What’s New in Health Care Reform: Sept. 30

What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.


Health Care Providers, Insurers Supersize

Five years after the Affordable Care Act helped set off a health care merger frenzy, the pace of consolidation is accelerating, transforming the medical marketplace into a land of giants. The trend is under a new spotlight now, as Congress zeroes in on the competitive and cost impact of proposed deals that would collapse the health insurance industry’s top five players into just three massive companies, each with more than $100 billion in annual revenue. Via Wall Street Journal.

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Health Care Costs Rise Again, and the Burden Continues to Shift to Workers

American workers saw their out-of-pocket medical costs jump again this year, as the average deductible for an employer-provided health plan surged nearly 9 percent in 2015 to more than $1,000, a major new survey of employers shows. The annual increase, though lower than in previous years', far outpaced wage growth and overall inflation and marked the continuation of a trend that in just a few years has dramatically shifted health care costs to workers. Via LA Times. 

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HHS Vows Push To Enroll More Uninsured In Obamacare This Fall

The health law’s upcoming enrollment period may be its toughest yet, with federal officials promising a vigorous outreach campaign to enroll millions of eligible yet hard-to-reach Americans who have yet to sign up for health insurance. This year’s enrollment campaign will be harder in part because officials will be pursuing those who have declined to sign up for health insurance during the two previous enrollment seasons. About half of those who qualify for coverage on the health law’s exchanges, or marketplaces, are ages 18 to 34. Via Kaiser Health News.

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High Deductibles More Common in Exchanges Than in Employer Plans

The Affordable Care Act created an individual market with premium subsidies on par with the dominant employer-based market, but the new plans are more likely to have high deductibles, according to a new Commonwealth Fund survey. The Commonwealth Fund surveyed almost 5,000 adults with ACA exchange or employer coverage and found that the costs of premiums were relatively similar. Roughly 60% of those with ACA plans either paid no monthly premium or less than $125, compared with 55% of people with employer plans. Employers subsidize the vast majority of their workers' health insurance premiums, and the government offers subsidies for the millions of Americans now enrolled in coverage through the exchanges. Via Modern Healthcare.

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HealthCare.gov Faulted for Weak Cybersecurity

The federal government stored the sensitive personal data of millions of people who purchased insurance through ObamaCare on a network with basic cybersecurity flaws, a federal audit revealed. HealthCare.gov, the much-maligned federal exchange for health care coverage, suffered from a number of security issues, according to the inspector general at the Department of Health and Human Services (HHS). Via The Hill.

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Expect More Health Systems to Get in the Insurance Game

Health insurance is a competitive and volatile business, as some health systems that have entered the market have painfully discovered.  But they're making the leap because the payoff is often a bump in revenue at a time of slow growth for hospitals.  “In the next several years an increasing number of not-for-profit hospitals will enter the commercial health insurance business, looking to improve care management and gain market share,” said a report released last week from Moody's Investors Service. Via Modern Healthcare.

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Patient Engagement, Coordination Key to Health Care Reform

The health care industry has been transformed in recent years due to ongoing reforms and medical technology adoption. Patient engagement, for instance, has been a key aspect of health care reform. Meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs has pushed forward the need for patient engagement and enabled patients to access and download their electronic health data. Via mHealth Intelligence.

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Presidential Candidates in Fantasy Land Over Health Care

Presidential candidates from both parties are full of sound and fury about various aspects of the U.S. health care system, but unless we as a nation get serious about big money in politics, all the noise will ultimately amount to nothing. Every one of the Republican candidates has pledged to repeal and replace the Affordable Care Act. But I’m not sure they realize that the interests of the insurance and pharmaceutical industries,  as well as hospitals and physicians, were considered first and foremost as the law was being drafted. Via The Center for Public Integrity.


How to Manage Increasingly Higher Medical Deductibles

Despite recent gains in the number of Americans who have health insurance, many people are still faced with paying for care out of pocket because of high deductibles. A new analysis from the Kaiser Family Foundation found that while health care premiums were growing modestly, employers were continuing to shift costs to workers in the form of higher deductibles — the amount patients must pay before their insurance kicks in. More workers have general annual deductibles, and the average this year is more than $1,300 for a single person, Kaiser found. Via NY Times.

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A Health-Care Model in Coal Country

A hospital system in Pennsylvania’s coal country has become a national poster child for the kind of carefully coordinated, data-driven health care that experts say one day could right the nation’s troubled medical system, providing better care at lower costs. Geisinger Health System, whose decades of investment in technology and integration have made it a pioneer in the use of electronic medical records and other data, dominates most of the rural markets it serves. The system focuses to an unusual degree on avoiding unnecessary procedures, in part because it also runs an insurance company that covers many of its patients. Via The Wall Street Journal.

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Kelley Schreiber

Kelley Schreiber is a Marketing Channel Manager at Mayo Medical Laboratories. She is the principle editor and writer of Insights and leads social media and direct marketing strategy. Kelley has worked at Mayo Clinic since 2013. Outside of work, you can find Kelley running, traveling, playing with her new kitten, and exploring new foods.