blog post: “…there is an alternative view of what is possible in health care, and that self-funding and a willingness to continue trying to control the health care value monster remains alive and vibrant.”
As self-funded employers strive for a value-based health care marketplace, they’re looking at ways to drive value at an individual level — through strategies to engage employees as better consumers and managers of their own health care.
Over the last couple of decades, Lowe’s has been on a journey to encourage its employees to become engaged health care consumers. What Lowe’s experience teaches us is that health care systems are complex, and individuals value guidance from a trusted source, particularly when faced with difficult or challenging decisions...

Wednesday, February 11, 2015

A Detailed Analysis of the Republican Alternative to Obamacare

GOP vs Democrat
Reposted 2/11/15 from The Health Care Blog
House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

Republicans will now argue they have a better health insurance reform plan and that Obamacare should be repealed and replaced by it––particularly if the Supreme Court plunges the new health law into chaos by throwing the subsidies out in 37 states.
They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.
My sense is that voters will end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can’t we take the best from both sides?

Tuesday, February 10, 2015

Employers: What the Anthem Breach Means to Employer Health Plan Sponsors

Advisory Information from the law firm Davis Wright Tremaine LLP

By Adam H. Greene, Sarah L. Bhagwandin, Sean B. Hoar, Christin S. McMeley, Dipa N. Sudra, Rebecca L. Williams, and Anna C. Watterson

On Feb. 4, 2015, Anthem announced a data breach involving the personal information of more than 80 million individuals resulting from what it characterized as a sophisticated, targeted cyber-attack. Group health plans may be affected because Anthem: (1) provides insured health benefits; (2) administers health benefits for a self-insured plan; or (3) administers out of area/network claims.

Employers, as plan sponsors on behalf of their group health plans, need to identify how the Anthem breach may affect them, if at all, and get their arms around what they need to do in response. The following is practical guidance on what employers need to know and do now and in the coming weeks to comply with their legal obligations.

Thursday, January 29, 2015

Can Business Savvy, Clout And Charisma Supercharge Patient Safety?

Michael Millenson

Originally published 1/29/15 in Forbes

At the recently concluded Patient Safety Summit organized by Joe Kiani, the dynamic CEO of Masimo Corp., a star-studded parade of political clout stepped up to support the goal of eliminating all preventable medical errors by 2020.

Vice President Joe Biden announced, “The president and I are with you on this.” Similar endorsements came from former President Bill Clinton, former Surgeon General Richard Carmona, a U.S. senator and two Congressmen.

“This isn’t another academic conference,” proclaimed Jim Bialick, president of the Patient Safety Movement Foundation that Kiani founded.“ This isn’t the same old thing.”

Wednesday, January 28, 2015

Health Savings Account-Eligible High Deductible Health Plans: Updating the Definition of Prevention

Note from  Brian: Here's an interesting article for health plan benefits managers, released last May by Mark Fendrick et al. at the University of Michigan's Center for Value-Based Insurance Design. It models the potential benefits that might accrue if HSA-eligible High Deductible Health Plans (HDHPs) were allowed to use an expended definition of preventive services. Given the popularity of HDHPs, especially among large, self-funded health plans, the findings, while speculative, are compelling. The authors assert that:

Utilizing the well-accepted and medically common definition of prevention that encompasses both primary and secondary preventive services could enhance HDHP attractiveness to potential purchasers and accelerate benefit design innovation. Expanding the definition of prevention to include evidence-based services that prevent chronic disease progression and related complications could enhance the ability of HDHPs to improve clinical outcomes while preserving the well-documented capacity to engage consumers and contain costs.

See here for the article's full detail.

Monday, January 26, 2015

A Courageous First Step


First posted 1/26/15 on The Health Care Blog

Note from Brian: Important story. Promising that Medicare is finally taking this step. Self-funded purchasers should demand that their plans take similar steps.

Earlier today, Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced that HHS is doubling down on the historic shift taking place across the health care industry towards value-based care, and is setting a target of having 50 percent of Medicare payments under value-based care arrangements by 2018.

This would mean that in less than three years, around a quarter of a trillion dollars of health care spending would be made to providers who are being compensated not for ordering more tests and more procedures, but for delivering better outcomes – keeping patients healthier, keeping them out of the hospital, and keeping their chronic conditions in check.

This shift will address a central problem of the US health care system, one that lawmakers and policy experts on all sides of the issue agree is a key contributor to runaway medical inflation.

The logic is straightforward: by simply paying for the volume of services delivered, every provider has a strong incentive to do more — more tests, more procedures, more surgeries. And under this system, there is no financial incentive to maintain a comprehensive overview of patient care – to succeed by keeping the patient healthy, and health care costs down.

Tuesday, January 20, 2015

Getting A Return on Electronic Health Record Investments

Note from Brian. A fundamental health care infrastructure problem is the continuing inability of Electronic Health Records (EHR) to seamlessly share data, despite a 4 year program that taxpayers poured $30 billion into. 

This failure in interoperability is a barrier to care coordination, forcing poorer outcomes at much greater cost. Not having complete or consistent patient information also seriously degrades the capacity of any health care provider to perform under risk-based reimbursement arrangements.

Perhaps the best solution to this issue is Direct exchange, which has created a framework, that would be integrated into every EHR, for secure exchange using a national network of accredited email providers. Some 160 communications and provider organizations now support this fledgling effort, on more than 10 million patient encounters have been updated using it.

No group should be more invested in interoperability and complete patient information than purchasers. These attributes are clearly in the interests of better care and cost.

On Thursday at Noon ET, David Kibbe, MD, the Founder and CEO of Direct Trust, will host a Webinar that lays out the business case for an interoperability platform, and why purchasers should support it. Hope you'll join us.

In the meantime, here's an article that lays out the basics of the issue.

Friday, January 9, 2015

House Approves Legislation Marking 40 Hours as 'Full Time' for PPACA Purposes

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. House of Representatives approved a measure on January 8 that would establish 40 hours as the benchmark for "full time" work under the Patient Protection and Affordable Care Act (PPACA). The 252-172 vote included 12 Democrats.

The Save American Workers Act (H.R. 30), introduced by House Ways and Means Committee member Todd C. Young (R-IN), would replace the number 30 (hours per week) with the number 40 (hours per week) for purposes of identifying full-time employees and satisfying the PPACA employer mandate under Internal Revenue Code Section 4980H. H.R. 30 would also modify the calculation of full-time equivalent workers by requiring employers to divide the aggregate number of hours of service of employees who are not full-time employees by 174 rather than 120.

President Obama has issued a Statement of Administration Policy asserting that he would veto H.R. 30 if it reached his desk, noting that the measure would increase the federal budget deficit, reduce the number of people receiving employer-based health insurance coverage and increase the number of individuals who are uninsured. The latest Congressional Budget Office budget score estimates that H.R. 30 would increase the deficit by $53.2 billion over the next ten years. House Minority Leader Nancy Pelosi (D-CA) stated in a January 8 news conference that the measure would add half a million people to the ranks of the uninsured.

Senators Susan Collins (R-ME) and Joe Donnelly (D-IN) have introduced a companion bill in the U.S. Senate, the Forty Hours is Full Time Act (S. 30), but legislative text remains unavailable at this time.

Thursday, January 8, 2015

Two Coalition Job Opportunities

The National Business Coalition on Health is seeking a dedicated and enthusiastic Director of Membership to support the organization's mission "to help member coalitions lead in improving health and the value of health care services in their communities." The Director of Membership Services serves as the coalition's primary contact for member support; provides strategic leadership for the association's membership program; cultivates relationships with member coalitions; maintains a working knowledge and understanding of coalition activities, interests, and needs; and subsequently strengthens networking and capacity building opportunities to ensure that coalitions are efficiently and effectively sharing best practices and learning from one another.

To read more about the job opportunity at NBCH, click here. To apply, please submit the requested materials to

The Maine Health Management Coalition is hiring a Director of Data Systems and Analytics. The Director will lead the Data Systems and Analytic Department at MHMC, develop and execute on a sustainable strategic plan, and to achieve excellence in a changing competitive landscape. The Director is also expected to play a leadership role integrating the Department with national efforts striving to achieve similar objectives.

To read more about the job opportunity at MHMC, click here. To apply, please submit the requested materials to

House Passes Bill Exempting Veterans When Determining Employer Mandate Applicability

NBCH thanks the American Benefits Council for the information provided in this post.

On January 6, the U.S. House of Representatives passed the Hire More Heroes Act (H.R. 22) by unanimous, bipartisan vote of 412-0.

The measure, sponsored by Representative Rodney Davis (R-IL), would exempt veterans already enrolled in coverage under TRICARE or the U.S. Department of Veterans Affairs (VA) from being taken into account for the purposes of determining if an employer is subject to the employer mandate under the Patient Protection and Affordable Care Act (PPACA).

The PPACA "shared responsibility" employer mandate under Internal Revenue Code Section 4980H, which took effect on January 1, requires employers with 100 or more full-time (or equivalent) employees to offer health coverage that satisfies affordability and minimum value requirements to their full-time employees or pay a penalty if even one full-time employee receives a premium tax credit for health coverage obtained through a health insurance exchange. (The 100 employee threshold is applicable only under transition relief for 2015; after 2015, the threshold is 50 employees.)

The bill would allow businesses to hire veterans covered by TRICARE or the VA without counting them as full-time employees. Supporters of the measure point out that it will help some small businesses stay below the mandate threshold as well as encourage the hiring of veterans.

The bill was previously introduced in the House in the 113th Congress and approved by a vote of 406-1. The measure was not considered by the Senate.