Category Archives: Health Care

Consumer-Driven Health Care in Its Adolescence

Source: Kevin O’Hara, Employee Benefit Plan Review, March 2007

As the groundswell continues for the implementation of the American health care model’s latest panacea, consumer-driven health care (CDHC), it becomes important to take a moment or two to review the progress to date. The popularity of CDHC plans has grown steadily in recent years with projections for their adoption rate to accelerate as early missteps are corrected. Difficulties encountered in the communication and administration of CDHC benefits short-circuited extremely optimistic early forecasts of their penetration rate as a percentage of all sponsored plan offerings. Recent surveys, such as the Kaiser Family Foundation Employer Health Benefits 2006 Annual Survey, indicate a continued increase in CDHC enrollment but at a much reduced rate than first anticipated.

AHRQ’S Annual State Snapshots Highlight States’ Gains and Lags in Health Care Quality

Source: Agency for Healthcare Research and Quality, June 11, 2007

AHRQ released new State Snapshots that show States have made promising gains in health care quality while identifying needed improvements in areas ranging from cancer screening to treatments of heart attack patients. The 51 State Snapshots—every State plus Washington, D.C.—are based on 129 quality measures, each of which evaluates a different segment of health care performance. While the measures are the products of complex statistical formulas, they are expressed on the Web site as simple, five-color “performance meter” illustrations. AHRQ’s annual State Snapshots is based on data drawn from more than 30 sources, including government surveys, health care facilities, and health care organizations.

A Health Link Hits Home

Source: Healther Kleba, Governing, Vol. 20 no. 6, March 2007

A handful of large and small telehealth programs are finding that remote monitoring can curb the costs of long-term care.

Although there are obstacles to widespread use–mostly in terms of upfront costs and patients’ acceptance–the technology is in place and the benefits are becoming clear. While the Alabama program is one of only a handful of experimental state and local efforts, there is already an impressive track record on remote monitoring. The U.S. Department of Veterans Affairs has been practicing telehealth for nearly five years, and the results suggest that the program could lower the cost of treating long-term and chronic-care patients. VA officials report that home-care monitoring has been cutting by about one-third the patient-care costs of those who are remotely monitored.

Intensive Care For Rural Hospitals

Source: Ronald A. Wirtz, Fedgazette, Vol. 19 no. 2, March 2007

Critical access program brings life, hope back to some rural hospitals. But if access is the goal, it may be overmedicating.

For rural hospitals, many of which have been gasping financially for years, the answer has been the federal Critical Access Hospital (CAH) program. This Medicare-based program gives rural hospitals the organizational equivalent of CPR because it purposefully pays rural hospitals more to care for Medicare patients than urban institutions receive. These higher reimbursement rates have improved profit margins and offered the possibility of upgrading long-neglected facilities.

Health Savings Accounts in National Compensation Survey Data

Source: Alan Zilberman, Bureau of Labor Statistics, November 29, 2006

The Bureau of Labor Statistics (BLS) recently reported that 6 percent of private industry workers have access to a health savings account (HSA), a relatively new kind of employer-provided health benefit. These data were published in the summary National Compensation Survey: Employee Benefits in Private Industry in the United States, March 2006. Data on HSAs currently are available for 2005 and 2006. BLS plans to continue to collect HSA data on workers in private nonagricultural industries.

The States Step Up

Source: Marilyn Werber Serafini, National Journal, Vol. 39 no. 11, March 17, 2007
(subscription required)

The ink was barely dry on then-Gov. Mitt Romney’s bold new plan to achieve nearly universal health coverage for Massachusetts residents when Vermont Gov. James H. Douglas signed similar legislation into law last year. “We have a goal of 96 percent coverage within the next three years, and I think we can do that,” Douglas recently boasted to National Journal. “We’re going to be quite aggressive with enrollment.”

Other state officials had been closely watching this pair of Republican governors as they steered away from the safe political path to push plans requiring employers to either offer their employees health insurance or pay a compensating fee to the state. The Massachusetts Legislature went a controversial step further when it decided to require all residents to certify on their state income tax forms that they had health insurance — or face a penalty. Before Massachusetts and Vermont took the plunge, most politicians had spoken only in muffled tones about health care mandates, fearful of a backlash from constituents — voting constituents.

Assessing Nursing Staffing Ratios: Variability in Workload Intensity

Source: Valda V. Upenieks, Jenny Kotlerman, Jaleh Akhavan, Jennifer Esser, Myha J. Ngo, Policy, Politics, & Nursing Practice, Vol. 8 no. 1, February 2007
(subscription required)

In 2004, California became the first state to implement specific nurse-to-patient ratios for all hospitals. These mandated enactments have caused significant controversy among health care professionals as well as nursing unions and professional organizations. Supporters of minimum nurse-to-patient ratios cite patient care quality, safety, and outcomes, whereas critics point to the lack of solid data and the use of a universally standardized acuity tool. Much more remains to be learned about staffing policies before mature links may be made regarding set staffing ratios and patient outcomes—specifically, how nurses spend their time in terms of variability in their daily work. This study examines two comparable telemetry units with a 1:3 staffing ratio within a California hospital system to determine the relative rates of variability in nursing activities. The results demonstrate significant differences in categorical nursing activities (e.g., direct care, indirect care, etc.) between the two telemetry units (X² + 91.2028; p ≤ .0001). No correlation was noted between workload categories with daily staffing ratios and staffing mix between the two units. Although patients were grouped in a similar telemetry classification category and care was mandated at a set ratio, patient needs were variable, creating a significant difference in registered nurse (RN) categorical activities on the two units.

Retiree Health Benefits Examined: Findings from the Kaiser/Hewitt 2006 Survey on Retiree Health Benefits

Source: Hewitt Associates: Frank McArdle, Amy Atchison, and Dale Yamamoto, Kaiser Family Foundation: Michelle Kitchman Strollo and Tricia Neuman, Findings from the Kaiser/Hewitt 2006 Survey on Retiree Health Benefits, December 2006

Employers continue to play an important role in providing health insurance coverage for pre-65 and age 65+ (Medicare-eligible) retirees. Employer-sponsored plans help bridge the gap in coverage for workers and spouses who retire before they turn age 65 and are eligible for Medicare. Today, an estimated 3.8 million early retirees (ages 55 to 64) and dependents receive health coverage from an employer or union. Without these benefits, early retirees often face significant challenges finding affordable coverage in the individual market, leading some to return to the workforce to gain access to health insurance. Employer plans also provide highly-valued supplemental benefits to more than 12 million retirees now on Medicare. For retirees on Medicare, employer plans remain an important source of prescription drug coverage, and provide additional cost-sharing protections, including limits on retirees’ out-of-pocket expenses.

Kaiser/Hewitt Survey Of Large Employers Finds Most Intend To Maintain Drug Coverage For Medicare Retirees In 2007 And 2008

Source: Craig Palosky, Larry Levitt, and Maurissa Kanter, Kaiser Family Foundation, Wednesday, December 13, 2006

Out-of-Pocket Costs for Retirees Continue to Rise for Employer Health Coverage

About One in 10 Firms Eliminate Retiree Health Benefits for Future Retirees

As the new Medicare drug benefit nears its second year, nearly eight in 10 large employers expect to continue to offer drug coverage to their retirees and accept subsidies from the federal government to offset some of those costs, according to a new survey of 302 large private-sector employers conducted by the Kaiser Family Foundation and Hewitt Associates.

Consumer-Directed Plans Cost Women $1,000 More Per Year Than Men

Source: BNA Pension & Benefits Reporter, Vol. 36 no. 16, April 17, 2007
(subscription required)

Consumer-directed health care plans cost working-age women about $1,000 more per year out of pocket than men, and are therefore “discriminatory” against women, according to a report by Harvard Researchers at Cambridge Health Alliance. CDHPs also cost middle-aged adults far more than younger participants, and raise costs substantially for those with even mild chronic conditions, the report says.