Managed Care - September 2008 - (Page 7)

NEWS AND COMMENTARY Uninsured Spend $30 Billion Out of Pocket, Study Says eople who will be uninsured for any part of 2008 will spend about $30 billion in out-of-pocket costs and receive about $56 billion in uncompensated care. The payer who picks up most of the tab? The federal government, not private insurers, pays about 75 percent or $42.9 billion, according to researchers at George Mason University and the Urban Institute. And while it is thought that private insurers adjust for uncompensated care by shifting costs, the researchers found that this isn’t the case. The study, published in Health Affairs, notes that cost shifting as a result of uncompensated care has a “very small impact on private insurance premiums.” Jack Hadley, PhD, a professor and senior health services researcher in the department of Health Administration and Policy at George Mason and lead author, estimates that $14.1 billion could be financed by shifting costs. The researchers say that total private health insurance expenditures for 2008 will be $829.9 billion, but the amount potentially associated with cost shifting represents at most 1.7 percent of private health insurance costs. “Covering the uninsured will likely lead to a significant increase in demand for both drugs and coverage by managed care programs,” says Hadley. “Since the currently uninsured tend to have lower incomes, they should be more likely to seek coverage through lower cost insurance products, i.e., managed care. Another possibility is that the expanded insurance coverage would be through public programs, especially Medicaid. Based on past experience, expanded Medicaid coverage is also likely to increase the demand for managed care plans.” P Employers Turn To CDHPs, Wellness Faced with continually rising health care costs, employers are looking to consumer-directed health plans (CDHPs) and wellness programs to keep them down. There was a 43 percent increase in the number of CDHPs offered this year, compared to 2007. These plans make up nearly 13 percent of all plan offerings by employers. The percentage of employees enrolled in CDHPs nearly doubled from 2006 through 2007. The findings, presented in the 2008 United Benefit Artists Health Plan Survey, also show that PPOs continue dominating the market with nearly 54 percent of plans offering this type of coverage and with nearly twothirds of employees enrolled. HMO enrollment continues to slip and now represents 21.3 percent of plans offered, with only 13.3 percent of employees enrolled. “The continued growth of CDHPs is a key headline to come out of the survey,” says Bill Stafford, UBA’s vice president for member services. “Feefor-service and exclusive provider organizations have virtually disappeared.” Employers are also increasingly offering comprehensive wellness programs to their employees. In fact, nearly 1 in 10 (9.8 percent) employers offers wellness programs in 2008, compared to just 7.4 percent in 2007. Of the employers that offer wellness programs, 79 percent include health risk assessments; 35 percent include seminars or workshops; 39 percent include on-site coaching or coaching by telephone for high-risk employees; and 40 percent offer biometric screening or physical exams. Half offer incentives for participating in wellness programs. NCQA Unveils Quality Measures The National Committee for Quality Assurance (NCQA) has unveiled the first set of quality measures to assess disease management clinical outcomes. When finalized, the 12 measures — covering five chronic disease areas — will allow employers, health plans, consumers, and others to evaluate the performance of disease management organizations. The proposed measures address asthma, ischemic vascular disease, chronic obstructive pulmonary disorder, diabetes, and heart failure. The measures will examine whether patients are getting the right treatment and procedures in managing their lifestyles and reducing risk. For example, one measure will determine whether patients with ischemic vascular disease are controlling their blood pressure appropriately. “More than 50 million Americans live with one or more chronic conditions,” says NCQA Vice President L. Gregory Pawlson, MD, MPH. “Disease management can be an effective way of improving the quality of their health and lives. Yet we know far too little about the effectiveness of these programs.” NCQA has long assessed the performance of disease management companies through its accreditation and certification processes. SEPTEMBER 2008 / MANAGED CARE 7

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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