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Tag: Department of Health and Human Services

Growth And Dispersion Of Accountable Care Organizations In 2015

In January, an additional 89 provider organizations joined the Medicare Shared Savings Program (MSSP) as accountable care organizations (ACOs). While this year’s new entrants are a smaller cohort than those that joined in 2013 and 2014, they represent a continuation of the expansion of the accountable care movement.

The recent Department of Health and Human Services (HHS) announcement of its goal to move 50 percent of Medicare payments to alternative payment models (including ACO-based arrangements) indicates the government’s strong backing of the model and, coupled with continuing endorsement of the approach from state Medicaid programs and commercial insurers, there is strong support for this care delivery approach to continue.

In an ACO, health care providers accept responsibility for the cost and quality of care for a defined population. Each ACO’s laudable goal is to achieve what Don Berwick has called the “triple aim” — to improve quality, increase patient satisfaction, and lower costs. The key to reaching those goals is to change how providers are paid, based on reaching certain cost and quality benchmarks. In effect, the objective is to change incentives so that it is in providers’ best interest to maximize health, rather than focus on increasing the volume of services rendered.

ACO Growth

Leavitt Partners has been actively tracking ACOs since 2010, maintaining a database that is updated regularly from publicly available information and personal and industry interviews. Over the past year, approximately 120 organizations have become ACOs in public and private programs, bringing the total to 744 since 2011 (Figure 1). The historical ACO growth data shown in Figure 1 are slightly different from our past estimates, as they are now based on the start date of the ACO’s contract, not on when the ACO was announced.
For example, the 89 ACOs announced in December 2014 are listed as beginning in January 2015, which is the start of their contract. Regardless of how many contracts an ACO is engaged in, both public and private, an ACO is counted only once. Note that some of the new Medicare Shared Savings Program participants already had commercial contracts, and are thus tracked beginning at the start of their first contract.

Figure 1

In addition to growth in the total number of ACOs, there has been continued growth in the number of people covered by ACO arrangements. Since the start of 2014, an estimated 4.5 million more people have been included in accountable care arrangements, bringing the total to 23.5 million covered ACO lives (Figure 2). Of these, only 7.8 million are part of the Medicare ACO programs (Pioneer and Medicare Shared Savings Program), meaning that the majority of ACO volume is coming from the commercial and Medicaid sectors.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Final 2016 Notice of Benefit and Payment Parameters

On February 20, the Department of Health and Human Services (HHS) issued final regulations on the 2016 Notice of Benefit and Payment Parameters. The regulations address a variety of Patient Protection and Affordable Care Act (PPACA) benefit provisions for 2016 affecting both the group and individual markets. While HHS clarified a few items from the proposed rule – namely the open enrollment period, minimum value, and medical loss ratio – many of the provision requirements remain the same. Here is an overview.

Open Enrollment Period

For the 2016 calendar year, the open enrollment period for non-grandfathered policies in the individual market, inside and outside the Marketplace, will run from November 1, 2015 through January 31, 2016, with various plan effective dates depending on when an individual enrolls.

Essential Health Benefit Benchmark Plans

It is confirmed that states may select new benchmark plans for 2017, based on plans available in 2014.

2016 Cost Sharing Limits

The 2016 maximum annual out-of-pocket limits are confirmed at $6,850 for individual coverage and $13,700 for family coverage. Additionally, the out-of-pocket limit for individual coverage applies to all enrollees, even if they are enrolled in family coverage. For example, if the plan has an individual out-of-pocket maximum of $5,000 and a family out-of-pocket maximum of $10,000, then if any family member’s out-of-pocket maximum reaches $5,000, services for that particular family member will be covered at coinsurance.

Reduced Maximum Annual Limitation on Cost Sharing

Individuals with household incomes between 100-200 percent of the Federal Poverty Level (FPL) have a reduced maximum annual limitation on cost sharing for self-only coverage of $2,250. Individuals with incomes between 200-250 percent FPL have a reduced maximum annual limitation on cost sharing for self-only coverage of $5,450.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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The Affordable Care Act—Countdown to Compliance for Employers

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in broad national standards aimed at improving the efficiency and effectiveness of the U.S. health care system. Referred to generically as “administrative simplification,” these rules govern the areas of privacy and security of health information, electronic health care transactions and code sets, and unique health identifiers. In the years that followed, the Department of Health and Human Services (HHS) issued comprehensive rules in each of these areas. A summary of these rules is available here.

HIPAA established national standards for transmitting health data electronically and using standard code sets to describe diseases, injuries and other health conditions and problems. The statute envisioned a system that uses one identification number per employer, health plan or payer and health care provider to simplify administration when engaging in the electronic processing of certain standard transactions. Examples of standard transactions include health care eligibility benefit inquiry and responses, health care claim status requests and responses, health care services reviews, health care claim payment/advice, health care claims (medical, dental or institutional), payroll deducted and other group premium payment for insurance products, and benefit enrollment and maintenance. Compliance with the HIPAA rules governing transactions and code sets is required only where information is transmitted between two HIPAA “covered entities” (i.e., certain providers, health plans, and clearinghouses) under one of the transactions referred to above.

Read the full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.