Group Calls for Laws to Stop Hepatitis Care Rationing
Those on the front lines of fighting viral hepatitis and HIV/AIDS urged lawmakers to overturn state Medicaid and managed care policies that block patients from getting new and effective hepatitis C treatments. The Center for Health Law and Policy Innovation of Harvard Law School documented system-wide insurance restrictions, such as only allowing only patients with advanced liver disease to get the new drugs; only allowing a small number of medical specialists to prescribe the drugs; and restricting access to patients who use alcohol and other substances or have an HIV co-infection. These exclusionary practices also apply to a number of private health plans, resulting in a series of lawsuits in California. These restrictions mean that only 5% to 6% of people with Hepatitis C are being treated successfully.
Specialists are calling on policymakers to pass state laws requiring insurance plans to follow evidence-based medical guidelines when covering Hepatitis C testing and treatment. These guidelines (published jointly by the American Association for the Study of Liver Diseases, the Infectious Diseases Society of America, and the Department of Veterans Affairs) support treatment in all Hepatitis C-infected people except those with a life expectancy of less than a year due to non-liver medical conditions. Advocates urge states to enact laws requiring Medicaid programs to offer first-line HIV medications and new Hepatitis C drugs on their formularies and to cap the co-payments for these therapies, ending system-wide practices by public and private insurers that restrict access to these drugs.
Veronica Miller, PhD, Executive director of the Forum for Collaborative HIV Research said, “While the cost of new therapies is a legitimate topic, without testing and treatment there will be little hope of reducing the burden of Hepatitis C and bending the cost curve.” Proponents say that expanded access to Hepatitis C testing and treatment is especially warranted now that the Centers for Disease Control and Prevention (CDC) is grappling with twin epidemics in the U.S. – Baby Boomers who are living with chronic Hepatitis C, and an explosion of acute Hepatitis C primarily occurring east of the Mississippi River in young adults who inject drugs.
“It is a sad fact that public and private insurers are responding to these twin epidemics by restricting access to new Hepatitis C drugs that have been found to produce high cure rates, sometimes exceeding 90%, within 12 weeks of treatment. We urgently need coverage policies that are intended to stem the tide of Hepatitis C and reduce its societal burden,” said infectious disease expert John G. Bartlett, MD, Professor Emeritus of Medicine in the Division of Infectious Diseases at The Johns Hopkins University School of Medicine. For more information, visit hivforum.org.
State Senate Clears Bill to Clean up Provider Directories
Senate Bill 137 cleared a major hurdle as it passed out of the Senate by a vote of 33-0. Senator Ed Hernandez, O.D. (D – West Covina), Chair of the Senate Health Committee, is author of the bill that would require health plans and insurers to post accurate health care provider directories on their Websites so that consumers will know if their doctor is part of a network before purchasing a health plan.
During last year’s open enrollment period many people had a hard time determining which plans their providers were a part of; some felt misled by the plans they chose. The problem was so bad that Covered California had to take its provider search tool off-line. It has not been reinstated.
A recent report by the Kaiser Family Foundation indicated that comparing provider networks is the most common difficulty in the plan selection process across all coverage groups. “We don’t allow other products to be sold with an inaccurate listing of ingredients…This bill would make sure provider directors are accurate and standardized, so consumers can know what they are buying and make the right decisions,” said Anthony Wright, executive director of Health Access California. SB 137 would also require the provider directories to indicate if the provider or staff speaks any languages other than English.
Connecting Women to Power Business Conference
The California State Board of Equalization (BOE) Chairman Jerome E. Horton invites entrepreneurs to the sixth annual Connecting Women to Power Business Conference on Thursday, June 18, 2015 at California State University, Dominguez Hills. The conference begins at 8:30 a.m. and ends at 5:00 p.m. “This conference, which has grown each year since its inception, provides California entrepreneurs, women and men, the opportunity to expand their business knowledge and find the inspiration to take on new challenges and achieve success,” said Chairman Horton. This year, the conference added an executive leadership course and a job fair for people interested in working for the State of California. The event features motivational speakers who will offer expert business advice and inspiring stories of success and triumph. Connecting Women to Power features multiple panel discussions throughout the day on topics including business financing, global business opportunities, wealth management, social media marketing, and franchising, to name a few. For more information, call 888-847-9652.
Study Finds That Pay-for-Performance Doesn’t Work
A study published in the New England Journal of Medicine finds little evidence that pay-for-performance programs reduce hospital mortality. Under the Affordable Care Act, CMS must adopt a pay-for-performance program for hospitals nationwide. CMS responded by creating the value-based purchasing program, which provides financial incentives for high achievement and improvement in performance — an approach closely modeled after the Premier HQID. Researchers looked at the Premier HQID program over six years. Even among hospitals that were poor performers at baseline, there was only a weak and inconsistent association between participating in the program and reducing mortality.
Poorly performing hospitals did improve under the Premier HQID program, but the improvements were similar to those seen under public reporting alone, with the exception of pneumonia. Prior studies of the Premier HQID showed that the early gains in process quality had mostly dissipated after five years. The modest benefits were most perceptible for hospitals that were eligible for larger bonuses, were well financed, or operated in less competitive markets.
Researchers said, “Proponents of pay for performance might argue that benefits with respect to mortality would take longer to become evident as hospitals reconfigure their underlying approach to delivering care. We find little evidence in the Premier HQID program to support this notion, even after six years of financial incentives under the program.” For more information, visit nejm.org.
AMA Seeks to Improve Mental Health Coverage
The American Medical Association (AMA) is calling on Medicaid and private health insurers to pay for physical and behavioral health care services provided on the same day. “Treating people with physical and behavioral health conditions can be two to three times higher than caring for those without co morbid conditions. Yet research shows that coordinated care management of mental and physical health conditions can greatly improve health outcomes and could save upwards of $48 billion annually in general health care costs,” said Mary Anne McCaffree, M.D.
The AMA is also encouraging state Medicaid programs to include payment for behavioral health care services in school settings in order to identify and treat behavioral health conditions as early as possible. “Less than half of the 43 million adults identified with a mental illness and the six million children identified as suffering from an emotional, behavioral, or developmental issue get treatment. A key barrier…is cost. If we don’t take the necessary steps to ensure that integrated physical and behavioral health care [are] provided as early as possible, the lack of comprehensive services will continue to have devastating consequences for these people and the health of our society,” she added. For more information, visit ama-assn.org.
Mental Health Bill Reintroduced
Chairman Tim Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX) reintroduced the Helping Families in Mental Health Crisis Act, H.R. 2646. The revamped bill builds upon the previous bipartisan version. H.R. 2646. It breaks down federal barriers to care, clarifies privacy standards, expands parity accountability, invests in services for the most difficult to treat cases, and drives evidence-based care. Rep. Murphy said, “We are moving mental health care from crisis response to recovery, and from tragedy to triumph.”
The Helping Families in Mental Health Crisis Act was first introduced in December 2013, following a yearlong investigation led by Oversight Chairman Murphy into the nation’s broken mental health system. The investigation revealed that the federal government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.
As documented in a recent Government Accountability Office (GAO) report, 112 federal programs intended to address mental illness aren’t connecting for effective service delivery. Also, there is a lack of inter-agency coordination for programs supporting people with serious mental illness.
While the federal government dedicates $130 billion towards mental health each year, the mental health system is best described by its deficits. To name just a few:
- There is a nationwide shortage of nearly 100,000 needed psychiatric beds.
- Three of the largest mental health hospitals are criminal incarceration facilities.
- Privacy rules frustrate physicians and family members and generate nearly 8,000 official complaints a year.
- Only one child psychiatrist is available for every 2,000 children with a mental health disorder.
- The leading federal mental health agency does not employ any psychiatrists.
The Helping Families in Mental Health Crisis Act of 2015, H.R. 2646 would do the following:
- Create an Assistant Secretary for Mental Health and Substance Use Disorders with mental health credentials within HHS. The assistant secretary would elevate the importance of mental health in the nation’s leading health agency, coordinate programs across different agencies, and promote effective evidence-based programs.
- Require the Assistant Secretary for Mental Health and Substance Use Disorders to make public all federal investigations into compliance with the parity law so that families and consumers know what treatment they have rights to access.
- Establish a National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs.
- Dedicate funding for the Brain Research Through Advancing Innovative Neurotechnologies Initiative.
- Require psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to appropriate post-hospital care and services.
- Provides additional psychiatric hospital beds for those with an acute mental health crisis who need short term (less than 30 days) immediate inpatient care.
- Support advances in tele-psychiatry to link pediatricians and primary care doctors with psychiatrists and psychologists in areas where patients don’t have access to care.
- Require the Assistant Secretary for Mental Health and Substance Use Disorders to study and recommend a national strategy to increase the number of psychiatrists, child and adolescent psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and mental health peer-support specialists.
- Include child and adolescent psychiatrists in the National Health Service Corps.
- Authorize the Minority Fellowship Program.
- Authorize, for the first time in federal law, the Recovery After Initial Schizophrenia Episode (RAISE), an evidence-based early intervention program.
- Reauthorize the National Child Traumatic Stress Network.
- Launch an early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
- Provide incentives to states to offer community-based alternatives to institutionalization.
- Reauthorizes the Garrett Lee Smith Suicide Prevention Program, invest in research on self-directed violence, and authorize, for the first time in the statute, the Suicide Prevention Hotline.
- Extend health information technology for mental health providers to coordinate care with primary care doctors using electronic medical records.
- Establishe an inter-agency Serious Mental Illness Coordinating Committee to organize, integrate, and coordinate the research, treatment, housing and services for people with substance use disorders and mental illness.
- Ends the decades-old prohibition on physicians volunteering at community mental health clinics and federally qualified health centers.
Congressman Murphy, a psychologist with nearly three decades experience, has been a champion for reforming the broken mental health system. He yearly introduces the bipartisan congressional resolution declaring May as Mental Health Month, to end the stigma associated with mental illness and promote public awareness of mental health. He will soon advance a similar resolution recognizing the month of June as PTSD Awareness Month. A provision in the previous version of his Helping Families in Mental Health Crisis Act was recently adopted on the House floor. Murphy offered a bipartisan amendment with Rep. Michelle Lujan Grisham (D-NM) and Rep. Earl Blumenauer (D-Ore.) to the Commerce, Justice, Science and Related Agencies Appropriations Act of 2016, to advance and expand Mental Health Courts, a successful model of collaboration between criminal justice and mental health systems for those with serious mental illness.
CDHP Enrollees Skew Older
A recent study by the Employee Benefits Research Institute finds that CDHP enrollees are more likely to be 45 to 54 than 21 to 34 in 2014. They are also more likely to be in households with $100,000 to $149,999. They are roughly twice as likely as people with traditional coverage to have college or postgraduate educations. For more information, visit ebri.org.
Actuaries Address Possible Post-King v. Burwell Disruptions
The American Academy of Actuaries released an issue brief examining possible changes to the Affordable Care Act if the Supreme Court hands down a decision prohibiting premium subsidies in states with federally facilitated marketplaces in the King v. Burwell case. Eliminating the subsidies would have enormous consequences for insurance enrollment, premiums, and the viability of health insurance markets, said Catherine Murphy-Barron, vice president of the Academy’s Health Practice Council (HPC). She explained, “Policymakers should understand the implications of any policy proposal intending to address the disruption caused by the potential loss of subsidies. Of central concern, a viable health insurance system must attract a broad cross section of risks and operate as a level playing field.” The Academy urges policymakers to follow market reform principles for ensuring a sustainable health care system. Allowing insurance to be sold across state lines could result in adverse selection, but could also increase competition. Allowing for association health plans could raise adverse selection concerns, she added. For more information, visit actuary.org.
Public Divided Over ACA Subsidies
The public is very divided over tying personal requirements to Affordable Care Act subsidies, according to a survey by HealthPocket. The survey asked, “Do you believe any requirements (e.g. no smoking) should be placed on people in order to get Obamacare health insurance subsidies?” Respondents chose one of the following answers:
- 37% “I’m not sure.”
- 34% “No, requirements would be unfair.”
- 29% “Yes, requirements would be fair.”
Those who answered, “Yes, requirements would be fair” were asked what requirements should there be in order to get Obamacare health insurance subsidies. Respondents chose the following answers:
- 71% Don’t take illegal drugs.
- 65% Don’t smoke.
- 43% Get preventive care such as flu shots.
- 37% Don’t be obese.
For more information, visit HealthPocket.com.
Lower-Income Families in Dire Need of Financial Planning
There are still major disparities between higher- and lower income households when it comes to financial preparedness, knowledge about health insurance, and employee benefit enrollment, according to a recent study by Aflac. The following are key findings:
- 78% of households earning less than $50,000 a year have less than $1,000 available to pay out-of-pocket costs of an unexpected serious illness or accident, compared to 19% of households earning $100,00 a year or more.
- 74% of households earning $100,00 a year or more have a financial plan, compared to 38% of households earning less than $50,000 a year.
- 65% of households earning less than $50,000 a year who are offered employee benefits are enrolled in major medical insurance, compared to 81% of households earning $100,00 a year or more.
- 19% of households earning less than $50,000 a year say they are extremely or very knowledgeable about high deductible health plans, compared to 37% of those earning $100,000 or more.
- 18% of households earning less than $50,000 a year are extremely or very knowledgeable about health savings accounts compared to 40% of those earning $100,000 or more.
- 20% of households earning less than $50,000 a year are extremely or very knowledgeable about flexible spending accounts compared to 51% of those earning $100,000 or more.
- 50% of households earning less than $50,000 a year spend less than 30 minutes researching their benefits options, while only 41% of those earning $100,000 or more say the same.
- 65% of households earning less than $50,000 per year have major medical coverage through work compared to 81% of households earning $100,000 or more per year.
- 25% of households earning less than $50,000 a year disability coverage compared to 56% of households earning $100,000 or more a year.
- More than half of Millennials agree, at least somewhat, that medical bills have hindered their ability to save.
- Baby Boomers are most likely to report feeling a financial impact from consumer-driven health care, adding further uncertainty to their retirement considerations.
- Even though 63% of employees participate in their company’s wellness program almost the same amount are pessimistic about the influence their companies’ programs have on their health.
Employee Benefits Guidance Tool
MassMutual is launching a tool to help Americans make financial decisions about health care coverage, insurance protection, and retirement savings. Within minutes, MapMyBenefits provides personalized guidance to help employees prioritize their health care, insurance, and retirement benefits. It helps them make the most of each benefit dollar based on their life stage, financial goals and personal financial situation. For more information call 1-800-874-2502, option 4.
EPIC Insurance Brokers and Consultants is launching EPIC Private Exchange Platform. The technology-driven, consumer friendly enrollment and benefit administration platform walks employees through the benefit decision and purchasing process. For more information, visit taniscomm.com.
No-Cost Chronic Illness Rider
AIG has added a no-cost chronic illness accelerated death benefit rider to three Quality of Life Insurance (QoL) products issued in California. The owner can accelerate some or all of their base life insurance benefit if they are certified as having a chronic illness, as defined under the rider. The money can be used for any purpose, including supplemental income, medical expenses, or long-term care. Coverage is reduced by the amount of the accelerated death benefit, which may also reduce premiums. Accelerated benefits can be paid in a lump sum, annually, for a fixed period of (not to exceed 24 months), or monthly payments for a fixed period (not to exceed 24 months). For more information, visit aig.com.
Group Term Life
Voya Financial launched a group term life product. Enhanced features include a variety of coverage options for employees, and life insurance benefits that can be used to help cover everyday expenses including funeral costs, medical bills, mortgage payments, and college tuition. Through an optional rider, an insured employee may be eligible to receive a portion of their benefit if they should become permanently confined to a healthcare facility. This benefit can be paid on a monthly basis, providing a stream of income for an employee or their family. For more information, visit voya.com.
ACA Compliance Tool
Infinisource is offering an Affordable Care Act (ACA) compliance tool. iSolved tracks and maintains data about employee status; dates and coverage in a single source. It can produce reports for ACA compliance. The iSolved ACA Checkup evaluates how employers’ criteria may subject them to certain provisions of the law. For more information, visit infinisource.com.