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Kristen Lepore

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Online Tools Help Consumers, Employers Compare Health Care Costs

Posted by Kristen Lepore on Oct 14, 2014 6:29:35 AM

Consumers accustomed to going online to compare the cost of cars, furniture and vacations can now do the same with medical procedures in Massachusetts. That’s good news for employers who have long struggled to control health premiums by helping workers become informed consumers of health care.

20-Price-of-pills.smallAs of October 1, all health insurance plans in Massachusetts have Web tools that allow customers to access real-time health care cost and quality information.  The online tools also permit people to estimate their annual out-of-pocket costs and track their health-care expenses. 

The tolls were mandated under the 2012 Massachusetts health care cost control law.

Patients are now able to compare the costs and outcomes of more than a thousand procedures - from knee and shoulder replacements to imaging and laboratory work – at various hospitals and clinics in Massachusetts. The result  is that consumers can save money on their out-of-pocket medical costs while saving employers money on direct health care payments and future premium costs. 

Associated Industries of Massachusetts and the commonwealth’s health insurance companies are working together to help employers and their workers utilize the new health care cost and quality tools. AIM and the insurers have planned a series of free, informational Webinars that will explain how employers may compare cost and quality information for health care services and communicate the information to employees. 

Employers play an important role in helping to lower annual health care costs by encouraging employees to use lower-cost, high-quality health care providers.  Employees often don’t understand that the cost of an MRI varies greatly from one provider to the next – in some cases by thousands of dollars.

The first Webinar will be conducted with Harvard Pilgrim Health Care on Thursday, November 6 at 10 am. Webinars with other health plans will be scheduled during the next four months.

Click here to register for the Webinar.

Meawnile, the Web tools may be found here:

Aetna Health Insurance Member Payment Estimator

Aetna Health Insurance WellMatch (currently available for employers with 750 or more employees)

Blue Cross Blue Shield Find a Doctor

Celticare Health Cost Estimation Tool

Fallon Health Care SmartShopper

Harvard Pilgrim Health Care Now iKnow (HPHC members must log into their account to access the tool’s link)

Health New England (HNE members must log into their account to access the tool’s link)

Tufts Health Plan EmpowerME

Encourage your employees to use these resources. Your broker or health insurance representative can provide educational materials for your employees now and again during your open enrollment. It might take time for them to use the tools regularly but the results will be worth your effort so remind them often. 

Contact me at klepore@aimnet.org if you tried the tools and have feedback on them. 

Topics: Associated Industries of Massachusetts, Health Care Costs, Health Insurance

Congress Overhauls Job Training Programs

Posted by Kristen Lepore on Jul 14, 2014 6:48:51 AM

Congress last week mustered rare and overwhelming bipartisan support to pass legislation that will streamline the sprawling federal workforce training system by eliminating 15 programs. The Workforce Innovation and Opportunity Act is designed to ensure that American workers attain skills for 21st- century jobs, to improve existing federal job training programs and to connect businesses with the skilled employees they need.

USCapitolIt marks the first time in more than a decade that the nation’s workforce training programs have been updated, though it remains unclear how the changes will play out on the state level.  The measure attracted unanimous support from the Massachusetts Congressional delegation.

Many Americans are not equipped with the necessary skills and education needed for high-demand careers in the knowledge economy. Experts project that the number of workers needed to filled highly skilled jobs will fall short by 11 million nationally in the next decade.  

Massachusetts faces a similar shortage. Northeastern University Economist Barry Bluestone estimates that that 100,000 skilled manufacturing jobs in Massachusetts will open up in the next decade as older workers retire. The number of young people graduating from Massachusetts high schools, meanwhile, is projected to fall by 9 percent by 2020.

What has been lacking in the face of a developing skills crisis is a coordinated solution.

The Federal legislation makes changes to encourage accountable state job-training strategies.  States will now be required to produce a single strategic plan describing how they will provide training, employment services, adult education and vocational rehabilitation through a coordinated, comprehensive system. 

We couldn’t agree more.  A well-thought out unified plan on how to solve this problem is sorely needed. 

AIM is developing its own strategic plan for Massachusetts. The Blueprint for the Next Century is a plan to create jobs, prosperity and economic growth in the coming decades. The document will outline problems and solutions to help jumpstart the Massachusetts economy, including how to solve the shortage of skilled workers.

We look forward to sharing our plan with state and congressional leaders.  

Topics: Training, Jobs

Judge Wise to Permit Comment on AG-Partners Settlement

Posted by Kristen Lepore on Jul 1, 2014 12:30:00 PM

An agreement with the potential to shape the Massachusetts health care market for decades deserves public debate and that’s just what Suffolk Superior Court Judge Janet L. Sanders wisely permitted yesterday in creating a comment period for the proposed settlement between Partners Health Care and the attorney general.

StethescopeSanders gave members of the public, including a group of rival hospitals and physician groups that oppose the settlement, until July 21 to submit comments. Attorney General Martha Coakley’s office will have until August 1 to respond to the comments in advance of a court hearing on August 5.

The proposed consent judgment, intended to resolve state and federal investigations into the market power of the largest hospital and physician group in Massachusetts, would allow Partners to acquire South Shore Hospital in Weymouth and at least two other community hospitals, but restrict its further expansion and temporarily cap its prices.

Partners’ price increases would be limited to general inflation. The parent company of Massachusetts General and Brigham & Women’s hospitals would also be prohibited from acquiring any more hospitals in Eastern Massachusetts for seven years without approval from Coakley’s office.

Critics of the settlement, including rivals Beth Israel Deaconess Medical Center in Boston, Lahey Health in Burlington, Tufts Medical Center in Boston, and Newton-based Atrius Health contend that the agreement would merely enshrine pricing disparities that have resulted from Partners’ market power. Judge Sanders denied without prejudice a motion by the competitor hospitals to intervene in the case, but also called for the comment period.

“What’s the big rush?” The Boston Globe quoted Judge Sanders as asking during a hearing on the matter Monday.

What’s the rush indeed?

Transparency and open debate are the building blocks of sound public policy decisions. It's especially true for a complex matters like this one that affect every Massachusetts citizen and every employer who seeks medical care and pays a medical bill.

AIM takes seriously its responsibility to speak for Bay State employers on issues that affect the cost and quality of health care. Our 4,500 hard-working member employers pay the highest health insurance premiums in the nation and struggle every day to grow in the face of rising costs to provide good health coverage to employees.

We look forward to the discussion.

Topics: Health Care Costs, Attorney General Martha Coakley

No Health Magic Wand for Massachusetts Employers

Posted by Kristen Lepore on Feb 18, 2014 6:50:00 AM

Massachusetts employers are living through a twisted version of Cinderella in which the federal fairy Godmother helps everybody but the one who needs to get to the Ball.

Health ReformThe Obama Administration waved its magic wand not once, but twice last week with administrative rulings postponing two key elements of federal health care reform. The government delayed by a year the requirement that medium-to-larger firms cover their workers or face fines and approved the Massachusetts Health Connector’s request to extend existing coverage plans for 124,000 subscribers beyond March 31 for another three months until June 30.

But employers seeking a little bibbidy-bobbidi-boo to avert catastrophic changes in health insurance rating requirements that threaten to raise rates for some by more than 50 percent were once again left with nothing but a pumpkin. It seems the only issue the government refuses to resolve with its magic dust is the one that has caused unnecessary rate shock for small businesses in a commonwealth that already had health reform down pat before the feds butted in.

The ACA limits to four the rating factors used to calculate small group health insurance premiums, while current Massachusetts law allows for additional consideration of factors such as industry, participation rate, group size, intermediary discount and group purchasing cooperatives.

Governor Deval Patrick requested a rating-factor waiver on September 3, noting that “a waiver of rating factor requirements will avoid increases in health insurance premiums for a large segment of our small-employer population and their employees.” Secretary of Health and Human Services Kathleen Sebelius denied the request on September 26.

A study by health insurance companies indicates that the rating changes have raised or lowered rates for small companies by up to 57 percent, on top of average increases of 3.7 percent in their base insurance premiums.

A separate survey by AIM found that 60 percent of small employers who renewed their health insurance policies on January 1 saw increased premiums. Among the employers who said they would consider making changes to their health plans as a result of the increases, 20 percent told AIM they plan to drop coverage all together because the price hikes are unaffordable.  As one member said, “We have not had a pay increase in 12 years and an 18 percent increase in our insurance is deplorable.”

The federal government has already granted more than 1,200 ACA waivers and made numerous administrative modifications to the law. Except on the rating factor issue.

The first waiver last week postponed enforcement of a federal requirement for employers with 50-99 full-time employees to provide health insurance and allow larger employers more flexibility in how they provide coverage. The second waiver came when the Centers for Medicare and Medicaid Services granted the Commonwealth Connector a three-month enrollment deadline extension as the state struggles to fix its troubled health care insurance website.

All of these machinations come in a state where the health care system was working smoothly before being co-opted by the Affordable Care Act.

Anyone seen our glass slipper?

Topics: Associated Industries of Massachusetts, Health Care Reform, Health Care Costs

Massachusetts Health Spending 36 Percent Above National Average

Posted by Kristen Lepore on Dec 18, 2013 2:24:00 PM

The percentage of the Massachusetts economy spent on health care dipped slightly from 2009 to 2012, but Bay State business and residents still shelled out 36 percent more than the national average on doctors, hospitals and prescriptions, according to a preliminary Cost Trends Report published today by the Massachusetts Health Policy Commission (HPC).

Health care costsThe report found that health care spending as a percentage of the Massachusetts economy edged down from 16.8 percent in 2009 to 16.6 percent in 2012, following a similar trend for the nation as a whole.  The document also confirmed what many employers already know – Massachusetts has the highest per capita health-care expenditures in the country at $9,278 versus $6,850 for the United States.

The gap reflects price growth in commercial insurance products and the fact that Bay State residents continue to use hospitals, long-term care facilities and other services at a much higher rate than residents of other states.

The commission notes that the high price of health care crowds out other priorities for consumers, businesses and government.

The Health Policy Commission was created by the 2012 Massachusetts health cost control law to limit increases in health spending to no more than the overall rate of economic growth in the commonwealth. That growth rate is expected to be 3.6 percent this year.

“The report provides both a clear picture of the factors that drive increases in medical spending and a roadmap for ensuring that Massachusetts maintains a world-class health care system that is affordable for everyone,” said Richard C. Lord, President and Chief Executive Officer of AIM and a member of the 11-person HPC.

“Failure to control costs will impede the ability of Massachusetts employers to compete and create jobs in a global economy.”

The rising cost of providing health care to workers represents a persistent concern for Massachusetts employers. It is a concern that has deepened for small employers during the past several months as provisions of federal health care reform threaten to increase premiums by up to 57 percent for companies with fewer than 50 workers.

Spending on hospitals and long-term care facilities accounts for much of the $2,463 annual difference in what Massachusetts consumers pay and what people in other states pay for care, according to the HPC report. Massachusetts residents pay $1,030 per year more than the national average on hospitals, $771 per year more on long-term care and home health, and $580 more on professional services.

Residents here also make uniquely heavy use of hospitals. The HPC report shows that inpatient admissions to hospitals in Massachusetts run 10 percent higher than the national average, while Bay Staters use hospitals for outpatient services 72 percent more frequently than Americans as a whole. Sixty-eight percent of all hospital discharges in Massachusetts take place from major teaching hospitals.

The report warns that while medical spending in Massachusetts slowed in tandem with national averages in 2009-2012, the commonwealth faces a challenge to keep growth rates low.

“Past periods of slow health care growth in Massachusetts, such as the 1990s, have been followed by sustained periods of higher growth,” the document said.

Topics: Health Care Reform, Health Care Costs, Massachusetts employers, Health Insurance

25 Business Groups Ask Congressional Delegation to Back Health Waiver

Posted by Kristen Lepore on Nov 21, 2013 3:18:00 PM

Associated Industries of Massachusetts and 24 other Massachusetts business organizations joined together today to ask the commonwealth’s Congressional delegation to support waiving provisions of the Affordable Care Act (ACA) that could raise premiums for some small Bay State employers by more than 50 percent.

Health Care ReformThe groups, including 17 chambers of commerce and several statewide organizations representing thousands of employers, support a waiver from rating-factor limitations imposed by federal health reform for insurance offered to employers with 50 or fewer workers.

The ACA limits to four the rating factors used to calculate small group health insurance premiums, while current Massachusetts law allows for additional consideration of factors such as industry, participation rate, group size, intermediary discount and group purchasing cooperatives.

“Without this waiver, many small employers in this state will see their health insurance premiums increase by as much as 57 percent. These steep increases are simply unaffordable for small employers and risk our impressive 97 percent coverage rate in the event that employers discontinue providing health insurance to their employees,” the organizations maintain in their letter, delivered this afternoon to the Bay State delegation.

Governor Deval Patrick requested a rating-factor waiver on September 3, noting that “a waiver of rating factor requirements will avoid increases in health insurance premiums for a large segment of our small-employer population and their employees.” Secretary of Health and Human Services Kathleen Sebelius denied the request on September 26.

The business groups argue that the federal government has already granted more than 1,200 ACA waivers and made numerous administrative modifications to the law. The most prominent of those modifications took place last week when President Barack Obama allowed individuals whose insurance had been cancelled to retain their policies for a year.

 

Topics: Health Care Reform, Health Care Costs

AIM Health Chair - Employers Can Control Costs with Wellness

Posted by Kristen Lepore on Oct 3, 2013 11:17:00 AM

Bill Grant, Chief Financial Officer of Cummings Properties in Woburn, and Chair of the AIM Health Policy Committee, told the state Health Policy Commission yesterday that his company has leveled health insurance premiums by engaging employees in wellness efforts. Three quarters of the company's workers now participate.

 

Topics: Health Care Reform, Health Care Costs, Issues

Governor Will Let Stand Repeal of Fair-Share Assessment on Employers

Posted by Kristen Lepore on Jul 11, 2013 2:48:00 PM

Governor Deval Patrick said today that he will let stand a budget provision repealing the Fair Share health care assessment on employers, even though the Obama Administration last week postponed a related provision of federal health reform.

Deval PatrickAssociated Industries of Massachusetts applauds the governor’s decision. Elimination of the Fair Share assessment created under the 2006 state health care reform law is part of package of changes intended to make way for the federal Affordable Care Act and reduce the administrative burden on employers who provide health insurance.

John Regan, Executive Vice President of Government Affairs at AIM, said the new implementation date for federal penalties does not diminish the value to employers and consumers of eliminating Fair Share and the Medical Security Trust Fund.

“The temporary presence or absence of health reform penalties does not drive benefit decisions for the vast majority of Massachusetts employers,” Regan said.

Included in the budget for Fiscal Year 2014 now on the governor’s desk is a provision eliminating the $295 per employee Fair Share assessment that Massachusetts employers have been paying under state health reform since 2006. The budget would also drop the requirement that employers collect and retain the Health Insurance Responsibility Disclosure (HIRD) form, and replace the current $67.20 per employee contribution to the Medical Security Trust Fund with a $50 per employee contribution to fund subsidized health care.

The measures were the product of extensive negotiations among AIM, state lawmakers and groups representing the health care industry and consumers.

The proposed changes became more complicated last week when the U.S. Department of the Treasury announced that it will postpone until 2015 the federal health reform mandate that larger employers provide health insurance for their workers or face penalties. Those penalties - $2,000 per each full-time employee after the first 30 for companies that do not provide insurance or $3,000 per full-time employee for employers who offer health insurance that is either not affordable or of minimum value– were expected to replace the Fair Share assessment.

Elimination of the Fair Share assessment has been a priority for the AIM Health Policy Committee and was proposed by Governor Patrick in January.

Topics: Health Care Reform, Issues, Health Care

AIM: Move Ahead with Plan to Eliminate Fair Share Assessment

Posted by Kristen Lepore on Jul 3, 2013 12:52:00 PM

Associated Industries of Massachusetts today urged Governor Deval Patrick to approve a carefully crafted health insurance compromise contained in the proposed state budget, even though the Obama administration yesterday postponed a key element of federal health care reform.

Health Care ReformIncluded in the budget for Fiscal Year 2014 now on the governor’s desk is a provision eliminating the $295 per employee Fair Share assessment that Massachusetts employers have been paying under state health reform since 2006. The budget would also drop the requirement that employers collect and retain the Health Insurance Responsibility Disclosure (HIRD) form, and replace the current $67.20 per employee contribution to the Medical Security Trust Fund with a $50 per employee contribution to fund subsidized health care.

The measures, intended to make way for the federal Affordable Care Act and reduce the administrative burden on employers who provide health insurance, are a product of extensive negotiations among AIM, state lawmakers and groups representing the health care industry and consumers.

The proposed changes became more complicated yesterday when the U.S. Department of the Treasury announced that it will postpone until 2015 the federal health reform mandate that larger employers provide health insurance for their workers or face penalties. Those penalties - $2,000 per each full-time employee after the first 30 for companies that do not provide insurance or $3,000 per full-time employee for employers who offer health insurance that is either not affordable or of minimum value– were expected to replace the Fair Share assessment.

The postponement raised the possibility that Massachusetts employers who do not provide affordable health insurance for their workers may face no financial penalty for the next 18 months.

John Regan, Executive Vice President of Government Affairs at AIM, said the new implementation date for federal penalties does not diminish the value to employers and consumers of eliminating Fair Share and the Medical Security Trust Fund.

“The temporary presence or absence of health reform penalties does not drive benefit decisions for the vast majority of Massachusetts employers,” Regan said.

“Those employers offer health insurance to ensure they attract and retain key talent in a competitive market.”

Regan stressed that the requirement under the federal Affordable Care Act that individuals purchase health insurance by January 1, 2014, remains in effect.

Mark J. Mazur, Assistant Secretary for Tax Policy at the U.S. Department of the Treasury, said in a blog post that the administration decided to postpone imposition of employer penalties after hearing concerns from business about the complexity of the requirements and the need for more time to implement them effectively.

“First, it will allow us to consider ways to simplify the new reporting requirements consistent with the law.  Second, it will provide time to adapt health coverage and reporting systems while employers are moving toward making health coverage affordable and accessible for their employees,” Mazur wrote. 

The administration says it will provide formal guidance within a week.

AIM believes the action by the Treasury Department confirms that the administration has the authority to grant a request to be made by Governor Patrick for a waiver from certain elements of the ACA that could drive up premiums for an estimated 60 percent of employers.

Elimination of the Fair Share assessment has been a priority for the AIM Health Policy Committee and was proposed by Governor Patrick in January.

 

Topics: Massachusetts state budget, Health Care Reform, Health Care Costs, Issues

AG: Oversight Needed to Realize Health Care Cost Control

Posted by Kristen Lepore on Apr 25, 2013 3:31:00 PM

Attorney General Martha Coakley is warning Massachusetts officials to step up their scrutiny of the health-care market to protect the ability of employers and consumers to make decisions that could reduce their health premiums.

CoakleyIn a new report entitled Examination of Health Care Costs and Drivers, Coakley notes that employers and consumers are working to control health care costs by enrolling in health insurance products that offer tiered or limited networks. But she says that health plans continue to pay providers a wide range of amounts for comparable services and that providers are increasingly aligning in ways that may cloud efforts to move toward a more efficient health care system.

Coakley offers five recommendations she said will create the transparency needed to protect lower-cost health care providers and maintain consumer options. The recommendations urge state oversight organizations to collect detailed financial information on the health-care market and to evaluate proposed hospital mergers in light of changes in contract prices, referral patterns, market share, and volume to higher cost facilities - and the impact of all of these factors on total costs to consumers.

“Massachusetts still faces significant challenges in addressing historic market dysfunction, aligning payments with value, and controlling overall health care spending. To achieve these goals, all health care market participants must be actively engaged in promoting value-based health care,” the attorney general writes in her third major study of health-care cost trends in Massachusetts. The study was released yesterday.

Massachusetts employers and consumers pay the highest health-care premiums in the country at $16,953 per year for a family plan, according to the Commonwealth Fund.  Health-insurance premiums in Massachusetts grew 67 percent for individual plans and 72 percent for family plans from 2003 to 2011, raising the burden on purchasers from 12.6 to 18 percent of median household income.

The attorney general’s report indicates that the health cost control law signed by Governor Deval Patrick in August 2012, which created systems to increase scrutiny of medical cost variations, will require careful oversight to rein in those differences. The law limits increases in medical costs to the overall rate of economic growth, calls for paying doctors for outcomes instead of procedures, steers patients to doctors who provide good care at reasonable prices, and coordinates care to keep patients healthy and out of the hospital.

“As described in our prior Reports, without other fundamental changes, a shift to global payments may actually exacerbate the price escalation associated with market dysfunction by establishing widely different per member per month rates based on historic pricing disparities,” the study says.

The attorney general issued six key findings about the health care market:

  1. Employers and individual health care purchasers have increasingly moved toward health insurance products with tiered networks and high deductibles, and moved away from HMO products that restrict referrals through a primary care gatekeeper.
  2. Purchaser enrollment trends have significant implications for health plans designing products and providers managing risk contracts.
  3. Health plans continue to pay providers a range of amounts under traditional “fee for service” arrangements and global payment arrangements to care for patients of comparable health.
  4. Health plan product designs affect risk selection, total medical spending, and care management.
  5. Providers are taking on increased insurance risk without consistent mitigation by health plans.
  6. Provider consolidation and alignments have significant market implications that should be carefully reviewed, particularly where proposed consolidations may reduce access to lower-cost options for consumers and undermine efforts to promote value-based decisions by purchasers.

Richard C. Lord, President and Chief Executive Officer of Associated Industries of Massachusetts and a member of the state Health Policy Commission (HPC), welcomed Coakley’s report.

“Attorney General Coakley provides refreshing clarity to a complex topic with this new report, as well as with her previous studies in 2010 and 2011. The report underscores the need for transparent and reliable information to identify, measure, and correct problems with the health care market,” Lord said.

The ability of Massachusetts to keep health spending equal to overall economic growth is particularly important in light of significant potential cost increases that employers and consumers will face when federal health reform comes to the commonwealth next year.

Topics: Health Care Costs, Issues, Health Insurance

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