1. Evaluation of Medicare’s Bundled Payments Initiative for Medical Conditions. Karen E. Joynt Maddox, E. John Orav, Jie Zheng and Arnold M. Epstein. N Engl J Med 2018;379:260-9. https://www.ncbi.nlm.nih.gov/pubmed/30021090
2. Medicare ACO Program Savings Not Tied to Preventable Hospitalizations or Concentrated among High-Risk Patients. J. Michael McWilliams, Michael E. Chernew and Bruce E. Landon. Health Affairs 36:2017;2085–2093. https://www.ncbi.nlm.nih.gov/pubmed/29200328
3. Care patterns in Medicare and their implications for pay for performance. Pham, H. H., D. Schrag, A. S. O’Malley, B. Wu, and P. B. Bach. New England Journal of Medicine 2007; 356(11):1130-1139. https://www.ncbi.nlm.nih.gov/pubmed/17360991
4. Time Out — Charting a Path for Improving Performance Measurement. Catherine H. MacLean, Eve A. Kerr and Amir Qaseem. N Engl J Med 2018: 378;19.
5. Adherence and health care costs. Iuga AO and McGuire MJ. Risk Manag Helathc Policy 7:35-44, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/
6. Greater Use of Preventive Services in U.S. Health Care Could Save Lives at Little or No Cost. Michael V. Maciosek, Ashley B. Coffield, Thomas J. Flottemesch, Nichol M. Edwards and Leif I. Solberg. Health Affairs 29: 2010;1656–1660. https://www.ncbi.nlm.nih.gov/pubmed/20820022
7. Healthy Aging Brain Center improved care coordination and produced net savings. French DD, LaMantia MA, Livin LR, Herceg D, Alder CA, Boustani MA. Health Affairs 2014;33:613-8. https://www.ncbi.nlm.nih.gov/pubmed/24711322
8. Adding value to relative-value units. Stecker EC and Schroeder SA. N Engl J Med 2013;369 (23):2176-79. https://www.nejm.org/doi/10.1056/NEJMp1310583?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov
9. Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper. Robert B. Doherty and Ryan A. Crowley, for the Health and Public Policy Committee of the American College of Physicians. Ann Intern Med 2013:159;620-626. http://annals.org/aim/fullarticle/1737233/principles-supporting-dynamic-clinical-care-teams-american-college-physicians-position
10. Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries. Antonia K. Bernhardt, Joanne Lynn, Gregory Berger, James A. Lee,Kevin Reuter, Joan Davanzo, Anne Montgomery and Allen Dobson. The Milbank Quarterly, 2016;1-29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020161/
RESEARCH FOUNDATION REPORTS:
1. Uncompensated Care for the Uninsured in 2013: A Detailed Examination. Teresa A. Coughlin, John Holahan, Kyle Caswell, and Megan McGrath. www.kff.org. May 30, 2014 https://www.kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/
2. Chronic Care: Making the case for ongoing care. Anderson, GF. Princeton, NJ: Robert Wood Johnson Foundation. 2010. The Effects of Medicaid Expansion under the ACA: Updated Findings from a literature Review, Larisa Antonisse, kff.org, Sep 2017 https://www.rwjf.org/en/library/research/2010/01/chronic-care.html
3. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013). The National Academies Press Open Book. http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx
4. How have providers responded to the increased demand for health care under the Affordable Care Act? Wishner JB and Burton RA. Urban Institute, November 2017. https://www.rwjf.org/en/library/research/2017/11/how-have-providers-responded-to-the-increased-demand-for-health-care-under-the-aca.html
5. The cost and volume of comparative effectiveness research. In Learning what works: Infrastructure required for comparative effectiveness research: Workshop summary. Holve, E., and P. Pittman. Institute of Medicine. Washington, DC: The National Academies Press. 2011:89-96. https://www.nap.edu/read/12214/chapter/2#10
6. Employer Health Benefits: 2017 Annual Survey. Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, Gregory Foster and Heidi Whitmore. The Kaiser Family Foundation and Health Research & Educational Trust. 2017. https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/view/print/
1. Centers for Medicare and Medicaid Services Financial Report, 2017. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwj63u_W0PTdAhVfIzQIHZnlAmMQFjAAegQIChAC&url=https%3A%2F%2Fwww.cms.gov%2FResearch-Statistics-Data-and-Systems%2FStatistics-Trends-and-Reports%2FCFOReport%2FDownloads%2F2017_CMS_Financial_Report.pdf&usg=AOvVaw1-Udg09bY8IZdj9vcX5H_l
2. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy. Chapter 13. “Status report on the Medicare Advantage Program.” March 2017. http://www.medpac.gov/-documents-/reports
LOW-WAGE WORKERS CAN'T AFFORD EMPLOYER-BASED HEALTH INSURANCE--IF THEY CAN GET IT.
Only one-third are even offered health insurance, and most can’t get a family plan. Their premiums are almost a third of their annual salary and their deductibles are twice as high as those for higher-wage workers. Even higher-wage workers who can better afford their insurance often struggle with out-of-pocket costs. Medicare for All and public option plans would offer better coverage for most of these workers. Axios
EMPLOYER HEALTH INSURANCE TOPS $20,000
Workers pay more in premiums and deductibles. Costs outpace inflation. Employer health plan look good last year? Maybe not this year--or next year. Low-wage workers often don't get any insurance, but if they do, they just can't afford it. That's why Medicare for All makes sense--workers deserve health care they can afford. Kaiser Family Foundation
Lisa Mears-Morris, left, and Latonya Gwynn go over resident files at Weinberg Villages, a housing complex for low-income seniors in Owings Mills, Maryland. The two are part of a national experiment aimed at helping seniors age in place. The idea is to improve their quality of life while cutting down on unnecessary trips to the emergency room.The Pew Charitable Trusts.
HOME CARE SAVES MEDICARE UP TO $1,450 PER PERSON EACH YEAR. That's want the Department of Health says of a in national pilot program funded by the Department of Housing and Urban Development that puts nurses and coordinators in affordable senior housing complexes. Visits to ERs, hospitals and specialists go down. And more seniors stay at home instead of winding up in nursing homes or rehab facilities. Medicare for All increases coverage for outpatient services like these. This is one way it will save money. Pew Trust. September 24, 2019. On-site Health Care Could Help Seniors Stay At Home.
WHAT DO DOCTORS THINK? THE AFFORDABLE CARE ACT IS GOOD FOR HEALTHCARE. INSURANCE COMPANIES ARE NOT.
In a study reported in the September 2019 issue of Health Affairs, researchers surveyed U.S. physicians in 2012 and 2017. The majority of doctors now say the ACA has improved healthcare (53%, up from 42% 5 years earlier). At the same time, doctors say insurance companies have made it harder for them to care for their patients—67% say they now spend more administrative time on insurance issues and 59% say they have less time to spend with patients. Medicare for All would reduce the time doctors waste on administration and give them more time with their patients. That would also save money.
SHORT-TERM HEALTH PLANS PROVIDE PROFITS, NOT HEALTHCARE.
An analysis by the government (the Center for Medicare and Medicaid Services) and the Association of Insurance Commissioners came to the same conclusion: the short-term health plans President Trump is promoting to allow states to bypass the Affordable Care Act are cheap because the insurers spend very little of the premium dollars they receive on healthcare for their policyholders. They range from 10% to less than 80% (and almost all spend less than 60%). The ACA requires insurers to spend at least 80-85% (depending on the size of the group). Where does the rest of the money go? Profits. LA Times Aug 12, 2019
THE TRUTH ABOUT MEDICAID WORK REQUIREMENTS.
Some states are now adding work requirements to Medicaid eligibility, but a recent study by the Kaiser Family Foundation shows the large majority of Medicaid adults are already working or unable to work. Two-thirds are working, and 23% are either disabled, sick, or the primary caregiver for someone who is disabled or sick. Only 7% are not working due to retirement, inability to find work or some other reason. Adding work requirements to Medicaid eligibility will only make it harder for those in need to document that they are eligible, putting more people at risk of worsening health outcomes and costing states even more money in the end.
MEDICARE PART D CASTASTROPHIC COVERAGE LEAVES 1 MILLION WITH HUGE OUT-OF-POCKET COSTS DUE TO EXPENSIVE DRUGS. A survey by the Kaiser Family Foundation reported on June 21, 2019 showed that in 2017, out-of-pocket spending for Medicare Part D enrollees who did not qualify for low-income subsidies had out-of-pocket spending above the catastrophic level. Their costs averaged over $3,200. The 10 drugs with the highest costs were for treatment of cancer, hepatitis C and autoimmune diseases. Their out-of-pocket costs averaged over $5,000 per drug. These costs to patients are because of the lack of any cap on out-of-pocket spending. Instead, Medicare Part D enrollees must pay 5% of drug costs after the catastrophic limit has been reachedCatastrophic coverage is not working for a large number of Medicare patients. Medicare for All would eliminate all deductibles and copayments and limit out-of-pocket costs for drugs to $200 a year.
ACAMFA JOINS NATIONAL GRASSROOTS CAMPAIGN FOR LOCAL COMMUNITY ACTION. ACAMFA has joined a major campaign that was launched in April 2019 by several national organizations. Medicare for All Resolutions is a grassroots effort to have local governments pass resolutions in support of Medicare for All. The healthcare costs to local governments have become overwhelming. It is time for them to have their voices heard by Congress. Learn how to get involved and start a local action in your community at www.medicare4allresolutions.org
or contact us.
ONE CAUSE OF HIGH DRUG COSTS? NYS AUDIT FINDS CVS OWES OVER $2 MILLION IN DRUG REBATES TO STATE.
June 12, 2019. New York State audited rebates from 6 drugmakers to CVS Health and found significant failures. CVS has paid $2.3 million to the State for outstanding claims from 2016 and 2017 and still owes over $300,000 more. CVS and other pharmacy benefit managers (PBMs) are under scrutiny by NYS and federal regulators for practices said to contribute to skyrocketing drug prices, like pocketing rebates instead of passing them on to plan holders or patients, and giving preference to high-cost drugs that they can get big rebates on, boosting their fees, instead of low-cost drugs that benefit everyone else. 3PBMs negotiate discounts from drug companies, but who gets the money.
NEW SURVEY SHOWS HIGH-DEDUCTIBLE PLANS ARE FINANCIAL BURDEN FOR MOST.
Over 20% with employer health insurance benefits have high-deductible plans. Most of them don’t have savings to cover their deductible and skipped or delayed treatment because of cost. Many have to increase credit card debt or take an extra job. Kaiser Family Foundation.
PRIVATE HEALTH INSURANCE COMPANIES TAKE ADVANTAGE OF MEDICARE PART C “ADVANTAGE” PLANS. About 30% of people on Medicare sign up for Part C instead of standard Medicare to get extra perks like gym memberships and drug plans, usually for an extra premium. The plans are supposed to lower costs, but Medicare does not save any money on them. Information from whistle-blowers now shows that Medicare Advantage plans extract billions of dollars in excess payments from Medicare by “cherry picking” the healthiest patients to enroll and “lemon dropping” patients with serious illnesses or large claims, convincing them to drop their coverage (both illegal practices). They also select the codes they use for diagnoses to ensure the highest reimbursement (upcoding). Estimates of the cost to Medicare in overpayments are more than $10 billion a year. Private health insurance companies are making big profits on Medicare Part C without reducing costs to Medicare or patients. According to Medicare, they don’t always get their profits by legal means.The New Yorker. Feb. 4, 2019.
WHAT’S THE FASTEST RISING HEALTHCARE COST? According to the Bureau of Labor Statistics, the cost of private health insurance is rising faster than other costs in healthcare. It rose more than 10% while the cost of professional services and hospital services rose 0.4% and 1.4%--less than overall inflation. It’s all due to the growth of managed care, including Medicare Advantage, Medicaid managed care and commercial insurance, according to Paul Hughes-Cromwick, an economist at Altarum Institute. The eight largest publicly traded insurers posted net income of $9.3 billion in the first quarter of 2019, an increase of almost 30% with combined profits of almost $22 billion over the course of 2018. Modern Healthcare. May 17, 2019.
LOCAL GOVERNMENTS OVERWHELMED BY RISING HEALTHCARE COSTS. A survey from the state School Boards Association showed that school employee health care costs are expected to increase more than 6% next year—much higher than inflation. Premiums cost between $8,900 and $24,000 a year (depending on single or family coverage). Teachers contribute between 13% to 16% of the cost. And between 2013 and 2018, costs in New York State rose 22% compared to aid to local school districts, which rose only 10%. The bulk of increases is from the cost of prescription drugs. “These increases will be unsustainable in the long-term,” said Michael Borges, executive director of the business officials group. Getting concessions in health costs was the top priority in recently negotiated contracts and 70% of districts got some savings from health costs in their most recent contracts. Healthcare costs are rising beyond the ability of local budgets to cope. Cutting benefits is the short-term answer. Where do they turn when there is nothing left to cut? Times Union. (Albany) April 13, 2019.
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PRICES FOUND TO BE UNRELATED TO CLINICAL BENEFIT OF CANCER DRUGS. A study published in Lancet Oncology looked at 65 drugs approved in the U.S. and Europe between 2009 and 2017 and found that costs were 2.3 times higher in the U.S. But nowhere were costs tied to the value of treatment. Whether the drugs offered minimal or large benefits to cancer patients made no difference in how much they cost. This non-sensical approach to paying for treatments argues for a better way to evaluate drugs and determine their prices. There are models for doing this.