Bill Would Make Home Medicare Program Permanent

Compassion & Choices praised the introduction of Independence at Home Act of 2016 (S. 3130). The bill would convert the Affordable Care Act’s home care pilot program into a permanent, national Medicare program. Under the Independence at Home program, patients with debilitating diseases get primary care at home from coordinated teams of doctors, caregivers, and other healthcare professionals. The program reduces avoidable emergency room visits, hospitalizations, and re-admissions. Mark Dann, federal affairs director for Compassion & Choices said, “A great benefit of providing care in a person’s home is advance care planning conversations seem to happen naturally more often and can be updated as their illness progresses and their care wishes change. If an individual ends up in the hospital, but did not want to be there, the whole team is aware of these wishes and can attempt to quickly correct the situation.”

How Do We Pay for a Growing Medicare Program?

To keep Medicare’s spending in check, seniors may need to pay a larger share of their healthcare, according to a study by National Center for Policy Analysis (NCPA). The study recommends the following:.
• Raise beneficiary premiums to cover excess cost growth.
• Raise deductibles and copays. Means-tested contributions to health savings accounts (HSAs) by the
federal government could complement the reformed insurance.
• Constrain the federal payment rate by procedure and service. Rather than paying the CMS-determined reimbursement to each provider, Medicare would give those amounts to the participants. Over time, a real market would emerge for health care due to seniors’ demand for lower prices.
• Have premium support payments rise at the same rate as per-capita GDP. This would offer a significant level of individual choice and payment responsibility while limiting the role of CMS in the Medicare market.

Medicare’s Competitive Bidding Program Drives Up Costs

Medicare’s competitive bidding program is driving up costs for diabetic patients, according a study by the National Minority Quality Forum. The study found that the competitive-bidding program disrupted beneficiaries’ ability to get diabetes testing supplies. Not having access to these supplies is associated with increased mortality, hospitalization rates, and inpatient costs. The Centers for Medicare and Medicaid Services (CMS) claims that the competitive-bidding program poses no health threat. However, the Government Accountability Office (GAO) says that CMS statistics did not reveal whether beneficiaries got the durable medical equipment they needed on time or whether they experienced health problems due to problems accessing the equipment. Jaime Davidson, M.D. of the University of Texas said, “We are particularly concerned about the disruption we detected in our analysis given the predominant use of rapid- and short-acting insulin by Medicare beneficiaries who are at significantly greater risk for hypoglycemia than younger individuals with insulin-treated diabetes.”

CEO offers tips on creating a financial wellness program

SUM180 CEO Carla Dearing says companies developing a financial wellness program should address financial concerns using emotional cues, such as security, stability and protection. Financial wellness programs should have a holistic approach and make it easy for employees to participate regardless of their financial situation, Dearing says. Employee Benefit News (2/16)

Does The Medicare Drug Discount Program Drive up Prices?

The Patient Protection and Affordable Care Act established the Discount Program to help Medicare Part D beneficiaries with their prescription drug costs while in the coverage gap. Until the Discount Program began in 2011, beneficiaries in the coverage gap paid 100% of drug costs. The Discount Program required manufacturers to provide a 50% discount on the price of brand-name drugs for beneficiaries in the gap.

The General Accountability Office (GAO) interviewed pharmacy benefit managers (PBMs) to get their take on the effects of the program. Most sponsors and PBMs told GAO that the Discount Program may be contributing to rising prices of some brand-name drugs by some manufacturers. However, most manufacturers say they don’t think that the Discount Program affected the drug prices that they had negotiated with sponsors and PBMs.

The PBMs said that some manufacturers decreased rebates for their brand-name drugs because of the Discount Program. In comparison, most of the plan sponsors did not observe manufacturers decreasing rebate amounts and most manufacturers said the Discount Program had no effects on their rebate negotiations. Most sponsors and PBMs told GAO that the Discount Program did not affect Part D plan formularies, plan benefit designs, or utilization management practices.

Prices for high-expenditure brand-name drugs increased at a similar rate before and after the Discount Program was implemented in January 2011. Specifically, from January 2007 to December 2010, before the Discount Program began, the median price for the basket of 77 brand-name drugs (weighted by the utilization of each drug) used by beneficiaries in the coverage gap increased 36.2%. During the same period, the median price for the basket of 78 brand-name drugs used by beneficiaries who did not reach the coverage gap increased 35.2%. From December 2010 through December 2011, the first year with the Discount Program, the median price for the two baskets increased equally by about 13%, the greatest increase in median price for both baskets compared to earlier individual years.

For more information, contact http://www.gao.gov/products/GAO-12-914

Communication Is Key to Successful Wellness Programs

Most employers say that weak employee engagement is the biggest obstacle to changing their employees’ health risk behavior, according to a white paper by Colonial Life. Just offering a wellness program and expecting a majority of employees to participate is prone to failure, said Steve Bygott of Colonial Life.  More than half of workers say they don’t know enough about their company’s wellness programs to participate. A Colonial Life survey found that 52% of workers whose employers offer wellness programs are only somewhat or not at all knowledgeable about them. However, 57% of employers believe their employees have a good understanding of the health and wellness programs offered and how to participate, but only 41% of employees agree.

Ninety-six percent of employees who met with a benefit counselor individually say it improved their understanding of benefit and 98% said the interaction was important.

The complete white paper is available in Colonial Life’s online newsroom at ColonialLife.com.

Last Updated 06/23/2021

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