Tag Archives: health insurance

Healthcare spending growth slowed in 2016

Private health insurance continues to be the largest payer for healthcare goods and services, accounting for just over one-third of total spending.

Susan Morse, Senior Editor

Healthcare spending grew at a slower rate in 2016 than during the previous two years, according to new analysis released Wednesday by the Office of the Actuary for the Centers for Medicare and Medicaid Services.

In 2016, U.S. healthcare spending grew at a rate of 4.3 percent to $3.3 trillion. This compares to spending increases of 5.1 percent in 2014 and 5.8 percent in 2015.

Spending growth in 2016 was more in line with the rate of 4.2 percent from 2008 to 2015.

chart for article, Healthcare spending growth slowed in 2016The slower growth is primarily due to decelerated spending for retail prescription drugs, hospital care, and on physician and clinical services, according to the Office of the Actuary report.ntions]

Spending growth also fell among the three major payers: private health insurance, Medicare and Medicaid.

The last time there was a spending drop of this type was in 2010, when there was a decrease in the three area of goods and services – retail prescription drugs, hospital care, and physician and clinical services, CMS said.

This is the first time in memory CMS has witnessed a slowdown in  goods and services spending, and among the three major payers.

For private health insurance and Medicaid, the slower growth was influenced by decelerated enrollment growth, while Medicare spending slowed because of lower enrollment increases due to defections to Medicare Advantage plans.

Medicare Advantage now makes up a third of all Medicare enrollment. This means slower growth in fee-for-service Medicare spending as MA is value-based.

CMS said it didn’t have details on how other value-based models such as bundled payments have played a part in slower healthcare spending increases.

Continue reading Healthcare spending growth slowed in 2016

Medical Marijuana – Without Any Marijuana!

By WorkCompAcademy.com 11/29/2016

Medical Marijuana logoSacramento, CA – The workers’ compensation community is bracing for the potential, and some say eventual, tidal wave of claims for medical marijuana as a form of treatment for pain related industrial injuries. But soon it may be possible to provide the claimed benefits of “medical” marijuana – without any marijuana at all!

Science Daily reports that Indiana University neuroscientist Andrea Hohmann took the stage at a press conference Nov. 14 in San Diego to discuss research conducted at IU that has found evidence that the brain’s cannabis receptors may be used to treat chronic pain without the side effects associated with opioid-based pain relievers or medical marijuana.

The study was discussed during the annual meeting of the Society for Neuroscience, the world’s largest source of emerging news about brain science and health. Hohmann was joined by three other international researchers whose work focuses on similar topics.

“The most exciting aspect of this research is the potential to produce the same therapeutic benefits as opioid-based pain relievers without side effects like addiction risk or increased tolerance over time,” said Hohmann, a Linda and Jack Gill Chair of Neuroscience and professor in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences.

Chronic pain is estimated to affect nearly 50 million adults in the United States. The rise in opioid-based pain relievers to treat chronic pain has also contributed to an opioid addiction epidemic in the United States, with 19,000 deaths linked to prescription opioid abuse in 2014. In Indiana, the use of needles associated with prescription opioid abuse led to a major HIV outbreak in the state’s southeastern region, prompting the governor to declare a public health emergency in 2015.

 Continue reading Medical Marijuana – Without Any Marijuana!

California Aims To Limit Surprise Medical Bills

September 11, 2016
Heard on Weekend Edition Sunday 
Stephanie O’Neill

Cassie Ray and husband Gerry  got a surprise bill from an out-of-network anesthesiologist
Cassie Ray (seen with her husband, Gerry) got a surprise bill from an out-of-network anesthesiologist after an operation. – Courtesy of Cassie Ray

When it comes to navigating the intricacies of health insurance, Cassie Ray considers herself a pro. She actually reads her policy, including the fine print.

So when the 57-year-old from Fairfield, Calif., needed routine follow-up surgery after a mastectomy, she did her homework.
“I looked up on my insurer’s network and made sure the outpatient facility that I was being referred to was in my network,” Ray says.

A month later, she received an unwelcome surprise: a $580 bill for an out-of-network anesthesiologist.

“I called the facility back, and at first, I felt like, this has to be a mistake. They’ll fix it,” Ray says.

Instead, the clinic said her only option was to negotiate the bill directly with the doctor. Ray’s experience illustrates the surprise of balance billing.
Continue reading California Aims To Limit Surprise Medical Bills

CA & NH Look to Help Consumers Get Healthcare Pricing Information

March 11, 2016 | Jordan Rao – Kaiser Health News

California healthcare cost comparisonTwo states are making inroads into revealing some of the biggest secrets of health care by publishing price information to help consumers comparison shop for doctors, dentists and prescription drugs.

New Hampshire, which already had the nation’s most advanced website allowing people to compare the cost of specific medical procedures, last week added prices for 16 dental procedures and 65 prescription drugs. The website, NHHealthCost.org, is run by the state insurance department and lets consumers see how much they would have to pay based on the price their insurer negotiated with each provider, rather than the sticker price that is charged. The site also shows the price uninsured people must pay.

California on Wednesday released an expanded version of its quality report cards on 154 large physician groups. Those cards, which already assess clinical quality and patient experiences, take a different tack than New Hampshire. Instead of drilling down on specific procedures, the report cards summarize the total cost of medical services run up by the average patient of each group. The medical groups care in total for more than 9 million people.

Elizabeth Abbott, the director of California’s patient advocate office, which put together the report cards, said that by coupling the cost rating with similar star ratings for quality, consumers and those who decide which medical groups to include in insurance networks will see that the most expensive medical groups may not be the ones that provide the best care.

“We want to have human resources departments and executives for health providers look at this to guide their decisions,” Abbott said.


8 New Total Worker Health™ Essentials Videos

In a series of 8 short videos, business industry leaders share their experiences with designing, implementing and evaluating Total Worker Health programs, practices and policies. The series is designed to help small businesses utilize innovative techniques to incorporate programs, practices and policies that can be tailored to their workplace.

Video 1: What is Total Worker Health™?

Video 2: Why Total Worker Health™?

Video 3: Management & Employee Involvement

Video 4: Designing Programs

Video 5: Low-Cost Strategies

Video 6: Engaging Employees

Video 7: Evaluating Programs

Video 8: Essential Elements & Closing Tips


What Will Workers’ Compensation Look Like in 20 Years?

Dept. of Workers' Comp crystal ballBy Safety National

At the 67th Annual SAWCA Convention, Frank Neuhauser, Executive Director of the Center for the Study of Social Insurance (CSSI) at University of California at Berkeley, opened this keynote session by discussing the future of workers’ compensation.

Workers’ Compensation’s Inefficient Delivery

He noted that the current system does not efficiently address the issues that employers and employees face today. In 1915, the system was primarily created to support a heavily industrialized workforce, which is no longer the case.

The organizational costs associated with administering $1.00 of medical treatment under workers’ compensation is estimated to be $1.25 versus .14 cents to administer at this same level of service under a group health plan.

In addition, the use of workers’ compensation Medicare set asides (MSA) create a loss between 25-40% to Medicare and the MSA process has exposures related to it that are inefficient and have the potential to become costly.

Neuhauser recommends that a more-streamlined approach needs to be designed by the states to limit the duration of employers’ liability of two years and then assess insurers and self-insurers “fair” payment to a Medicare Trust Fund.

Improvement Needed on Controlling Non-Traumatic Claims Costs

Non-traumatic injuries make up 67% of claims and 75% of claim dollars. So where do these injuries frequently occur? An employee is four times more likely to suffer a fatal injury away from the workplace and 75% of workers are in occupations that are low hazard.


California Workers’ Compensation – North vs South


At the 2015 California Coalition on Workers’ Compensation Annual Conference, a panel discussed the huge disparity in claims costs between northern and southern California.  The panel consisted of:

    • Alfonso Moresi – Commissioner, Workers’ Compensation Appeals Board and partner in law firm Laughlin, Falbo, Levy and Moresi
    • Richard Newman – Chief Judge for the California Department of Industrial Relations
    • Mark Priven – Principal with Bickmore Risk Services

map of California showing higher Workers' Comp rates in LA areaThe litigation rates in Southern California are much higher than the rest of the state, accounting for approximately 75% of the total court opening filings statewide. Along the same lines, the number of workers’ comp judges in Southern California is also significantly higher than the rest of the state so that they can process this high volume.

For those that practice in both areas of the state, there is a significant difference in the level of professionalism and conduct in the courts and there are also procedural differences seen in the different areas. By statute, the procedures in the two areas should be the same but, in practice, that is not the case. One of the major differences is that lawyers in Southern California usually will not settle claims without an appearance before the Board. Most plaintiff attorneys in the South do not even meet with their clients until the Board hearing and they use that first Board appearance as their initial meeting spot. In Northern California, judges will sanction attorneys who show up for a hearing unprepared.

Insurance carrier rates are 11-32% higher in the Los Angeles area versus the rest of the state. This trend is only in the LA area, not the San Diego area, therefore it is not a Southern California trend.

For public entity self-insured employers, claims costs in the LA area are 15-20% higher than the rest of the state. One-third of this is due to increased frequency, and two-thirds is due to higher individual claim costs.


AED Failures: A Reminder that Maintenance is Vital

NOTE: If you have specific questions about AED’s, we encourage you to contact our associate (and AED expert), John Fowler

(805) 705-3631AED heart with lightning bolt logo

SCA News

WASHINGTON– More than 1,000 cardiac arrest deaths over 15 years are connected to the failure of automated external defibrillators (AEDs); battery failure accounted for almost one-quarter of the failures. The study was published online last week in Annals of Emergency Medicine (“Analysis of Automated External Defibrillator Device Failures Reported to the Food and Drug Administration”http://bit.ly/ox6YYr).
“Survival from cardiac arrest depends on the reliable operation of AEDs,” said lead study author Lawrence DeLuca, MD, EdD, of the University of Arizona Department of Emergency Medicine in Tucson. “AEDs can truly be lifesavers but only if they are in good working order and people are willing to use them.”
Researchers analyzed reports to the Food and Drug Administration (FDA) about all adverse events connected to use of an AED between January 1993 and October 2008. Of the 40,787 AED-related events reported to the FDA, 1,150 adverse events connected to fatalities were reported (3%). Almost half (45 percent) of failures occurred during the attempt to charge and deliver a recommended shock to the person in cardiac arrest. Problems with pads and connectors accounted for 23.7 percent of the failures and battery power problems accounted for 23.2 percent of the failures.
Sudden cardiac arrest is a leading cause of death in North America and Europe. Odds of survival decline by 7 to 10 percent per minute of delay in defibrillation. Even as AEDs have proliferated in public places such as airports and offices, bystanders are reluctant to use them. An Annals of Emergency Medicine study published earlier this year found that less than half of people in public places reported being willing to use an AED and more than half were unable to recognize one.
“AEDs are like any other piece of medical equipment: They can experience unexpected failures,” said Dr. Deluca. “I would recommend that people maintain AEDs as recommended by the manufacturer. If an unexpected device failure occurs it is vitally important to promptly contact both the manufacturer and the FDA. Then be sure to return the unit (and accessories such as pads or batteries) to the manufacturer immediately so that it can be analyzed and a cause for the failure identified and fixed.”
Read the abstract here.
SOURCE: American College of Emergency Physicians/ PR Newswire

The Evolving Healthcare Model: Impact of ACA on Workers’ Comp

By Safety National 05/13/2015 10:51:00

Affordable Care Act logoConsider the implications to your organization of possible changes in access to care, consolidation of providers and facilities and the use of accountable care organizations. All this is rapidly becoming a reality under the changes to our healthcare system brought on by the Affordable Care Act (ACA). How will this impact your business? What steps can you take to ensure your injured workers have access to the best care? What issues are on the horizon?  This was the subject of a 2015 SIIA Workers Compensation Executive Forum session presented by  Kimberly George, Senior Vice President, Senior Healthcare Advisor with Sedgwick.

Putting politics aside, ACA has resulted in changes to the healthcare delivery model that cannot be undone. There has been significant consolidation of clinics, facilities and provider networks. Things like stand-alone outpatient surgical centers and neighborhood physicians have all but become extinct.  Workers’ compensation needs to respond to the new realities of this healthcare delivery model.

What are the primary Affordable Care Act considerations for workers’ compensation? Many have indicated that cost shifting to workers comp and access to care are the biggest concerns. When you think of access to care, the question becomes will we end up with a tiered medical system where some systems reimburse at higher rates than others. Those who do reimburse at higher rates will have a greater ability to select the providers who deliver superior outcomes and also ensure access to care. Continue reading The Evolving Healthcare Model: Impact of ACA on Workers’ Comp

What You Need to Know About Personalized Medicine

By Safety National 04/30/2015

Benefits of PGX Testing

PGX testing workflowDue to the potential cost savings, pharmacogenetic testing is expected to become an effective tool for risk managers. Currently, only 50% of patients respond positively to their medications. We are all different, so a uniform way of prescribing is not effective. PGX maps drugs with your unique genetic makeup to increase effectiveness. From a workers’ compensation standpoint, it can help to:

  • Proactively drive the right treatment from the beginning of a claim.
  • Reduce the amount of doctor visits, physician billing frequency and overprescribing.
  • Diminish drug addiction and dependency.
  • Reduce adverse drug reactions – the leading cause of death in the U.S.
  • Resolve long-tail claims.

This innovative RIMS 2015 session explored a new era of technology emerging in heathcare – personalized medicine. It is expected to revolutionize healthcare and, thus, will become very useful in the workers’ compensation arena.

Speakers included:

  • Geralyn Datz, President, Southern Behavioral Medicine Associates PLLC
  • Sonny Roshan, CEO, Chairman, Aeon Laboratories, LLC
  • Kimberly George, Senior Vice President, Corporate Development, M&A, Healthcare, Sedgwick

How it Works

Using a simple, in-office test, genetic testing determines how a patient’s genetic makeup will determine a successful or unsuccessful response to a prescribed medication. Pharmacogenetic testing (PGX) taps into DNA to uncover how a single prescribed medication is metabolized. It is being used to improve and expedite patient care by optimizing or eliminating the typical trial and error process, which can lead to adverse reactions, drug tolerances, addiction or death. PGX is rapidly becoming a standard of care and is considered in line with good clinical practice.