What’s New in Health Care Reform: Nov. 18

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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.


Mayo Clinic: Medicare Payments Should Recognize Complexity of Patients, Health Care

Mayo Clinic is urging the Centers for Medicare and Medicaid Services to keep the complexity and diversity of health care and patients in mind as it shifts physician payments from volume-based reimbursement to one based on the value of the care provided. Via Mayo Clinic News Network.

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New Health Plans Offer Discounts For Diabetes Care

Talk about targeted. Consumers scrolling through the health plan options on the insurance marketplaces in a few states this fall may come upon plans whose name — Leap Diabetes Plans — leaves no doubt about who should apply. Via Kaiser Health News. 

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Many Say High Deductibles Make Their Health Law Insurance All But Useless

Obama administration officials, urging people to sign up for health insurance under the Affordable Care Act, have trumpeted the low premiums available on the law’s new marketplaces. But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage. Via NY Times.

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More Doctors Offering Direct-Pay Health Care

Health care providers say they are transitioning to direct-pay medicine because they are able to spend more time with fewer patients, which allows them to drill down to the cause of a medical issue instead of ordering extra tests. The doctors are also more readily available to patients after hours. Via USA Today.

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Obamacare Signs Up 543,000 In Week One, Outpacing Last Year

In total, 543,098 people picked plans on the U.S.-run website for health insurance. HealthCare.gov opened for business on Sunday, Nov. 1, about two weeks earlier than last year, when about 462,000 people signed up for coverage during the first week of enrollment. The numbers aren’t perfectly comparable to last year, because Hawaii is now using the U.S. system. Via Bloomberg.

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Study Finds Marketplace Silver Plans Offer Poor Access To HIV Drugs

In most states, consumers with HIV or AIDS who buy silver-level plans on the insurance marketplaces find limited coverage of common drug regimens they may need and high out-of-pocket costs, according to a new analysis. In 31 states and the District of Columbia, silver-level plans cover fewer than seven of the 10 most common drug treatment options or charge consumers more than $200 a month in cost sharing, according to an analysis of 2015 silver plans by consultant group Avalere Health. Only 16 percent of those marketplace plans cover all 10 of the top HIV/AIDS drug regimens and charge less than $100 a month. Via Kaiser Health News.

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Obamacare No Help To Those Who Want To Quit Smoking

There have been lots of criticisms of Obamacare from its early clunky website to claims it is forcing companies to shed jobs. But here’s a new one: some of its provisions designed to encourage Americans to quit smoking are creating difficulties for the poorest Americans. Via U.S. News & World Report.

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Many Eligible for ObamaCare Subsidies Not Claiming Them, Study Finds

Most of those eligible for health insurance subsidies under the Affordable Care Act are failing to claim them, according to a new study. Researchers with the Robert Wood Johnson Foundation and the Urban Institute estimated that more than 24 million people were eligible for ObamaCare tax credits last year. By March, only 41 percent of them had selected a plan on a government insurance exchange. Via Fox News.

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Millions Face Premium and Deductible Sticker Shock under Obamacare

Millions of Americans who recently began shopping for new health insurance coverage under Obamacare may be suffering from sticker shock. Increases in 2016 premiums for health insurance coverage -- ranging from basic to top-flight policies -- will be in the double digits and easily eclipse premium hikes recorded between 2014 and 2015, according to a new analysis from consulting firm McKinsey & Co. Via The Fiscal Times.

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Companies Continue Chipping Away at Health Insurance Benefits

Companies’ health care costs in 2015 rose at the lowest rate in at least 20 years, a report shows, but workers' share of costs continue to skyrocket. The average health care rate increase for mid-sized and large companies was 3.2% this year, the lowest since the consulting firm Aon started tracking it in 1996. Despite this, the average amount workers have to contribute toward their health care is up more than 134% over the past decade and that trend will accelerate. Via USA Today.

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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.