Thursday, December 11, 2014

ACA enrollment: MD, US; Obama on Colbert; Coops; MA plans; Gruber; +

1) Maryland ACA News

Maryland rushes to reenroll residents in subsidized health insurance plans

Md. Emphasizes Need to Re-Enroll in Health Plans

2)  More ACA News

What To Watch For During This Year’s Open Enrollment Period: Lessons From The Health Reform Monitoring Survey

Obamacare Co-ops Cut Prices, Turn Up Heat on Rival Insurers
Value-Based Payment Is Spreading, but Models Need Refinement

The Washington Post's Wonkblog: Why We Haven’t Seen The Last Of Jonathan Gruber  

Some interesting comments on implications of the Gruber hearing. 

Baby Boomers Getting Covered and Staying Covered

Center for Budget and Policy Priorities has a number of useful webinars on ACA.
Some Health Law Provisions Become Capitol Hill TargetsSpending Deal Includes Provisions With Health Industry Impact Confusion Fuels Consumers' Medical Debt 
4) Wellness at Work: Popular But Unproven

is a new advocacy resource that will examine the health care-specific background and positions of the members of the 114th Congressional Freshman class.

6) Summary: Governors' Letters to Congress on the Future of CHIP,

Extending CHIP: Let's Not Mess With Success or Toy With the Program’s Future

Very important that CHIP is extended 

7) Alliance for Health Reform Session:
  Medicare Advantage in a Changing Health System
This is a link to the slides, etc.  


MEDICARE ADVANTAGE ENROLLMENT, PAYMENT, AND QUALITY: Currently, 28% of Medicare beneficiaries are covered through Medicare Advantage, and in 2014, beneficiaries had an average of 10 plan choices per county, said Arielle Mir. Plans are paid a monthly per-enrollee amount to provide Medicare Part A and B benefits; payment amounts are based on plan bids relative to fee-for-service benchmarks that are calculated on a county-by-county basis. On average Medicare pays about 6% more for an enrollee in Medicare Advantage than they would if a comparable enrollee were in fee-for-service Medicare. Medicare Advantage plans can receive higher payments based on a star rating system derived from clinical quality and consumer satisfaction measures.
  • MEDICARE ADVANTAGE POLICY LANDSCAPE: Medicare Advantage offers a vision in which managed care plans create savings relative to fee-for-service Medicare by forming networks, negotiating rates with providers, coordinating care, and conducting utilization management, said Mark Miller. The alternative vision of private plans in Medicare was that managed care, and extra benefits, should be offered for everybody, which requires managed care plans to be subsidized in areas of the country where fee-for-service utilization is low. Payment reforms enacted through the Affordable Care Act in 2010 more closely aligned Medicare Advantage and fee-for-service payments. There has been 9% annual growth in Medicare Advantage enrollment since that time, along with continued wide availability of plans, and on average, managed care plans are now bidding below the fee-for-service benchmark, with HMOs more likely to do so than other types of plans.
  • MEDICARE ADVANTAGE QUALITY AND ACCESS: Existing studies that compare quality and access between Medicare Advantage and traditional Medicare tend to be based on relatively old data and a limited set of measures, pointing to the need for more timely, comparable data and information, said Marsha Gold. On average, HMOs perform better than traditional Medicare on preventive services, and Medicare HMO beneficiaries were less likely to have potentially avoidable hospitalizations than beneficiaries in traditional Medicare. Evidence on readmissions is inconclusive, with findings differing across studies and many lacking important adjustments for potentially confounding factors.
  • INTERSECTION BETWEEN MEDICARE ADVANTAGE AND DELIVERY SYSTEMS: Medicare Advantage is focused on care coordination, preventive care, and total patient wellness in ways not possible under fee-for-service Medicare, said Robert Margolis. The risk based payment structure under Medicare Advantage incentivizes coordinated care and the investment of savings from lower admissions and readmissions back into patient-centered care. There is nothing comparable to the Medicare Advantage quality rating system in traditional Medicare, he added.
  • NEW KAISER FAMILY FOUNDATION STUDY ON MEDICARE ADVANTAGE. Private insurance plans delivering services to people enrolled in Medicare enrolled about 16 million beneficiaries in 2014. Most were enrolled in managed care plans such as HMOs or preferred provider organization (PPOs), that receive funds from the federal government to provide Medicare-covered benefits to those enrolled. Study here:

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