The immediate focus of most HIPAA organizations and their vendors is on the conversion and mitigation of potential risks related to ICD-10 implementation. Many of those risks relate to the data fog that will ensue for at least 18 months following the October 1, 2013, implementation.
Some organizations have thought about what will happen after the data fog clears—the long-term advantages that ICD-10 will likely offer include better identification of fraud or abusive practices, improved ability to manage care and disease processes, and tracking public health and risks.
However, few have thought about the immediate opportunities that ICD-10 offers starting on the first day of implementation. Organizations do not have to wait two or more years for historical ICD-10 data to improve condition management, enhance population management, or engage in outcomes analysis. With a little foresight, organizations may even be able to use ICD-10 to improve coding. Find out more in this new white paper.
So how great is the need for such coverage? It depends on how you look at the data. “One in two Americans are likely to need long-term-care services sometime in their lives,” says Amy Pahl, a consulting actuary for Milliman Inc, a leading actuarial and consulting company. However, Pahl adds, of those who might need long-term care, about a third will not meet the most common deductible period of 90 days because they will either die or recover before then.
To determine if a long-term-care policy makes sense for you, it is important to understand how the coverage works and what’s available.
As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered by commercial insurance plans increased by 6.96% over the year ending November 2011, down from the +7.10% reported for October. Growth rates in Medicare claim costs rose by 2.37%, as measured by the S&P Healthcare Economic Medicare Index, down from the 2.55% reported for October. The S&P Healthcare Economic Professional Services Medicare Index also dropped from +4.15% in the year ending October 2011 to +3.62% in November. The S&P Healthcare Economic Hospital Medicare Index increased slightly to +1.33% in November from its +1.28% October value.
A new video looks at how the employer-sponsored health insurance system in the United States works—and how healthcare dollars flow into and out of that system.
Alternatives to traditional fee-for-service (FFS) reimbursement have gained attention as financial pressures mount and as many recognize how FFS may not provide incentives for efficient care. The recent Centers for Medicare and Medicaid Innovations (CMMI) Bundled Payments for Care Improvement Initiative is a prominent example, as are private payor contracts.
This healthcare reform briefing paper provides an overview of bundled payments and discusses recent developments, as well as an analysis of considerations in contracting for bundled payments.
The role of private health insurance differs significantly from one country to another. A key reason for this relates to the availability and the delivery of public healthcare within each country. In addition, governments often dictate the role of private health insurance within any particular country. This eight-part series focuses on international health markets, comparing and contrasting the key elements of risk selection practice in the public and private health insurance markets in each region.
Health insurance market summary
The provision of hospital inpatient care in all of these countries is mostly provided by public hospitals. Conversely, the provision of outpatient primary and specialist care is dominated by the private providers, which is due to the lower cost per visit and convenience (private clinics are spread across the country compared with the limited locations of hospital-based primary and specialist facilities in the public sector). One exception is China, where outpatient care is also mostly provided by the public sector.
In the case of China, the financing of public care is via a social health insurance (SHI) program, while in Hong Kong, Malaysia, and Singapore it is funded by an allocation of government budgets with limited out-of-pocket payments by the patient at the point of service.
The Milliman Medical Index measures the total annual cost of healthcare for a typical family of 4 covered by a preferred provider plan (PPO). In 2002 it was $9,235. For 2011 it was $19,393
Milliman’s Employee Benefit Research Group issued the following benefit alert:
States will be able to use existing group health benefit plans as benchmarks for establishing the minimum “essential health benefits” (EHB) package that will be offered in 2014 by plans in the state-run Exchanges under the health reform law (“PPACA”), according to a bulletin released by the Department of Health and Human Services (DHHS). The bulletin, released on Dec. 16, describes the agency’s intended approach to defining the EHB package to be included in health plans covering small groups and individuals.
The bulletin addresses covered services but does not provide guidance on calculating the actuarial or the minimum value of a plan. Thus, self-insured group health plans, large group insured plans, and “grandfathered” plans – which are not required to cover the EHB – will still have to await direction from DHHS on determining whether an employer’s share of the costs represents at least 60% of the total allowed cost of benefits. In addition, if these plans cover EHB, they must comply with PPACA’s annual and lifetime dollar limits that apply to EHB for all plans.
The bulletin indicates that the DHHS approach will allow states to choose one of the following as a benchmark:
one of the three largest small group insurance products in the state;
one of the three largest state employee health plans;
one of the three largest federal employee health plan options; or
the largest non-Medicaid health maintenance organization (HMO) offered in the state’s commercial market.
The default plan for a state that does not select a benchmark will be the largest plan in the state’s small group market.
If the selected benchmark plan does not include all 10 mandatory categories of benefits – such as pediatric oral and vision care – benefits from another benchmark option must be added. DHHS also plans to issue further guidance allowing health insurance issuers to adjust benefits, including both the specific services covered and any quantitative limits, as long as they continue to offer coverage for all 10 statutory EHB categories and they do not reduce the value of coverage.
The bulletin also addresses standards for defraying the cost of state-mandated benefits in excess of the EHB.
The DHHS is seeking public comments on the bulletin by Jan. 31, 2012.
Based on available results for medical professional liability (MPL) specialty writers through the third quarter of 2011, recent financial trends persist.
Premium volume continues to drift downward and coverage-year combined ratios continue to creep upward as softer rate levels impact underwriting results. Lower bond yields are reflected in lower investment income, further pressuring operating margins. Nonetheless, favorable takedowns of historical claim reserves continue to buoy calendar-year results and boost capital levels.
An article first published in Medical Liability Monitor examines the collective financial results of a group of insurers specializing in MPL coverage with direct written premium of about $4.3 billion in 2010.
The authors compare the historical financial results through September 30 of each year to full-year results in order to infer what year-end 2011 results might look like.
Follow us on Twitter
Recent Comments