Conservatives in House Unveil ObamaCare Replacement Bill

Conservatives representing nearly three-quarters of the House Republican conference unveiled their proposed replacement for President Obama’s healthcare law Wednesday, delivering on a long-delayed GOP promise.

The bill from the Republican Study Committee would fully repeal the 2010 law and replace it with an expansion of health savings accounts, medical liability reform and the elimination of restrictions on purchasing insurance across state lines.

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Employers Are Dropping Spousal Coverage, Cite Affordable Care Act Costs for Decision

Pointing to costs of the Affordable Care Act (ACA), some employers are dropping spouses from their group health plans next year.

In Mercer’s 2012 National Survey of Employer Sponsored Health Plans, which represents data from nearly 2,810 employers of all sizes, 6% of employers reported excluding spouses from coverage, and another 6% reported charging a spousal surcharge. This represents a total of 12% of employers with some type of special provision for spousal coverage, says Tracy Watts, a senior partner in Mercer’s Washington, D.C., office.

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Patient-Centric Quality Measures Are Needed for True ACO Ratings

ACOs and payers should weave much more specific, function-oriented patient satisfaction and patient-driven decision-making measures into the quality standards that determine reimbursement for physicians and organizations, ACO executives say.

Creating these new quality measures — and scoring well on them — will require widespread changes in health information technology (HIT) systems, physician attitudes and organizations, says Palmer Evans, M.D., former senior vice president and chief medical officer at Tucson Medical Center in Arizona and senior advisor to the South Arizona Accountable Care Organization, which includes Tucson Medical Center and more than 170 physicians.

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Oscar: The New Kid That May Change Health Insurance

Three friends, and technology entrepreneurs, teamed up to do something that has been inconceivable to date—create a start-up health insurance company to take on conventional health insurers on the NY exchange.

Oscar co-founders, Josh Kushner, Kevin Nazemi and Mario Schlosser, plan to change the health insurance industry through technological interfaces, telemedicine and real transparency. Their goal is to redesign insurance to be geared toward the user experience, to make patients seek out their insurer before their doctor.

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New Health Insurance Cooperative Goes Live With Help from Care Management Firm

Tampa, FL – August 27, 2013 – Health Integrated, Inc., a recognized innovator in care management strategies for vulnerable, fragile and at-risk individuals, has partnered with Meritus (dba Meritus Mutual Health Partners (PPO) and Meritus Health Partners (HMO)), Arizona’s first and only consumer-operated and oriented (Co-Op) insurance plan, to deliver its full care management platform for the plan and its members. Meritus will begin enrolling new members in October 2013 for coverage beginning January 1, 2014.

For Meritus, Health Integrated is providing a full suite of care management services on a state-of-the-art care management platform, including:

  • Health Risk Assessments
  • Chronic Condition Management
  • Case Management (Medical and Behavioral)
  • Utilization Management (Medical and Behavioral)
  • 24/7 Behavioral Health Crisis Line

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Hospitals, Health Systems Quicken Pace to Own Insurers, Full-Risk Health Plans

Nationwide, about 100 provider-sponsored health plans are owned by hospitals or health systems, says Joe Damore, vice president of population health management for the Premier healthcare alliance. Moreover, he tells HPW that approximately 20 more health systems are in the process of getting licensed to offer their own plans. These likely will be implemented within the next 18 months or so for at least a 20% increase over that time period, says Damore.

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California Public Exchange to Delay Quality Rating System

Covered California has decided not to include a quality rating system for health plans when the new insurance marketplace kicks off enrollment in October.

The issue has been controversial because some plans have complained there is not enough time to prepare their reporting systems to track the requested data.

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Bare Bones Health Plans Expected To Survive Health Law

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization.

Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage.

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them.

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ACA Sparks Renewed Interest in CDHPs; FedEx Shifts to Account-Based Plans

The trend toward consumer-directed health plans (CDHPs) got a major convert this month when package delivery giant FedEx Inc. said it would not only offer such plans, but actually switch its entire 400,000-some workforce to account-based insurance starting in 2014. Cigna Corp. and WellPoint, Inc.’s Anthem Blue Cross and Blue Shield will administer the new benefit.

Consultants and industry stakeholders didn’t blink at the news, considering that CDHPs have been around for more than a decade, but did stress that the reform law appears to be accelerating the speed at which large groups are moving away from more traditional coverage.

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ACA Obstacle: Consumers’ Confusion When Picking a Plan

Recent surveys show that U.S. residents are confused by the ACA — and, more generally, by health insurance — which has led some observers to question whether the exchanges’ open enrollment period will proceed smoothly or be too overwhelming for those who would benefit most from the reform law.

Many health care experts see the health insurance exchanges as the most crucial component of the health reform law.

Supporters hope that the exchanges — which primarily will serve individuals and small businesses — will function similarly to websites like Amazon and Expedia, allowing users to choose among various health plans through an easily navigable online store.

Open enrollment begins Oct. 1, and if survey findings are any indication, it could be a very confusing time for those buying insurance.

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