Employee Benefit Solutions, Inc.

“CCIIO is encouraging states to allow “unloaded” ACA plans to be offered outside of the marketplace. This includes silver plans (where a state or insurer is using silver loading) or all metal level plans (where a state or insurer is using broad loading). The guidance essentially gives CCIIO’s blessing to states and insurers who have been or would like to restrict CSR loading to on-marketplace plans only.”

More details at HealthAffairs:

https://www.healthaffairs.org/do/10.1377/hblog20180805.711405/full/

H.R. 6199, renamed the Restoring Access to Medication and Modernizing Health Savings Accounts Act and passed by a margin of 277-142, would:

• Reverse the Affordable Care Act’s (ACA’s) prohibition on using tax-favored health accounts to purchase over-the-counter medical products.

• Treat menstrual care products as qualified medical expenses that could be purchased with all tax-advantaged health care accounts.

• Treat certain sports and fitness expenses–including gym memberships and the cost to participate in certain physical exercise programs–as qualified medical expenses up to a limit of $500 a year for an individual and $1,000 a year for a family.

• Allow high-deductible health plans (HDHPs) to cover up to $250 (self-only) and $500 (family) annually for nonpreventive services that currently may not be covered predeductible. This would let HDHPs cover outside the deductible, albeit on a limited basis, chronic-condition treatment and telehealth services, for example.

• Permit individuals with HSA-qualifying family coverage to contribute to an HSA if their spouse is enrolled in a medical flexible spending account (FSA), currently a disqualifying scenario.

• Allow limited use of employer onsite medical clinics and other employment-related health services without risking HSA eligibility.

• Protect HSA-eligible individuals who participate in a direct primary care (DPC) arrangement from losing their HSA eligibility and allow DPC provider fees to be covered with HSAs (capped monthly at $150 per individual and $300 per family).

Read more coverage at SHRM:

https://www.shrm.org/ResourcesAndTools/hr-topics/benefits/Pages/House-passes-bills-enhancing-HSAs-FSAs-HRAs.aspx

Contributor Bruce Japsen writes in Forbes (7/25) that Anthem’s move “to exit some individual markets under the Affordable Care Act in favor of growing its Medicare business helped boost profits in the health insurer’s second quarter.” This allowed the insurer to “increase profits by 23% to $1 billion, or $3.98 per share, compared to $855 million, or $3.16 per share, in the year ago period.” Revenue rose by 2 percent to $21.2 billion. Data show that during “the second quarter, Anthem added 254,000 Medicare members thanks in part to acquisitions the company made in south Florida, a lucrative market for Medicare Advantage plans.” CEO Gail Boudreaux said the company intends “to invest more in operations and acquisitions in the Medicare Advantage business, which has helped offset the loss of medical members.”

“Artificial intelligence technology will play a vital role in the success of value-based care models, and it also promises to improve clinical care, writes attorney Pamela Hepp of Buchanan, Ingersoll & Rooney. However, the adoption of AI in health care raises legal and regulatory issues, including determination of responsibility for poor outcomes, data breaches, and guidelines for licensure and malpractice:

From Scientific American: “Regardless, these clinical applications raise interesting legal questions. For example, if there is an untoward outcome, who is liable—the physician, the manufacturer of the robot under a product liability claim, or both? These machines and devices also store patient data, leading to HIPAA privacy and security concerns in connection with the sharing and storing of such data. On the other hand, artificial intelligence may help health organizations in addressing cyber security by predicting ransomware attacks and other types of unauthorized activity.

Another issue: if a robot is delivering care, how is it regulated? The Food and Drug Administration currently regulates devices, but the practice of medicine is regulated at the state level through licensure by boards of medicine. Will additional licensure or regulatory scrutiny be required if the devices supplant the physician’s practice of medicine? Will such technology become the “standard of care,” such that its use is expected in patient care and the failure to use it could result in malpractice?”

Full Article @ Scientific American

A Medicare Trustees report released Tuesday finds that Medicare’s trust fund will be depleted in 2026, three years earlier than last year’s report found.

“The Trustees recommend that Congress and the executive branch work closely together with a sense of urgency to address the depletion of the [trust fund] and the projected growth [in spending],” the trustees report states.

A report from the Office of the Inspector General finds the following:

• Total reimbursement for all brand name drugs in Part D increased 77 percent from 2011 to 2015, despite a 17 percent decrease in the number of prescriptions for these drugs.
• After accounting for manufacturer rebates, reimbursement for brand name drugs in Part D still increased 62 percent from 2011 to 2015.
• Part D unit costs for brand name drugs rose nearly 6 times faster than inflation from 2011 to 2015.
• The percentage of beneficiaries responsible for out of pocket costs of at least $2,000 per year for brand name drugs nearly doubled across the 5-year span.

WHAT WE CONCLUDE

Our findings show that although there were fewer prescriptions for brand name drugs in 2015 than in 2011, increases in Part D unit costs for brand name drugs led to greater overall Medicare Part D spending and higher beneficiary out of pocket costs for these drugs. Generally, plan sponsors base their reimbursement amounts on the prices that manufacturers set for their drugs. Therefore, increasing manufacturer prices for brand-name drugs may result in increasing costs for Medicare and its beneficiaries, especially those beneficiaries who need access to expensive maintenance drugs.

The complete report can be seen online:  https://oig.hhs.gov/oei/reports/oei-03-15-00080.asp

From 2015 to 2016, the percentage of small firms offering medical coverage through a self funded health plan grew from 10% of firms to 15% of firms (that’s a single year increase of 50% and a much faster shift than we have seen in the past for migration to things like High Deductible Health Plans / HSAs).

While fully insured may still cover the lion’s share of small group health plans currently, the trend of self-funded or ‘level-funded’ contracts in the small group market continued to accelerate in 2017 and doesn’t show signs of slowing down in ’18.

Read the issue brief from Employee Benefit Research Institute:

EBRI_IB_442

Interesting findings from the latest study from FAIR Health:

• From 2007 to 2016, urgent care centers showed an increase in claim lines of 1,725 percent—a growth rate more than seven times that of ER claim lines (229 percent) in the same period;

In retail clinics and urgent care centers in 2016, acute respiratory infections, such as the common cold, were the number one diagnostic category—but in telehealth, mental health-related diagnoses were the number one diagnostic category;

• Across all places of service studied in 2016, more claim lines were submitted for women than men in every adult age group;
• In 2016, the median charge for a 30-minute new patient office visit (CPT®1 code 99203) ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic;
• From 2007 to 2016, claim lines for ASCs increased more in rural (127 percent) than urban (95 percent) areas; and
• The age group 31 to 40 years accounted for the greatest percent of claim lines among patients using urgent care centers (18 percent),

but among those using telehealth, the peak age groups were 41 to 50 and 51 to 60 years (each 19 percent).

Read the full report: FH Medical Price Index and FH Healthcare Indicators–white paper

Findings  In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending.

Conclusions and Relevance  The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.

Full Report from JAMA: https://jamanetwork.com/journals/jama/article-abstract/2674671?redirect=true