NYBGH has Renamed and Relocated!

New York Business Group on Health has expanded to help employers across the northeast improve health care. As part of the expansion, the organization has been renamed to Northeast Business Group on Health (NEBGH). The new and improved NEBGH blog can be found at www.nebgh.org/blog, where all new posts created after November 22, 2010 will be available.

A press release announcing the name change is available by clicking here.

Please also visit us at NEBGH.org.

New York Employer Coverage Survey Released

A new report on employer-sponsored health insurance, released this week by the New York State Health Foundation, indicates that the percentage of New Yorkers covered by their employer has fallen over the last decade, from 69% in 2001 to 58% in 2009.  This percentage is, furthermore, slightly lower than the national average of 65%.  The percentage of employers actually offering coverage, though, remained steady at 70% over the same period.  Decreases in take-up are attributed to tighter eligibility rules, increased cost-shifting, and limited coverage choices.

The complete report, "Decade of Decline: A Survey of Employer Health Coverage in New York State" can be accessed by clicking here.

CMS Launches Innovations Center and Announces New York's Inclusion in an Eight-State Medical Home Demonstration

The Centers for Medicare and Medicaid Services (CMS) announced the opening of its new Center for Medicare and Medicaid Innovations and the launch of demonstration projects, one of which will include New York State.

The CMS Innovations Center was created by the Affordable Care Act in hopes to jump start innovation in health care payment and delivery reform through the promotion of quality and coordinated care. The permanent center will be guided by a diverse stakeholder group consisting of members from a broad range of the health care marketplace that includes hospitals, physicians, consumers, payers, states, employers, advocates, and other federal agencies.

In short, the Innovation Center seeks to promote better care for individuals, develop models to coordinate care to improve health outcomes, and create community care models. In addition to these specific focuses of the Innovation Center, CMS also announced the launch of three care coordination projects: Expansion of the Multi-Payer Advanced Primary Care Practice Demonstration (in which New York will participate), the Federally Qualified Health Center Advanced Primary Care Practice Demonstration, and the launch of the Medicaid Health Home State Plan Option. There will be an additional $1 million in grants provided to states for demonstration projects they design.

To learn more about the CMS Innovations Center visit http://www.innovations.cms.gov/

NYBGH Annual Meeting Tomorrow! Uwe Reinhardt Giving Keynote

Please join us for the NYBGH 2010 Annual Meeting tomorrow, November 10th from 4:00 to 7:30pm.  The business portion of the meeting runs until 6:00pm, with cocktails until 7:30pm.  Registration begins at 3:45pm.

The keynote speaker is Uwe E. Reinhardt, James Madison Professor of Political Economy and Professor of Economics at Princeton University.  His speech is titled, "The Accountable Care Act: Why Have It? What Next?"

The event is being held at Con Edison, located at 4 Irving Place (at 14th Street) in Manhattan.  To register, please visit www.nybgh.org. 

NEJM Article Examines Health Care in the Mid-Term Election

A recent article in the New England Journal of Medicine (NEJM) examines various public polls assessing the public's mood on health reform and how it might affect the results of Tuesday's mid-term Congressional election.  Robert Blendon and John Benson of the Harvard School of Public Health argue that not only will health reform affect how individuals vote, but also that Tuesday's outcome could have a significant impact on the rest of health reform implementation. 

The authors show that Americans' view of health reform remained relatively stable before and after reform's passage.  Additionally, they put forth the following six assertions:

• Americans today generally have very negative views about the general direction of the country, which can be seen in their inclination to not vote for incumbent candidates
• Health care is an important but secondary issue in the election, with jobs and the federal budget deficit being at the forefront
• More than seven months since reform's passage, a majority of Americans neither support or oppose the package; however, 38% of registered votes believe that the US economy will be worse off than better off (21%) because of the health reform law
• 41% of registered votes think that most provisions of the law should be repealed and replaced with a completely different set of proposals
• Most registered voters (73%) who intend to vote for a Democrat support the reform law, while 80% of registered votes who intend to vote for a Republican oppose the law
• Polling results indicate that there is considerable political uncertainty about the future of the health reform law

The complete article can be found by clicking here.

Health Information Exchange Decoded

A recent post by Margalit Gur-Arie on The Health Care Blog provides a beginner's guide to the concept of health information exchange.  Following its introduction, the post describes both the centralized and federated models in addition to explaining how the HITECH Act has and will continue to impact the field.

Click here to access the full post.

Health Reform Lawsuit to Move Forward

Yesterday a federal judge in Florida ruled that multi-state challenges against the individual mandate and Medicaid expansion under the new health reform law can move forward.  Florida Northern District Judge Roger Vinson did not rule that he agrees with the assertion that the law is unconstitutional, but only that it won't be dismissed outright, as the Obama administration had requested.  However, four other counts related to taxation and requirements that states enforce the law were thrown out by Vinson.

The challengers argue that the individual mandates seeks to regulate "inactivity" because it would penalize people for not buying health insurance.  In his ruling, Vinson appears open to this line of reasoning, quoting a 16 year old Congressional Budget Office (CBO) report concluding that "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action.  The government has never required people to buy any good or service as a condition of lawful residence in the United States."  Though, Vinson added a disclaimer in which he adds, "Of course, to say that something is 'novel' and 'unprecedented' does not necessarily mean that it is 'unconstitutional' and 'improper.'  There may be a first time for anything.  But, at this stage of the case, the plaintiffs have most definitely states a plausible claim with respect to this cause of action."

The White House, though, remains optimistic that the law will hold.  The administration's response, via The White House blog, can be found by clicking here.

Vinson's ruling can be found by clicking here.
The story, as reported by The Hill, can be found here.

Health Plan Trend Expected to Hold Steady in 2011

Segal Company's recently released 2011 Health Plan Cost Trend Survey estimates that medical and prescription drug cost trend will remain relatively unchanged from 2010.

The survey indicates that 2008 was the bottom of a downward pattern and that trend began elevating again beginning in 2009.  Also noted is that one of the short-term drivers of health plan cost trend is compliance with the new health reform law - the Patient Protection and Affordable Care Act.  

As reported by Business Wire, Key findings of the survey include:

• Compared to 2010, trend rates for indemnity plans and high-deductible health plans (HDHPs) are expected to decrease in 2011.

• Trend rate for preferred provider organizations (PPO) and point of service (POS) plans are slightly higher than in 2010.

• All 2010 medical plans types are projected to experience cost trends that are more than eight times higher than the consumer price index for all urban consumers.

• Prescription drug trend projections have remained below 10% for the last three years.

• Price inflation for inpatient hospital stays is the largest component of overall plan cost trend.

The complete findings of the 2011 Health Plan Cost Trend Survey can be found by clicking here.

Kaiser Family Foundation Launches Revamped Site

Today the Kaiser Family Foundation (KFF) launched a revamped version of their health reform gateway, chock full of resources on the new health reform law.  Included on the site are new features that provide explanations of the basics of the law, in-depth analysis of policy issues in implementation, and quick and easy access to relevant data, studies, and developments.

One of the site's new features, The Scan, provides a daily feed of easily-digestible summaries of the latest research and studies from the Foundation and others, as well as official actions and other developments related to the health law. Other new elements include:

• A customizable implementation timeline,
• A series of video clips featuring experts answering specific questions about the law and on a variety of other health policy topics,
• An interactive state map with key state-specific information related to health coverage and the health law,
• A public opinion poll tracker,
• A health reform subsidy calculator, and
• An official document finder that provides quick access to federal regulations and studies related to the health law.

Click here to access the new site.

Health Costs Projected to Continue Climbing

A new report from the Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary notes that health care costs are expected to increase at a slightly higher rate over the next 10 years because of the new health reform law. The authors estimate that national health spending will reach nearly $4.6 trillion by 2019, increasing by 6.3 percent on average annually. This increase is 0.2 percentage points faster than expected before the health reform law was passed in March. Additionally, the team of economists predict that health spending will be at 19.3 percent GDP in 2019.

The report, published in Health Affairs, can be found by clicking here.
The New York Times story is available here.
And The Wall Street Journal article is here.

Texas Employers Unite to Lower Costs

On Thursday a group of nine North Texas employers announced the creation of a three-year effort called the "Texas Health Strategy Project", aimed at creating high-value benefit packages for their employees. The employers involved are Archon Group, Brinker International, the cities of McKinney and Mesquite, Energy Future Holdings, the Federal Reserve Bank of Dallas, Haggar Clothing, Interstate Batteries and Triumph Aero-Structures.

By collecting more employee-level data and improving how they manage health benefits, the group hopes to keep workers healthy and out of doctors' offices. Additionally, by banding together, the employers hope to more efficiently comply with the health reform law's new requirements. National Business Coalition on Health President Andrew Webber is quoted in the article as quipping, "As health care costs continue to rise, more employers are recognizing the value of tailoring benefits to the health risks within their employee populations."

Click here to read the complete article from the Dallas News.

NYBGH Health Reform Event

Tomorrow, August 25th, NYBGH is hosting a breakfast club event titled, "Health Care Reform: Getting Through 2011 Open Enrollment and Framing Longer-Term Strategies".  The event is sponsored by Mercer and is open to HR professionals and fund administrators only (including non-NYBGH members) and is complimentary.

Two Mercer benefits professionals will be the featured speakers: Barry Schilmeister, FSA, MAAA and Ilse de Veer.

The event will be held from 8:00 - 10:00am at the University Club of New York, located at One West 54th Street (at Fifth Avenue) in Manhattan.

To register, please visit https://www.nybgh.org/calendar/index.html or email Jen Cole at jcole@nybgh.org.

Survey Indicates How Employers are Dealing with Health Reform

Complying with the new health reform law will force some employers to hike premiums and increase cost-sharing obligations, a new survey shows. On Wednesday, the National Business Group on Health (NBGH) released the results of its 2011 annual plan design survey, which indicate that employers will be making many plan design changes to comply with the requirements of the new law.

Of the 72 large employers - representing 3.7 million employees - that were surveyed, 70 percent said they will eliminate lifetime dollar caps on overall benefits and 63 percent expect to increase 2011 premium rates, up from 57 percent in 2010.

Other findings, as reported by The Hill, include:

• Twenty-five percent of large businesses plan to hike the co-pay or co-insurance costs for prescription drug benefits at retail pharmacies, while 21 percent have the same plan for mail-order pharmacy benefits.

• Twenty-six percent will remove annual caps on overall benefits.

• Thirty-seven percent plan to alter annual or lifetime limits on specific benefits, including dental, mental health and infertility benefits.

• Thirteen percent said they will eliminate pre-existing condition exclusions for youngsters.

The complete survey results can be accessed by clicking here.

A C-SPAN broadcast of the press briefing can be found by clicking here.

Flexibility More Important than Grandfathered Status

A recent Hewitt Associates survey has found that 90 percent of large employers expect to lose their plans' grandfathered status by 2014, with the majority doing so within the next two years. Under the "grandfather" provision of the new health reform law, health plans can maintain many of their current coverage provisions and are not required to comply with certain new mandates if they do not significantly reduce benefits, change insurance carriers, or increase cost-sharing obligations.

Of the 466 companies - representing 6.9 million employees - that were surveyed by Hewitt, 72 percent expect to lost grandfathered status because of health benefit plan design changes and/or changes in cost-sharing requirements. Additional reasons cited were consolidation of health plans, changes to insurance carriers, and union negotiations. The survey also found that most self-insured plans (51 percent) are expected to lose grandfather status in 2011 and another 21 percent will lose their status in 2012. This expectation is similar for fully-insured plans.

Click here for the complete press release.

New CDHP Report Available

The number of employers offering a consumer-directed health plan (CDHP) has increased in the period from 2005 to 2009, according to a new Employee Benefits Research Institute (EBRI) report.  While fewer small businesses are offering CDHPs as an option, increasing numbers of large employers are adding the cost-savings plan to their menu of health benefits.  Actual enrollment has increased too, with 19.1 million, or 11%, of individuals with private health insurance enrolled in a CDHP.  The study's author, Paul Fronstin, also found that enrollment in CDHPs results in 1.5% savings to the employer.

The complete set of findings are available in the August EBRI issue brief and can be found by clicking here.

Health Reform 2.0: Massachusetts Style

In the last day of the legislative session last Saturday, the Massachusetts state legislature passed a bill aimed at reigning in health insurance costs and enhancing small businesses' health insurance purchasing power.  Health insurers will now be required to spend at least 88 percent of the premiums they collect on services directly tied to medical care and quality improvement activities. The New York state legislature passed a similar bill in June requiring health insurers to spend 82% of premium dollars on medical care.  Federal regulators are expected to release in the coming weeks their definition of what activities can and cannot be counted towards the medical loss ratio (MLR) calculation.  Health plans, employer groups and other business advocates are advocating for federal regulators to include wellness and disease management programs, among other things, in the numerator.

The bill also includes a provision that will now allow Massachusetts small businesses to enhance their health insurance purchasing power by forming purchasing cooperatives. Businesses with fewer than 50 employees will be able to band together to exert greater purchasing clout and insurers will be required to offer plans that include low-cost providers in their networks.  To combat consumers signing up for health insurance only right when they actually need medical services, the bill also allows insurers to restrict plan enrollment to only two open enrollment periods in 2011 and one in years thereafter.

Click here to read more.

Employers Assisting in Managing Chronic Care

Friday's Patient Money column in the New York Times highlights NYBGH member Pitney Bowes as one of the number of employers helping their employees better manage their chronic conditions.  The author briefly compares and contrasts various employer-sponsored chronic care management programs, and features Pitney Bowes as one of the companies that manages chronic conditions at their on-site health clinics.

Click here for the complete article.

New York Times Articles Highlight Industry Activity

Two recent, national articles highlight some of the work that business coalitions, like NYBGH, and employers are focusing on.  Reed Abelson, writing for the New York Times, sheds light on some employers' interest in narrowing their physician and/or hospital networks in order to save costs for both the company and their employees.  Andrew Webber, the President of National Business Coalition on Health (NBCH), is quoted in the article, quipping about the choice battle during the managed care wars of the 1990's.

This article can be found by clicking here.

In a second article, Abelson describes some physicians' groups', such as the American Medical Association (AMA), ire over how health insurers rank and rate physicians participating in their networks. In a recent letter to some of the nation's largest insurers, the AMA and 47 other groups, "called on the insurers to make public how they assessed doctors’ performance and to allow the insurers’ methods to be reviewed by independent parties."  America's Health Insurance Plans (AHIP) responded to the letter, defending insurers' practices, asserting that employers and other purchasers have asked their health plans to ardently work towards achieving greater value and improved clinical performance..

Click here to access this blog post.

HIT Meaningful Use Regulations Released

"The widespread use of electronic health records (EHRs) in the United States is inevitable", asserted Dr. David Blumenthal, the national coordinator for health information technology at the US Department of Health & Human Services (HHS), in a recent New England Journal of Medicine article.   

HHS released on Tuesday the final rules for expanding the use of electronic health records by hospitals and physicians. Eligible physicians and hospital facilities can qualify for Medicare and Medicaid incentive payments if they adopt certified EHR technology and subsequently use it to achieve specified patient health outcomes. Two regulations, in fact, were released by HHS.  The first defines the "meaningful use" goals that providers must meet in order to qualify for the bonus payments. The second rule describes the technical capabilities required for certified EHR technology. This marks the finalization of a highly scrutinized proposed rule that was released on January 13, 2010.

The program, created by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, is expected to award up to $27 billion in bonus payments over ten years.  Providers may receive up to $44,000 under Medicare and $63,750 under Medicaid.  Hospital facilities, on the other hand, may be eligible to receive millions of dollars for implementation and meaningful use of EHRs under both aforementioned public health care programs.

Click here for the HHS press release, which links to a fact sheet on and the text of the final rules.

Obama to Use Recess Appointment for Berwick

The White House yesterday announced that President Obama, to the chagrin of many Congressional Republicans, will use a recess appointment to make Don Berwick the administrator of the federal Centers for Medicare and Medicaid Services (CMS). Mr. Berwick is touted as an expert in and advocate of quality improvement in health care and is also a renowned Harvard professor and pediatrician. His appointment will remain valid until the end of the 111th Congress in January, at which time he will be subject to another confirmation, and presumably a hearing.

Click here to read more from Politico.
Kaiser Health News has released a resource guide on Mr. Berwick.  Click here to access it.