Author Anthony Nefouse

Recently Wellpoint took some really bad press on the treatment of Breast Cancer. Some of that bad press was wrong. Anthem was accused of purposely rescinding policies of women diagnosed with breast cancer. This accusation was really way out of bounds. Wellpoint has paid for the treatment 10 of  thousands of women who have suffered from Breast Cancer.  So I think its appropriate that Anthem is implementing the key provisions of this new act.

WellPoint, Inc. (NYSE: WLP), the nation’s largest health insurer by medical membership, announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Rep. Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.

The adoption of these provisions builds on WellPoint’s existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of WellPoint’s members already receive the standard of care indicated in the legislation. However, WellPoint believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, WellPoint will standardize clinical guidelines for women recovering from mastectomy to offer a voluntary 48-hour minimum in-hospital stay.

“Women recovering from breast cancer surgery will decide, in consultation with their physicians, whether hospitalization for 48 hours is required,” said Sam Nussbaum, Chief Medical Officer, WellPoint. “We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It’s important for us and our members that WellPoint continues to lead in this area,” he added.

“We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments to shape improvements in care for women with breast cancer,” said Nussbaum. “Our goal is to ensure that our members receive optimal care.”

WellPoint also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, WellPoint is taking steps to provide comprehensible, straight-forward explanations of benefits so that members more clearly understand their treatment options.

“WellPoint works to ensure that all of our members are getting best practice care,” said Dijuana Lewis, Chief Executive Officer of WellPoint’s Comprehensive Health Solutions business unit. “We are especially proud of our record in improving care for women with breast cancer in this country and believe these added measures will increase the quality of care that our members receive.”

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Congress is poised yet again to consider another extension of the current May 31, 2010, eligibility deadline for the COBRA subsidy program provided under the American Recovery and Reinvestment Act (ARRA).

Eligibility for the Federal COBRA premium subsidies would be extended through year-end and employers would have more time to fund their pension liabilities under a tax bill that the House could vote on this week.

Under the measure, the “American Jobs and Closing Tax Loopholes Act”, the 65 percent, 15-month COBRA premium subsidy program would be extended to involuntarily terminated employees through December 31, 2010.

Without congressional action, employees who lose their jobs after May 31 will not be eligible for the subsidy.

If passed by the House, the act would move to the Senate for another vote. It remains uncertain when the proposed act will be reconciled in a final bill and seems unlikely that this will come before Congress breaks for its recess May 29 through June 6, 2010.

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As it stands as of June 1st  the Medicare Reimbursement rate for Medicare is going to be reduced 21%. This means the Doctors and Hospitals are going to be paid 21% less for treating Medicare patients. This is going to have a huge impact on physicians practices.

What could happen is Doctors will not be able to take on any new Medicare patients. Thus we could see rationing.

It’s very important if you or your family member are on Medicare that you contact your Doctor to make sure they know you. You want to build a relationship with the Doctor so that you are not treated as a number. Also prepare yourself for longer waiting times for treatment.

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The House prepares for action on a physician payment fix while the administration trudges through early implementation steps for a new health coverage law.” Notably, “this week marks the two-month anniversary of its enactment on March 23.” The law’s “implementation gets slower as the wheels of regulatory agencies churn through new rule making…prior to a September 23 benchmark deadline, six months after enactment of the law. Two reports released this month documented some expected market forces that will affect the law’s cost and effectiveness,” including a “report on an AARP study that drug prices have spiked over the past 12 months

The physician payment fix is a very big issue of healthcare. As of June 1st the reinbursment rate for Doctors treating medicare patients will be reduced 21%. This is going to have a huge impact on doctors and hospitals.

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This is interesting that the house speaker would criticizes the Governor on the Healthy Indiana Plan.  When responsible leaders makes a decision to limit the enrollment into a subsidized health plan it usually comes down to math.  There are actuaries that can  predict what its going to cost to fund claims on a large group of people. Then we add into the equation a large group of people that are unable to get coverage elsewhere. So now we have a group of people that are high utilization which mean very high healthcare cost.  If you continue to add people to that plan how do you fund it?

INDIANAPOLIS — House Speaker Pat Bauer say Gov. Mitch Daniels has “obliterated” the state’s Healthy Indiana Plan by limiting new enrollment in the program.

Bauer said Tuesday that the action Daniels took in March after Congress passed the health care overhaul has hurt about 30,000 Hoosiers who he said cannot get health care coverage though other means.

Daniels ordered the Family and Social Services Administration to freeze enrollment for childless adults in the state’s medical saving accounts, saying the federal legislation will put 500,000 more residents on Medicaid and lead to higher state taxes.

Agency spokesman Marcus Barlow says no one has been removed from this plan, but enrollment is capped.

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A cafeteria plan is an employer-sponsored plan that allows employees to choose certain pre-tax benefits or cash. For example, an employee may choose to pay his or her share of premiums for employer-sponsored health insurance before taxes through the plan.

A cafeteria plan must have a written plan document governing the plan and may not discriminate in favor of highly compensated or key employees. To ensure compliance with the nondiscrimination rules, plan sponsors are required to perform several nondiscrimination tests each plan year.

The Patient Protection and Affordable Care Act makes broad changes to the rules and mechanisms affecting certain types of health policies, including significant changes to cafeteria plans and health flexible spending accounts (FSA).

Under the new rules, a sponsor of a “simple cafeteria plan” is not required to perform nondiscrimination testing. Thus, the administrative burden of offering a cafeteria plan is lessened, making it is easier for small employers to offer a cafeteria plan to their employees.

Effective January 1, 2011, certain employers that establish “simple cafeteria plans” are exempt from the Code Section 125 non-discrimination requirements, as well as the non-discrimination requirements applicable to the plans offered through the cafeteria plan (for example, Code Section 129 non-discrimination testing for dependent care FSAs, Code Section 105(h) non-discrimination testing for self-insured medical plans, etc). The act defines a simple cafeteria plan as a plan “which is established and maintained by an eligible employer,” and for which certain contribution, eligibility and participation requirements are met. In general, an eligible employer is an employer that employed an average of 100 or fewer employees for either of the prior two years. Plans that qualify as a simple cafeteria plan for any given year are treated as meeting applicable non-discrimination requirements for that year (that is, non-discrimination testing is not required for these plans).

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This is the question that’s at the heart of the matter. And it’s
what we need to understand before we can try to control costs.
It’s important to look at the real drivers behind high and rising
health care costs and health care premiums.

More expensive technology, used more often — No
doubt, modern medicine is amazing and can save lives.
And as better tests and more expensive equipment
and pharmaceuticals emerge, we can expect to see an
increase in the use of these services. Technology is the
key driver of health spending, accounting for an estimated
half to two-thirds of spending growth.

 Inflation — Just as we spend more today for a gallon of
milk than we did 20 years ago, we spend more today for
the same medical services than we did in years past. This
medical price inflation outpaces general inflation and is
driving 51% of the growth in health care spending.

Cost shifting — When government programs like Medicaid
and Medicare underpay for medical services that patients
receive, private insurance companies have to pick up the
balance. A 2008 report — issued by an independent firm that
researches health care trends — estimates the total annual
cost shift from Medicare and Medicaid to private insurers is
more than $88 billion. The report also estimates cost shifting
accounts for $1,788 of the annual health care costs for a
typical family of four, or 10.7% of their total costs.
 

Government Regulations
Private health insurers spend over $339.2 billion in order
to comply with government health care regulations. While
we spend some of this money paying for benefits that
we’re required to cover like certain screenings and certain
prescription drugs, more than half of the money is spent on
regulatory costs such as filing and reporting requirements.

 Patient lifestyles — Increasing numbers of patients
who are challenged by obesity, smoking, drug abuse,
poor nutrition and physical inactivity contribute to an
increase in the use of, and therefore the cost of, health
care services.8 These preventable risk factors9 can also
contribute to chronic diseases, which account for 75% of
the money spent on health care in the U.S. each year.

 Obesity — The percentage of obese adults now
exceeds the percentage of healthy weight adults.

 Tobacco use — One in five adults smoke.
 

Sedentary lifestyle — Less than one-third of adults
report getting regular exercise.

Poor nutrition — One in six adults has high cholesterol

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On average, 87 cents of every dollar you pay us is spent
covering medical care and services that members receive like
doctor visits, hospital costs, prescription drugs and more.
So when the costs for these services go up, so must our
premiums. Another 10 cents of every premium dollar funds
the services we provide like claims processing, enrollment
and billing, provider credentialing and complying with
government regulations. We also use this portion of your
premium dollar towards our efforts to control the rising cost
of care. More about that in a bit.
That leaves three cents of every premium dollar for profits.
Let’s put that into perspective. The combined annual profits of
the top 10 health insurers are equal to just two days worth of
national health care expenditures – or 0.5% of the estimated
$2.5 trillion the nation spent on health care in 2009

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It happens whenever you visit a new physician, or one you haven’t seen in a while: You have to fill out an intimidating, mile-long form with dozens of questions about every illness and chronic medical condition that you and close relatives have had, every time you’ve been hospitalized, every prescription drug you’re taking, and so on. Wouldn’t it be great if the doctor could pull the information up without handing you that clipboard?

The technology to bring medical records into the digital age is available–you can already start assembling your own medical history on one of several free Web services. These services are unlikely to replace pencil and paper in most doctors’ offices anytime soon, but they can be useful memory jogs and aides to third-party caretakers.

The largest of these services–Microsoft HealthVault, Google Health, and WebMD Personal Health Record–all offer you accounts with sections for noting your medical history, including chronic conditions, visits to doctors and hospitals, test results, treatments, and prescription drugs. Should you decide to use any of these services, be prepared to spend several hours gathering information and typing it into form fields.

All three seem sensitive to people’s concerns about privacy, promising account holders full control over their data and who gets it. “We have a really strict set of rules about what can happen to this data,” says Sean Nolan, chief architect and general manager for Microsoft’s Health Solutions Group, which created HealthVault.”You as a consumer own it.”

In fact, HealthVault’s homepage enumerates the site’s privacy policy, which among other things promises not to target ads or services based on your information without your consent. Google Health even lists a privacy policy for developers who want their apps to appear on Google Health.

Microsoft HealthVault

Microsoft appears to be the furthest along in bringing interactivity to its app. In HealthVault you’ll find a list of health-care industry participants (insurers, doctors, hospitals, pharmacies) that Microsoft has partnered with for collecting and/or providing data. For example, I was able to download records of drug prescriptions I’ve filled at Walgreens.

Also, a growing number of health-monitoring devices-blood-pressure and glucose-level readers or weight scales, for example-can import readings into HealthVault, which can vastly simplify some tedious record-keeping. Microsoft maintains a list of HealthVault-enabled devices on its site, and a device’s packaging will also say if it works with HealthVault.

The data can travel both ways: One of the newest destinations for your data is the U.S. Department of Health and Human Services, which lets you import data from HealthVault to fill in the Surgeon General’s My Family Health Portrait, an XML-based health genealogy tool.

HealthVault includes links to a number of applications that use your data to help you make informed decisions. For example, the free Mayo Clinic Health Manager application will make recommendations based on data you store in HealthVault–say, more frequent cancer screenings based on family history. Again, the HealthVault site maintains a list of apps that use HealthVault to store information.

Google Health

Google Health supports importing health records from a list of sources such as medical centers and pharmacies. It has links to a couple of fee-based services that will convert paper medical records–obtained from you via fax or from your health care providers–into electronic data that you can import into Google Health.

Google Health also has links to online health tools (a diabetes risk assessor, for example) and services that will help you find health-care providers. Finally, it gives you access to services that will let you share your medical data, by printing a card to carry with you in case of emergency, for example, or by creating a record that some doctors will take in lieu of a clipboard form.

WebMD Personal Health Record

More of a do-it-yourself proposition, WebMD Personal Health Record leaves you on your own for entering data. But filling out the site’s lengthy HealthQuotient questionnaire can be a valuable wake-up call for embracing a healthier lifestyle: At the end of the exercise you get a numerical rating for your overall health. You also receive an explanation of how you ranked compared with other users your age, and bar graphs showing your risk levels for serious problems such as stroke and heart attack.

Other Tools for Tracking Medical History

Some insurance companies are providing their customers access to patient-centric medical records–histories that present a better picture of a person’s health as a whole rather than the traditional claim-by-claim records that focus on specific services in single visits. And some are also starting to offer patients tools to help track the costs of their care, in order to ensure that they are being properly reimbursed and, in some cases, to help set priorities when budgeting is required.

One of these tools is the Quicken Health Expense Tracker, which makes it easier to manage medical claims and doctor bills. The Health Expense Tracker helps you figure out what a claim was for (it can look up medical codes and explain them in plain English) and then match it with the appropriate doctor bill, so you can see if you’re being charged correctly. In a related development, Intuit has begun marketing an online bill-payment system to physicians, who have been extremely slow to allow patients to settle their bills electronically.

Slow Adoption Rate

Most insurance companies make claim information available online to their customers. But, says Forrester Research analyst Elizabeth Boehm, these records are designed for billing purposes and aren’t nearly as good as patient-centric records for help in assessing an individual’s overall health.

Unfortunately, Boehm adds, very few people (no more than 3 percent of the U.S. population) are taking advantage of online medical-history tools because they’re a lot of work-and because doctors don’t really trust them anyway.

It’s a sort of Catch-22: Electronic health records won’t be useful until more doctors and hospitals contribute to them, but doctors and hospitals won’t contribute to them until they’re more useful. Still, even without doctor buy-in, these records can be invaluable in some instances–for example, to other caregivers (such as relatives of the patients)–who may not be familiar with the family history.

The transition to electronic record-keeping is getting a boost from the Obama administration’s stimulus plan, which includes incentives for physicians who move to electronic medical records. The administration considers the adoption of this technology crucial, as it can help cut costs by eliminating duplication of effort (for example, tests that one doctor performs because he doesn’t have the results of the same test performed by another doctor). It will take some time, but systems that allow patients to manage their own health-care information will continue to pick up speed. The clipboard’s days are numbered.

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The small group tax credit, which will benefit millions of small businesses, has just become more attractive. That’s because the IRS has just released new details clarifying that the tax credit also applies to premiums for dental and vision benefits – not just health benefits. And there’s more good news:

  •  Eligible companies that already get state tax breaks to help pay premiums can also claim the federal assistance.
  • A business owner’s salary won’t be taken into account when figuring out the company’s average wages – helping more firms stay below the cutoff for the federal credit. To qualify for the credit, companies must not employ more than 25 employees and the average annual compensation of those employees cannot exceed $50,000.
  • Nonprofits – including churches and other religious congregations – are eligible to claim a partial credit.

See the latest information at irs.gov.

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