The health plans of tens of millions of people were at stake for the merger between health insurance giants Anthem and Cigna.
Reported by IBTimes 2 days ago.
What About The Consumers?
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Glance: The New 'Big Three' of Health Coverage
Glance: A snapshot of the new 'Big Three' of health insurance
Reported by ABCNews.com 2 days ago.
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Anthem mega-merger may knock Kaiser down a notch in California
HMO giant Kaiser Permanente might lose its perch atop California's health insurance world.
Reported by L.A. Times 2 days ago.
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Glance: The new 'Big Three' of health coverage
Anthem Inc.'s $48 billion purchase of rival Cigna Corp. is set to create the nation's largest health insurance company. The combination, in tandem with Aetna Inc.'s pending purchase of rival insurer Humana Inc., would leave three health insurers that would dominate the rapidly changing industry landscape in the U.S. Sluggish growth in traditional employer-paid health care is combining with faster growth in government-sponsored health care such as Medicare or the subsidized plans created by the health care overhaul to make the companies seek mergers. Anthem runs Blue Cross plans in 14 states and specializes in selling group coverage to businesses It also has a large Medicaid business. Aetna has a solid position in employer-funded health plans, including pharmacy-benefits management and dental plans. Humana's key focus is on government-funded health care plans and has a strong position in the Medicare Advantage market.
Reported by SeattlePI.com 2 days ago.
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Anthem Deal For Cigna Would Hasten Health Insurance Consolidation
One reason health insurers are looking to get bigger is that the hospitals and doctor groups across the negotiating table have also gotten bigger.
Reported by NPR 2 days ago.
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Breakingviews: The Regulatory Hurdles to Health Insurance Mergers
Anthem and Cigna are the latest health insurers to forge a deal, but they and their peers need to satisfy many regulators before pairing up.
Reported by NYTimes.com 2 days ago.
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Brick School Board Approves Slight Pay Increase For Teachers
Patch Brick, NJ -- The contract terms also include what the district's labor attorney called a significant concession on health insurance.
Reported by Patch 2 days ago.
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Do 3 big insurers flash red for govt? Mergers get close look
WASHINGTON (AP) — Would a reduction from five health insurance giants to three trigger a flashing light for regulators concerned about industry competition? At only three companies, "The agencies' ears tend to perk up," said Allen Grunes, who led merger investigations at the Justice Department as an antitrust attorney. In this case, the Justice Department will have to pass judgment on Anthem's planned $48 billion acquisition of rival Cigna, a deal that would create the nation's largest health insurer by enrollment with about 53 million U.S. patients. Some states have a very competitive environment for health insurance while in others a few companies dominate the market, said Jesse O'Brien, a health care advocate with the U.S. Public Interest Research Group.
Reported by SeattlePI.com 2 days ago.
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Anthem bids $48 billion for Cigna to create health giant
Anthem is buying rival Cigna for $48 billion in a deal that would create the nation’s largest health insurer by enrollment, covering about 53 million U.S patients. In just three weeks, starting with Aetna’s $35 billion bid for Humana Inc. on July 3, the landscape of U.S. health care has been altered in a buyout frenzy that could transform five massive U.S. health companies into just three, including UnitedHealth Group. Larger insurers have negotiating power to squeeze better rates from drug companies and health care providers. Regulators scrutinizing the two mega-deals will be trying to assess whether these combined companies would have so much power that they could dominate markets and drive already high health care costs even higher. Employer-sponsored health insurance is growing slowly and with the recent overhaul of the nation’s health care system, providers are jostling for the largest share of the millions of people who have signed up. Health insurance is Cigna Corp.’s main business, but it also sells group disability and life coverage in the U.S., and it has a growing international segment that Anthem lacks. Much of Cigna’s health insurance business involves coverage where the employer pays the claims and then hires Cigna to administer the plan. Cordani will serve as president and chief operating officer of the combined business, with Anthem’s Joseph Swedish as chairman and CEO.
Reported by SFGate 2 days ago.
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Anthem-Cigna Deal Is Bad For Doctors On Obamacare Networks
News that Anthem (ANTM) will buy Cigna (CI) for $54 billion-- a deal that closely follows the proposed merger of Aetna (AET) and Humana (HUM) -- will intensify regulators’ focus on antitrust issues in the health insurance industry. Because Anthem’s proposed acquisition of Cigna creates the nation’s largest health insurer with [...]
Reported by Forbes.com 2 days ago.
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Venerable Phila. health insurer Cigna acquired by Anthem
Indianapolis-based Anthem Inc. said Friday that it would acquire Cigna Corp., a major national health insurer with Philadelphia origins and 1,100 local employees, in a deal that would create the largest health-insurance company in the United States.
Reported by philly.com 1 day ago.
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Anthem-Cigna deal alarms consumer activists
In a mega-deal that alarms some health policy experts and consumer advocates worried about increasing industry consolidation and the prospect of higher premiums, the health insurance giant Anthem has agreed to acquire rival Cigna for $54 billion.
Reported by San Jose Mercury News 1 day ago.
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Dr. Michael Lazar Named Medical Director of the SonaCare HIFU Pilot Project in Puerto Vallarta
Leading Santa Rosa, California, Urologist Dr. Michael Lazar, has been named Medical Director of the High Intensity Focused Ultrasound (HIFU) project currently underway at a well-equipped medical facility in Puerto Valarta, Mexico. This procedure involves the implementation of a new technology using sound waves to destroy cancer cells in the male prostate gland.
Santa Rosa, CA (PRWEB) July 26, 2015
This project is sponsored by SonaCare Medical, LLC, developers of minimally-invasive HIFU technologies designed to significantly improve the quality of life for prostate cancer patients using focused ultrasound energy waves emitted from the firm’s Sonablate® 500 transrectal probe to destroy cancer cells without conventional surgery.
SonaCare’s Sonablate® 500HIFU Ablation Software™ utilizing T3 Technology™ enables the operator to target ablation zones with sophisticated planning and localization tools, treat disease with pin point accuracy while sparing untargeted tissue and track with advanced real-time ultrasound imaging.
Dr. Lazar has been a pioneer in the application of HIFU by working closely with SonaCare physicians and engineers in the development of this new technique. He has been treating patients with successful HIFU procedures with minimal side effects since April 2007.
“In the past, the entire prostate gland was removed surgically or irradiated causing issues associated with incontinence, erectile dysfunction (ED) and weeks of recovery,” according to Dr. Lazar. “Today we can cure the cancer by treating the whole gland, or focally in the region of the cancer only, in just a few hours without blood loss and minimal side effects. This is a real game changer. Virtually all patients can be up and walking out of the hospital the same day to resume normal activities with little or no pain.”
Dr. Lazar said that cancer can now be detected in very early stages based on PSA blood testing along with MRI and ultrasound scans and a biopsy. This may allow treating only the areas with cancer cells using HIFU rather than excising the whole gland with a scalpel. Another factor to consider is that many cancers of the prostate progress slowly, so there is less reason to destroy the entire prostate just to address localized cancer that has not spread throughout the gland, a significant factor when it comes to maintaining erectile function and urine flow through the urethra following a full oblation (removal) procedure.
While HIFU is pending FDA approval for general use in the United States, SonaCare Medical is currently conducting a clinical trial in the U.S. and Canada to determine the safety and efficacy of a minimally invasive prostate cancer treatment using HIFU with the Sonablate® 500. The trial is for patients who have recurrent prostate cancer after receiving a previous treatment with external beam radiation therapy. To be eligible to be considered for the U.S. recurrent trials, candidates must:· Have been treated with external beam radiation therapy two or more years prior;
· Have low-risk, organ-confined recurrent prostate cancer T1c or T2a;
· Be between the ages of 40 and 85;
· Have a PSA level between 0.5ng/mL and 10ng/mL;
· Have a recent (within six months) prostate biopsy that is positive for cancer.
There is no cost to enroll in the study, nor does it require health insurance. For more information call 877.605.HIFU.
For more information about Dr. Michael Lazar, go to the HIFU website or call (707) 546-5553. His office is located at 1140 Sonoma Ave #1A, Santa Rosa, CA 95405. Reported by PRWeb 9 hours ago.
Santa Rosa, CA (PRWEB) July 26, 2015
This project is sponsored by SonaCare Medical, LLC, developers of minimally-invasive HIFU technologies designed to significantly improve the quality of life for prostate cancer patients using focused ultrasound energy waves emitted from the firm’s Sonablate® 500 transrectal probe to destroy cancer cells without conventional surgery.
SonaCare’s Sonablate® 500HIFU Ablation Software™ utilizing T3 Technology™ enables the operator to target ablation zones with sophisticated planning and localization tools, treat disease with pin point accuracy while sparing untargeted tissue and track with advanced real-time ultrasound imaging.
Dr. Lazar has been a pioneer in the application of HIFU by working closely with SonaCare physicians and engineers in the development of this new technique. He has been treating patients with successful HIFU procedures with minimal side effects since April 2007.
“In the past, the entire prostate gland was removed surgically or irradiated causing issues associated with incontinence, erectile dysfunction (ED) and weeks of recovery,” according to Dr. Lazar. “Today we can cure the cancer by treating the whole gland, or focally in the region of the cancer only, in just a few hours without blood loss and minimal side effects. This is a real game changer. Virtually all patients can be up and walking out of the hospital the same day to resume normal activities with little or no pain.”
Dr. Lazar said that cancer can now be detected in very early stages based on PSA blood testing along with MRI and ultrasound scans and a biopsy. This may allow treating only the areas with cancer cells using HIFU rather than excising the whole gland with a scalpel. Another factor to consider is that many cancers of the prostate progress slowly, so there is less reason to destroy the entire prostate just to address localized cancer that has not spread throughout the gland, a significant factor when it comes to maintaining erectile function and urine flow through the urethra following a full oblation (removal) procedure.
While HIFU is pending FDA approval for general use in the United States, SonaCare Medical is currently conducting a clinical trial in the U.S. and Canada to determine the safety and efficacy of a minimally invasive prostate cancer treatment using HIFU with the Sonablate® 500. The trial is for patients who have recurrent prostate cancer after receiving a previous treatment with external beam radiation therapy. To be eligible to be considered for the U.S. recurrent trials, candidates must:· Have been treated with external beam radiation therapy two or more years prior;
· Have low-risk, organ-confined recurrent prostate cancer T1c or T2a;
· Be between the ages of 40 and 85;
· Have a PSA level between 0.5ng/mL and 10ng/mL;
· Have a recent (within six months) prostate biopsy that is positive for cancer.
There is no cost to enroll in the study, nor does it require health insurance. For more information call 877.605.HIFU.
For more information about Dr. Michael Lazar, go to the HIFU website or call (707) 546-5553. His office is located at 1140 Sonoma Ave #1A, Santa Rosa, CA 95405. Reported by PRWeb 9 hours ago.
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PopHealthCare’s Small Group and Individual Risk Adjustment Coverage Adds 300,000 Members
PopHealthCare, a leading innovator in prospective and retrospective risk adjustment services, health care analytics, quality improvement, and field-based high-risk population care delivery, announced today that they have added 300,000 members in their commercial small group and individual (SG&I) risk adjustment portfolio. The SG&I population is offered coverage through health plans and the health insurance marketplace and is subject to risk adjustment as part of the Patient Protection and Affordable Care Act (PPACA).
Nashville, Tenn. (PRWEB) July 26, 2015
PopHealthCare, a leading innovator in prospective and retrospective risk adjustment services, health care analytics, quality improvement, and field-based high-risk population care delivery, announced today that they have added 300,000 members in their commercial small group and individual (SG&I) risk adjustment portfolio. The SG&I population is offered coverage through health plans and the health insurance marketplace and is subject to risk adjustment as part of the Patient Protection and Affordable Care Act (PPACA).
“Historically these services have focused predominantly in the Medicare Advantage markets, but with the statutory changes under the PPACA, the complexities of risk adjusted payment methodologies has been introduced to the SG&I markets as well,” said Robert Carroll, Chief Operations Officer at PopHealthCare. “To accurately predict financial performance in this new risk-adjustment environment, health plans require predictive data analytics and accurate coding and documentation to circumvent the large degree of uncertainty while maintaining positive ROI.”
To share the financial risk and help stabilize premiums between health insurance issuers that cover higher-cost and higher-risk population, the PPACA established a transitional reinsurance program and a permanent risk adjustment program. Results of these programs were released by CMS on June 30, 2015 in the report "Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year" which used data submitted as part of the first full year of the PPACA. According to this report, both the risk adjustment methodology and the transitional reinsurance program are working as intended. The Transitional Reinsurance Program is providing protection to issuers with exceptionally high costs, and the Permanent Risk Adjustment Program is compensating issuers that enrolled higher risk individuals and is protecting against adverse selection within a market within a state.
Although CMS announced that programs are working as intended, some of the major health plans issuing marketplace plans have reported unplanned results – a significant disparity in reimbursement under CMS’ reinsurance program as compared to their estimates.
“A discrepancy in reimbursement is problematic not only for investors but for the members and better health outcomes,” said Carroll. “We’re very excited to be a vendor of choice for plans offering this coverage and to work with health plans on and off the exchange to create flexible, customized risk adjustment and high-risk population care delivery solutions that provide accurate revenue, improved quality scores and reduced medical costs.”
For more information on key themes and considerations for the SG&I population, PopHealthCare invites you to review the brief, "Four Risk Adjustment Themes to Consider about the Commercial Small Group and Individual Market". This report can be downloaded here: http://www2.pophealthcare.com/smallgroup
About PopHealthCare: PopHealthCare offers groundbreaking programs in high risk population management that drive rapid, large, and demonstrable improvements in member quality of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores, and reduced medical costs. With decades of experience, PopHealthCare is led by a team of long-standing leaders in health care analytics, field-based high-risk population care delivery, and both prospective and retrospective risk adjustment services. PopHealthCare has designed its high impact services to meet the needs of local, regional and national health plans and provider organizations and currently partners with over 35 health plans across the U.S. and in Puerto Rico. Reported by PRWeb 9 hours ago.
Nashville, Tenn. (PRWEB) July 26, 2015
PopHealthCare, a leading innovator in prospective and retrospective risk adjustment services, health care analytics, quality improvement, and field-based high-risk population care delivery, announced today that they have added 300,000 members in their commercial small group and individual (SG&I) risk adjustment portfolio. The SG&I population is offered coverage through health plans and the health insurance marketplace and is subject to risk adjustment as part of the Patient Protection and Affordable Care Act (PPACA).
“Historically these services have focused predominantly in the Medicare Advantage markets, but with the statutory changes under the PPACA, the complexities of risk adjusted payment methodologies has been introduced to the SG&I markets as well,” said Robert Carroll, Chief Operations Officer at PopHealthCare. “To accurately predict financial performance in this new risk-adjustment environment, health plans require predictive data analytics and accurate coding and documentation to circumvent the large degree of uncertainty while maintaining positive ROI.”
To share the financial risk and help stabilize premiums between health insurance issuers that cover higher-cost and higher-risk population, the PPACA established a transitional reinsurance program and a permanent risk adjustment program. Results of these programs were released by CMS on June 30, 2015 in the report "Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year" which used data submitted as part of the first full year of the PPACA. According to this report, both the risk adjustment methodology and the transitional reinsurance program are working as intended. The Transitional Reinsurance Program is providing protection to issuers with exceptionally high costs, and the Permanent Risk Adjustment Program is compensating issuers that enrolled higher risk individuals and is protecting against adverse selection within a market within a state.
Although CMS announced that programs are working as intended, some of the major health plans issuing marketplace plans have reported unplanned results – a significant disparity in reimbursement under CMS’ reinsurance program as compared to their estimates.
“A discrepancy in reimbursement is problematic not only for investors but for the members and better health outcomes,” said Carroll. “We’re very excited to be a vendor of choice for plans offering this coverage and to work with health plans on and off the exchange to create flexible, customized risk adjustment and high-risk population care delivery solutions that provide accurate revenue, improved quality scores and reduced medical costs.”
For more information on key themes and considerations for the SG&I population, PopHealthCare invites you to review the brief, "Four Risk Adjustment Themes to Consider about the Commercial Small Group and Individual Market". This report can be downloaded here: http://www2.pophealthcare.com/smallgroup
About PopHealthCare: PopHealthCare offers groundbreaking programs in high risk population management that drive rapid, large, and demonstrable improvements in member quality of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores, and reduced medical costs. With decades of experience, PopHealthCare is led by a team of long-standing leaders in health care analytics, field-based high-risk population care delivery, and both prospective and retrospective risk adjustment services. PopHealthCare has designed its high impact services to meet the needs of local, regional and national health plans and provider organizations and currently partners with over 35 health plans across the U.S. and in Puerto Rico. Reported by PRWeb 9 hours ago.
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State Health Insurance Markets Struggle With Cost Challenges
Future of some state-run health insurance markets threatened by low enrollment, high overhead
Reported by ABCNews.com 4 hours ago.
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People With Disabilities Are Twice As Likely To Be Poor. These Businesses Are Fighting That Stat
The staggering unemployment and poverty rates among people with disabilities is a reminder of how much work still needs to be done to protect this underserved demographic.
Sunday marks 25 years since Congress passed the Americans with Disabilities Act, a bill that aimed to give the group equal opportunities to pursue jobs and public and private services. While some vital progress has been made, people with disabilities still face incredible challenges when it comes to obtaining employment and becoming financially stable.
Last year, 17.1 percent of people with disabilities were employed, according to the Bureau for Labor Statistics. The BLS only started tracking such stats in 2008.
While the estimates aren't directly comparable, a report released by the Berkeley Journal of Employment & Labor Law argues that employment figures have actually declined since the passing of the ADA.
In 1990, men with "work limitations" had an employment rate of 50.4 percent. Women who had similar restrictions had an employment rate of 40.7 percent at the time, the report noted.
Bottom line, people with disabilities are twice as likely to be poor today than people who don’t have disabilities, NPR reported.
Part of the problem, experts say, is that the ADA didn’t push the hiring of people with disabilities.
“It mandated providing accommodations, physical accommodations so people could access buildings, but it didn't say hiring people with disabilities was a priority,” Jay Ruderman, president of the Ruderman Family Foundation, told the Baltimore Sun.
A major issue people with disabilities face is wariness from potential employers. Many hiring managers are uncertain about how they’ll be expected to cater to people with disabilities and therefore often opt to exclude this group altogether, NPR reported.
"Employers are scared to hire us," Debbie Eagle, who’s been blind since she was born, told NPR. "Because they don't know what kind of accommodations we require. And if they don't meet what we consider to be reasonable accommodations, they're afraid we'll sue them."
Eagle, 43, has a bachelor’s degree in special education and said she’d love more than anything to be able to find work and stop relying on government assistance.
Michael Morris, executive director of the National Disability Institute, agrees with Eagle and told NPR that the issue at hand is that “attitudes are slow to change.”
Veterans, both those with disabilities and without, are facing an overwhelming amount of such stigma when they return home.
While most veterans come back without any emotional issues, experts say that hiring managers are skeptical that vets will “go postal” while on the job, USA Today reported in 2013.
"They didn't even hide it," Timothy "Rhino" Paige, a former Air Force pilot, told USA Today of the discrimination he faced while trying to get a job.
Paige developed post-traumatic stress disorder in 2005 when he was tasked with transporting the remains of deceased Americans from Iraq.
There’s often the pervasive notion that people with disabilities just want to “milk the system” and avoid working at all costs. But experts say that’s rarely the case.
“They’re broke, bored, poor, and they're tired of it,” Susan Webb, who works for an employment network in Phoenix, told the Atlantic.
But when employment opportunities do become available, they’re often low-wage roles that don’t offer the same kind of medical coverage they get from government benefits.
And once people receiving federal benefits save more than $2,000, they risk losing their benefits, NPR reported.
“They might see a lot of low-wage work with scant labor protections. Nothing that comes with the kind of health insurance you get on disability,” Olga Khazan, wrote in a piece for the Atlantic. “Would you trade a guaranteed check for a fast food job?”
To give people with disabilities a chance to thrive, a number of companies are working to develop business models that make more room for people with disabilities.
Seven years ago, Walgreens launched an initiative to hire people with disabilities at their distribution centers and offer the same pay and roles, while also demanding the same expectations, the Sun reported.
Employees with Down syndrome, cerebral palsy and other disabilities now make up 12 percent of Walgreens’ distribution center workforce.
Other companies have developed models around the strengths of people with disabilities.
Rising Tide, for example, a car wash in Parkland, Florida, was first developed by a family that was eager to find a suitable job for their son who has autism.
Father and son duo John and Tom D’Eri came up with the idea when their son and brother, Andrew, was about to turn 22 and would age out of the system.
The D’Eris realized that a car wash business would be an ideal venture for people with autism since the tasks require precise attention to detail, which a characteristic people with autism bear.
Eighty percent of the staff is made up of people with autism and is expected to expand to three locations by next year, according to NationSwell.
Prospector Theater, a nonprofit movie theater in Ridgefield, Connecticut, has also committed to hiring people with physical and developmental disabilities.
The company finds each employee’s “inherent sparkle” so that they can do the job that satisfies them most, and each gets individualized training, Mike Santini, director of development, told The Huffington Post.
People with disabilities make up 60 percent of the theater’s staff.
"It's an incredibly talented pool," Santini, told HuffPost. "They're an untapped resource. They're really excited about their jobs, and they're really dedicated. They just need a workplace that's accommodating and welcoming."
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 hours ago.
Sunday marks 25 years since Congress passed the Americans with Disabilities Act, a bill that aimed to give the group equal opportunities to pursue jobs and public and private services. While some vital progress has been made, people with disabilities still face incredible challenges when it comes to obtaining employment and becoming financially stable.
Last year, 17.1 percent of people with disabilities were employed, according to the Bureau for Labor Statistics. The BLS only started tracking such stats in 2008.
While the estimates aren't directly comparable, a report released by the Berkeley Journal of Employment & Labor Law argues that employment figures have actually declined since the passing of the ADA.
In 1990, men with "work limitations" had an employment rate of 50.4 percent. Women who had similar restrictions had an employment rate of 40.7 percent at the time, the report noted.
Bottom line, people with disabilities are twice as likely to be poor today than people who don’t have disabilities, NPR reported.
Part of the problem, experts say, is that the ADA didn’t push the hiring of people with disabilities.
“It mandated providing accommodations, physical accommodations so people could access buildings, but it didn't say hiring people with disabilities was a priority,” Jay Ruderman, president of the Ruderman Family Foundation, told the Baltimore Sun.
A major issue people with disabilities face is wariness from potential employers. Many hiring managers are uncertain about how they’ll be expected to cater to people with disabilities and therefore often opt to exclude this group altogether, NPR reported.
"Employers are scared to hire us," Debbie Eagle, who’s been blind since she was born, told NPR. "Because they don't know what kind of accommodations we require. And if they don't meet what we consider to be reasonable accommodations, they're afraid we'll sue them."
Eagle, 43, has a bachelor’s degree in special education and said she’d love more than anything to be able to find work and stop relying on government assistance.
Michael Morris, executive director of the National Disability Institute, agrees with Eagle and told NPR that the issue at hand is that “attitudes are slow to change.”
Veterans, both those with disabilities and without, are facing an overwhelming amount of such stigma when they return home.
While most veterans come back without any emotional issues, experts say that hiring managers are skeptical that vets will “go postal” while on the job, USA Today reported in 2013.
"They didn't even hide it," Timothy "Rhino" Paige, a former Air Force pilot, told USA Today of the discrimination he faced while trying to get a job.
Paige developed post-traumatic stress disorder in 2005 when he was tasked with transporting the remains of deceased Americans from Iraq.
There’s often the pervasive notion that people with disabilities just want to “milk the system” and avoid working at all costs. But experts say that’s rarely the case.
“They’re broke, bored, poor, and they're tired of it,” Susan Webb, who works for an employment network in Phoenix, told the Atlantic.
But when employment opportunities do become available, they’re often low-wage roles that don’t offer the same kind of medical coverage they get from government benefits.
And once people receiving federal benefits save more than $2,000, they risk losing their benefits, NPR reported.
“They might see a lot of low-wage work with scant labor protections. Nothing that comes with the kind of health insurance you get on disability,” Olga Khazan, wrote in a piece for the Atlantic. “Would you trade a guaranteed check for a fast food job?”
To give people with disabilities a chance to thrive, a number of companies are working to develop business models that make more room for people with disabilities.
Seven years ago, Walgreens launched an initiative to hire people with disabilities at their distribution centers and offer the same pay and roles, while also demanding the same expectations, the Sun reported.
Employees with Down syndrome, cerebral palsy and other disabilities now make up 12 percent of Walgreens’ distribution center workforce.
Other companies have developed models around the strengths of people with disabilities.
Rising Tide, for example, a car wash in Parkland, Florida, was first developed by a family that was eager to find a suitable job for their son who has autism.
Father and son duo John and Tom D’Eri came up with the idea when their son and brother, Andrew, was about to turn 22 and would age out of the system.
The D’Eris realized that a car wash business would be an ideal venture for people with autism since the tasks require precise attention to detail, which a characteristic people with autism bear.
Eighty percent of the staff is made up of people with autism and is expected to expand to three locations by next year, according to NationSwell.
Prospector Theater, a nonprofit movie theater in Ridgefield, Connecticut, has also committed to hiring people with physical and developmental disabilities.
The company finds each employee’s “inherent sparkle” so that they can do the job that satisfies them most, and each gets individualized training, Mike Santini, director of development, told The Huffington Post.
People with disabilities make up 60 percent of the theater’s staff.
"It's an incredibly talented pool," Santini, told HuffPost. "They're an untapped resource. They're really excited about their jobs, and they're really dedicated. They just need a workplace that's accommodating and welcoming."
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 hours ago.
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State health insurance markets struggle with cost challenges
WASHINGTON (AP) — State-run health insurance markets that offer coverage under President Barack Obama's health law are struggling with high costs and disappointing enrollment.
Reported by Denver Post 1 hour ago.
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Valuing Medicaid
AP Photo/Christian K. Lee
In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act.
July 30 marks the 50th anniversary of Medicare and Medicaid, the two essential pillars of public health insurance in America. Medicare, for all of its shortcomings and enormous costs, has become politically unassailable—as dear to Tea Party Republicans as it is to single-payer Democrats. Medicaid has also steadily grown. Including the closely related Children’s Health Insurance Program, Medicaid now covers more than 70 million people. Yet it has never attained the same popularity or political security as Medicare or shed the stigma of “welfare medicine” that it acquired at its founding.
Whatever happens in next year’s presidential election, Medicaid will be the center of a great political fight. If the Democrats win, they should seek to expand the program to cover nearly four million poor and uninsured Americans shut out of the Affordable Care Act’s Medicaid expansion. If the Republicans win, they will likely reduce Medicaid funding, and perhaps convert the whole program into a block grant. Because Medicaid will be a main political battleground, it is important to understand what’s right and what’s wrong with the program.
-How Valuable Is Medicaid?-
An important recent paper by Amy Finkelstein, Nathaniel Hendren, and Erzo Luttmer, “The Value of Medicaid,” tries to determine how much it is worth, but in a narrow way whose baseline assumptions understate the value of the program. The authors use data from the Oregon Health Insurance Experiment. The experiment worked like this: Oregon had more poor and uninsured people than they could insure under Medicaid. So they held a lottery for who could apply for Medicaid coverage. Finkelstein and her colleagues realized that this lottery was in effect an experiment that would allow them to study the impact of Medicaid coverage on the previously uninsured. Following a reasonable—but contestable—economic methodology, Finkelstein and colleagues estimated an equivalent dollar-value to the improved health observed among lottery winners. The authors then explored what happened to a dollar that was spent on providing Medicaid: Who actually benefited and by how much? And would recipients have been willing to pay for their Medicaid benefits if they had to?
The study’s major findings, widely reported in The Wall Street Journal, Vox, Forbes, and many other media outlets, can be summarized as follows:
1. Uninsured people who get Medicaid only gained from 20 to 40 cents in value from each dollar spent by the government.
2. A principal reason why the benefit of getting insured was so small is that when uninsured people received care, they typically paid only 20 cents on the dollar for those services. Safety-net providers, state or local government, friends, relatives, or someone else absorbed the remaining costs. When a recipient became insured, Medicaid paid some of these costs at the rate of about 60 cents per dollar.
3. Because a large fraction of Medicaid expenditures financed care that recipients would have received anyway (for example, by leaving bad debt at hospitals), it is unclear whether recipients themselves would have been willing to pay the full costs of Medicaid.
While the Oregon Health Insurance Experiment was a well-designed study, too few of the study participants experienced serious medical conditions to investigate how Medicaid affected their health or quality of life. In addition, the experiment—and thus Finkelstein, Hendren, and Luttmer’s study—did not examine how Medicaid affected recipients’ families or the health-care institutions that care for low-income uninsured patients. Medicaid’s long-term benefits as an investment in infants and children were also beyond the scope of the Oregon experiment.
But perhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. Finkelstein and her colleagues placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.
These authors did not use a low value-of-life threshold because they are moral monsters—they are not. Rather, they defined this threshold based on reasonable assumptions about what low-income recipients themselves would have been willing to pay, had they been spending their own money for their Medicaid benefits. Poor people aren’t willing to spend as much as rich people would spend for access to the same health care. Given the choice between a Medicaid benefit that costs $4,000 and $4,000 in simple cash, many or most low-income people might well prefer to take the cash.
Had these authors valued the health of poor patients as highly as health services researchers typically value the health of the average patient, their results would have been quite different. The authors know this and to their credit, they show in an appendix that Medicaid’s health benefits appear much more financially valuable when one employs standard $100,000-plus thresholds used in medical cost-effectiveness research.
Although Finkelstein, Hendren, and Luttmer’s baseline assumptions are methodologically defensible, they have radical implications that are rarely so bluntly applied in other domains of health-policy research. Choices about how to financially value the health of poor people relative to the health of others are inevitably both politically and morally freighted. It strains credulity, for example, to imagine American policymakers using this low a value for life when analyzing mammography, prostate cancer treatment, or implantable cardiac defibrillators for seniors.
-So What Have We Learned About the Value of Medicaid?-
Finkelstein and her colleagues are right that a dollar of Medicaid does not necessarily provide a full dollar’s worth of benefits to a Medicaid recipient in the strict sense that the recipient might prefer the cash to the insurance coverage. They are also correct that an important share of the value goes to others rather than to the recipient herself. What are the implications?
The authors are careful not to make any normative statements based on these findings, but others such as Michael Cannon, Tyler Cowen, and John Graham have done so. They make two arguments: First, Medicaid is an inefficient way to benefit the poor. If a Medicaid dollar results in only 20 cents in benefit to a previously uninsured person, wouldn’t it be more efficient to simply give that person a dollar? And, second, Medicaid is actually a subsidy for people other than those it ostensibly helps.
We see matters rather differently. Economists have long understood that poor people would prefer cash to subsidized health insurance (especially if they can still get health care for free). So why does every developed country, including the United States, subsidize health insurance for the poor? Part of the reason is that those countries have broader moral and public-health criteria for thinking about health insurance and poor people’s lives. Universal health care expresses a commitment to the well-being of fellow citizens. Everyone should have access to a decent minimum of care; caring for others in distress is a primary expression of human solidarity.
Moreover, such programs, including Medicaid, bring measurable and significant improvements in public health that have wide social—and economic—consequences.
Ben Sommers and his colleagues found that previous expansions of state Medicaid programs significantly reduced all-cause mortality in those states, compared to matched states that did not expand health insurance. By one credible estimate, Massachusetts’s Romneycare insurance expansion prevented about one death per year for every 830 adults newly enrolled in health coverage. If these estimates carry over to the 16 million Americans newly-insured under the Affordable Care Act, health reform is now preventing about 19,000 deaths every year. That’s more than the annual lives saved by seat belts, frontal air bags, motorcycle helmets, child restraints, and minimum drinking age laws—put together.
Moreover, the counterfactual proposal to give every poor person the cash value of Medicaid (but no health insurance) is a valuable thought experiment but an absurd policy proposal. At the margin, many poor people would trade some of their Medicaid benefits for some cash. But such trades are rarely, if ever, actually on offer.
Voters want to provide for the health of their neighbors and to protect these neighbors from the financial ruin that often follows serious illness. When my neighbor requires $50,000 for a life-saving kidney transplant, that need has special urgency, as do other basic necessities such as nutrition and shelter. The moral interest of the community does not hinge on my neighbor’s willingness to pay. We respond to critical needs because we understand the consequences of failing to meet them, not just for the individual in question but for all those whose lives are connected to hers.
-Should We Leave Medicaid as Is?-
The foregoing arguments help to explain why most citizens of wealthy democracies are committed to universal health insurance, despite its inefficiencies. Of course, these arguments do not require us to support Medicaid as it is currently structured.
The analysis by Finkelstein and colleagues should prompt us to ask how public health insurance could be restructured to deliver better value to both the recipients and society. Proposals to improve these programs include some of the innovations featured in the ACA, such as “medical homes” for patients that attempt to provide better-coordinated care. Medicaid might be extended to require coverage of other services such as dental care, and it could be more effective in promoting beneficial health behaviors. Greater use of comparative effectiveness research in the design of Medicaid benefits could promote individual and population health. We should also consider schemes that would replace Medicaid altogether, including Republican proposals to enroll many low-income people in health insurance exchanges, as long as these approaches guarantee every American access to a decent minimum of care.
What about the finding that much of the value of Medicaid goes to people other than the recipient? The answer to this question depends who is actually getting these dollars, and what they do with them.
When Medicaid relieves burdens on loved ones who are covering the medical bills of an uninsured family member, the program is promoting the security and well-being of American families.
If the transfer is going to community safety-net institutions and other charity-care providers, that transfer may be essential to sustain the health-care institutions that serve the indigent and the uninsured. Medicaid payments for what otherwise would have been uncompensated care benefit the larger community, as well as individual providers.
Financial difficulties of major public hospitals in states that reject ACA’s Medicaid expansion underscore Medicaid’s importance in stabilizing fragile networks of safety-net care. A recent Chicago Tribune story, “Obamacare gives Cook County Health a financial boost,” notes that for the first time, the majority of patients in the county health system were insured, primarily through the Medicaid expansion.
Such coverage expansion also makes possible a properly integrated system of care. Thirty years ago, childbirth was the largest single category of uncompensated care. During the 1980s and early 1990s, Medicaid was expanded to provide a near-universal entitlement to prenatal and neonatal care. This expansion made possible the current system of neonatal intensive care units that has markedly reduced infant mortality.
But not every possible transfer to a non-recipient is benign. In some states, Medicaid funds do not pass directly from the state government to people who provide care. Instead, they pass from the state through third parties such as managed care plans, and then to providers, often at below-market rates. If so, some of the transfer is to such plans, which should be carefully scrutinized to ensure that they deliver substantial benefit to recipients.
How can we be sure that a reformed Medicaid (or an alternative) would provide recipients with more value than the current version? We can't be sure. But here we find the last lesson from Finkelstein and her collaborators, and, more generally, from the Oregon experiment. Despite the limitations to the Oregon data, it is far more valuable to have them than to have none at all. Future Medicaid reform must be designed with powerful data-gathering exercises built into the process, so that we can evaluate program performance against hard benchmarks. Funding mechanisms such as Medicaid provide a key point of leverage for introducing reforms and gathering the data to evaluate those changes. We hope to see many future experiments like the one in Oregon, and many other papers of corresponding high quality that force us to consider what we are really buying within our $2.9 trillion health-care system. Reported by The American Prospect 4 hours ago.
In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act.
July 30 marks the 50th anniversary of Medicare and Medicaid, the two essential pillars of public health insurance in America. Medicare, for all of its shortcomings and enormous costs, has become politically unassailable—as dear to Tea Party Republicans as it is to single-payer Democrats. Medicaid has also steadily grown. Including the closely related Children’s Health Insurance Program, Medicaid now covers more than 70 million people. Yet it has never attained the same popularity or political security as Medicare or shed the stigma of “welfare medicine” that it acquired at its founding.
Whatever happens in next year’s presidential election, Medicaid will be the center of a great political fight. If the Democrats win, they should seek to expand the program to cover nearly four million poor and uninsured Americans shut out of the Affordable Care Act’s Medicaid expansion. If the Republicans win, they will likely reduce Medicaid funding, and perhaps convert the whole program into a block grant. Because Medicaid will be a main political battleground, it is important to understand what’s right and what’s wrong with the program.
-How Valuable Is Medicaid?-
An important recent paper by Amy Finkelstein, Nathaniel Hendren, and Erzo Luttmer, “The Value of Medicaid,” tries to determine how much it is worth, but in a narrow way whose baseline assumptions understate the value of the program. The authors use data from the Oregon Health Insurance Experiment. The experiment worked like this: Oregon had more poor and uninsured people than they could insure under Medicaid. So they held a lottery for who could apply for Medicaid coverage. Finkelstein and her colleagues realized that this lottery was in effect an experiment that would allow them to study the impact of Medicaid coverage on the previously uninsured. Following a reasonable—but contestable—economic methodology, Finkelstein and colleagues estimated an equivalent dollar-value to the improved health observed among lottery winners. The authors then explored what happened to a dollar that was spent on providing Medicaid: Who actually benefited and by how much? And would recipients have been willing to pay for their Medicaid benefits if they had to?
The study’s major findings, widely reported in The Wall Street Journal, Vox, Forbes, and many other media outlets, can be summarized as follows:
1. Uninsured people who get Medicaid only gained from 20 to 40 cents in value from each dollar spent by the government.
2. A principal reason why the benefit of getting insured was so small is that when uninsured people received care, they typically paid only 20 cents on the dollar for those services. Safety-net providers, state or local government, friends, relatives, or someone else absorbed the remaining costs. When a recipient became insured, Medicaid paid some of these costs at the rate of about 60 cents per dollar.
3. Because a large fraction of Medicaid expenditures financed care that recipients would have received anyway (for example, by leaving bad debt at hospitals), it is unclear whether recipients themselves would have been willing to pay the full costs of Medicaid.
While the Oregon Health Insurance Experiment was a well-designed study, too few of the study participants experienced serious medical conditions to investigate how Medicaid affected their health or quality of life. In addition, the experiment—and thus Finkelstein, Hendren, and Luttmer’s study—did not examine how Medicaid affected recipients’ families or the health-care institutions that care for low-income uninsured patients. Medicaid’s long-term benefits as an investment in infants and children were also beyond the scope of the Oregon experiment.
But perhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. Finkelstein and her colleagues placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.
These authors did not use a low value-of-life threshold because they are moral monsters—they are not. Rather, they defined this threshold based on reasonable assumptions about what low-income recipients themselves would have been willing to pay, had they been spending their own money for their Medicaid benefits. Poor people aren’t willing to spend as much as rich people would spend for access to the same health care. Given the choice between a Medicaid benefit that costs $4,000 and $4,000 in simple cash, many or most low-income people might well prefer to take the cash.
Had these authors valued the health of poor patients as highly as health services researchers typically value the health of the average patient, their results would have been quite different. The authors know this and to their credit, they show in an appendix that Medicaid’s health benefits appear much more financially valuable when one employs standard $100,000-plus thresholds used in medical cost-effectiveness research.
Although Finkelstein, Hendren, and Luttmer’s baseline assumptions are methodologically defensible, they have radical implications that are rarely so bluntly applied in other domains of health-policy research. Choices about how to financially value the health of poor people relative to the health of others are inevitably both politically and morally freighted. It strains credulity, for example, to imagine American policymakers using this low a value for life when analyzing mammography, prostate cancer treatment, or implantable cardiac defibrillators for seniors.
-So What Have We Learned About the Value of Medicaid?-
Finkelstein and her colleagues are right that a dollar of Medicaid does not necessarily provide a full dollar’s worth of benefits to a Medicaid recipient in the strict sense that the recipient might prefer the cash to the insurance coverage. They are also correct that an important share of the value goes to others rather than to the recipient herself. What are the implications?
The authors are careful not to make any normative statements based on these findings, but others such as Michael Cannon, Tyler Cowen, and John Graham have done so. They make two arguments: First, Medicaid is an inefficient way to benefit the poor. If a Medicaid dollar results in only 20 cents in benefit to a previously uninsured person, wouldn’t it be more efficient to simply give that person a dollar? And, second, Medicaid is actually a subsidy for people other than those it ostensibly helps.
We see matters rather differently. Economists have long understood that poor people would prefer cash to subsidized health insurance (especially if they can still get health care for free). So why does every developed country, including the United States, subsidize health insurance for the poor? Part of the reason is that those countries have broader moral and public-health criteria for thinking about health insurance and poor people’s lives. Universal health care expresses a commitment to the well-being of fellow citizens. Everyone should have access to a decent minimum of care; caring for others in distress is a primary expression of human solidarity.
Moreover, such programs, including Medicaid, bring measurable and significant improvements in public health that have wide social—and economic—consequences.
Ben Sommers and his colleagues found that previous expansions of state Medicaid programs significantly reduced all-cause mortality in those states, compared to matched states that did not expand health insurance. By one credible estimate, Massachusetts’s Romneycare insurance expansion prevented about one death per year for every 830 adults newly enrolled in health coverage. If these estimates carry over to the 16 million Americans newly-insured under the Affordable Care Act, health reform is now preventing about 19,000 deaths every year. That’s more than the annual lives saved by seat belts, frontal air bags, motorcycle helmets, child restraints, and minimum drinking age laws—put together.
Moreover, the counterfactual proposal to give every poor person the cash value of Medicaid (but no health insurance) is a valuable thought experiment but an absurd policy proposal. At the margin, many poor people would trade some of their Medicaid benefits for some cash. But such trades are rarely, if ever, actually on offer.
Voters want to provide for the health of their neighbors and to protect these neighbors from the financial ruin that often follows serious illness. When my neighbor requires $50,000 for a life-saving kidney transplant, that need has special urgency, as do other basic necessities such as nutrition and shelter. The moral interest of the community does not hinge on my neighbor’s willingness to pay. We respond to critical needs because we understand the consequences of failing to meet them, not just for the individual in question but for all those whose lives are connected to hers.
-Should We Leave Medicaid as Is?-
The foregoing arguments help to explain why most citizens of wealthy democracies are committed to universal health insurance, despite its inefficiencies. Of course, these arguments do not require us to support Medicaid as it is currently structured.
The analysis by Finkelstein and colleagues should prompt us to ask how public health insurance could be restructured to deliver better value to both the recipients and society. Proposals to improve these programs include some of the innovations featured in the ACA, such as “medical homes” for patients that attempt to provide better-coordinated care. Medicaid might be extended to require coverage of other services such as dental care, and it could be more effective in promoting beneficial health behaviors. Greater use of comparative effectiveness research in the design of Medicaid benefits could promote individual and population health. We should also consider schemes that would replace Medicaid altogether, including Republican proposals to enroll many low-income people in health insurance exchanges, as long as these approaches guarantee every American access to a decent minimum of care.
What about the finding that much of the value of Medicaid goes to people other than the recipient? The answer to this question depends who is actually getting these dollars, and what they do with them.
When Medicaid relieves burdens on loved ones who are covering the medical bills of an uninsured family member, the program is promoting the security and well-being of American families.
If the transfer is going to community safety-net institutions and other charity-care providers, that transfer may be essential to sustain the health-care institutions that serve the indigent and the uninsured. Medicaid payments for what otherwise would have been uncompensated care benefit the larger community, as well as individual providers.
Financial difficulties of major public hospitals in states that reject ACA’s Medicaid expansion underscore Medicaid’s importance in stabilizing fragile networks of safety-net care. A recent Chicago Tribune story, “Obamacare gives Cook County Health a financial boost,” notes that for the first time, the majority of patients in the county health system were insured, primarily through the Medicaid expansion.
Such coverage expansion also makes possible a properly integrated system of care. Thirty years ago, childbirth was the largest single category of uncompensated care. During the 1980s and early 1990s, Medicaid was expanded to provide a near-universal entitlement to prenatal and neonatal care. This expansion made possible the current system of neonatal intensive care units that has markedly reduced infant mortality.
But not every possible transfer to a non-recipient is benign. In some states, Medicaid funds do not pass directly from the state government to people who provide care. Instead, they pass from the state through third parties such as managed care plans, and then to providers, often at below-market rates. If so, some of the transfer is to such plans, which should be carefully scrutinized to ensure that they deliver substantial benefit to recipients.
How can we be sure that a reformed Medicaid (or an alternative) would provide recipients with more value than the current version? We can't be sure. But here we find the last lesson from Finkelstein and her collaborators, and, more generally, from the Oregon experiment. Despite the limitations to the Oregon data, it is far more valuable to have them than to have none at all. Future Medicaid reform must be designed with powerful data-gathering exercises built into the process, so that we can evaluate program performance against hard benchmarks. Funding mechanisms such as Medicaid provide a key point of leverage for introducing reforms and gathering the data to evaluate those changes. We hope to see many future experiments like the one in Oregon, and many other papers of corresponding high quality that force us to consider what we are really buying within our $2.9 trillion health-care system. Reported by The American Prospect 4 hours ago.
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Big mergers for health insurance companies
Health insurance giant Aetna announced the purchase of Cigna, leaving consumers to choose from three major providers
Reported by CBS News 17 hours ago.
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High Costs Plague Some State-Run Health Insurance Markets
Outlook for some state health insurance markets uncertain due to low enrollment, high costs
Reported by ABCNews.com 9 hours ago.
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