Pace of U.S. health spending slowed in 2016 Sunday, Dec 10 2017 

By Phil Galewitz | Kaiser Health News U.S. health spending rose to $3.3 trillion in 2016, but the pace slowed compared with the previous two years as demand for drugs, hospital care and physician services weakened, according to a federal study released last week. The analysis from the Office of the Actuary at the Centers […]

Kentuckians Have A Week To Sign Up For Coverage On Healthcare.gov Friday, Dec 8 2017 

Kentuckians have one more week to sign up for health insurance on Healthcare.gov.

As of Dec. 6, about 36,000 people in the state had signed up, that’s about 44 percent of the people enrolled for 2017.  This year’s enrollment period is only half as long as the previous year.

While most people have received letters that they will be automatically re-enrolled, many Kentuckians will have a choice of a different network of doctors and different benefits. That’s because in every county, there will only be one available option.

In some cases, the changes are good news.

Ray Weaver, who owns a music store in Louisville, said he paid $800 a month for his Anthem plan in 2017. When he received a letter in the mail in October that he’d be automatically enrolled in a new CareSource plan, he thought the price would jump up – that’s what’s happened every year. But Weaver said he was pleasantly surprised when his insurance broker ran the numbers for his plan starting in 2018.

“For one year, our premium just dropped incredibly,” said Weaver. “It went from $800 to $300 [a month] for a similar plan. And it’s not because our finances have changed.”

Every year, insurance plans and their benefits offered on Healthcare.gov change, as do prices. But this year was a little different.

In October, President Donald Trump announced the government would no longer pay insurers to lower copays or deductibles for people with certain incomes. In response, insurers increased monthly premiums. But because those premiums went up, so did the subsidies that help people purchase insurance.

In some cases, the costs evened out. Ashley Shoemaker, an application assister at Family Health Centers in Portland, said, however, that the letters didn’t provide to people all of the information.

“We’ve had a lot of people come in confused and scared because of the letters that they see that their premiums are going up, but what a lot of people don’t realize is that payment assistance goes up as well,” Shoemaker said.

Around 80 percent of Kentuckians receive financial help to pay for health care premiums, according to Shoemaker. Individuals who make $48,240 a year or more do not qualify for a subsidy.

The Trump administration slashed funding for nonprofit “navigators” like Shoemaker this year. Instead, officials are directing consumers more toward brokers. That’s resulted in more phone calls for people like Joel Thompson, an insurance broker in eastern Kentucky.

“Under the previous administration they were so focused on the nonprofits with the navigators that they kind of neglected to see us as a resource,” Thompson said.

Normally this would mean good business for Thompson, but CareSource, which is the only insurer in half of Kentucky’s counties, doesn’t pay brokers. Anthem, on the other hand, pays around $100 per enrollee.

Even though he’s not being paid for most of the help he provides, Thompson said he sees it as a way to not only help people, but also build up a list of potential clients. Thompson also sells life, vision and dental insurance. Those companies do reimburse brokers.

“Eventually, even if I don’t get any compensation for enrollment, there are other things down the road that maybe I could help with that I’d be paid for,” he said.

Open enrollment on Healthcare.gov ends on December 15.

With Aetna Deal, CVS Looks To Turn Stores Into Health Care Hubs Monday, Dec 4 2017 

CVS Health is looking to create a national network of community medical clinics that will serve as “America’s front door to quality health care.”

That’s the goal, according to a statement by CEO Larry Merlo on his company’s deal for Aetna. It’s an ambitious one for CVS, a company better known as a quick stop for Tylenol and a Coke.

To get there, CVS agreed to pay $69 billion in cash and stock for Aetna, the companies said Sunday. The companies said that together they want to offer more health care services in CVS drugstores.

“CVS wants to be more than just a retail outlet,” says Craig Garthwaite, a professor at Northwestern’s Kellogg School of Management. “They’re expanding the retail clinics so they won’t be quite urgent care, but they’ll resemble a direct primary care facility.”

The company changed its name to CVS Health three years ago and is trying to reposition itself has a health care company rather than just a drugstore.

The vision is that customers, especially those covered by Aetna insurance policies, will seek more of their basic health care at an expanded CVS clinic.

CVS operates more than 1,100 MinuteClinics at locations in its drugstores and within Target stores. CVS says its pharmacists and nurse practitioners can provide ongoing health care for people with chronic conditions like diabetes, high blood pressure or asthma.

“Patients with diabetes will receive care in between doctor visits through face-to-face counseling at a store-based health hub, and remote monitoring of key indicators such as blood glucose levels,” CVS said in the announcement of the acquisition.

The companies are counting on the notion that people will prefer going to a clinic around the corner over making repeated trips to their doctors that might require appointments and waits.

Garthwaite says the combination will also alter CVS’s incentives when providing pharmacy benefits – which it does now for nearly 90 million people including most of those with Aetna health plans. “If you only have responsibility for the cost of the diabetes medication, you might impose a higher co-pay,” Garthwaite says. “If you’re responsible for all the medical costs that can ensue if people don’t get their diabetes medications, then you may want a smaller co-pay.”

The CVS-Aetna combination is enormous, but it’s also the continuation of a trend toward insurance companies and health care providers getting together to offer integrated service, said Walid Gellad, a doctor and professor of health policy and management at the University of Pittsburgh.

For example, the insurance company Oscar Health signed a deal to work with the Cleveland Clinic to sell health coverage in Ohio.

The combination of CVS and Aetna aims for something else. “This is a different angle because the delivery part is focused on pharmacies, not hospitals or doctor’s offices,” Gellad says. “Many are pushing for more health care services to happen in pharmacies, and this is one mechanism to make that happen.”

He says Aetna could help drive patients into the CVS clinics by making it cheaper to go there than to a primary care doctor. “The real potential here is for changing how healthcare is delivered in primary care settings,” he says.

CVS doesn’t need to buy Aetna to make that happen, says Lynn Quincy, a consumer health care analyst at Altarum, a health care analysis and consulting firm. She says she’s skeptical that the combination of the two companies will lead to savings for consumers.

“We already see that pharmacy benefit managers don’t really use their clout in service to consumers,” she says. “Nothing about this deal says that’s going to change.”

It’s unlikely that CVS will really transform itself from a pharmacy company to an integrated health care company, says Martin Gaynor, a professor of economics at Carnegie Mellon University. “That’s an awfully big step,” he says. “In fact, it’s more than just a step to go from where they are to becoming a health care hub.”

He says the obvious motivation behind the merger is that CVS and Aetna can save money on prescription drugs by simplifying the complicated way medications are paid for, and eliminating one middlemen looking to make a profit.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

Baptist Health To Accept CareSource Health Plans In Kentucky Wednesday, Nov 29 2017 

Baptist Health providers will soon accept CareSource insurance offered on Healthcare.gov. That’s because starting in 2018, CareSource will be the only health insurance choice for half of the counties in Kentucky on the individual market created through the Affordable Care Act.

“Given that CareSource is going to be the only option in many of these counties, a number of patients and physicians had reached out to us and asked if we’d consider CareSource,” said Donna Ghobadi, a vice president at Baptist Health.

CareSource currently provides health insurance to around 23,000 Kentuckians with Healthcare.gov plans. That will double next year as the company expands into many more counties following Anthem’s decision to pull out of half of Kentucky’s counties in 2018. The counties are mostly in eastern and central Kentucky and had the lowest number of people enrolled.

Anthem officials said at the time they were pulling out because the Healthcare.gov market was uncertain, citing multiple attempts this past summer by Republicans to repeal and replace the individual mandate and the subsidies that allow many people to buy insurance. Last year, Anthem offered only limited-provider networks in half the counties with their plans in an effort to reduce costs.

That move leaves CareSource as the sole health insurer for Healthcare.gov buyers in Jefferson, Oldham and Bourbon counties, along with 58 other counties. Baptist Health has many hospitals and doctor offices in CareSource’s newly covered counties.

If Baptist Health didn’t accept CareSource insurance, patients with that coverage would have had to pay out-of-network prices — meaning they would be charged higher co-pays, which are fees due at the time of a visit. Deductibles are also higher with out-of-network providers, meaning a patient would have higher out-of-pocket costs before insurance kicks in.

“Without being able to access your health care benefits and have it be out-of-pocket, I don’t think that would have been financially viable for many of our patients,” Ghobadi said.

The enrollment period to buy insurance on Healthcare.gov is open until Dec. 15. After that date, people will have to wait until this time next year to purchase a plan. Some could be eligible for an extension if they’ve moved, gotten married or had a baby.

As of Nov. 25, almost 28,000 people in Kentucky had bought a Healthcare.gov plan. Last year, a little over 80,000 people bought coverage on the site.

CareSource is also a relatively new insurance company in Kentucky. In 2015, it joined Kynect, the former state-based marketplace. Also that year CareSource started selling similar health plans in Indiana.

Analyst: Humana possible takeover target of Cigna Monday, Nov 27 2017 

Shares of Humana and Cigna rose in early morning trading as an industry analyst said that Humana’s steps last week to pay its executives millions of dollars in a “change of control” event made it a possible takeover target of its rival Cigna. Humana shares were up $3.15, or 1.3 percent at 10:30 a.m., while […]

State unveils drug treatment hotline Sunday, Nov 19 2017 

As part of the state’s Don’t Let Them Die campaign, the Justice and Public Safety Cabinet and Operation UNITE have created the KY Help Call Center to connect residents with drug treatment, according to Gov. Matt Bevin’s office. The toll-free hotline — 1-833-8KY-HELP (1-833-859-4357) — opens on Dec. 1 and is intended for individuals struggling […]

About a third of Americans unaware of ACA open enrollment Friday, Nov 17 2017 

By Phil Galewitz | Kaiser Health News While the Affordable Care Act’s fifth open enrollment season is off to a surprisingly good start, many uninsured people said they weren’t even aware of it, according to a survey released Friday. Nearly a third of people overall — including a third of people without health insurance — […]

U of L, Kindred Partner To Create Health Tech Solutions Thursday, Nov 16 2017 

The University of Louisville and Kindred Healthcare have announced the creation of HIVE, a partnership to design health technologies aimed at making the aging process a little easier.

The organizations opened HIVE with an official ribbon cutting ceremony Thursday at the former K-I Lumber & Building Materials office building near the Belknap campus.

Raelene Kost works at Kindred, a Louisville-based hospice and home care company. She heads up the company’s Contact Center, which is kind of like a customer service center for patients and caregivers who have questions about insurance, prescriptions or anything else.

“The cool thing about this is you’re pulling in a different set of people that maybe have a different view on what you’re doing,” Kost said.

Engineering students from U of L have already worked on several projects with Kindred.

“We’ve been able to take issues that we hear from the field, whether it’s the therapist going out into the home, that we’ve been able to take those issues and develop a program or product to support that,” Kost said.

Kindred’s nurses were reporting issues with the way they screened potential hospice patients. Through the HIVE partnership, an app was created to help streamline the process.

Hospice is intended to provide care for a patient in the last six months of life with the goal of making the patient comfortable, according to CharlesWardrip, chief information officer at Kindred. That differs from other health care settings, like in a hospital, where treatment is given to prevent death.

Hospice patients also report better pain control, more satisfaction with their care and fewer deaths in the hospital or intensive care units than other people with similarly short life expectancies that don’t go to hospice. That’s according to a study out last year from the medical journal BMJ.

“Many times those who need it don’t understand that they could benefit,” Wardrip said. “Now as they’re out there talking, they can gather info and identify whether the patient would benefit.”

The app from HIVE also helps makes it clearer if Medicare will pay for a potential patient. Medicare pays on average $140 a day for hospice care, which many advocates say isn’t enough. So the possibility of forgoing payment because of a faulty screening system is worth the development of that app.

There’s a laundry list of requirements to qualify for hospice, including having recurrent infections, deteriorating mental ability and progressing weight loss. Kost said it’d take 25 minutes on average to complete the initial evaluation for hospice and the app helps to simplify the process.

“To be able to have a team that can take our odd idea and turn it into an app for a tablet is really what makes it so worth it,” she said.

Disclosure: Susan Moss, Senior Vice President of Marketing and Communications at Kindred Healthcare, is a member of LPM’s Board of Directors. 

Louisville’s Almost Family acquired by competitor Thursday, Nov 16 2017 

Louisville-based home health care provider Almost Family has been acquired by a Louisiana-based competitor LHC Group in an all-stock deal valued at $836 million. Almost Family’s shares spiked more than 15 percent in morning trading. Post-merger, LHC will have 31,000 employees at 781 locations in 36 states and annual revenue of $1.8 billion, making it […]

Small local company helps answer some big questions (in space) Thursday, Nov 9 2017 

About 14 miles northwest of Louisville, in a town of about 800 residents, a small cadre of engineers is designing technology to tackle some of the world’s toughest challenges, from helping astronauts survive long space voyages to 3-D printing human organs. Techshot, a private company based in Greenville, Ind., performs work for medical, military and […]

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