Wednesday, September 17, 2014

New Anthem Blue Cross plan takes on Kaiser

Taking aim at HMO giant Kaiser Permanente, insurer Anthem Blue Cross is joining forces with several big-name hospitals and their doctors to create an unusual health plan option for employers in Southern California.

The joint venture being announced Wednesday brings together seven rival hospital groups in Los Angeles and Orange counties, including well-known institutions Cedars-Sinai Medical Center and the UCLA Health System. The deal reflects the pressure insurers and hospitals alike are facing to hold down healthcare costs for employers and their workers.

Read the full article via the Los Angeles Times here.

David Lansky Addresses Pacific Business Group on Health's State-of-the-Art Travel Surgery Program

David Lansky, President and CEO of Pacific Business Group on Health, was recently interviewed by U.S. Domestic Medical Travel in regards to the coalition’s Employers Centers of Excellence Network (ECEN) which offers a state-of-the-art travel surgery program, and serves to provide patients with high quality, affordable healthcare. You can access the full interview here.

Tuesday, September 16, 2014

CMS to Continue Webinar Series on Reinsurance Contributions

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

The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) will host the latest in a series of webinars on required Transitional Reinsurance Program (TRP) contributions under the Patient Protection and Affordable Care Act (PPACA).

Under PPACA, during the first three years that health insurance exchanges are operational (i.e., 2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance the three-year transitional reinsurance program. The fee is $63 per covered life for 2014.

HHS and CMS released guidance on the process for making TRP contributions in May, previewing "a streamlined process for the collection of reinsurance contributions" through This issuance was followed by an initial series of webinars to provide an overview of policy and operations for reinsurance contributions, followed by a second series to provide an overview of how a contributing entity can submit its annual enrollment count and make reinsurance contributions through

CMS has announced this latest webinar series to provide an overview of the "job aid" available to assist entities in the development of supporting documentation and detail how an entity can update reinsurance contribution filings through if an issue arises after submission. The new webinars will be held on the following days and times:
  • Wednesday, September 17, 2-3:30 p.m. ET
  • Friday, September 19, 2-3:30 p.m. ET
  • Wednesday, September 24, 2-3:30 p.m. ET
Registration will be on a first-come, first-serve basis, limited to three participants per organization. Registration will be limited to selecting only one of the event dates. You will need to log in to the official Registration for Technical Assistance Portal for more information.


NBCH Names Top Performing Health Plans According to 2014 eValue8 Results

Annual health plan survey and evaluation encourages transparency and accountability,
promotes quality improvement

WASHINGTON – September 16, 2014 – Kaiser Permanente Colorado was named the top performing health plan according to the 2014 eValue8 results released by the non-profit National Business Coalition on Health (NBCH). A critical element of purchasers’ value-based purchasing strategy, eValue8 is an annual health care accountability and quality improvement assessment used by employers and coalitions to manage the quality and efficiency of America’s health plans.

“We’ve incorporated eValue8 and the results into our RFI and procurement process,” said Kerry Schaefer, manager, Compensation & Benefits, for King County in Washington. “Plans can’t do well on an eValue8 survey unless they are putting a heavy emphasis on value-based benefit design.”

2014 benchmark plans
Plans who achieved the best performance (benchmark) among all insurers responding for specific modules include:
  • Physician and Hospital Management and Measurement – Aetna Washington
  • Helping Members Stay Healthy – Kaiser Permanente Colorado
  • Helping Members Become Good Consumers – Cigna CaliforniaHelping Members Manage Acute/Episodic Conditions – Cigna Connecticut and Group Health Cooperative
  • Helping Members Manage Chronic Conditions – Kaiser Permanente Colorado
  • Pharmaceutical Management – Kaiser Permanente Colorado
  • Business Practices – Cigna California
Additional details on the 2014 results and other top ranking plans can be found on NBCH’s eValue8 website. Participating NBCH member coalitions included the Colorado Business Group on Health, Healthcare 21 Business Coalition, Memphis Business Group on Health, MidAtlantic Business Group on Health, Northeast Business Group on Health, Pacific Business Group on Health and the Washington Health Alliance.

According to the NBCH Value-based Purchasing Council, savvy plans understand that buying health care on price alone is only a quick fix. While it might save some money in the short-term, it is neither a sound nor sustainable strategy to bend the cost curve. Value-based purchasing can help shift the paradigm of why employers offer health benefits, from seeing it as a recruitment and retention tool, to an opportunity to improve population health, increase productivity, and ultimately the employers’ bottom line.

“eValue8 helps purchasers understand the value of their investment in providing health benefits,” said Foong-Khwan Siew, Director eValue8 for NBCH. “The program advances value-based purchasing by measuring and reporting on year-to-year plan accountability.”

2015 survey release
The 2015 eValue8 survey will be available for health plans to complete in November. NBCH encourages purchasers and their consultants to ask their plans to respond to eValue8 2015 to assess the value of their investment.

About eValue8
An annual health care purchasing and quality improvement assessment process, eValue8 was created by business coalitions and employers like Marriott and General Motors to measure and evaluate health plan performance. eValue8 asks health plans questions about how they manage critical processes that control costs, reduce and eliminate waste, ensure patient safety, close gaps in care and improve health and health care.

NBCH believes that local business coalitions are key in facilitating multi-stakeholder collaborations at the community level to educate consumers, and improve quality and efficiency of the health delivery system. Purchasers interested in having their plans report performance in a variety of health services can contact NBCH or their local business coalition.

About National Business Coalition on Health 
National Business Coalition on Health (NBCH) is a national nonprofit membership organization of purchaser-led health care coalitions, representing more than 4,000 employers and about 35 million employees and dependents. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. NBCH seeks to accelerate the nation’s progress toward safe, efficient, high-quality health care and the improved health status of the American population.

NBCH’s 19th Annual Conference will be held November 10-12, 2014 in Washington. Additional details and registration information can be found here:

Wednesday, September 10, 2014

Employer-Sponsored Family Health Premiums Rise 3 Percent In 2014

Average annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, continuing a recent trend of modest increases, according to the Kaiser Family Foundation (KFF)/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey released today. Workers on average pay $4,823 annually toward the cost of family coverage this year.

Read more via Health Affairs Blog

Friday, September 5, 2014

Direct contracts with medical providers help self-insured employers control costs

A growing number of self-insured employers are bypassing health plan administrators and contracting directly with providers in efforts to limit the increases in their health care costs.

Direct contracting isn't new, but more employers are considering it among other cost-cutting measures, and many providers are better prepared to run the numbers.

According to Aon Hewitt's “2014 Health Care Survey,” conducted between December 2013 and January of this year, 11% of employers are engaging in some form of direct health care provider and service contracting during this plan year, and 28% expect to do so in the next three to five years.

Read the full story via Business Insurance here.

C-suite must band together to rein in health care costs

Steve Twedt's article today in the Pittsburgh Post-Gazette features comments from NBCH CEO Brian Klepper's keynote at the Pittsburgh Business Group on Health's annual symposium.

Dr. Klepper called on C-suite executives to band together if they are to overcome the power of the health care industry and to rein in health care costs.

"Business leaders need to develop a national health care data warehouse and analytics platform that will arm them with information showing which plans and providers produce the best value for the money as far as quality, safety and cost. They have to come together to work as one, to be a counterweight to the health care industry."

Wednesday, September 3, 2014

New NBCH Action Brief: Breast Cancer

Among American women, breast cancer is the most common non-skin cancer and the second leading cause of cancer death, exceeded only by lung cancer. In 2010, medical costs associated with female breast cancer were estimated at $16.5 billion - the highest cost for any cancer site - with total cancer costs in the United States amounting to nearly $125 billion. The significant financial burden of cancer, compounded with the emotional strain of diagnosis and treatment, can create a complex situation for employers. This Action Brief outlines the scope of breast cancer as well as how health plans are addressing the issues based on data from eValue8. Lastly, the brief highlights actions employers can take to improve breast cancer prevention strategies and to better support workers and dependents facing breast cancer diagnosis and treatment.

Access the lastest in NBCH's series of Action Briefs here.

Tuesday, September 2, 2014

Webinar: Access to Specialty Medications & Value-based Insurance Design

Join the National Pharmaceutical Council for a webinar on September 29 from 1:00-2:00 pm ET. NBCH's CEO, Brian Klepper, will present on the webinar along with a panel of other leading health and benefits experts. Read the webinar announcement from NPC below and register online today.
Specialty medications have been making health care headlines in recent months because of their effectiveness and higher costs. How can we ensure that patients will have access to the treatments that work best for them?

Join us for a webinar with a panel of leading health and benefits experts on Monday, September 29 at 1 pm ET. Our panel will discuss specialty medications and the use of tactics such as value-based insurance design (V-BID) by payers and purchasers as they develop their health care coverage options.

Speakers include:
  • A. Mark Fendrick, MD, Director, University of Michigan Center for Value-Based Insurance Design
  • Will Shrank, MD, Chief Scientific Officer and Chief Medical Officer, Provider Innovation and Analytics, CVS Caremark Corporation
  • Brian Klepper, PhD, Chief Executive Officer, National Business Coalition on Health
  • Moderator: Kimberly Westrich, MA, Director, Health Services Research, NPC
We’ll discuss:
  • The current health care environment and challenges with specialty medications and health benefit designs;
  • How V-BID could be utilized to address these challenges; and
  • The view from employers and steps they are taking to manage employee health.
For additional background on this topic, check out:

IRS Releases Instructions for PPACA Information Reporting Forms

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

The Internal Revenue Service (IRS) released long-awaited instructions for the forms to be used by applicable large employers and insurers for reporting information regarding health care coverage and "minimum essential coverage" as required under the Patient Protection and Affordable Care Act (PPACA). The IRS also issued Questions-and-Answers documents regarding information reporting by health coverage providers and reporting of offers of health insurance coverage by employers.The FAQs provide a summary of who is required to report, what information must be reported and how and when to report.

The forms are to be used to fulfill the requirements specified in final regulations implementing the reporting of minimum essential coverage (MEC) under Section 6055 of the Internal Revenue Code) and the reporting of health insurance coverage under Section 6056 of the Internal Revenue Code. These reporting requirements were delayed for 2014 under previously issued Notice 2013-45 transition relief and will not be effective until 2015, making the first required reporting due in early 2016 (though the IRS is encouraging voluntary reporting for coverage in 2014).

Code Section 6055 requires every health insurance issuer, sponsor of a self-insured health plan, government agency that administers government-sponsored health insurance programs and other entities that provide minimum essential coverage to file annual returns reporting certain information for each individual for whom minimum essential coverage is provided and to provide a copy of the return to the individual. Form 1095-B is to be used to comply with Code Section 6055. Form 1094-B is to be used to transmit these returns to the IRS. An employer that sponsors a insured health plan will not report as a provider of health coverage under section 6055. The health insurance carrier is responsible for reporting that coverage.

The instructions for Forms 1094-B and 1095-B are to be used for:
Form 1094-B: Transmittal of Health Coverage Information Returns
Form 1095-B: Health Coverage

Code Section 6056 requires every applicable large employer (generally, an employer that employed on average at least 50 full-time employees or equivalents) to file a return with the IRS that reports the terms and conditions of the health care coverage provided to the employer's full-time employees during the year. Form 1095-C is to be used to satisfy this requirement. Form 1094-C is to be used to transmit these returns. An applicable large employer that provides self-insured coverage is subject to the reporting requirements of both sections 6055 and sections 6056. As discussed in the IRS FAQs on Information Reporting by Health Care Providers (Section 6055), FAQ 27, such employers will combine section 6055 and 6056 reporting on Form 1095-C.

The newly released instructions for Forms 1094-C and 1095-C are to be used for:
Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return
Form 1095-C: Employer Provided Health Insurance Offer and Coverage

Also on August 28, the IRS issued a draft Form 1095-A, Health Insurance Marketplace Statement, and instructions. Health Insurance Marketplaces (also known as health exchanges) must file Form 1095-A to report information on all enrollments in qualified health plans through the Marketplaces. The purpose of the Form 1095-A is to report information to the IRS about family members who enroll in a qualified health plan through the Marketplace. Form 1095-A is also furnished to individuals to allow them to claim the premium tax credit, to reconcile the credit on their returns with advance payment of the premium tax credit and to file an accurate tax return.

The IRS also updated its Form 1040, the U.S. Individual Income Tax Return, to add a new Line 61 in which taxpayers would indicate whether they have full-year health coverage or if they will be liable for the "individual responsibility" mandate penalty.

The IRS is accepting comments on the draft forms. Comments may be submitted on the Comment on Tax Forms and Publications page on Although no comment deadline is identified, comments should be submitted as soon as possible as final forms are expected to be posted by the end of the year. 

Sunday, August 31, 2014

Where We Donate vs. Diseases That Kill Us

Hat tip to Jay W. Lee and Jane Sarasohn-Kahn for sharing this.

Friday, August 29, 2014

This Ability

Steve Gladstone

Posted August 25, 2014 on Insights for the Blind

Note from Brian: Steve Gladstone is a close friend since childhood and a fixture in South Florida's arts community. In addition to his blindness, which came on in his early 20's from retinitis pigmentos just as he was brought onto (and then released from) the American Shakespeare Company, over the last few years he's also been afflicted with hearing and balance problems. He turned to writing, which I would argue is his best virtue.

A little different something for a Friday post. Enjoy.

You read it right: this ability.

What I can’t do is see.

What I can do is act, write, sing, dance, tell jokes (my best virtue), run a business, listen, observe human behavior, give guidance to my adult children, love, shop for groceries, and water my plants. I can also clean my house (but avoid doing that as much as possible).

I’ve found that most of the world sees my disability first – blindness trumps all my other abilities until people get familiar with me. And then something curious happens – they forget I’m blind.

Often a pal will walk away from me when we’re out and about. We stop to put our plastic bags in the recycling bin in front of the supermarket and my pal takes off without me. Funny stuff. I simply call out, “Hey, did you forget something?”

I’ve always found it curious that folks in our society create an instant opinion of others based on skin color, gender, disability…hey, even clothing, before the first words are uttered between the two parties.

Years ago, when I was selling consumer electronics, an unshaven customer walked into my shop wearing cut-off jeans, flip-flops and a torn sweatshirt. All my salespeople ignored him until he asked for some help. I immediately gave him my full attention. An hour later he was out the door with a $4500 stereo system. Turns out he was an attorney, satisfying his inner slacker on his day off. My sales guys were miffed.

I suppose it’s our nature to judge folks before we get to know them. Must be in our DNA. Where disability is concerned, the ruling seems to be if one part of you is broken, the rest of you must be broken too.

It has occurred to me that Franklin D. Roosevelt might not ever have been elected President if TV sets were abundant in the 1930s. People seeing a man in a wheelchair might have had serious doubts that he could lead this country out of the Great Depression or be a strong Commander-in-Chief as we entered World War II.

Imagine seeing a woman in a wheelchair and instantly becoming interested in her skills rather than her method of ambulating. And then maybe also finding out that she plays basketball and is a med student too. It’s about what we can do, not what we can’t do. It’s about this ability.

By the way, I now only give guidance to my grown children when they ask for it. Unsolicited advice from anyone is unwanted, especially from blind fathers with this ability.

Wednesday, August 27, 2014

IRS to Host Webcast for Employers on Reporting of Minimum Essential Coverage under Tax Code Section 6055

NBCH thanks the American Benefits Council for the information provided in this post.
The Internal Revenue Service (IRS) will host a webcast for employers on September 9 at 2:00 p.m. Eastern Time to describe how applicable large employers should report minimum essential coverage under Internal Revenue Code Section 6055, as required by the Patient Protection and Affordable Care Act (PPACA).

(This follows the agency's recent webcast on employer reporting of health care coverage under Section 6056. A digital playback is available here.)

Code Section 6055 requires every health insurance issuer, including sponsors of self-insured health plans, to file annual returns reporting certain information for each individual for whom minimum essential coverage is provided and to provide a copy of the return to the individual.

On March 5, the Internal Revenue Service (IRS) issued final regulations on Section 6055 reporting, followed by the release of draft forms on July 24. IRS instructions for completing the forms have not yet been released. These reporting requirements will not be effective until 2015 (first reporting is due in early 2016).

The September 9 IRS webinar will cover:
  • Internal Revenue Code Section 6055
  • Who is required to report
  • What elements are required to be reported
  • How do government entities designate reporting
Speakers for the webcast will include Tennille Francis, Tax Law Specialist, IRS office of Federal State & Local Governments; Stephen Tackney, Deputy Division Counsel/Deputy Associate Chief Counsel, IRS office of Chief Counsel; and Jeffrey T. Rodrick, Senior Technician Reviewer, IRS office of Chief Counsel.

Interested individuals can register for the IRS webcast here.

Tuesday, August 26, 2014

Now Politico Tries RUC Raking

Note From Brian: In 2007 I was a Fellow at the first week-long Aspen Health Forum, and found myself in a shuttle to the Aspen Institute campus with Roy Poses, MD, Associate Professor of Medicine at Brown University, and relentless investigative journalist on the blog Health Care Renewal. 

Dr. Poses asked me whether I'd ever heard of the RUC, and I told him that I hadn't. He told me that it was a hugely important but vastly underappreciated issue, and urged me to check it out when I returned home, which I did. Soon afterward, I published an article on The Health Care Blog called Bad Medicine: How the AMA Undermined Primary Care in America. Three years later, with David Kibbe MD, I revisited the subject, first with an article calling for primary care societies to Quit the RUC, and then with a larger campaign that culminated in a lawsuit against Medicare and HHS.

In this article published today, Roy responds to the Politico article by Katie Jennings published late last week, and distills the RUCs problems down to a few key salient points. As usual, he gets to the nub of the problem.

Some readers may dismiss this issue as overly technical or overblown. While it is not the only problem in health care, though, I assure you that it is one of the most central, driving literally hundreds and hundreds of billions of unnecessary dollars every year, and distorting care and cost patterns all through health care. For anyone interested in deeper health care policy dynamics, this is a must read. 

Roy Poses, MD

Posted 8/26 on Health Care Renewal

It has been a year since we wrote about the RUC, the American Medical Association's Relative Value System Update Committee. There is only one thing new since then. Politico just made another attempt to shed some light on this obscure committee and its outsize effect on health care.

Friday, August 22, 2014

Employers should demand hospital participation in quality and safety survey

Originally Posted on Health News Colorado 8/22/14

By Robert Smith

The Leapfrog Group recently issued the results of its 2013 Leapfrog Hospital Survey, an in-depth examination of seven key areas of hospital quality and safety: medication errors, maternity care, high-risk surgeries, Intensive Care Unit (ICU) physician staffing, serious adverse events, safety practices and hospital-acquired conditions (HACs) – including infections in ICUs, pressure ulcers, and injuries.

The report, prepared by Castlight® Health, is based on hospital performance data gathered through the Leapfrog Hospital Survey of 1,437 U.S. hospitals in 2013, the highest hospital participation rate to date in the annual survey.