Centers for Medicare & Medicaid show ACA savings

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Under the discount program in the ACA, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries who landed in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs. Next year, Medicare Part D participants who fall into the donut hole will receive savings of about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the coverage gap will be closed.
Source: csbj.com

Video: Medicare Savings Program – FREE-B

UM to drop from Pioneer ACO program, will continue to seek Medicare cost savings

The University of Michigan Medical School’s Faculty Group Practice this week joined six of the 32 other Pioneer accountable care organizations nationally in announcing plans to drop out of the Pioneer ACO program – one of Obamacare’s most ambitious cost containment and quality improvement test projects. But David Spahlinger, M.D., the faculty plan’s executive director, said the UM Pioneer ACO is not giving up on the concept of coordinating care for Medicare patients. For efficiency, physician partnership and integration reasons, Spahlinger said the UM Pioneer ACO plans to join a larger ACO in Medicare’s shared savings ACO program for which it already participates. Under health care reform, ACOs are groups of physicians, hospitals and other providers who band together to contract with Medicare. If approved by Medicare, the UM Pioneer ACO would join The Physician Organization of Michigan ACO, an organization formed last year by UM and eight other physician organizations in Michigan. The POM ACO board also is expected to vote on adding UM later this month. The POM ACO includes 1,800 physicians and cares for more than 81,000 Medicare beneficiaries across Michigan. UM’s Pioneer ACO, which cares for 23,000 Medicare patients, includes 2,000 faculty physicians and IHA, an Ann Arbor-based multispecialty practice with ties to Ann Arbor-based St. Joseph Mercy Health System. UM Pioneer ACO reported it achieved cost savings of 0.3 percent for Medicare during 2012. To share savings with Medicare, however, the UM Pioneer ACO needed to achieve a minimum 2 percent savings, Spahlinger said. “We didn’t receive any additional revenue in 2012,” said Spahlinger, noting that the UM faculty group has been participating in a Medicare shared savings project since 2005 when it was part of the Medicare Physician Group Practice demonstration project, a forerunner of ACOs. “We have had savings of 3.4 percent, 2.9 percent …” in the past, he said. “You get to a point of diminishing returns” trying to remove costs out of Medicare patient care. Spahlinger said UM could have continued in the Pioneer program and generated additional savings by increasing use of care coordinators to reduce chronic care costs and working more closely with home health agencies. “We went through the pros and cons of that,” he said. “We just decided to combine the two programs. It is simpler, and as an academic center we get referrals from all over the state. The partnerships we develop with other groups across the state help us develop relationships for coordination of care.” Spahlinger said one-third of the Medicare patients in the UM Pioneer ACO receive care outside of the university system. Detroit Medical Center, which operates Michigan Pioneer ACO, reported first year savings of 4.5 percent, said Mohamed Siddique, M.D., chairman of the Michigan Pioneer board. “When we all embarked on the ACO journey, many of us were unsure and anxious,” Siddique said in a statement. “But we were willing to take on the challenge of changing the course of health care in Southeast Michigan. We knew we would take care of one of the sickest patient populations.” In a statement, Medicare said costs for 669,000 beneficiaries enrolled in the 32 Pioneer ACOs rose only 0.3 percent in 2012 compared with a 0.8 percent rate for other Medicare patients. Some 13 out of 32 pioneer ACOs produced shared savings with CMS, saving nearly $33 million for Medicare. The Pioneer ACOs earned more than $76 million. Only two Pioneer ACOs lost money, totaling approximately $4 million. Seven of the Pioneer ACOs that did not produce savings, including the UM Pioneer ACO, have asked Medicare to drop out of the Pioneer program and apply to the Medicare Shared Savings Program, another ACO model. However, all 32 Pioneer ACOs, including UM’s, improved in all 15 quality measures and earned incentive payments. Under Medicare’s shared savings program, the quality and cost of care are measured differently while the goal of reducing costs and improving health of patient remains. Unlike Pioneer ACOs, which assume financial risk for patients under their care, shared savings ACOs do not assume financial risk. “We still have to save 2 percent (under shared savings),” Spahlinger said. “We feel we can reduce administrative costs and eliminate staff duplication by being a part of one ACO.” POM ACO includes the University of Michigan Health System, Oakland Southfield Physicians, Olympia Medical Services, United Physicians, Advantage Health/St. Mary’s Care Network, Crawford Mercy Physician Hospital Organization, Lakeshore Health Network, Physicians’ Organization of Western Michigan and Wexford Physician Hospital Organization.
Source: crainsdetroit.com

Medicare Savings: Cut Benefits to the Elderly or to Big Pharma's Windfall Profits?

The Ryan plan would change Medicare from a guarantee of health care (with associated premiums, co-payments, and deductibles) to a "premium support" program. In other words, it would be a voucher program – the voucher being a flat payment given to beneficiaries to obtain either Medicare coverage or to buy a private insurance policy. This would increase costs significantly for Americans because annual increases in the amount of this voucher would likely fail to keep pace with the growth in health care costs from year to year. Thus, beneficiaries would have to pay increasingly more out of their own pockets for insurance coverage, either through Medicare or from private insurers.
Source: foreffectivegov.org

Medicare Savings Program sees enrollment rise

Enrollment increased 5.2% in 2010 and 5.1% in 2011, according to the GAO. It attributed the growth to factors including the SSA’s efforts as well as the economic downturn. The Medicare Improvements for Patients and Providers Act of 2008 requires that the SSA address the roadblocks preventing low-income beneficiaries from signing up for the savings program. Those barriers were pegged as low awareness and cumbersome enrollment processes. In addition to outreach, the SSA was also required to transfer information on beneficiaries who file a low-income subsidy application to a state Medicaid agency. Officials in 28 states reported growth in their Medicare Savings Programs as a result of Social Security Administration transfers, the GAO found. The GAO noted that the amount of additional work for states will depend on whether they decide to re-verify the information beneficiaries provided to the SSA and whether their eligibility requirements align with the federal government’s.
Source: modernhealthcare.com

GAO: More enrollees take advantage of Medicare Savings Programs

Despite historically low numbers, enrollment for the Medicare Savings Programs is up, the Government Accountability Office reported Friday. With enrollment rising every year since 2007, the report suggests the Social Security Administration has been successful at eliminating barriers to enrollment, which could reduce Medicaid spending for certain beneficiaries. Historically, low enrollment has been attributed to a lack of awareness about the four programs (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualifying Individual, and Qualified Disabled and Working Individual), as well as cumbersome enrollment processes through state Medicaid programs, GAO noted. For instance, in 2004, only a third (33 percent) of eligible beneficiaries were enrolled for the Qualified Medicare Beneficiary program, and only 13 percent were enrolled in the Specified Low-Income Medicare Beneficiary program, the report noted.
Source: fiercehealthcare.com

Medicare Savings Programs: Analyzing Options for Expanding Eligibility

Despite the financial assistance offered through Medicare savings programs (MSPs), many eligible beneficiaries do not enroll in them. In this study, researchers examined changes that would simplify eligibility requirements and align them with the low-income subsidy for the Medicare Part D drug benefit. They also examined policy options that would extend eligibility for MSPs and the subsidy by relaxing resource standards or by opening eligibility to incomes as high as 200 percent of the federal poverty level. To do this, the researchers built a model to simulate baseline eligibility and examined the effect of eliminating the resource standards and increasing the income threshold.
Source: commonwealthfund.org

Truven Builds Accountable Care Organization For Medicare Shared Savings Program Recipients

“MSSP participants’ HIT infrastructure, analytics capabilities, operations, and physician engagement all need to align in new ways, essentially changing the fundamental nature of the healthcare business,” said Larry Yuhasz, director at Truven Health Analytics. “We have designed this solution to help get the ACO up and running quickly to meet the requirements of the Affordable Care Act, while also laying a foundation that can grow in functionality as the organization decides to adopt more advanced approaches to population health.”
Source: cbslocal.com

The Window on the ACO Class of 2014 Is Closing Soon!

With the March 2010 passage of the ‘Patient Protection and Affordable Care Act (PPACA), the ‘follow the money’ floodgates are once again opening for hospitals, physicians, integrated delivery systems, health plans, and consultants. This time, instead of migrating ‘HMO lite’ (neither staff nor group model) platforms into mainstream medicine via IPAs, or MeSH model JV’s, we’re now talking about their ‘new and improved’ successors broadly cast as ‘Accountable Care Organizations aka ‘ACOs’.
Source: acowatch.me

Improving the Medicare Savings Programs Would Help Low

[1] The typical non-elderly adult with income between 100 percent and 150 percent of the poverty line spent 3.8 percent of his or her income on health care. Katherine Desmond et al., “The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003,” Kaiser Family Foundation, September 2007. The AARP Public Policy Institute has reported starker results. It found that in 2003, Medicare beneficiaries age 65 and older spent an average of 22 percent of their income on out-of-pocket medical expenses. Again, low-income seniors faced the largest financial burdens: seniors with incomes between 135 percent and 200 percent spent 28 percent of their income on health care, on average, while seniors below 135 percent of the poverty line spent 33 percent. Craig Caplan and Normandy Brangan, “Out-of-Pocket Spending on Health Care by Medicare Beneficiaries Age 65 and Older in 2003,” AARP Public Policy Institute, September 2004.
Source: cbpp.org

Where Does Your Trust Lay, America?

Posted by:  :  Category: Medicare

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Washington, D.C. has a unique solution for the problems caused by their meddling: They want to meddle some more. The healthcare overhaul known as “Obamacare” was passed in response to increasing healthcare costs. President Obama promised Americans that under this law, “If you like your [insurance] plan, you can keep it.” Unfortunately, due the regulations within Obamacare, thousands of people have lost their insurance plan, or seen costs rise. America was deceived, yet again, by the belief that government is the answer to social issues. Due to this delusion, thousands more are now uninsured.
Source: themississippicollegian.com

Video: Mississippi Medicare Supplements

MHA Press Room: Dartmouth Atlas Report Examines Prescription Drug Use among Medicare Patients

Dartmouth researchers found that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.
Source: typepad.com

Gov. Phil Bryant proposes $4.4 million to Mississippi hospitals to offset Obamacare losses

Republican Gov. Phil Bryant says Mississippi needs to pursue health care businesses to promote economic growth during a health care economic development meeting Thursday, Aug. 15, 2013, at the Jackson Convention Complex, in Jackson, Miss. Bryant says the state is working to create "medical corridors" by offering incentives to private companies such as pharmaceutical firms, medical equipment manufacturers and others. (AP Photo/Rogelio V. Solis)
Source: gulflive.com

AARP Launches “Commonsense Solutions” Videos About Medicare

“As Medicare continues to provide access to health care for millions of seniors and those with disabilities, AARP is celebrating its 48 successful years and advocating for responsible, commonsense solutions that will strengthen the program by lowering drug costs, improving care coordination and cracking down on over-testing, waste and fraud. Nearly 50 million Americans—15 percent of the nation’s population, and growing—depend on Medicare for health security which is why AARP will continue our work to ensure that it is there for current and future generations.
Source: aarp.org

Medicare Expert Patricia Barry, Ask Ms. Medicare

Eligibility Learn about how you can qualify for health coverage under Medicare. Enrollment Learn about when and how to sign up for Medicare according to your circumstances. Disenrollment Learn about how to opt out of Medicare if you are already enrolled. Out of Pocket Expenses Learn about your share of Medicare costs. Medical Coverage (Part A and Part B) Learn about medical services covered under Part A (hospital insurance) and Part B (outpatient insurance). Prescription Drug Coverage (Part D) Learn about how Medicare’s prescription drug program works. Medicare Private Health Plans Learn about the Medicare Advantage program, an alternative way of receiving Medicare benefits. Sources of Information and Help Learn about how to find personal help on Medicare issues.
Source: aarp.org

State Of Mississippi Medicaid Selects MedeAnalytics’ Accountable Care Solution

Physicians in the state of Mississippi will utilize the Meaningful Use-certified system to provide better coordinated care for aged, blind and disabled (ABD), dual-eligible, special needs, and other Medicaid beneficiaries. Realizing the goals of a statewide, integrated system, Medicaid patients’ profiles are prepopulated with medical, pharmacy and claims histories, enabling better-informed decisions at the point of care. Physicians also have access to fully informed ePrescribing capabilities that integrate prescription drug claims and formularies as well as provide adverse drug reaction alerts.
Source: healthcaretechnologyonline.com

Some uninsured may get help without Medicaid expansion

A Mississippi Institutions of Higher Learning economic brief by state economist Bob Neal last year made the nuts-and-bolts of the Medicaid expansion question clear: “The results in each scenario indicate that Medicaid expansion will generate additional state Medicaid costs in years 2017-2025. From 2014-2020, cumulative state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $109 million to $98 million. From 2014-2025, total state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $556 million to $497 million.”
Source: gulflive.com

Forget about Obamacare, seniors: Deadline looms for your Medicare changes

“This year the Medicare deadline is the same as last year, but we’ve had so much confusion with seniors because so much media has played on health care reform and the exchanges and the website not working properly,” said Jennifer Harper, the manager of Medicare sales for Viva Health. “Seniors are confused about the deadline and are afraid if they make changes they’ll lose their health insurance altogether. “
Source: al.com

Daily Kos: California GOP creates FAKE Healthcare Exchange Website Full of Spin

Coveringhealthcareca.com’s “Learn More” section may be the most telling. At the top of the page, visitors see links to the websites of Covered California, the Kaiser Family Foundation, the California Attorney General, and the National Republican Congressional Committee — the group whose job is to keep and increase the Republican majority in the House. Further down the page, some links take readers to national news outlets, like The Los Angeles Times and the Associated Press, but others lead to the websites of partisan organizations like The Heritage Foundation, The Heartland Institute, and The Galen Institute. The section headings on the page gives a flavor of the focus: “Rising Cost of Health Care,” “Privacy,” “Rate Hikes,” “Impact on the Economy,” “Bureaucracy,” “IRS Penalty.”, If you click in the link that says “I Don’t Have Health Care” it takes you to a calculator that tells you How Expensive Your Tax Penalty will be for not buying health care under the mandate.
Source: dailykos.com

Tuesday, November 19, 2013: Religious freedom, bear baiting and Medicare enrollment — Opinion — Bangor Daily News — BDN Maine

Posted by:  :  Category: Medicare

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The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Video: Medicare Annual Enrollment Period 2014

Medicare Open Enrollment Ends Dec. 7

· Spanish, Medicare, 1-800-633-4227 · Spanish, National Alliance for Hispanic Health, 1-866-783-2645 · Korean, National Asian Pacific Center on Aging, 1-800-582-4259 · Chinese, National Asian Pacific Center on Aging, 1-800-582-4218 · Vietnamese, National Asian Pacific Center on Aging, 1-800-582-4336 · Ask a trusted friend or relative for help
Source: orcasissues.com

The Medicare Annual Enrollment Period (AEP) Ends on December 7

The Medicare Annual Election Period (AEP), also known as the Annual Enrollment Period, occurs from October 15 to December 7 of each year and it gives beneficiaries the chance to shop around for a new Medicare plan. This includes making changes to their Medicare Advantage (MA) and/or Medicare Part D coverage for the following year. With only a few days left in this enrollment window, it is important for beneficiaries to make sure that they are enrolled in the right Medicare plan(s) for their needs for the following year, for the Medicare Annual Enrollment Period may be one of the only times they can make changes to their health and drug coverage.
Source: ehealthmedicare.com

Medicare open enrollment period ends Saturday, Dec 7, 2013

Unlike other years, this year you will also hear a lot about the Affordable Care Act’s Health Insurance Marketplace which opened October 1, 2013. The Marketplace Open Enrollment period which runs through March 31, 2014, and overlaps with the Medicare Open Enrollment period. The Health Insurance Marketplace is designed to help people who don’t have any health coverage. If you have health coverage through Medicare, the Health Insurance Marketplace will not have any effect on your Medicare coverage.
Source: copd-international.com

Medicare Open Enrollment FAQ

A: If you’re enrolled in Medicare, you’re not eligible for the tax credits that some people qualify for on the marketplaces, but you already get a substantial break on costs. The overall costs of care under Medicare Part B, which pays doctors’ visits, and Part D, the prescription drug benefit, are subsidized 75 percent from federal general revenues. Plus, if you’re a Medicare beneficiary with limited resources and income, you may qualify for low-cost Part D drug coverage under the Extra Help program. Go to www.ssa.gov, call 800-772-1213 or visit your local Social Security office.
Source: aarp.org

Medicare open enrollment deadline is this Saturday, Dec. 7

LocalHealthGuide is a health news and information web service for Seattle and the Puget Sound Region. We are independent and unaffiliated with any hospital, medical association or insurer. If you have questions or if your group has an upcoming event that you would like us to cover, please let us know by going to our “Contact Us” page and dropping us a note. — Michael McCarthy, Editor
Source: mylocalhealthguide.com

UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans

Medicare officials review the private plans every year to make sure they comply with network adequacy and other requirements, but the agency did not approve the reconfigured networks resulting from the new provider cancelations. Spokesman Raymond Thorn said the agency “is currently reviewing UHC and other plans’ provider networks and closely monitoring all areas that have experienced disruptions to ensure that beneficiaries have full, transparent and timely information and access to needed care.”
Source: kaiserhealthnews.org

Ohio offers help during Medicare open enrollment

CANFIELD, Ohio – The Canfield Key Club has raised over $1,000 for a Valley organization dedicated to the rescue of abandoned, abused and injured animals. The Key Club will present a check to Falcon Animal
Source: wfmj.com

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