This article is very interesting if you are looking for a way to explain to someone else or just want to better understand how the healthcare system works.  It goes into great detail about healthcare pricing and how you the consumer can benefit from using pricing to your advantage. Health plans, employers, and state governments increasingly expect Americans to use information about pricing when making health care decisions. After all, the more consumers know about pricing, the better they can budget for out-of-pocket expenses and for routine costs related to chronic conditions, the more intelligently they can choose among providers, and the more easily they can bring pricing information directly into conversations with those providers. Those conversations can lead to more sensible decision making about care, avoiding costly tests and procedures that are unlikely to improve health outcomes. Consumers who are especially knowledgeable and motivated can even negotiate what they will pay for services at their preferred health care facilities, as some anecdotal evidence has shown. To read the full article visit
Who wants out of Obamacare? A group called ColoradoCare is petitioning for a 2016 ballot question that, if approved, would allow the state to extricate itself from the complicated federal law and establish universal health coverage under an independent board of directors. So far, the group has met resistance from critics who contend that ColoradoCare is socialized medicine of the first magnitude. But it’s not exactly the “state-run, single-payer system” opponents are making it out to be. ColoradoCare wouldn’t be run by any state agency. It would be an independent payment system with an elected 21-member board of directors and wouldn’t exert state control of health providers. It would, however, use its immense buying power to contract with providers to control per-capita costs. ColoradoCare calls for a payroll tax of varying rates to raise roughly $25 billion for universal health coverage. Every worker and employer would pay into the system, but private insurance would still be available for individuals and businesses that want to pay extra for health coverage. It would end the state health insurance exchange, Connect for Colorado, but it wouldn’t displace TriCare, Veterans Affairs benefits or the Indian Health Service, and the state would still receive federal assistance, including Medicare and Medicaid. A moral imperativeT.R. Reid is a former Washington Post bureau chief now living in Denver. He is chairman of the Colorado Foundation for Universal Health Care and met with the Sentinel’s editorial board recently to push for the ballot initiative. The foundation is dedicated to the proposition that “decent, ethical democracies should provide health care for anyone who needs it,” Reid said. Health care, Reid contends, should be like public education — available to all and funded by all. While Republicans have been talking about repealing and replacing Obamacare for five years, ColoradoCare provides a way out of Obamacare with a solution that will make health care available to everyone — something Obamacare hasn’t done. Congress can’t fix Obamacare or get the nation off an “unsustainable” track of rising health care costs, Reid said. It’s going to take individual states coming up with money-saving solutions. The rest of the country looks at Colorado as a public policy innovator for tackling things like legal marijuana, drilling regulations and teen contraception. Reid promotes ColoradoCare by emphasizing three things: It covers everybody, it saves billions in administrative costs and it’s not Obamacare. State Sen. Irene Aguilar, a Denver physican who represents the 32nd District, has introduced bills attempting to establish something similar to ColoradoCare. When they failed, the group decided to go the route of the ballot initiative. Aguilar, a Democrat, has been touring the state attempting to explain how ColoradoCare would work and quell fears that the program amounts to an additional $25 billion in taxes. “What we need to know is that Coloradans currently spend about $49 billion annually for health care. Varied governmental sources contribute $24 billion. The rest of us already pay the $25 billion difference privately, but we do it in such a complicated, convoluted fashion that 30 percent of our health dollars are wasted,” she wrote in a guest column for the Colorado Statesman in July. Something needs to changeWe agree that exerting downward pressure on the healthcare system needs to happen sooner than later. Starting in 2017, the Affordable Care Act allows states to opt out and design their own health care system. ColoradoCare is an effort to do that. Make no mistake, everyone will take a haircut under a ColoradoCare-like system. Doctors and hospitals won’t make as much money as they’re accustomed to. Could that affect the quality of care? Private insurance will obviously take a huge hit. We doubt the ballot initiative will pass. It’s going to take a couple of election cycles for voters to become comfortable with any version of a single-payer system. But it’s inevitable that some brave state will attempt to curb health care costs as a means of growing its economy. Should it be Colorado? That’s the $25 billion question. To learn more click here.
A California county voted Tuesday to restore primary health care services to undocumented adults living in the county. Contra Costa County, east of San Francisco, joins 46 other California counties that have agreed to provide non-emergency care to immigrants who entered the country illegally. "Providing health care coverage to all is not only about the human morality issue that we should address, but also from a cost-effective point of view ... this is absolutely the right thing," said Jane Garcia, CEO of La Clínica de la Raza, which serves 25,000 patients in Contra Costa, many of them low-income Latinos. Adult immigrants who are undocumented are not able to participate state health exchanges under the Affordable Care Act, but can get emergency care in hospitals. The program is not full scope insurance, but will provide preventive care. Health care providers and other supporters say that increasing access to preventive services will cut down visits to the emergency room and save the county money in the long run. "It will mean better health care access for all, improved public health, lower cost to our health care system, and it's just the right thing to do for people, especially undocumented adults who are not covered under the Affordable Care Act," said County Supervisor John Gioia, a supporter of the measure. The movement to increase health care access to more residents has also made strides at the state level. In June, the California legislature and Gov. Jerry Brown announced a budget deal to provide public healthcare coverage for undocumented children from low-income families as early as May 2016. A number of California counties were already covering children regardless of immigration status, says Tanya Broder, staff attorney at the National Immigration Law Center. That paved the way for the statewide agreement. "California is one of the few states with a large immigrant population that recognizes that it makes sense to provide health care to immigrants ineligible for federal care," said Broder. "And the state is taking steps to provide coverage to all residents, but it's not there yet." At least two recent proposals to expand health coverage to undocumented adults have been unsuccessful in the state legislature. However, Broder believes the issue will resurface next year. "Now, the conversation is not whether we should cover people regardless of immigration status. It's how do we do it," said Broder. Washington, Illinois, New York, Massachusetts and the District of Columbia already provide health coverage for immigrant children. But D.C. goes even further. At the state level, only D.C. allows all qualifying residents, including the undocumented, to receive public health coverage through the DC Healthcare Alliance program, according to data from the National Immigration Law Center. In its first year, the program, Contra Costa Cares, will assign up to 3,000 people a "medical home" at a community health center. Benefits will include regular physician check-ups, immunizations, a nurse advice line and mental health services. Rosa Arriaga, 72, joined the dozens of supporters wearing "Health4All" t-shirts who packed the supervisors' meeting. She buys over-the-counter medication to help ease the arthritic pains she feels in her knees and along her left arm, but hopes to get regular medical treatment for her asthma and depression as well. "I have worked, paid taxes and never asked for anything from the government. But now I feel sick, and I need to see a doctor," said Arriaga in Spanish. She has lived in Richmond for 24 years. "It's not just me. A lot of other people in the county need this program," added Arriaga, who is currently unemployed and says she has trouble paying the rent for a single room she shares with her nephew. The Cares program is being established as a year-long pilot program. It will benefit 16 percent of the estimated undocumented population in Contra Costa, about 19,000 people. Advocates hope the program will continue and be expanded after this first year.   The Board of Supervisors agreed to allocate $500,000 to Cares. In addition, three local hospitals — including Kaiser, Sutter Health and John Muir Health — have promised an additional $500,000 in funding. Supervisor Candace Andersen cast the lone dissenting vote, saying that she worries that funding for the program is not sustainable. "To me when you start a pilot program, you need to see where to go next, and I don't see the funding in place right now," said Andersen. "I'm very troubled that we are having to take half a million dollars from our general fund." Before the summer, only a few counties in California provided health care services to immigrants in the country illegally. In June, a group of 35 mostly-rural counties in California opted to cover all residents regardless of immigration status, according to the advocacy group Health Access. Last week, the Monterey County Board of Supervisors gave a thumbs-up to expanding health care services. "Contra Costa is in good company in regards to this," said Anthony Wright, executive director of Health Access. "It's a really important step forward." In California, an estimated 1 million undocumented immigrants remain uninsured, said Wright. To learn more click here.
Here's a great way to reduce your healthcare costs: Get healthy, and stay healthy. In general, the fitter and healthier you are, the fewer diseases and conditions you'll likely develop. That can lead to fewer prescription drugs, fewer doctor visits, and avoiding dialysis and various surgeries. One big way to reduce healthcare costs is to quit smoking. The American Cancer Society has detailed major health benefits of quitting, per various studies. For example: -- 20 minutes after quitting: Your heart rate and blood pressure drop. -- 1 year after quitting: The excess risk of coronary heart disease is half that of a continuing smoker's. -- 5 years after quitting: Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years. -- 10 years after quitting: The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases.  -- 15 years after quitting: The risk of coronary heart disease is that of a non-smoker's. Exercising and taking in sufficient calcium can also strengthen your bones and slow bone loss over time, while exercise and weight loss can lower your blood pressure and reduce cholesterol, reducing or even eliminating the need for drugs to control them. They can keep diabetes away, too. One well regarded study found that those who exercise just a little can lower their risk of premature death by 20%, while those who engage in moderate exercise for 450 minutes a week can lower it by 39%. Socializing is another way to improve your mood, and even your health . Tending to your health can pay off handsomely -- in the form of a longer, less costly, and more enjoyable life.  Brian Stoffel  If you and your family are relatively healthy, one of the best ways to hold healthcare costs down is to use a high-deductible health plan (HDHP). If you buy insurance on the marketplace, this is the equivalent of a Bronze Level plan. The biggest financial benefit of such plans is that the monthly premium you have to pay is often significantly reduced. As a trade-off, however, you're responsible for all out-of-pocket payments up to a higher limit -- usually over $10,000 per family. Of course, if you're healthy, it shouldn't matter. But should unexpected emergencies arise, you may end up losing a lot of cash. There is, however, a way to mitigate some of these costs. Health Savings Plans (HSAs) allow individuals to put away $3,350 -- and families up to $6,650 -- in pre-tax dollars to cover qualified medical expenses. If you're over 55, you can add up to $1,000 on each of those contribution limits. Unlike Flex Spending plans some employers offer, the money in an HSA doesn't disappear on New Year's Day. In fact, you can invest the money and allow it to grow over time tax-free. Given that withdrawals from the account are also tax free so long as they are for medical purposes, you can save a lot of cash by getting an HDHP with an HSA. Sean Williams  As my Foolish colleague Selena points out, staying healthy and getting regular preventative care can play a big role in keeping your long-term healthcare costs down. However, being an informed consumer can be just as important. I'm certainly not talking about searching online for your symptoms and trying to diagnose yourself -- that's what doctors are for. Instead, I mean being proactive in understanding your treatment options so as to minimize your costs. Here are a few things to consider when visiting your primary care physician, or PCP. First, are there generic or biosimilar option available for the medication he or she is prescribing? Generic medicines are closely examined by the Food and Drug Administration and held to the same high standards that brand-name drugs are held. This means you could save 80% or more by requesting generic therapies from your PCP. By the same token, with biosimilars beginning to hit the market, consumers could be in line for discounts of anywhere from 15% to perhaps as high as 40%. Another effective cost-cutting tactic is simply to ask your physician or insurer for a discount, or visit a drugmaker's website to see if they offer any sort of income breaks for low-income individuals or seniors. Although these can vary, most pharmaceutical companies do offer some degree of financial assistance if you can't afford your medication. The key here is simple: be knowledgeable. You don't need to be able to diagnose yourself, but understand that there are probably options available once you have your diagnosis to lower your long-term healthcare costs. The $15,978 Social Security bonus most retirees completely overlook  If you're like most Americans, you're a few years (or more) behind on your retirement savings. But a handful of little-known “Social Security secrets” could help ensure a boost in your retirement income. In fact, one MarketWatch reporter argues that if more Americans knew about this, the government would have to shell out an extra $10 billion annually. For example: one easy, 17-minute trick could pay you as much as $15,978 more... each year! Once you learn how to take advantage of all these loopholes, we think you could retire confidently with the peace of mind we're all after. Simply click here to discover how you can take advantage of these strategies. To learn more click here
The draft recommendations are open for public comment until October 12, with a final recommendation to be developed after the feedback has been considered. Details of the Recommendations CVD and cancer are the leading causes of death in the United States, with CVD responsible for approximately 30% and cancer around 25% of deaths. Colorectal cancer is the third most common cancer in the United States, causing an estimated 50,000 deaths in 2014. The USPSTF recommends that adults 50 to 59 years of age take low-dose aspirin for the primary prevention of CVD and colorectal cancer. Individuals should have a 10% or greater risk for CVD, not be at increased risk of bleeding, have a life expectancy of at least 10 years, and be willing to take low-dose aspirin for at least 10 years. For adults 60 to 69 years of age, the decision to use low-dose aspirin in those with a 10-year CVD risk above 10% should be taken on an individual basis, with the same caveats as in younger individuals. In both age groups, the USPSTF concluded that there was "moderate certainty" that there was a net benefit with aspirin use, relative to the risk for small to moderate harms, including gastrointestinal bleeding (GI) and hemorrhagic stroke. For adults younger than 50 years and those older than 70 years, the USPSTF concluded that there is insufficient evidence to balance the potential risks and benefits of aspirin use in CVD and colorectal cancer prevention. Determining Risk To determine CVD risk, the USPSTF developed a microsimulation model using a calculator derived from American College of Cardiology/American Heart Association pooled cohort equations, which are the only externally validated risk tools in the United States. Although the benefits of aspirin use for CVD prevention were assessed with three separate systematic reviews and a decision analysis model, the evidence for colorectal cancer was derived from an update of a review conducted in 2007. Overall, aspirin appears to reduce the risk for colorectal cancer by 26% to 40%, with at least 5 to 10 years of use required to achieve the reduction. As people with a shorter life expectancy are therefore less likely to see a benefit from prolonged aspirin usage, the USPSTF recommendations say that it is "most likely to have an impact when it is started between the ages of 50 and 59 years." However, aspirin use is also associated with an increased risk of GI bleeding and hemorrhagic stroke, with risk factors including aspirin dose and older age, as well as a number of conditions and concomitant medication use. The risk of bleeding or stroke is small in adults 59 years and younger and moderate in those 60 to 69 years. Although the risks could not be determined in adults 70 years and older, the USPSTF says that the potential harms are significant and the benefits in terms of colorectal cancer are lower in this age group. The USPSTF points out that the optimal dose of aspirin for CVD prevention is unknown, with primary prevention trials showing benefits with a wide range of doses. Given the association between bleeding risk and increasing aspirin dose, they suggest a "pragmatic" dose of 81 mg/day. The draft recommendations nevertheless recognize that there are a number of "important" research gaps in the use of aspirin for the prevention of CVD and colorectal cancer. Specifically, they say that more research is needed on the effect of aspirin in different subgroups, the best dosing strategies, the long-term impact of aspirin in patients with previous adenoma, and the durability of aspirin's effects if it is discontinued. First Recommendation for Cancer Prevention "I think the real news here is the colon cancer recommendations," commented Ranit Mishori, MD, MHS, FACP, associate professor of family medicine at the Georgetown University School of Medicine in Washington, DC. "It's first time that aspirin is considered for preventive therapy for cancer by an official, highly respected, well-regarded organization," she told Medscape Medical News. "I think we're going to be seeing more recommendations for cancer prevention with aspirin in the future, because there are multiple studies going on right now looking at the benefits of aspirin for the prevention of other cancers, including lung cancer, melanoma and prostate cancer," she added. However, Dr Mishori expressed concern that the recommendations would encourage patients to see aspirin as the only prevention strategy they need to follow. She told Medscape Medical News: "There's no magic bullets in health and in medicine, and every time that the headlines make bold statements about 'take this to prevent that,' there's a risk that individuals will take it as, 'All I have to do is take that statin, all I have to do is take aspirin, or all I have to do is take that obesity pill, or whatever you want'." Dr Mishori continued: "This is just one additional factor in a larger strategy for prevention of cancer or cardiovascular diseases, so nothing should be taken as the only one solution, and that applies here as well." Another potential issue is that of adherence because of the length of time that patients will have to take aspirin to see a benefit. She said: "We all know that, when patients are given prescriptions, even for 1 week of antibiotics or 2 weeks, or anything that is actually important for an acute condition, a large percentage of patients may not even fill the prescription and, if they do fill it, they take it for a few days and then they stop." Dr Nissen believes the draft recommendations could do more ham than good. He said: "Most people who are taking aspirin right now are the worried well. They are not people that should be taking aspirin and I believe that the net harms probably exceed the benefits for many of people." He explained that there is a lack of randomized controlled trials to support the statements, adding: "So they are speculating. They are kind of taking a guess at who would benefit. I don't think that's good public policy." "I think you want to have very clear evidence of benefit before you treat large groups of patients with a therapy that has both risks as well as benefits," he said. The lack of hard evidence has consequently resulted in a series of recommendations that give out a complicated message about who should take aspirin. "I think that, frankly, patients and primary care physicians are going to be very confused by these recommendations," Dr Nissen said. He continued: "I think that one of the reasons why it's not clear that there's a benefit from aspirin is that other therapies have so significantly lowered the event rate that there isn't a lot of room for benefit from aspirin." Dr Nissen concluded: "I think these are a very confused, complicated set of recommendations that are not going to clarify for physicians who to treat and who not to treat." The authors have disclosed no relevant financial relationships. To learn more click here.
SAN DIEGO — Once the rate of influenza-vaccinated healthcare workers reaches about 50%, there is no further reduction in the rate of patients with hospital-acquired influenza, a new study shows. "It's not that we should stop vaccinating, because it's still a benefit to healthcare workers, but we should be focusing on other interventions to reduce nosocomial influenza," said investigator Brandon Dionne, PharmD, from the University of New Mexico Health Sciences Center in Albuquerque. "At a certain point, you don't have a real return on vaccination for reducing nosocomial flu, and we should look to things like hand-washing, better screening of patients, and better isolation precautions," he told Medscape Medical News. The study results were presented here at the Interscience Conference of Antimicrobial Agents and Chemotherapy 2015. In their retrospective, cross-sectional study, Dr Dionne and his team found no overall association between the rate of vaccinated healthcare workers and nosocomial influenza. During the five flu seasons from 2010 to 2015, there was a significant increase in the rate of vaccinated healthcare workers at the University of New Mexico Health Sciences Center (P < .001). However, the rate of hospital-acquired influenza — defined as infections diagnosed at least 48 hours after admission in patients who presented to the hospital without influenza-like symptoms in the previous 24 hours — plateaued once about half the healthcare personnel were vaccinated. In contrast, the Healthy People 2020 objective calls for the mandatory immunization of 90% of healthcare personnel. And a policy statement on infectious diseases just issued by the American Academy of Pediatrics declared that influenza vaccination should be mandatory for all healthcare personnel (Pediatrics. Published online September 7, 2015). Dr Dionne has disclosed no relevant financial relationships. Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC) 2015: Abstract I-296. Presented September 18, 2015. To learn more click here.
On Tuesday, Hillary Clinton issued her defense of the Affordable Care Act andproposals to change the landmark health law, signaling the next battle in a war with all the signs of a political stalemate. Americans are basically evenly split in their assessments of the law and sharply divided along partisan lines; Republican presidential candidates want to scrap the law, while Democrats support keeping it (Clinton) or expanding it (Bernie Sanders). None of this is new to anybody, nor expected to change anytime soon. But that conclusion misses a huge part of the story, according to just-published research by Johns Hopkins University sociologists. Stephen L. Morgan and Minhyoung Kang found the ACA's passage caused a sharp drop in support for health-care spending across party lines and might have ushered in a broader conservative "cold front" when it comes to other issues. The chart above shows their core finding from the long-running General Social Survey. The percentage of Americans saying the country spends "too little" on health dropped from the years before and after its passage (comparing surveys from 2004-2008 to 2010-2014*). The falloff in support for greater health spending was sharpest among Republicans (24 percentage points), but was also large among independents (16 points) and Democrats (12 points). Now, you might point out that support for health spending before and after Obamacare does not demonstrate that the law caused it to drop. The public could be reacting to something else, such as the stimulus policies enacted after the Great Recession or to government spending more generally. But much of the authors' article in Sociological Science tries to rule out alternate theories. Running against the theory of a general backlash against federal spending, the drop in support for more health spending was much larger than it was in other areas, such as the environment or assistance to the poor. The cross-partisan drop in support also undermines the idea that support for health spending simply became more polarized along party lines, as many Democrats became less supportive of health spending after its passage. The authors found the over-time shift was similar even after controlling for demographics and political ideology and when looking at answers from the same respondents who were re-interviewed before and after the ACA. In short, it's possible something else caused the drop, but Obamacare is the biggest culprit. The big question then is why support for health spending plummeted in reaction to the law. The researchers have some theories. "The leading explanation is that the campaign to discredit the bill took a toll on everyone," Morgan said in a telephone interview. He and Kang argue that the ACA's passage might have ushered in a conservative "cold front," in which the public reacts to a pattern of growing liberalism by taking a conservative turn. Along those lines, the GSS survey found a smaller down-tick in support for national spending on a variety of issues beyond health care (including Social Security, assistance to the poor and help to other countries). The "cold front" idea was first proposed in the 1970s, when the public took a conservative turn on spending priorities after a long run trending toward liberalization. A related theory is that public opinion is a thermostat. Morgan described it broadly: "As government expands, people become less enthusiastic about government expanding." Here's how University of Texas's Christopher Wlezien described it in a 1995 paper: We observe that the signals the public sends to policymakers, in the form of preferences for “more” or “less” spending, react to changes in policy. ... [T]here is negative feedback of spending decisions on the public’s relative preferences, whereby the public adjusts its preferences for more spending downward when appropriations increase, and vice versa. What's striking is that with the ACA, even Democrats behaved like thermostats, withdrawing support for increased health spending after the Democratic-sponsored law was passed. The latest findings bolster the idea that, while most Americans do not want to repeal the law, Democrats paid a political price for passing the ACA. A2012 political science article by Brendan Nyhan and colleagues estimated that Democrats would have retained at least 25 additional U.S. House seats in the 2010 elections if they had voted against the ACA, enough to maintain a majority. The cause? Democrats' votes in favor of the law led voters to perceive a member as being more liberal and distant, which was associated with lower support. The evidence of a lasting public retrenchment on health care makes Democratic plans to protect or expand the law more politically challenging. Clinton introduced a cap on prescription drug prices at a rally Monday, saying, “I'm not going to let them rip away the progress we've made. I'm not going to let them tear up that law, kick 16 million people off their health coverage, and force this country to start the health-care debate all over again." Sanders doubled down on expanding health coverage, reiterating his support for a single-payer health care system this summer. Democrats can take comfort that many of their specific policy proposals are popular. Indeed, the GSS found a majority of Americans and independents still says the country spends "too little" on heath. But the bigger lesson is Americans tend to turn in the opposite direction of policy; Democrats won big in passing health-care reform, but the public's appetite for more ambitious action has shrunk. Anne Gearan contributed to this post. To learn more click here.
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% 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 healthcare costs to workers. Over the past decade, the average deductible that workers must pay for medical care before their insurance kicks in has more than tripled from $303 in 2006 to $1,077 today, according to the report from the nonprofit Kaiser Family Foundation and the Health Research & Educational Trust. That is seven times faster than wages have risen in the same period.  “It’s a quiet revolution,” said foundation president Drew Altman. “When deductibles are rising seven times faster than wages … it means that people can’t pay their rent. … They can’t buy their gas. They can’t eat.” By comparison, workers’ wages increased 1.9% between April 2014 and April 2015, according to federal data analyzed by the report’s authors. Consumer prices declined 0.2%. Raising deductibles and co-pays has traditionally been a way for employers to keep premiums in check. And the new report shows that premium growth remained modest in 2015. An average employer-provided health plan cost workers $1,071 in 2015. That is down nearly 1% from 2014, marking the first time that the survey has documented an absolute decline in workers’ share of premiums. The average family plan cost workers $4,955, up 3% from last year. “It’s a quiet revolution,” said foundation president Drew Altman. “When deductibles are rising seven times faster than wages … it means that people can’t pay their rent. … They can’t buy their gas. They can’t eat.” By comparison, workers’ wages increased 1.9% between April 2014 and April 2015, according to federal data analyzed by the report’s authors. Consumer prices declined 0.2%. Raising deductibles and co-pays has traditionally been a way for employers to keep premiums in check. And the new report shows that premium growth remained modest in 2015. An average employer-provided health plan cost workers $1,071 in 2015. That is down nearly 1% from 2014, marking the first time that the survey has documented an absolute decline in workers’ share of premiums. The average family plan cost workers $4,955, up 3% from last year. By comparison, employees’ share of health insurance routinely shot up by double digits in the early 2000s. Businesses continued to pick up the bulk of the cost of health coverage for their workers, paying more than $5,000 on average for a single plan and more than $12,500 for a family plan. Employers’ rising health costs are often singled out as a cause for stagnant wage growth in recent years, as businesses have put money into health benefits that might otherwise have gone to workers’ paychecks. There is also growing evidence that the steep rise in deductibles and other out-of-pocket expenses such as co-pays are preventing workers from benefiting from the overall slowdown in healthcare cost growth. The average deductible for a silver plan on marketplaces nationwide this year is more than $2,500, according to other research by the Kaiser Family Foundation. Beyond costs, the new report contains more encouraging news about the endurance of employer-provided coverage, as 57% of employers reported offering benefits, from 2014. That number has been closely watched, as critics of the Affordable Care Act had charged that many businesses would begin to drop their health plans when the health law began offering Americans guaranteed coverage. As has long been the case, many more large businesses provide health benefits, with 98% of firms with 200 or more employees offering their workers at least one health plan. This year, employers with at least 100 full-time workers will have to provide benefits or pay a penalty. The requirement will apply to employers with at least 50 full-time employees in 2016, though Republicans and Democrats are working on legislation that could alter this so-called employer mandate. The survey also provided more hints about the potential impact of another provision of the Affordable Care Act. Starting in 2018, employers with particularly generous health plans will be subject to a new excise tax, known as the “Cadillac tax.” This year, employers with at least 100 full-time workers will have to provide benefits or pay a penalty. The requirement will apply to employers with at least 50 full-time employees in 2016, though Republicans and Democrats are working on legislation that could alter this so-called employer mandate. The survey also provided more hints about the potential impact of another provision of the Affordable Care Act. Starting in 2018, employers with particularly generous health plans will be subject to a new excise tax, known as the “Cadillac tax.”  
Newswise — People in addiction treatment programs around the world use tobacco at two to three times the rate of people who are not being treated for addiction, according to a review of research studies from 20 countries other than the United States.   The review, led by Joseph R. Guydish, PhD, a UC San Francisco professor of medicine and health policy, was published on Tuesday, Sept. 22, 2015 in the journalAddiction.   “When people come into treatment for drugs and alcohol, we are not treating another addiction that has a significant chance of eventually killing them, which is tobacco use,” said Guydish. “At a public health level, this means that our addiction treatment efforts should address smoking and tobacco use better than they do now.”   Guydish and his team reviewed 54 studies, involving a total of 37,364 participants in 20 countries on six continents, which were published in English from 1987 to 2013. They found that among people in treatment for drug and alcohol use, the overall rate of smoking was 84 percent, compared with a rate of 31 percent for members of the general population, matched for gender and year of study.   The results agree with an earlier review led by Guydish of smoking addiction treatment programs in the U.S. In that paper, the authors found that the median smoking rate among people in addiction treatment was 76.3 percent, in contrast with the smoking rate in the general U.S. population, which is now estimated at less than 18 percent. “Every person who enters substance abuse treatment ought to have their tobacco use evaluated and treated,” said Guydish. “If they don’t want to be treated and quit right away, they should have some education to help them think more about quitting.”   Guydish observed that “there are data from a number of studies which strongly suggest that you can improve substance treatment outcomes by addressing smoking among the patients in treatment. That’s what we should be doing.”   The World Health Organization (WHO) has created a policy package called MPOWER, noted Guydish, which is designed to assist countries in implementing anti-smoking initiatives. “We would recommend that WHO pay attention to this finding and use it to extend their MPOWER strategies,” said Guydish. “Anyone who is interested in smoking reduction internationally could use this information at the policy level.”   Co-authors of the study are Emma Passalacqua, Anna Pagano, PhD, Thao Le, MPH, Barbara Tajima, MEd, Lindsay Docto, Daria Garina and Kevin Delucchi, PhD, of UCSF; Cristina Martínez of the Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; and JongSerl Chun of Ewha Womans University, Seoul, South Korea.   The paper is titled, “An International Systematic Review of Smoking Prevalence in Addiction Treatment.”   The study was supported by funds from the National Institute on Drug Abuse and the UCSF Tobacco Related Disease Research Program.   UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals.    
Implementing a value-based strategy is on the mind of nearly every health care organization in the U.S. It seems that every week, one or another announces a new “Center for Health Care Value” or “Center for Health Care Innovation.”  These organizations are accepting the fact that the volume-driven system is in its dying days, and that the future will demand that they deliver demonstrably better value: improved outcomes, lower costs, or both. Many institutions are overwhelmed by the change required and don’t know where to begin. As Michael Porter and Thomas H. Lee recently described in the HBR article “The Strategy That Will Fix Health Care,” implementing a value strategy involves dismantling specialty departments in favor of condition-specific practices, being paid and held accountable for results, pursuing geographic expansion, and more. It is a formidable transformation. But some institutions are succeeding, and we find that nearly every element of their value strategies builds on and is strengthened by one thing: the ability to measure outcomes. Here are five reasons why: 1. Outcomes define the goal of the organization and set direction for its differentiation. Few health care organizations have made it their explicit goal to deliver excellent outcomes. Providers commonly cite quality, research, or education as goals, but few measure their patients’ treatment outcomes or report them – either to their clinicians or the public. Improving value can only happen when providers align the focus of their clinical teams and their market strategy on achieving excellent outcomes, and in turn invest the resources to measure and report them. In 2005, when Prof. Dr. Hartwig Huland led the opening of a Martini Klinik, a new prostate cancer center in Hamburg, Germany, he wanted to deliver the best care in the world for its patients, and he defined “best” in terms of outcomes: rates of cancer recurrence, incontinence, erectile dysfunction – things everyone knew were important but few measured. Focusing first on clinical excellence and driving his team to measure and improve it, Huland’s center gained a regional, then national, then international reputation and is now the highest volume center for prostate cancer care in the world. (See this Harvard Business School case for more.) 2. Outcomes inform the composition of integrated care teams. Clinical training is inherently siloed, but value-based health care requires integration around the patient. This is not easy for specialists who are not used to working closely together, or worse, even dislike each other. But defining and measuring outcomes can bridge the disciplinary divide as teams must necessarily collaborate to achieve better results. Data that exposes poor performance in particular can be a strong motivator to join together to improve. At Texas Children’s Hospital (TCH), in the early days of its pediatric cardiac surgery program, newly recruited director Charles Fraser investigated the hospital’s performance relative to national referral centers as reported in the literature. The conclusion was disheartening – on most procedure types, TCH significantly underperformed. Citing its outcomes performance as a mandate for change, Fraser set about a complete restructuring of the team: pediatric cardiac surgeons and cardiologists started collaborating more closely, dedicated pediatric cardiac surgery operating rooms and ICU space was created, and a systematic outcomes tracking program was put in place. The final result? Today, TCH enjoys a nationally recognized program with mortality rates significantly below the national average. (For more, see this HBS case.) 3. Outcomes motivate clinicians to compare their performance and learn from each other. Comparison of outcomes is essential to disseminate innovations from one individual or team to another. Unfortunately, most quality measurement has focused narrowly on complying with evidenced-based processes. Although such compliance is important, it has limited impact on outcomes (often less than a quarter of variation in outcomes is estimated to be due to compliance with these processes). A more comprehensive focus on processes and outcomes and their interaction always shows opportunities to improve, from increasing survival rates and long-term functioning to reducing complications and speeding recovery. Comparing these types of outcomes in a transparent and collaborative way can be a powerful motivator for improvement. This philosophy underlies a remarkable collaboration between Blue Cross Blue Shield of Michigan (BCBS Michigan), the state’s largest commercial payor, and a collection of public and private providers in the state. These “Collaborative Quality Initiatives(CQIs),” financially supported by BCBS of Michigan, focus on state-wide outcome measurement for particular medical conditions or procedures coupled with frequent in-person discussions among would-be competitors to understand variations in practice and performance and to debate how best to improve outcomes. This data-driven dialogue across the network dramatically speeds the identification and adoption of best practices. For example, in 2008 the network discovered high rates of complications in bariatric surgery patients who had deep venous thrombosis (DVT) filters placed during their operation. Within one year of the network-wide meeting where the results were discussed, DVT filter use dropped by 90%. Nationally, the FDA communication warning against use of such filters lagged by more than two years, and is still being implemented. 4. Outcomes highlight value-enhancing cost reduction. Alongside influencing outcomes, clinical decisions also drive the cost of care: choosing which drugs to prescribe, which procedures to perform, and whether to admit patients to acute care facilities have significant cost impact. The trouble is, clinicians generally overestimate the benefit of their care, which means that many decisions lead to high costs with little impact on outcomes. Getting costs under control requires engaging clinicians with data that can help them understand which activities and services can be reduced or eliminated without compromising outcomes. At the Massachusetts General Hospital (MGH), amidst an aggressive shift from volume-based fee-for-service contracts to risk-based population contracts (which put providers at risk for the cost of care), the Division of Population Health Management team knew it needed a better process for determining who was best served by resource-intensive procedures, particularly those such as gastric bypass, diagnostic coronary catheterization, and lumbar fusion whose efficacy was uncertain. Rather than require that physicians follow rigid protocols, the Division created a decision support system to help clinicians determine when a procedure was indicated, based on a patient’s clinical circumstances. Criteria from the literature regarding the appropriateness of various procedures were integrated into the electronic medical record, and patients received videos and handouts explaining the risk and benefits of the various treatment options, as well as personalized consent forms that adapted those risk and benefits for their specific circumstances. The entire system was informed and refined by ongoing tracking of outcomes, as reported by both patient and clinicians. Clinical decision making improved; for example, rates at which patients were determined to be “maybe” or “likely” appropriate for diagnostic catheterization climbed from 86% to close to 97%. Patients’ confidence in their own decision making also improved. One of the local private payors was so happy with the impact that it agreed to waive the requirement for prior authorizations on all procedures for which this system was in place — a triple win for patient, provider, and payor. 5. Outcomes enable payment to shift from volume to results. As payment transitions from a fee-for-service world to a value-based world, good outcomes are shifting from a lofty idea into a business imperative. Paying for results and packaging payment into a bundled price will create a fundamentally different marketplace dynamic. At present, it is unclear which provider organizations will win business and which will lose business in this environment. It is clear, however, that without a clear knowledge of their outcomes, no provider will be able to succeed withbundled payment contracts. In Stockholm County, Sweden, the single payor wanted to expand the delivery of hip and knee replacements to eliminate long waiting lists. Armed with two decades of detailed outcome and case-mix data from the national registry, the payor developed a reimbursement model that packaged pre-operative, operative, and early post-operative care into a single price with a two-year warranty (five years if an infection was found in the first two years). Although the pricing of the model was 20% lower than the typical market price, several small, focused private providers signed on. With a clear price but greater flexibility on the delivery of care, these providers set about streamlining operational efficiencies and adding in outcome-improving steps. Within two years, the volume of hip and knee replacements delivered at these small specialty hospitals tripled while full-service hospitals watched their volumes drop by 20% (see this HBS case for further reading). Now the initiative is being expanded across the country and in seven other conditions. Earlier this year, the Centers for Medicare and Medicaid announced that by 2016, 85% of payments will be linked to quality. Private payors are joining arms with CMS in pushing this agenda. In other advanced economies, similar initiatives are underway. The value-based shift is upon us. If you are leading a health care provider organization and are uncertain how to navigate the shift, we have one suggestion: start by measuring your outcomes. To learn more click here  

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