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Posts Tagged ‘California HealthCare Foundation’

Consumers Enrolling Online with Covered California Say There’s Room for Improvement – CHCF.org

February 9th, 2016 Comments off

CHCF retained gotoresearch, a division of the San Francisco-based user experience and design agency gotomedia, to conduct this research over each of the last three open enrollment periods. The findings are based on unscripted, real-time observation of people applying for or renewing coverage online, and they capture sources of consumer satisfaction, knowledge, confusion, and frustration.Like Anthony, most other participants in the CHCF-sponsored research were confronted with problems with the online enrollment process. Of 31 people eligible to enroll in or renew a Covered California health plan in the second (2014-15) and third (2015-16) open enrollment periods, only one was able to complete the task during the observed research session. Sessions lasted 45-90 minutes for renewals and 90-120 minutes for new enrollees.Today, CHCF released Room for Improvement: Consumers’ Experience Enrolling Online with Covered California, which describes this user testing in further detail, discusses common problems experienced by participants, and offers recommendations for improving the online enrollment process.

Source: Consumers Enrolling Online with Covered California Say There’s Room for Improvement – CHCF.org

This report shows how a combination of factors can deter online enrollments — this one involving the nation’s largest state-based health benefit exchange. Many consumers have low levels of health insurance literacy, unable to fully take into account premiums, deductibles, co-pays, co-insurance and annual out of pocket maximums when selecting a plan. Even when benefits are standardized as they for California exchange plans.

As the CHCF report and video illustrates, in order to self enroll consumers must also possess a degree of income tax literacy that many — particularly the younger adults the plans hope to attract — may lack. Then there are complex family situations and sporadic, unpredictable incomes of those participating in the “gig” economy that exponentially increase the challenge of online self-enrollment. If an online enrollment portal adds to the burden by being less than user friendly as reported here, it’s no wonder many are flummoxed by the enrollment process and simply throw up their hands and log out.

Shopping online for plans is one thing. But enrolling in an individual health plan offered on a state health benefit exchange can be like filing an income tax return — and a relatively complex one at that for many. Call center support can only go so far. Imagine trying to file an income tax return by phone. That makes the role of insurance agents and in person assisters just as vital as that of tax preparers for many income tax filers during the current tax filing season.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

High out of pocket costs for major medical care warrant policy scrutiny

May 6th, 2014 Comments off

The cruel paradox of those with health insurance seeking bankruptcy protection from high medical bills could grow despite the policy intent of the Patient Protection and Affordable Care Act to expand the safety net of individual health insurance.

It’s most likely to occur in the case of hospitalizations where multiple health care practitioners attend to an insured patient and only some of them are in the patient’s health plan provider network. The patient is then placed in the situation where his or her insurance plan isn’t subject to the calendar year out of pocket maximums ($6,350 for individuals; $12,700 for family coverage) that apply only for care rendered by providers in the plan’s provider network, potentially exposing patients to significantly higher bills. Emily Bazar of the California HealthCare Foundation (CHCF) details one such instance involving a plan purchased through California’s health benefit exchange marketplace, Covered California, in her Sacramento Bee column.

This circumstance warrants study by the CHCF and other policy research organizations since it could occur nationwide. If such incidents increase, it could lead to calls for policy changes that make available all inclusive major medical coverage for hospital stays and other types of high cost care. Limited provider networks may be able to work fine for routine care like physician visits and exams, but can potentially leave major gaps for catastrophic care.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Achieving single, integrated marketplace for individual, Medicaid health plans faces initial difficulties

April 14th, 2014 Comments off

Section 1413(c)(1) of the Patient Protection and Affordable Care Act requires each state to “develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data …that allows a determination of eligibility for all such programs based on a single application.” That means state health benefit exchanges must operate as integrated marketplaces offering both commercial insurance plans (referred to as Qualified Health Plans or QHPs) as well as Medicaid coverage for those whose household incomes meet their state’s Medicaid eligibility guidelines. The policy rationale – known as “no wrong door” and “one touch and you’re done” – is to reduce the ranks of the medically uninsured by simplifying the process of getting health coverage and removing roadblocks to enrollment.

Implementing that Affordable Care Act mandate, however, has been challenging from IT integration standpoint given the variety of legacy state computer systems that manage their Medicaid programs and state rules governing them, including those of the three dozen states using the federal marketplace, healthcare.gov.

That’s also been the case in California, where enrollment elegance has proven elusive. “I think we’ve oversold simplicity,” said Frank J. Mecca, executive director of the County Welfare Directors Association of California. Mecca made that observation today at a California Healthcare Foundation (CHCF) briefing in Sacramento on early consumer experiences with enrollment in the Golden State’s exchange, Covered California.

Mecca described the IT interface between the California Healthcare Eligibility, Enrollment and Retention System (CALHEERS) and the IT system that manages Medicaid eligibility and enrollment, the Statewide Automated Welfare System (SAWS) as a “clogged highway.” Consequently, Mecca noted, a large backlog of potential Medicaid enrollees remain stuck in the system. Mecca credited Covered California and the California Department of Health Care Services (DHCS), the state’s Medicaid administrator, for their efforts to remedy the backlog and improve the interface between the two IT systems. “It’s not an easy thing to fix,” Mecca added. “Things have improved tremendously, but we still have a long way to go.”

Both Mecca and another panelist at the briefing, Sonya Vasquez, policy director of the community-based health advocacy and policy organization, Community Health, said greater emphasis should be placed on marketing both Covered California QHPs as well as Medi-Cal, the state’s Medicaid program, particularly given Medi-Cal does not have set enrollment periods. They also said more effort should be made to make consumers aware in-person assistance is available for those seeking to enroll in coverage, including welfare department staff who can sign up applicants for either Covered California QHPs or Medi-Cal. (California is among those states have expanded Medicaid eligibility to 138 percent of federal poverty guidelines).

Consumers participating in focus groups conducted in early 2014 by PerryUndem Research/Communication were mostly uninsured and had substantial knowledge gaps for both Medi-Cal and QHP coverage and advance tax credit subsidies for the latter for households with incomes between 138 and 400 percent of federal poverty. (Click here for the full report on the findings presented at today’s CHCF briefing.)

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Large Kaiser Permanente market share predisposes California to ACOs

September 28th, 2013 Comments off

The large market share of Kaiser Permanente – an integrated managed health care service plan that bears medical risk like an insurer but also directly provides care though its clinics and hospitals – makes California a unique environment favorable to the formation of Accountable Care Organizations (ACOs). Kaiser Permanente accounted for 40 percent of individual and group plan enrollment in 2011, according to the California HealthCare Foundation (CHCF).

The dominance of the Kaiser model is a major influence on California’s health plans and providers to emulate that model to hold down costs and compete against it. The Golden State is also home to large physician organizations experienced in managing financial risk for patient care, easing the way for ACO growth.

A paper explaining California’s unique ACO market dynamics prepared by the Center for Studying Health System Change was posted this week at the CHCF’s California Health Care Almanac.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Data illustrate growth in insurance coverage of primary care over 50-year period

September 28th, 2013 Comments off

The California HealthCare Foundation (CHCF) has produced an interactive graphic showing the sources of health care payments in the United States from 1960 to 2011. Particularly striking is the shift in physician and clinical services that comprise much of primary care. In the 1960s, most of these costs were paid directly out of pocket by patients. Beginning in the late 1970s, commercial insurance plans began picking up a larger proportion, reaching a peak of 49 percent in 2005 before declining slightly to 46 percent for 2011, according the CHCF compilation.

Proponents of pre-paid direct primary care contend that covering primary care in the same health plan as high cost catastrophic care such as hospitalization – covered under “major medical” policies in the 1960s — is as nonsensical as using car insurance to cover routine maintenance and oil changes.

The CHCF issued an issue brief on Direct Primary Care Medical Home Plans authored by Dave Chase noting these plans offer significant potential health care cost savings over all inclusive plans such as HMOs while providing economic incentive for primary care physicians – many of whom will be needed to care for new patients obtaining health coverage under the Patient Protection and Affordable Care Act.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

ACA needs a Direct Primary Care/Medical Home fix

August 15th, 2013 Comments off

Add one to the list of possible future amendments to the Patient Protection and Affordable Care Act: revisiting Section 1301(a)(3) that recognizes Direct Primary Care/Medical Home plans as qualified health plans sold in the state exchange marketplace.

Direct Primary Care (DPC) is paid directly – as the name suggests – by patients to primary care providers and not by insurers or managed care plans. Direct primary care payment is typically effected via basic monthly fee (as well as additional charges for some procedures and tests) that includes direct access to doctors and other primary care providers. Table 2 of this California Healthcare Foundation paper lists several DPC providers and their fees.

As author Dave Chase notes, there are potential downstream medical utilization cost savings from early preventative primary care intervention. Section 1301(a)(3)’s direct linkage of DPC to a “medical home” suggests an added benefit of keeping patients more connected with a primary care provider who can follow a patient over time and help coordinate referrals and care from other providers. The DPC primary care model also fosters economic incentive for primary care physicians to help alleviate concerns of a post-ACA primary care doctor shortage to handle the influx of newly insureds.

In order to be a qualified individual health plan sold on the exchange marketplace under Section 1301(a)(3), a DPC/Medical Home plan must be a health plan that includes primary care as well as nine other essential benefits. This applies to qualified health plans sold through exchanges as well as those sold outside the exchange marketplace. The primary care requirement however isn’t compatible with DPC because as noted previously, the patient – not a health plan or insurance – pays primary care services directly out of pocket via DPC fees. Plus plans must fall into one of the four metal tier actuarial values (AV) specified in the ACA ranging from bronze (60 percent AV) to platinum (90 percent AV), values predicated on both primary and higher cost care.

The appropriate form of insurance for a DPC patient is catastrophic coverage currently exempt from the metal tier AV requirements under Section 1302(e) but limited to young people under age 30 or those exempt from the individual coverage mandate because of financial hardship or coverage costs exceeding eight percent of income.  It’s the right type of coverage for DPC because as the name implies, it is designed not for relatively low cost primary care but rather big dollar costs such as hospitalizations and surgeries.  Referred to as “wraparound” coverage, it picks up where DPC leaves off. It acts as a true insurance product in that these costly services are typically accident-related or otherwise unexpected.

Section 1302(3) should be amended to include those enrolled in DPC arrangements in addition to the so-called “young invincibles” and recognized as meeting the ACA’s individual responsibility requirement to have some form of health coverage. The current limits on out of pocket costs for individual plans at Section 1302(c) would probably work well for DPC “wraparound” coverage.  However, since DPC patients are by definition paying primary care costs out of pocket, catastrophic DPC plans should include only a flat high dollar deductible.  Finally, to provide greater incentive for individuals and families to enroll in DPC/Medical Home plans, the ACA should amend the Internal Revenue Code to make 50 percent of DPC fees paid in a calendar year tax deductible for all taxpayers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

WellPoint’s Anthem Blue Cross spurns Calif. small-business exchange – latimes.com

July 19th, 2013 Comments off

Health insurance giant Anthem Blue Cross said it won’t participate in California’s new insurance market for small businesses.

Anthem, a unit of WellPoint Inc., is California’s largest insurer for small employers. This surprising move could hamper the state’s ability to enroll businesses in its new exchange called Covered California that opens Jan. 1 as part of the federal healthcare law.

Instead, Anthem said it will keep selling coverage to small firms outside the exchange in direct competition with the state-run market. Anthem also remains one of 13 health insurers that will offer policies to individuals in Covered California.

via WellPoint’s Anthem Blue Cross spurns Calif. small-business exchange – latimes.com.

This development isn’t a propitious one for the California Small Business Health Options Program (SHOP) exchange marketplace. Not having a payer with such a significant market share could make it harder for the SHOP to attract small employers. Unlike the individual exchange marketplace, the SHOP relies almost completely on market aggregation forces to improve affordability, competition and choice in this market segment. Covered California is expected to announce participating SHOP plans for 2014 early next month.

In 2011, the California HealthCare Foundation estimated Anthem Blue Cross had 22 percent of the Golden State’s small group market, covering 548,000 enrollees.

 

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Absence of rules means Direct Primary Care Medical Home QHPs unlikely to be offered on exchange marketplace in 2014

June 7th, 2013 Comments off

An innovative type of health plan that bundles pre-paid primary and preventative care with catastrophic insurance coverage isn’t likely to be sold on state health benefit exchange marketplaces in 2014.

The reason is the federal Department of Health and Human Services (HHS) has not yet developed rules governing Direct Primary Care Medical Home Plans, recognized at Section 1301(a)(3) of the Affordable Care Act as qualified health plans (QHPs) eligible to be sold through the exchanges. However, Section 1301(a)(3) requires such plans meet HHS criteria. HHS has not yet issued regulations defining those standards nor any guidance indicating when the rules will be forthcoming.

In April of this year, the California HealthCare Foundation issued an issue brief on Direct Primary Care Medical Home Plans authored by Dave Chase noting these plans offer significant potential health care cost savings over all inclusive plans such as HMOs while providing economic incentive for primary care physicians – many of whom will be needed to care for new patients obtaining health coverage under the Affordable Care Act.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Independent study of potential benefits of direct primary care needed

April 30th, 2013 Comments off

The California HealthCare Foundation has published an issue brief on pre-paid primary care plans, known as direct primary care.  Direct primary care (DPC) unbundles physician office visits and some other limited services from health insurance coverage and is directly paid out of pocket by consumers, leaving insurance to cover hospitalizations and catastrophic care events.  It has the potential to lower premiums since it eliminates the administrative burden on both payers and providers to process routine care reimbursements as well as potentially avoiding higher cost care by allowing primary care providers to offer more intensive preventative care and lifestyle coaching to ward off preventable, chronic conditions.

The issue brief notes some DPC providers have pegged overall health care cost savings in the 20 to 30 percent range.  Cost reductions of that size can go a long way toward achieving the triple aim of better care at lower cost and with better outcomes and warrant independent research to more fully investigate the potential savings.  The research should also examine how DPC might favorably affect the business model of primary care medical practice and its potential to attract more physicians to the field at the same time the number of people with insurance coverage – and the concurrent need for primary care practitioners – is expected to increase starting in 2014 under the Patient Protection and Affordable Care Act.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Schedule control: Real cultural change toward achieving a healthier California

November 16th, 2012 Comments off

California, which once basked in the suntanned imagery of youthful vigor and health and fitness recognizes the shine has faded as its population grows older and more sedentary and obese, spawning an unprecedented increase in chronic, preventable disease.  Earlier this year, the administration of Gov. Jerry Brown formed a task force with the vision of restoring the Golden State to the healthiest in the nation by 2022.  This week, the Let’s Get Healthy California Task Force released a draft report outlining how the state will achieve that vision based on six goals and associated priorities and health indicators.

Brown and his Health and Human Services Agency Secretary Diana Dooley – who also chairs Covered California, the state’s health benefit exchange — are to be commended for initiating and championing this monumental project.  When it comes to something as big as improving the health status of the nation’s most populous state, one of the task force’s members, Dave Regan, president of Service Employees International Union – United Healthcare Workers West, clearly understands what’s needed to generate the enormous momentum to counter the sickly, sedentary status quo.  Here’s what he said with the release of the draft report as reported by the California HealthCare Foundation’s California Healthline:

There’s lots and lots of good stuff in here. What I’m thinking about is what’s not in here,” said Dave Regan, president of Service Employees International Union. “I keep going back to two things — 80% of what drives health care costs is behavioral, and only 20% of the cost of health care can be affected by what we do today.”

Regan said there needs to be a bigger change, a cultural change, to affect some of the root causes of rising health care costs and poor health of Californians.

“When you look at the goals and indicators in here, we may have a forest-and-trees effect. The behavioral culture is far more influential than all of us nibbling at the margins. … Unless we change the behaviors of millions of people, then we’re just tilting at windmills.”

Regan’s exactly right.  And he need look no further than the state workforce – a large portion represented by his union –  to see a glaring example of a subsection of the bigger California health problem.  These thousands of state employees need to get out of their offices and cubicles and exercise more.  Especially as they drive up the cost of providing them health care with one third driven by chronic conditions and raise serious questions as to whether the state will be able to afford to provide them health coverage in retirement.

But they are held prisoner by a rigid, outmoded Industrial Age work culture that requires them to be at the desks from 8 to 5, Monday through Friday.  Most could shift their work outside this fixed time frame and location, thanks to today’s information and communications technology — much of it innovated in California — that makes it easily possible for them to do their jobs in a home office or other locations where they can be productive.

This “work shifting” is an essential cultural change that Regan correctly says is needed because it affords people control over their daily schedules and frees up hours each week of wasted commuting time.  A 2011 University of Minnesota study found when people are afforded control over when and where they perform their jobs, they got more sleep and exercise.  Schedule control is thus a potentially powerful cultural shift because it enables healthy living – a goal identified in the task force report – and makes it easier for people to adopt healthier lifestyle choices.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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