In this week’s summary, you’ll find info on health exchange plans and technical problems, Medicare Part D trends for 2014, clinical trials affected by the federal government shutdown, and more!
Experts interviewed by Reuters suggest that the online enrollment problems encountered by consumers attempting to sign up for health care coverage were likely due to website architectural flaws. For example, health marketplaces are requiring consumers to supply large amounts of data to apply, overwhelming the system. Simply adding capacity will not fix software configuration problems.
More than 40,000 people have signed up for New York’s health insurance marketplace during its first week of operation. The open enrollment period ends on March 31 and New York is hoping to sign up at least one million consumers.
Non-profit Blue Cross plans are leading the way on health exchanges, by offering coverage in almost every state that has an exchange and at an affordable price for consumers. Wellpoint, which is the for-profit version of Blue Cross plans, is also operating in all 14 states where it operated before the Affordable Care Act. Non-profit Blue Cross plans were originally formed by doctors and hospitals to provide affordable insurance coverage to their patients. Non-profit plans do not have to make a return to investors. In theory, this should enable them to keep their prices down. Questions remain on whether these plans will keep premiums down in the long term.
Medicare Part D
The Kaiser Family Foundation looks at Medicare Part D trends for 2014, according to new information released by the Centers for Medicare and Medicaid Services (CMS). Consumers will have the option of four additional stand-alone prescription drugs plans (PDPs) than in 2013, for a total of 35 plans. Of the 36 million people enrolled in Part D plans, 22.7 million will participate in the PDPs, with the rest enrolled in Medicare Advantage Plans. Premiums are expected to rise 5%, on average. Persons in receipt of the low-income subsidy will have access to more plans in 2014, with no monthly premium. Lastly, the use of preferred pharmacy networks and use of formulary cost-sharing tiers is expected to increase.
Health Affairs published this submission from The NYS Health Foundation on integrating behavioral health care . Roughly half of all people with mental health disorders also have substance abuse problems. In New York State, only ten percent of this co-occurring population received evidence-based care for both problems. This article demonstrates how the state is working towards better integration of care.
This article by Kaiser Health News discusses high-cost outliers , or the one-percent of costliest patients that account for 21% of all U.S. healthcare spending. These are persons with multiple chronic conditions, such as heart failure, diabetes, kidney failure and severe psychiatric problems. They frequent emergency rooms for care, due to the difficulty in navigating our fragmented health care system. There are numerous pilots around the country that are successfully addressing the needs of these populations through the use of hospital discharge planning, transportation access to medical appointments, frequent phone calls and home visits from medical personnel and assistance with medication compliance.
Clinical trial access has been hampered by the partial government shutdown, according to the National Institute of Health (NIH). Only critically ill patients are receiving waivers to enroll in clinical trials. Staffing at the NIH has been hard-hit by the shutdown. The NIH is the largest source of medical research funding in the world. There is concern about potential long-term effects on research if the shutdown drags on.
-Jaime Venditti, 10/11/13