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Posts Tagged ‘Jill Van Den Bos’

Ten critical considerations for health insurance plans evaluating participation in public exchange markets

December 26th, 2012

The Patient Protection and Affordable Care Act (PPACA) will introduce new marketplaces for individual and small group health insurance, effective January 1, 2014, in the form of public exchanges. Health insurance plans need to fully prepare for and understand the impact that the public exchanges may have on their business. Whether or not a health plan participates, the logjam that blocked reform progress for several months appears to have been cleared; PPACA is now moving forward with weekly releases of regulations and rules (most are preliminary rules and open for comments). This momentum of rule writing brings new terminology and issues to light, which are critical to understand before making decisions on whether or not to participate in the public exchanges.

This paper provides 10 critical considerations based on the preliminary rule recommendations published in the last half of November. As these rules are finalized, the considerations and market dynamics may change.

Reform , , , ,

Medicaid expansion: Wyoming as microcosm

October 9th, 2012

A new article in a Wyoming blog about Medicaid expansion offers a helpful view of the decision facing states. Here is an excerpt from that article:

A report for the Wyoming Department of Health prepared by Milliman, Inc., an actuarial consulting firm, forecasts the added costs of the program at $116 million to $148 million between 2014 and 2020, based on their best estimate of 28,200 new enrollees. The report said the enrollment could be as low as 17,000 and might exceed 44,000. Under the best estimate, Milliman expects about 3,700 “woodwork” cases that the federal government would reimburse at only 57 percent.

In the same report, Milliman notes potential for significant savings. Some current state health programs would be at least partially subsumed under Medicaid, enabling the state to discontinue their funding and save money. But forecasting these savings — frequently called “cost offsets” — is much more difficult than predicting the cost of enrolling new patients in Medicaid.

“Detailed data was available for the Medicaid cost analysis,” said Jill Van Den Bos, a senior consultant at Milliman and the lead author of the study. The researchers used U.S. Census data and claims-data, among other sources, to predict costs.

“But it was harder on the cost-offset side,” Van Den Bos said. Eligibility for some free services offered by the state — such as colorectal cancer screening, and breast and cervical cancer treatment — is set at 250 percent of FPL. But it is difficult to know how many participants in those programs would fall under the eligibility limit of 133 percent of FPL.

“There is no hard data,” Van Den Bos said. “Assuming uniform distribution, it’s about half.” The state might also be able to reduce its bill for funding the Wyoming State Hospital, which took $60 million from the general fund and  “generated only $1.4 million in revenue from all third party payers,” including Medicaid, the report said. But once again, the savings are hard to pin down, since it is unclear how much Medicaid will pay for the indigent — for example, how many days of care per year — until more information arrives from Washington.

“The uber-person who had access to all of the data on Earth would still have a better data for the cost side than the cost-offset side,” Van Den Bos said.

This excerpt gets at two of the complicating factors surrounding this kind of analysis:

  • First, a range is important. States want to know their full budget exposure, and thus need 100% enrollment scenario estimates, but also have to account for the behavioral vagaries of other enrollment scenarios.
  • Second, the data supporting cost estimates is clearer than the data supporting cost offsets. This is compounded with each state having a unique Medicaid situation and its own local set of programs that may be subsumed by expansion, such as the payments to the Wyoming State Hospital mentioned here.

 
States face a complex decision as they wrestle with whether or not to expand their Medicaid program.

Reform , ,

Cost drivers of autoimmune inflammatory diseases

October 4th, 2012

This analysis published in the Journal of Occupational and Environmental Medicine (subscription required) by Ksenia Draaghtel and Jill Van Den Bos examines the total cost burden of autoimmune inflammatory diseases. The study takes an employee and employer’s perspective by using direct and available indirect costs from a national data source. The data includes total direct medical costs, number of absence days, and indirect costs related to work absences.

Read more about the study here.

Research , , ,

Sustainable provider payment arrangements

October 3rd, 2012

In the 1990s, managed care programs faced a series of difficulties. Providers who accepted risk experienced financial trouble and consumers resented and abandoned plans that placed limits on access and choice, leading to a perception of medical care rationing. These problems resulted in a widespread return to fee-for-service reimbursement and an escalation in medical utilization and costs. Now, insurers and their employer clients are looking for ways to shift some financial risk back to providers as a way to encourage the alignment of incentives to achieve better care delivery.

Jill Van Den Bos’ explores this topic in her new paper, “Sustainable provider payment arrangements: What are the key elements conceptually?” The paper takes a brief look at the shortcomings of provider payment during the 1990s and considers payment arrangements that may make provider risk sharing sustainable in the future.

Reform , ,

CMS announces 27 new ACOs for Medicare Shared Savings Program

April 12th, 2012

The Center for Medicare and Medicaid Services (CMS) recently designated 27 providers to take part in the Medicare Shared Savings Program as accountable care organizations (ACOs). Quoted in a Modern Healthcare article, CMS emphasized the mix of provider types chosen:

The mix of organization types—just over half are physician-led—was touted by CMS officials.

“There were some people who feared that the only entities that would participate would be hospital-dominated systems,” Jonathan Blum, director of the Center for Medicare at the CMS, said in a call with reporters. “That has not happened.”

The 27 ACOs join 32 Pioneer Model ACOs chosen in December of 2011 and six Physician Group Practice Transition Demonstration entities initiated in January of 2011. Counting all these entities, ACOs will serve more than a million Medicare patients. Milliman consultant Jill Van Den Bos recently wrote a paper on risk management and cost controls  targeted at Pioneer ACOs.

Reform , ,

The impact of patient cost sharing for antihypertensive medications

February 22nd, 2012

A new article published by Dovepress Journal examines the impact of patient cost sharing for antihypertensive medications on adherence, utilization, and expenditures. The trend has been for managed care organizations and employers to require patients to bear a greater out-of-pocket burden for healthcare resources consumed. This study illustrates the potential adverse effects of higher patient cost sharing among patients with hypertension stratified by different risk levels. A decrease in the proportion of days covered was predictive of higher resource utilization and healthcare costs, which should be of interest to payors and employers alike.

Read the article here.

Cost , , ,

Pioneer ACOs: Quantifying risks and identifying opportunities

February 13th, 2012

In May 2011, the Centers for Medicare and Medicaid Services (CMS) unveiled a program to spur growth of accountable care organizations (ACOs) prior to the full implementation of the Medicare Shared Savings program. The Pioneer ACO model is a good fit for hospitals or large medical practices with a demonstrated history of care coordination and quality improvement. These organizations are pioneers in the sense that they have already embarked on organized care practices and have some of the needed infrastructure in place and are therefore leading the way for others. As such, it is expected that Pioneer ACOs will be able to demonstrate methods for achieving both cost savings and care improvement in the Medicare fee-for-service (FFS) population.

Participants in this program will have the potential to be financially rewarded for per-patient savings, but they are also at risk for a loss should patients cost more than expected in aggregate.

This white paper discusses the elements of risk associated with Pioneer ACOs as well as potential strategies for controlling costs and identifying opportunities for savings.

Cost ,

Work absences and rheumatoid arthritis

September 6th, 2011

Rheumatoid arthritis, estimated to affect 1.3 million adults in the United States, often results in disability and decreased work-related productivity. A new study by Jill van den Bos, Ksenia Draaghtel, et al., and published in the Journal of Health & Productivity, reviews the absence days and direct and indirect costs associated with rheumatoid arthritis for employees who received an anti-tumor necrosis factor (anti-TNF) agent compared to those who did not receive therapy.

See the full article here.

Evidence-based medicine , ,

Medical errors: Human or systemic?

April 18th, 2011

That’s the qustion posed by The Lancet. The article cites recent articles from Health Affairs and the New England Journal of Medicine.

Who or what is to blame for medical errors and their consequences? Overworked providers, an unnecessarily complex medical system, or uninformed patients? Patients are often handed from one doctor to another and, in the process, communication between providers can break down. Time spent filling out paperwork is time not spent with patients improving the quality of their care. Decision making often does not involve informing a patient about the balance between benefits and harms of individual treatments, or incorporating patients’ goals into planned treatment. And it does not help that existing guidelines allow medical residents in the USA to work on average 28 h more per week than junior doctors in countries of the European Union. US health providers and policy makers must make patients’ safety a national priority. A good start in the right direction will be to implement at the federal level a mandatory and comprehensive nationwide monitoring system to track medical errors.

Quality of Care ,

More than 2 million patient injuries

April 7th, 2011

A new paper in Health Affairs is drawing attention back to a study we have blogged about before: The cost of medical errors. Bloomberg has the story:

Medical errors that caused harm to patients cost the U.S. $17.1 billion in 2008, according a review by the Seattle consulting firm Milliman Inc. of medical claims from 2001 through 2008 that also was published in the current issue of Health Affairs. Jill Van Den Bos, a Milliman health-care consultant, is the lead author.

The study identified about 564,000 injuries to patients admitted to U.S. hospitals and 1.8 million injuries to people using outpatient services. The most common and most expensive injuries were pressure sores and infections following surgery, Van Den Bos and her colleagues conclude.

The full Bloomberg article includes coverage of this and one other patient safety study in the latest issue of Health Affairs.

And here is the National Journal’s coverage.

And here is coverage from MedPage Today.

Quality of Care , ,