Tuesday, July 18, 2017

After hospital closes, hope for healthcare coming back to Crockett

CROCKETT, TX (KTRE) -The past 17 days have been difficult for Crockett area residents looking for healthcare.

The Crockett Clinic opened its doors for the first time this morning for the first time since Little River Healthcare close Timberlands Hospital at the end of June due to financial issues.

"We have been a clinic here for 50 years," Dr. Christopher Haeckler said. "We were only managed by Little River for three months. When they announced they were closing, we had to shut down and make sure we got all of our accounts back opened in our name, so we could operate."

The clinic does primary care and can see people of all ages. They are currently working on getting permits back to do X-rays as well. The shock still has not worn off.

"It's like running into a brick wall," Haeckler said. "One minute everything is okay, and then the next, you are being called over to the hospital and being told that you are getting shut down. We are very fortunate that we could go back to work, but the community is pulling together the best they can."

The clinic being opened was good news to George Gale, who brought his wife for an early afternoon appointment. The couple lives in a subdivision on Houston County Lake and just driving to Crockett takes 20 minutes. Gale is concerned that it will only get worse the longer the city goes without a hospital.

"We have to go to Palestine, Lufkin, or Nacogdoches," Gale said. "Elderly people are just not in shape to drive over there, and some can't drive it. They have to have a hospital here."

Inside the hospital, it is quiet. There is very little activity except for a dentist office and a foot doctor that operate as private practices. Crockett Dental Care has been inside the hospital building for 17 years. The closure came as a shock for them. Everyday, the staff still goes outside at noon to pray for a resolution. It is a practice that started the day after the closure was announced.

"We know we are going to have healthcare," said Office Manager Laura Holcomb. "We don't know what shape or form that is going to be, but we know we need it and that God will provide."

Inside the office, just like at business across the county, a coin jar is set up to collect change that will be donated to the Houston County Hospital Board with expenses they now have.

"We had a 25-year lease with Little River," Holcomb said. "We did not think about having to do fund-raising efforts. Now the board has expenses they did not think about like yard work and attorney fees."

As the days count on, someone has left a message on the sign that once said Timberlands. It is a message to help people remember the struggle facing the community. It is a sign that simply reads, "Keep Hope Alive." Holcomb smiled when she thought about the sign.

People can donate to the fundraising effort by dropping off funds at: The Grapeland Messenger, Twisted Sister, Lucky Cleaner, Knox Furniture, The Houston County Courier, The Moosehead Cafe, Davy Crockett Drug, Crockett Dental Care, The Houston County CO-OP, Mike's Corner Store, Lovelady State Bank, and Prosperity Bank.

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Thursday, July 13, 2017

Provider-sponsored plans carry on, despite hefty losses

Northwell's CareConnect in New York City rides losses, boosts premiums to stay in market.

It seems simple enough: A provider wanting to move into value and looking to gain the population health prowess needed to get there decides to sponsor a health plan.

Sometimes it works, but recently there's been harsh examples showing how it hasn't.

Health systems backpedaling their decision by recently divesting of health plans that put them in the red include Catholic Health Initiatives of Englewood, Colorado and Tenet Healthcare in Dallas.

Other providers that have been resetting their business plans due to insurance losses include Texas Children's Hospital in Houston, Banner Health in Phoenix, and Partners HealthCare System in Boston.

The majority provider-sponsored plans have not even produced savings, according to independent consultant Paul Keckley.

"It's hard to get scale, to get enrollment, especially where you get dominant in the market," Keckley said. "They've run into challenges."

But when he talks to clients, Keckley finds that most didn't enter the insurance game to make money.

"They went in for the long-term population health management," Keckley said. "This is an excuse to get doctors to work together."

Systems that are making it work have said they were modest about expectations going in, he said.

One example is the Marshfield Clinic Health System and Security Health Plan in Wisconsin. Its two hospitals, 40 clinics and health plan are thriving if CFOs can base that definition on a margin of 1 to 2 percent.

Another success is Sentara Healthcare and its health plan Optima Health in Virginia.

"Running a hospital is very different from running a health plan," said Michael Dudley, president and CEO of Optima Health and senior vice president of Sentara Healthcare. "It takes a lot of patience and a lot of time. It takes time in terms of several years, for people to understand both sides of the equation. Hospital administers are designed and have the incentive to fill hospital beds. A health plan executive is designed to help people stay healthy and not need healthcare."

Providers taking on the disparate businesses of treating patients and then taking the responsibility for paying for that treatment seems like a crazy business model. But as Woody Allen said about accepting craziness from a guy who thought he was a chicken, "We need the eggs."

Providers need the information, the data and the population health. If there's one certainty providers agree on, it's that the move to value-based care will continue.

"I think from the standpoint of population health management, it gives you a perspective," said Richard Miller, deputy CFO, business strategy for Northwell Health and senior vice president, payer relations and contract development. "Without having a health plan, we wouldn't have that level of insight around care management and analytics."

Managing a plan is harder than you think, said Howard Gold, Northwell's executive vice president, chief managed care and business development officer. "It's not for the faint of heart. I think providers can do well on certain kinds of value-based contracts, bundled payment or shared savings. A lot of that rests on how providers organize and deliver care, not the funding mechanism. The issue is, is there enough money in value-based  programs, or does value-based take funding away from providers?"

Having a health plan gave Northwell more knowledge on how to handle shared savings and even risk contracts, Gold said.

New York-based Northwell Health, formerly the North Shore-LIJ Health System, suffered losses due to its health plan CareConnect. It originally set premium prices low because it was a narrow network, and also ran up against risk adjustment numbers that favored the larger Oxford Health Plan owned by UnitedHealthcare.

Northwell is in the number two spot for business, right behind Oxford, Miller and Gold said.

Northwell posted an operating loss of $36.2 million during the first quarter, with $22.7 million of that from losses in CareConnect's individual and small group plans.

The losses were due to federal risk adjuster methodology in the small group line of business, which represents about 80 percent of the business.

In the budget neutral risk adjustment system, CareConnect had to pay $130 million in 2016 because the government deemed its members were less sickly than the populations served by other plans in the New York City metropolitan area.

State regulators have since agreed to reduce the risk adjustment by 30 percent in 2018 and 40 percent in 2019, in a move signaling recognition of CareConnect's higher cost for member care.

Northwell has filed for a 30 percent premium increase in its individual line of business, and for a 20 percent hike in small group.

Both products are sold on or off the exchange.

"The relief from New York State partially helps us to move towards a breakeven or better financial result," Gold said. "The rate increase, both in the small group and individual line, we believe will move us in the right direction."

Even with the premium increase, CareConnect has a low-priced insurance product compared to the market, Gold said.

"It does move us closer to break even," Miller said. "We're pricing products to be sustainable."

Northwell and CareConnect have made a decision to stay in the commercial line of business. For individual and small group, "we're here to stay for now, and do what we have to do to fix it," Gold said. "We may get more relief depending on what's happening in Washington on risk-adjuster."

Northwell started the health plan in 2014 to take advantage of the newly insured under the Affordable Care Act and Medicaid expansions in 31 states and the District of Columbia, according to Miller and Gold, who serve on the board of the Northwell Health Plans Holding Company.

"The rationale was to enter with a narrow network product around our providers, but not (be) exclusive," Gold said. "By having our own insurance company, patients to the extent they needed healthcare, would use our healthcare and physicians. We thought that would give us a competitive edge. More would come into the health system and stay in network."

That has happened, he said.

"The more we're in it, the better results we'll have."

Alan Murray, CEO of CareConnect, said Northwell CEO Michael Dowling recruited him to work in the managed care environment to see how the system could move into risk. That's when CareConnect was founded three-and-a-half years ago.

"The reason Northwell started this was to be in the business of keeping people well, to be part of an integrated delivery system," Murray said.

If not for the risk-adjustment, by any other measure, CareConnect is successful, Murray said.
It has a medical loss ratio under 80 percent, an integrated arrangement with the health system and a large amount of value- based contracting. Administrative costs are running about 15 percent.

"Next year we'll probably break-even if get rate increases," Murray said. "The cultural impact of owning the medical risk of a population is not just your ability to manage a population, you have to retain them from a medical experience. We focus heavily customer experience."

Programs to improve care include Northwell Health Solutions that coordinates home visits and takes responsibility for patients for 30 days post discharge from the hospital or emergency room.

"If you're going to start an insurance company, you're starting a completely new business," Murray said. "Like any other business, you have lessons learned as you move forward. Very few businesses start up and start making a profit in three years."

Sentara Healthcare, which owns the health plan Optima Health, has been successful in the provider-sponsored business for a number of years.

Optima Health offers commercial products including employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

Sentara Healthcare, which has 12 hospitals, also contracts with non-Sentara providers.
Optima is about halfway down the continuum to value-based agreements, moving towards the total cost of care targets and taking risk, Dudley said.

It will stay in the exchange market, Dudley said, though it also had adverse selection and the risk adjusters did not fully make up for the losses sustained.

"For those providers who got into health plan business last five years, a start-up is tough," Dudley said. "If there isn't good experience and knowledge to anticipate risk, there might be losses."

To be successful, a provider-sponsored health plan must have everyone in the organization aligned on goals and have experienced leadership on the health plan side, he said.

Health plans need to have enough enrollees to be competitive on pricing. Many of the 140 provider-sponsored health plans in a recent Robert Wood Johnson Foundation report were only able to price competitively by paying their own providers below-market rates.

The report found that most provider forays into health insurance have failed financially. Of 37 provider-sponsored health plans that have formed since 2010, only four were profitable in 2015, according to the report released in June by Allan Baumgarten, an independent research analyst.

"This is risky business for providers to get into," Dudley said. "For those of us who have been it for a number of years, we've had made it work. We foresee we will see strong results going forward."


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Friday, June 23, 2017

Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard

For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.

Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.

"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.

The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.

That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.

And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.

"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."

All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.

Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.

"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.

But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.

Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.

"So we're still providing care, but we're no longer being compensated," Noble says.

And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.

The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.

"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.

In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.

"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.

"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.

For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.

"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"

Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.

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Friday, June 2, 2017

Viet Nam News - Hospital fees hike for the uninsured

HÀ NỘI – Some 50 hospitals will impose a fee hike for people without health insurance from Thursday (June 1).

The fees will be applicable at special-class and first-class hospitals of the Ministry of Health and hospitals under sectors.

The fee hike for the uninsured will be imposed in 30 provinces in August, another 15 provinces in October and the remaining 18 provinces in December.

 Accordingly, nearly 1,900 different services and products at public healthcare facilities will become more expensive for the uninsured.

Healthcare service fees that have been adjusted include those for health check, technical service and testing.

Specifically, the fee for a health check will increase from VNĐ20,000 (US$0.8) to VNĐ39,000 ($1.7) at special-class and first-class hospitals.

Bed charge for intensive care and for patients undergoing organ transplants at special-class hospitals will hike from VNĐ354,000 ($15) to VNĐ677,000 ($29).

Operation and surgery fees will be more expensive by 20 to 30 per cent.

Lê Văn Phúc, deputy head of Việt Nam Social Insurance’s Health Insurance Policy Department, said the fee hike this time is significant for in-patients, patients being treated for a long period without holding health insurance or those using technical services and testing. For example, positron emission tomography-computed tomography (PET/CT) will cost over VNĐ20million ($867).

The move makes the fees for the uninsured equal to the current fees applied for people with health insurance.

“The basic difference between the insured and uninsured is 80-100 per cent of the hospital fee of the insured will be covered, while the uninsured have to pay 100 per cent,” Phúc said.

According to Nguyễn Nam Liêm, head of the ministry’s Department of Planning and Finance, the similar hospital fee for both groups -- the insured and the uninsured -- is to ensure equality and encourage people to buy healthcare insurance. According to the health ministry, Việt Nam currently has 75 million health insurance cardholders, or 81.3 per cent of the population, which means nearly 20 per cent of the country is uninsured, most of whom have above average living standards.

The health ministry is encouraging nearly 20 per cent of uninsured population to buy health insurance to avoid financial burden in case of sickness.

 A healthcare insurance card in Việt Nam can be bought at more than VNĐ600,000 ($26) per year and comes with huge benefits. – VNS

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Tuesday, May 23, 2017

Nearly 20 Million Have Gained Health Insurance Since 2010

The number of Americans without health insurance has fallen drastically in recent years, according to new data from the National Center for Health Statistics.

In 2016, there were 28.6 million Americans without health insurance, down from more than 48 million in 2010. Some 12.4 percent of adults aged 18 to 24 were uninsured, 69.2 percent were covered by private plans and 20 percent had public coverage.

Among children under 18, 5.1 percent were uninsured, 43 percent had public insurance and 53.8 percent had private plans.

Of those covered by private insurance in 2016, 11.6 million had purchased their plans through the federal Health Insurance Marketplace or state-based exchanges established by the Affordable Care Act.

Young people were more likely to be uninsured than their elders, the N.C.H.S. found. Almost 17 percent of adults aged 25 to 34 lacked insurance, while less than 9 percent of those aged 45 to 64 were uninsured.

The lead author of the report, Robin A. Cohen, a statistician at the N.C.H.S., pointed out that high-deductible health plans have become more popular. In 2010, 25.3 percent of the insured under the age of 65 had high-deductible plans. By 2016, nearly 40 percent had them.

From 2010 to 2016, rates of the uninsured declined in all age groups, down 14.4 percent among those aged 18 to 24, 16.5 percent among those aged 25 to 34, 13.7 percent among those aged 35 to 44, and down 8.9 percent in the 45-to-64 age group.

While rates of the uninsured declined sharply among the poor over those years, 26.2 percent of the near-poor (those with an income of 100 to 200 percent of the federal poverty level) and 23.2 percent of the poor (an income of less than 100 percent of the poverty level) lacked health insurance.
There were stark differences by race and ethnicity. While 25 percent of Hispanics were uninsured in 2016, 15 percent of African-Americans, 8.6 percent of whites and 7.5 percent of Asians lacked health insurance.

States that chose to expand Medicaid coverage to people with low incomes had the ranks of their uninsured cut in half, to 9.2 percent in 2016 from 18.4 in 2013. In states that did not expand Medicaid, the rate moved down slightly, to 17.9 percent in 2016 from 22.7 percent in 2013.
Texas, Louisiana, Mississippi, Georgia and Florida were among the states with the highest percentage of uninsured residents. New York, Ohio, Michigan, Minnesota and California were among those with the lowest percentages.

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Wednesday, May 17, 2017

Tuesday, May 16, 2017

Health Insurance Industry Supports GOP Attempt to Repeal Obamacare Protections

After several failed attempts, President Trump and the Republican-controlled House of Representatives narrowly passed legislation known as the American Health Care Act to repeal and replace President Obama’s signature Affordable Care Act, or Obamacare. The measure, which carried by a 217 to 213 vote, was rushed through the House on May 4 before the Congressional Budget Office could score the bill to assess its cost and impact on national healthcare. But a previous CBO evaluation on a less severe version of the bill found that at least 24 million Americans would lose their health insurance coverage if the AHCA were ever signed into law.

Negotiations with the GOP’s right-wing “House Freedom Caucus” faction secured sufficient votes for passage, but their members extracted concessions that undoubtedly will make the bill even less popular than the previously debated version. Key provisions include the loss of protections for those with pre-existing conditions, mandated employer insurance plans are now in jeopardy, Medicaid expansion is ended with an $800 billion budget cut, Planned Parenthood is defunded and the wealthiest Americans receive a $765 billion tax cut over 10 years.

The AHCA bill now moves to the U.S. Senate, where many Republicans open criticized the measure, and say they’ll draft new reform legislation from scratch, which then must be sent back to the House. Between The Lines’ Scott Harris spoke with Wendell Potter, a former health insurance industry executive and whistleblower. Here, he assesses the provisions in the GOP House bill, prospects for action in the U.S. Senate, and the role of the insurance industry in eroding key benefits in the ACA.

WENDELL POTTER: It is awful, awful legislation. It is about some of the worst I've ever seen and it is something that would take us back to what life was like for many people before the Affordable Care Act was passed. In fact, make it worse. It's estimated that at least almost 25 million people would lose their health insurance. Just as bad, a lot of people who have pre-existing conditions – and quite frankly, that is almost a majority of us these days – would face higher premiums and in some cases, wouldn't be able to afford coverage at all. It would allow insurance companies essentially to do what they used to do, which is to declare some uninsurable. Blackball them and not enable people to get not only the insurance they need, but access to care that they need. In so many ways, it would put the insurance industry much more in the driver's seat once again, of our health care system than they already are. And would lift and engage some of the most egregious practices that needed to end.

BETWEEN THE LINES: Wendell, the insurance industry in the United States helped write the Affordable Care Act, Obamacare. And they reaped a lot of profits because of the expanded pool of customers for their insurance with the subsidies that came online and all that. What was the role as you understand it, of the insurance industry in working with Republicans on this piece of legislation that has passed the House of Representatives. It's not law yet, it still needs to go through the Senate and back to the House. There's a whole long process ahead.

WENDELL POTTER: You're exactly right. The insurance companies have done very very well since the Affordable Care Act went into effect. They've been reporting record profits. So they've done well. But what they don't like is that can't engage in some of these practices that they once did. They think that there's a chance they might even be more profitable if they got rid of some of these restrictions on them. They would like to go back to the time when they could pick and choose who to insure so that they could weed out people who really need coverage. And definitely, they're working behind the scenes to help lawmakers' message, if you will, what they're trying to do here in ways that they think can be sold to the American public, but they're selling them a bill a goods.

On the other hand, the insurance companies don't like that the Republicans would change the Medicaid program to what's essentially referred to as a block grant program. In other words, the federal program just would provide a certain amount of money to the states. The effect would be to reduce the Medicaid payments almost a trillion dollars over the next several years. Insurance companies don't like that because many states have largely turned over their Medicaid programs to insurance companies. So insurance companies would see a significant decline in revenues if that part of the bill goes through.

BETWEEN THE LINES: There are many listeners who have heard about a universal single-payer health care bill that's going through the California legislature. And I'm wondering if you think there's a chance that we could see an example of universal health care in one of our largest states – California – that could be an example for the federal system much in the way that Saskatchewan, a province in Canada, was the first to adopt a universal single-payer system in that country, in Canada and was later adopted by the federal government in Ottawa. 

WENDELL POTTER: I think it's entirely possible. And there is strong support for single-payer healthcare in California, and also in Oregon and Washington, too. And other states. California would be especially significant if it were to pass a single-payer bill. There is a bill that is before the California legislature now that has been introduced that would create a single-payer system. It may not get approved this year, but there is strong support for it, growing support for it. And I think what you're going to see is that business leaders are going to wake up and start embracing this. And business leaders in particular are, I think, waking up to understanding that a multi-payer system in which we have all these insurance companies that really cannot control cost and that add cost to the system – it just doesn't make sense for them or the country. Health care for those employers that provide coverage – it's an expense they can't predict year after year, and like I said, insurance companies are demonstrating that they cannot control health care costs. And I think the gig is up for them, or will be in a few years because employers who are very politically active I think may be ultimately, be the death knell for the system that we have now.

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