Medicare Advantage plans continue to appeal to retirees

About 17.7 Medicare beneficiaries are enrolled in a Medicare Advantage plan now, compared with nearly 16.5 million people in September 2014, according to the CMS. About 31% of eligible beneficiaries are enrolled in a MA plan, compared with 13% a decade ago, according to the Kaiser Family Foundation, and a Health Affairs survey found that more than half of new Medicare enrollees chose an MA plan this year. (9/17)

A Look At Healthcare’s Super-Utilizers

The need is intense, yet temporary for many patients who use a lot of health care services. These patients with multiple visits to the emergency room and multiple hospital admissions are known as “super-utilizers.” They have become the focus of community- and primary care–based interventions.

Health Affairs looked at 4,774 publicly insured or uninsured super-utilizers from May 1, 2011 to April 30, 2013. Three percent of adult super-utilizers accounted for 30% of adult charges. But fewer than half of patients who were super-utilizers on May 1, 2011 remained so seven months later. Only 28% remained at the end of a year. Solutions to over-utilization include improving predictive modeling to identify people who are likely to experience sustained levels of avoidable utilization, better classifying subgroups for interventions, and implementing stronger program evaluation designs.

Americans underestimate long-term care needs, costs

About 70% of people age 65 and older will need long-term care at some point, and the average cost for a private nursing home room for one year is about $95,000. Yet many adults underestimate both their need for care and care costs because they believe family members will provide care, according to a study published in the journal Health Affairs. The Washington Post (tiered subscription model)/Wonkblog (1/6)

Sluggish Economy, Not Health Reform, Drove Spending Slowdown

The economic downturn can take the credit for about 70% of the recent decline in health care spending growth from 2009 to 2011, according to a study published in the August issue of Health Affairs. As the economy recovers, health spending is likely to increase at a faster pace. “The slowdown was mostly due to the sluggish economy, not to structural change in the health care sector. The Affordable Care Act may ultimately succeed at reducing costs, but it hasn’t done so yet,” said study co-author David Dranove of the Kellogg School of Management at Northwestern University.

“There has been disagreement, over the years, as to whether health spending is recession proof. This study shows it’s not. The analysis, which focuses on privately insured people, highlights that the slowdown in health spending was not only caused by people who lost their jobs and employer-provided health insurance. Even people who retained insurance during the downturn reigned in their health spending. This demonstrates the broad effects of a recession on health spending,” said Co-author Craig Garthwaite, an assistant professor at the Kellogg School of Management.

Health spending growth slowed 2.6% from 2009 to 2011. The authors predict that health-spending growth would have been 1.8% higher if the economy had not faltered in 2008.  Insured people living in the hardest hit areas experienced the smallest increases in health spending. Thus, they concluded that 70% of the decline in health care spending growth was the result of the stagnant economy.  For more information, visit -and-future-research-projects@healthcostinst.

Spending on Mental Health and Substance Abuse Grows Slower

Spending on mental and substance use disorders is likely to grow at a slower pace than all health spending through 2020, according to a study by Truven Health. Spending will fall from 7.4% in to 6.5% in 2020. The study was published in the August journal Health Affairs. A major factor contributing to slower growth is that several major mental health medications are set to expire. Prescription medications accounted for 28% of  mental health spending compared to 11% of all health care spending in 2009. Also, spending for mental health treatment in state-operated psychiatric hospitals has slowed as a result of the recession and a slow economic recovery. “That growth in behavioral health expenditures is projected to slow relative to overall health spending even as recent health reform and parity legislation helps to increase behavioral health coverage and access is good news for consumers and their families,” said Tami Mark, lead author from Truven Health Analytics. For more information, visit

The ACA Boosts Mental Health Services

After implementation of the ACA, mental health treatment increased 5% for 18- to 25-year olds who have possible mental health disorders  The study, published in Health Affairs, found smaller, but consistent, effects among all young adults, not only those with possible illnesses. For people getting mental health treatment, uninsured visits declined 12%, and visits paid by private insurance increased 13%. For more information, visit

Why ACA Open Enrollment Dates Should be Changed


A study by Health Affairs, recommends shifting open enrollment to February 15 to April 15. On November 15, state and federal health exchanges will open their portals and phone lines for the 2015 open enrollment season, which runs through next February 15. The end of the year is traditionally open season for health insurance.

According to the report, people make better decisions when they are not stressed by financial worries — as they often are during the end-of-year holiday season. For example, Google searches relating to financial concerns were highest in the summer and just before the Thanksgiving and Christmas holiday season. Health insurance information searches dropped substantially from Thanksgiving to Christmas, but then rose sharply the last week of December and in early January.

According to the Congressional Budget Office, nearly 19 million uninsured low- and moderate-income Americans are expected to get health insurance through the exchanges. Many file their tax returns well before the April 15 deadline and are likely to receive sizable refunds.

During the first months of the year, they feel more financially secure in anticipation of their tax refund. With the holiday season behind them, they can focus on choosing a health insurance plan. Also, between mid-February and mid-April, people are likely have more accurate calculations of their premium subsidy. Given what is known about how financial stress affects decision-making, holding open enrollment just before or during the holiday season is a mistake. The ACA’s goals of maximizing enrollment in the health plans and maintaining a healthy balance of enrollees with low and high risks of having high medical expenses are more likely to be achieved if the open enrollment season is shifted to the two months between February 15 and April 15 each year, according to the report.

Study IDs reasons for higher employee health care spending

A study in Health Affairs showed employees with depression spent 48% more on health care than those who were not depressed. Health care spending also was higher for workers with high blood pressure or blood glucose or those who were physically inactive, smoked or were obese. Emory University researchers said well-designed and implemented follow-up health programs are needed to change employee behaviors and reduce health risks. MedPage Today (free registration) (11/6)

Last Updated 10/20/2021

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