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Member News: Kaiser Permanente is using socioeconomic data to better serve patients. A form asking about debt, child care and other social factors determines if a patient is assigned a navigator, who can help overcome obstacles to seeking health care like finding transportation and scheduling appointments. The forms are also helping doctors gain a better understanding of patients’ needs.
Lawmakers considering bipartisan approach to health care
Sen. Lamar Alexander (R-TN), chairman of the Senate health committee, is working with Sen. Patty Murray (D-WA) to craft a plan to stabilize the ACA markets. The approach includes guaranteeing funding for CSRs while giving states increased flexibility to offer different insurance plans. However, the efforts to support the markets may be too late. Health plans need to finalize rates and sign contracts for 2018 by the end of September. Funding CSRs would provide market stability, and without the payments premiums could rise and insurers may leave markets.
The Administration seems to be operating on opposite tracks when it comes to the ACA, according to some health experts. The Administration has cancelled contracts with companies that helped many individuals sign up for ACA plans and issued weekly maps showing counties that may be left without ACA health plans. But at the same time, HHS, which directly oversees the exchanges, is operating mostly as usual, holding its annual meeting with navigators who direct consumers to ACA plans. It still remains unclear if the Administration will help or hinder the marketplaces as open enrollment approaches.
Hospitals questioning CMS decision on outpatient knee and hip surgery
CMS is considering paying for knee and hip surgery in outpatient settings. The announcement has drawn praise from ambulatory center operators and many orthopedic surgeons, but some hospital leaders are concerned. Hospitals are skeptical that providing outpatient surgery will yield better outcomes, and many expressed concern about revenue loss. CMS is taking comments until September 11.
New technology can increase spending
Adopting new technologies contributes a lot to the growth of health care spending. To battle that growth, the health care industry promotes price transparency as a way to encourage competition and lower spending. However, most hospitals and providers really don’t embrace price transparency, and continue to advertise the latest procedures with seemingly little regard for costs – and doctors, not consumers, are frequently making decisions about procedures.
New methods for diagnosing Alzheimer’s could simplify diagnosis
At the Alzheimer’s Association International Conference in London, researchers debuted a brain imaging technique and a blood test for detecting Alzheimer’s. Both tests are seen as less invasive, cheaper methods of diagnosis, and their discovery could lead to wider screenings. Researchers also presented data on the efficacy of an existing but little-used imaging test that is currently not covered by most insurers; scientists are hoping to prove the imagining technique can lead to improved care in order to eventually secure reimbursement from CMS.
Collapse of Penn Treaty American likely to lead to higher premiums from other insurers
The collapse of Pennsylvania-based Penn Treaty American Corp. may force insurers to apply a surcharge on premiums in order to cover losses incurred due to an obscure rule that requires other insurance companies to pay off an insolvent insurer’s claims. Market share determines how much an insurer must contribute, with larger insurers paying more. Penn Treaty American’s collapse is one of the largest insurance failures in American history, and experts believe it will have a significant impact on other health insurance providers, with some paying hundreds of millions of dollars.