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State Health Care Mandates Would Lower Uninsured Rate 

Millions of U.S. consumers would gain access to health insurance while their premium expenses would decline if all states implemented their own health care mandates, according to a study from The Commonwealth Fund and Urban Institute. Massachusetts and New Jersey have mandates and, if every state followed their lead, nearly four million consumers would have health insurance and premium costs would decline by an average of almost 12 percent, according to a news release from The Commonwealth Fund. 

“These mandates would replace the Affordable Care Act’s penalty for not having health insurance, a fee that Congress eliminated, effective 2019,” it states. Currently, the Affordable Care Act requires most Americans to have an insurance plan or face a financial penalty in an effort to “stabilize insurance markets by encouraging healthy people to purchase and stay enrolled in a health plan,” The Commonwealth Fund reports.  

The Congressional Budget Office expects premiums will rise and more consumers will lose their health insurance when the penalty is eliminated in January 2019. However, according to The Commonwealth Fund and Urban Institute Study, if states take the reins and create their own mandates:  

Millions more consumers would have health insurance. In fact, enacting state individual mandates across the country in 2019, when the federal penalties are lifted, would lower the number of uninsured by 3.9 million—or 11.4 percent.  

If all states enacted their own mandate, health care premiums would decline an average of 11.8 percent. The impact on premium rates would differ across states, for example, premiums would decline by more than 20 percent and Colorado, the District of Columbia, Kentucky, Nevada, North Dakota, Washington, and West Virginia would see declines of more than 15 percent.  

The study also shows uncompensated care costs for health care providers would significantly decline. “When patients are uninsured and can’t pay their medical bills, state and federal governments, as well as physicians, hospitals and community health centers, absorb the costs of this uncompensated care,” according to the news release. “As more people gain coverage mandates, demand for uncompensated care would fall by $11.4 billion nationally.  

States can also enact comparable mandate penalties to those at the federal level to mitigate any negative effects of eliminating the penalties under the Affordable Care Act. The study’s authors, Linda Blumberg, Matthew Buettgens and John Holahan from the Urban Institute note that there are significant challenges to getting state-level mandates off the ground.  

“Some states, for example, do not have state income taxes, and new financial structures would have to be developed to collect individual mandate penalties,” they report. “Other state political environments are not conducive to enacting individual mandate legislation, even in states where governors and state policymakers generally support the [Affordable Care Act.]”  

More information: More information: https://bit.ly/2mKefe5

Health Care Merger and Acquisition Activity Builds Momentum 

Merger and acquisition activity in the health care sector remains strong this year, particularly for not-for-profit hospitals and health systems, according to an analysis by Kaufman Hall. The number of total transactions reached 50 in the first half of this year. In the second quarter alone, 16 of 21 transactions occurred among not-for-profit hospitals and health systems compared to five transactions among for-profit health care providers, according to the analysis (https://bit.ly/2LDRvKV).  

“When combined with first quarter results, more than 76 percent of deals announced in the first half of 2018 involve not-for-profit acquirers, while less than 24 percent involve for-profit acquirers.” “Not-for-profit hospital and health system leaders nationwide are moving aggressively to broaden their organizations’ base and expand their presence, extending capabilities across larger geographies in order to address continued uncertainty in the industry,” Anu Singh, managing director at Kaufman Hall, said in a news release.  

Revenue cycle management vendors for the health care industry should take note of these trends, according to Corporate Advisory Solutions (CAS), which recently published its second quarter report on merger and acquisition activity (https://bit.ly/2mMr1ZO

“This consolidation is positive for patients, increasing the quality of care to a larger population, but vendors will need to be larger and offer a wide breadth of service offerings to remain competitive,” according to the report. Overall, CAS reports the revenue cycle management (RCM) services sector bounced back to a “normal” volume of mergers and acquisitions after a quiet first quarter. There were five deals totaling a combined enterprise value of $987 million in the second quarter.  

“The RCM industry continues to experience robust growth, which is expected to persist moving forward,” CAS reports. Hospital merger and acquisition activity also continues at a fast pace which, according to data from the Healthcare Financial Management Association, included 25 transactions in the first half of this year, CAS reports. The industry is benefiting from growing health care expenditures which, CAS and the Altarum Institute report, are surpassing growth in the GDP.  

Year-over-year spending increased from 4.5 percent in December 2017 to 4.9 percent in February this year, according to the Altarum Institute. “Within the industry, a push from local governments and advocacy groups for increased price transparency may positively re-shape how consumers make decisions about their health care [expenditures.] A less opaque structure will surely cause prices to drop across the board, strongly benefiting individuals,” CAS reports.  

Finally, advances in telehealth bolster consolidation of health care systems as patients have access to personalized care at home and break away from the traditional care model. Among other trends to watch, according to CAS, providers continue their move toward value-based care payment structures. See Data Watch for a graph depicting the CAS findings on RCM mergers and acquisitions in the second quarter.

Care Quality: Is Value-Based Care Working?

Value-based care, the model that bases payments on quality of care, is starting to reduce medical costs and improve patient services, according to a recent survey from Change Healthcare conducted by ORC International.  In fact, the results show value-based care is accomplishing the “triple aim” sought after in the industry, meaning providing better care for consumers, improving population health management plans and lowering health care expenses.

According to “Finding the Value: The State of Value-Based Care in 2018,” the model is reducing unnecessary medical costs 5.6 percent on average while improving care and patient engagement.  Nearly 25 percent of respondents said their savings exceed 7.5 percent.  

“Despite easing or ending of federal mandates, commercial lines of business are investing in value-based innovation, accelerating the decline of pure fee-for service faster than previously projected levels. Indeed, today nearly two-thirds of payments are now based on value,” according to a news release on the survey from Change Healthcare (https://bit.ly/2KcCGyS).

The survey includes 120 payers such as Managed Medicare and Managed Medicaid across multiple regions and organization sizes.  “Payers are finding the positive impact of value-based care as they scale these models—particularly episodes of care—and that’s starting to bend the cost curve in a significant way,” Carolyn Wukitch, senior vice president and general manager, Network and Financial Management, Change Healthcare, said in the news release. 

“However, the demand to innovate at the pace of change is challenging payers. They lack satisfactory analytics and automation to better engage providers, operationalize their models and assess effectiveness overall.”  Additional findings from the survey include:

Nearly 80 percent of payers say they’ve experienced improvements in care quality, while 64 percent report improvements in provider relationships and 73 percent report better patient engagement.

The fee-for-service model is fading at a faster rate than predicted in previous studies, now representing just 37.2 percent of reimbursement, and projected to drop below 26 percent by 2021.

More than half of payers surveyed, however, “are not very satisfied with their current value-based analytics, automation and reporting capabilities—despite the fact that many of these are designed and developed in-house.”

Visit 2018VBCstudy.com to access the complete research report, Finding the Value: The State of Value-Based Reimbursement in 2018. Examples of value-based care models for health care providers are available from the Centers for Medicare and Medicaid Services (http://go.cms.gov/1jxyhoF.)

 

Research Shows Growth in Health Care Prices

The prices for a range of health care services are growing more rapidly than economic inflation in the U.S., according to new research published by the Kaiser Family Foundation (KFF).  The research focuses on trends in health care prices, use of services and health care spending in the U.S. versus other similar countries.

Consumers with private insurance experience particularly high increases in costs for services. The KFF also finds that there is “significant geographic variation in prices.”  “For example, the average price of a full knee replacement for those in large employer plans increased from $19,595 in 2003 to $34,063 in 2016, growth of 74 percent compared to a 28 percent increase in general inflation,” it reports.

In New York City, the average cost of the same knee replacement is more than double the cost in the Louisville, Ky., area.  Overall, private insurance prices for inpatient hospital services are significantly more than what is paid by Medicare and Medicaid, and the gap is increasing over time, according to the KFF.

Compared to other countries, the KFF finds that the prices in the U.S. are higher for health care and prescription medications, but use of services, such as physician visits, is lower.  And, the average health care spending per person in other comparable countries is half as much. In the U.S. the average health expenditures per person in 2016 was $10,348, compared to $7,919 in Switzerland and $5,551 in Germany.

The U.S. spent 18 percent of its GDP on health care in 2016, compared to 12 percent in Switzerland.  More information: https://kaiserf.am/2yPwrMa

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