The U.S. Department of Health and Human Services (HHS) today announced a series of initiatives to work with states to save money and better coordinate care for the 9 million Americans enrolled in both Medicare and Medicaid. The new initiatives include better access to Medicare data and better coordination of health care between Medicare and Medicaid. The initiatives will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.
“Medicaid costs are largely driven by the complex medical needs of low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid. We know that by working together, we can provide better, more coordinated care while lowering health care costs and saving money for states,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald M. Berwick, M.D. “Medicare and Medicaid spends $300 billion each year to care for people enrolled in both programs. Better coordinated care for this vulnerable population could yield savings and improve care and coverage in Medicaid.”
Currently, 60-percent of Medicare-Medicaid enrollees, “dual eligibles,” have multiple chronic conditions and 43-percent have at least one mental or cognitive impairment. While only 15-percent of Medicaid enrollees are also Medicare beneficiaries, Medicare-Medicaid enrollees represented 39-percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group – about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per Medicare-Medicaid enrollee was $15,459 in 2007, over six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).
The Medicare-Medicaid Coordination Office today launched the Alignment Initiative, an effort to more effectively integrate benefits under the two programs. Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.
A lack of alignment between the programs can lead to fragmented or episodic care for people with both Medicare and Medicaid coverage, which can reduce quality and raise costs. For example, Medicaid and Medicare have different coverage standards for those accessing durable medical equipment in the community. This can lead to fragmented care and coverage gaps that could result in patients losing access to the treatments and equipment that help them live at home or in the community. Even temporary coverage gaps can be disruptive if patients no longer have coverage for wheelchairs or other expensive medical care. The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals. Better alignment in these areas can reduce costs by improving health outcomes and making care coordination more efficient.
Today, HHS also announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries. For example, a state that wants to expand its long term care and behavioral health care management program to serve low income seniors and people with disabilities needs data on their Medicare-covered hospital, physician, and prescription drug use. With Medicare data, states can identify high risk and high cost individuals, determine their primary health risks, and provide comprehensive individual client profiles to its care management contractor to tailor interventions.
“Navigating the two programs can be both complicated and burdensome for beneficiaries and their families and caregivers,” said Medicare-Medicaid Coordination Office Director Melanie Bella. “We are facilitating a national conversation on how to make these programs better serve the people that depend on them every day. We are working with states toward new levels of seamlessness so as to smooth the care journeys for these individuals.”
The first step in the Alignment Initiative is a notice for public comment that will be displayed in the Federal Register. The notice requests public input on priorities and key goals. Individuals wishing to submit comments have until July 11, 2011 to do so. For more information on the Alignment Initiative notice for comment, visit: www.ofr.gov/inspection.aspx. The Medicare-Medicaid Coordination Office will continue to engage with local stakeholders around the country on the Alignment Initiative through regional listening sessions.
The announcement of the new policy on state Medicare data for enrollees in Medicare and Medicaid will be published in a Center for Medicaid, CHIP and Survey & Certification (CMCS) Informational Bulletin today. The Bulletin is available at: www.cms.gov/CMCSBulletins/CMCSB/list.asp#TopOfPage.
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Wednesday, May 11, 2011
Tuesday, May 10, 2011
Most uninsured unable to pay hospital bills according to new HHS report
A new report released today by the U.S. Department of Health and Human Services (HHS) shows that few families without health insurance have the financial assets to pay potential hospital bills. On average, uninsured families can only afford to pay in full for approximately 12-percent of hospital stays they may experience – and even higher income uninsured families are unable to pay for most potential hospital stays. Hospital stays for which the uninsured cannot pay in full account for 95-percent of the total amount hospitals bill the uninsured. Other studies have estimated that the bills for all types of health care that the uninsured cannot pay – the uncompensated cost of care – is up to $73 billion a year, a significant portion of which is shifted into higher costs for Americans with insurance and their employers.
“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”
Approximately 50 million Americans are uninsured. The report found that most uninsured people have virtually no savings. In fact, the median financial assets for all uninsured families are just $20. Even among higher income families, assets are low. Half of families with income at 400-percent of the Federal Poverty Level (FPL), or $89,400 a year for a family of four in 2011, have financial assets below $4,100.
Every year, nearly 2 million uninsured Americans are hospitalized. With 58-percent of these hospital stays resulting in bills of more than $10,000, most uninsured people are unable to afford potential hospital bills. Even the top 10-percent of uninsured families with the most assets are estimated to be able to pay the full bill for only half of potential hospital stays. Uninsured families can, on average, afford to pay the full bills for only about 12-percent of the hospital stays they might experience, bills that account for just 5-percent of the total amount hospitals bill them.
“Health insurance is critical in helping protect families from unexpected hospital costs,” said Sherry Glied, HHS assistant secretary for planning and evaluation. “This report shows that even higher income uninsured families are struggling to meet the high costs of health care. No family should bear the burden of being one illness or accident away from bankruptcy.”
The high cost of hospitalization means that lacking health insurance poses a greater risk of financial catastrophe than lacking car insurance or homeowner’s insurance. Although people are 50-percent more likely to have car accident than to be hospitalized in a given year, the average bill for a hospital visit is over two and a half times higher than the average loss for a car accident. And, while the bill for a single hospitalization is about the same as the average loss from a house fire, a person is ten times more likely to be hospitalized than to experience a house fire.
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“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”
Approximately 50 million Americans are uninsured. The report found that most uninsured people have virtually no savings. In fact, the median financial assets for all uninsured families are just $20. Even among higher income families, assets are low. Half of families with income at 400-percent of the Federal Poverty Level (FPL), or $89,400 a year for a family of four in 2011, have financial assets below $4,100.
Every year, nearly 2 million uninsured Americans are hospitalized. With 58-percent of these hospital stays resulting in bills of more than $10,000, most uninsured people are unable to afford potential hospital bills. Even the top 10-percent of uninsured families with the most assets are estimated to be able to pay the full bill for only half of potential hospital stays. Uninsured families can, on average, afford to pay the full bills for only about 12-percent of the hospital stays they might experience, bills that account for just 5-percent of the total amount hospitals bill them.
“Health insurance is critical in helping protect families from unexpected hospital costs,” said Sherry Glied, HHS assistant secretary for planning and evaluation. “This report shows that even higher income uninsured families are struggling to meet the high costs of health care. No family should bear the burden of being one illness or accident away from bankruptcy.”
The high cost of hospitalization means that lacking health insurance poses a greater risk of financial catastrophe than lacking car insurance or homeowner’s insurance. Although people are 50-percent more likely to have car accident than to be hospitalized in a given year, the average bill for a hospital visit is over two and a half times higher than the average loss for a car accident. And, while the bill for a single hospitalization is about the same as the average loss from a house fire, a person is ten times more likely to be hospitalized than to experience a house fire.
-----
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Assisted Living Costs Rising Faster Nationally Than in Georgia, Finds Genworth's Annual Cost of Care Survey
/PRNewswire/ -- According to Genworth's 2011 Cost of Care Survey, assisted living cost inflation in Georgia is being outpaced by national cost increases. Overall, the cost of long term care services in Georgia is well below national levels.
The median hourly rate to receive care in the home, Americans' preferred long term care setting, is $17.50 an hour in Georgia for home health aide services and $19 per hour nationally. The cost for this type of care has increased 1.5 percent a year over the past six years in Georgia, and 1.4 percent nationally during this same period.
The cost for a private nursing home room in Georgia has risen 4.4 percent annually over the past six years, and in line with the national rate. The median annual rate in Georgia for a private nursing home room is $63,875 per year, less than the national rate of $77,745 per year.
Nationally, the median annual cost of long term care in an assisted living facility is $39,135, an increase of 6.0 percent annually over the past six years. In Georgia, the annual cost of assisted living care is $28,800 and costs have risen 0.7 percent per year over the same time period.
Click here for an interactive map of long term care costs in 15 regions across Georgia, as well as nationally.
Knowing Local Care Costs for Productive LTC Discussions
"Understanding local caregiving expenses is an essential first step for families faced with rising care costs," said Buck Stinson, president, U.S. Life Insurance Products at Genworth. "Genworth's Cost of Care Survey arms consumers with the knowledge to have informed conversations, whether they are speaking with a family member, a care provider or financial professional, about how they might realistically pay for care."
Now in its 8th year, Genworth's Cost of Care Survey not only provides Georgia residents with national and local long term care cost data, but also information on cost inflation over time. Armed with this information, consumers and their advisors can:
* Develop a comprehensive financial plan to cover anticipated future long term care costs
* Conduct an informed discussion with family members to address future long term care needs and preferences
* Negotiate more effectively with providers of long term care services
Negotiating With Care Providers: It Never Hurts to Ask
Some consumers may be surprised to learn that they have the power to negotiate with care providers to help contain costs. Care providers, particularly assisted living facilities and home care agencies, often face stiff competition in their local markets. Consumers should feel comfortable addressing the issue of costs, and the opportunity to lower them, when discussing care options with a provider of long term care services. Genworth's Cost of Care Survey provides localized cost data that empowers families to confidently discuss care costs and options with service providers.
Know What to Ask: Tips for Reducing Caregiving Costs
While nursing homes generally do not discount their rates because they are strongly influenced by the effect of Medicare/Medicaid on their overall business plans, assisted living facilities and home care providers are more apt to do so. Tips on where to start when negotiating with a long term care provider include:
* Know Local Costs: Genworth's Cost of Care Map provides the median cost of long term care across the U.S., including 15 regions in Georgia, to help consumers plan for the potential costs associated with the various types of long term care available in their preferred location and setting.
* Fee Waivers: Assisted living facilities often charge a one-time fee when a client first moves in. If the facility is in a competitive market, or has a surplus of vacant units, they may discount or waive this fee (or offer other discounts such as free rent for a period of time).
* Special Rates : Facilities will sometimes have a special rate if residents move in at the first of the month or during a time that is known to have higher vacancy rates.
* Vacancy Rates : Facilities may allow a resident to choose a more expensive room, at a lower price, if vacancies are currently high.
* Lower Hourly Rates: Home care agencies may lower their hourly rate if the services needed are easy to staff and long term, such as a weekday schedule that is predicted to last several months.
* Shop Around: If a home care agency's fees are at the high end of the local range, they may lower rates if they know the client is interviewing several agencies and cost is an important factor. Let care providers know if a lower rate has been quoted elsewhere for the same services.
* Premium Waivers: Agencies usually charge a premium for weekend services. For a client that also engages services for a significant amount of weekday hours, the agency may waive this premium.
* Ask for an Upgrade: Nursing homes generally do not discount their rates, however, certain extra amenities, or a private room upgrade, may be available under certain circumstances.
It is important to note that most of these price concessions are based on the availability of staff, or residential units, which is a factor that fluctuates often for some businesses. Contacting several providers before making a final decision offers the best chance of securing safe, appropriate services at a reasonable rate.
"While consumers should seek out quality and value when shopping for long term care, it is crucial that they have a financial plan in place to pay for long term care," said Stinson. "The cost of long term care remains one of the biggest risks to one's retirement security, especially with ever-increasing healthcare costs."
For consumers interested in learning more about the cost of care in their local market, Genworth offers an interactive map of long term care costs in 437 regions across all 50 states, including 15 regions in Georgia, at www.Genworth.com/CostofCare. The site offers a range of educational tools that help consumers compare costs across geographies, project future costs and share comparisons and calculations with family, friends or a financial professional.
Additional Resources:
* Genworth's "Let's Talk" campaign was developed to help families initiate conversations about long term care preferences, options, and strategies.
* Genworth Celebrates Caregivers Facebook Page: Caregivers can have their questions about caregiving challenges answered by a professional care advocate.
* An interactive Cost of Care press release containing downloadable content is available at:
http://multivu.prnewswire.com/mnr/genworthfinancial/49612.
About Genworth's 2011 Cost of Care Survey
Genworth's Cost of Care Survey, is the most comprehensive study of its kind, covering nearly 15,500 long term care providers nationwide. The survey includes 437 regions which cover all Metropolitan Statistical Areas defined for the 2010 U.S. census. Genworth annually surveys the cost of long term care across the U.S. to help Americans plan for the potential costs associated with the various types of care available in their preferred location and setting. CareScout®, part of the Genworth Financial family of companies, has conducted the survey since 2004. Located in Waltham, Massachusetts, CareScout has specialized in helping families find long term care providers nationwide since 1997. Genworth's 2011 Cost of Care Survey was conducted during January, February and March 2011.
-----
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Twitter: @gafrontpage & @TheGATable @HookedonHistory
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Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
The median hourly rate to receive care in the home, Americans' preferred long term care setting, is $17.50 an hour in Georgia for home health aide services and $19 per hour nationally. The cost for this type of care has increased 1.5 percent a year over the past six years in Georgia, and 1.4 percent nationally during this same period.
The cost for a private nursing home room in Georgia has risen 4.4 percent annually over the past six years, and in line with the national rate. The median annual rate in Georgia for a private nursing home room is $63,875 per year, less than the national rate of $77,745 per year.
Nationally, the median annual cost of long term care in an assisted living facility is $39,135, an increase of 6.0 percent annually over the past six years. In Georgia, the annual cost of assisted living care is $28,800 and costs have risen 0.7 percent per year over the same time period.
Click here for an interactive map of long term care costs in 15 regions across Georgia, as well as nationally.
Knowing Local Care Costs for Productive LTC Discussions
"Understanding local caregiving expenses is an essential first step for families faced with rising care costs," said Buck Stinson, president, U.S. Life Insurance Products at Genworth. "Genworth's Cost of Care Survey arms consumers with the knowledge to have informed conversations, whether they are speaking with a family member, a care provider or financial professional, about how they might realistically pay for care."
Now in its 8th year, Genworth's Cost of Care Survey not only provides Georgia residents with national and local long term care cost data, but also information on cost inflation over time. Armed with this information, consumers and their advisors can:
* Develop a comprehensive financial plan to cover anticipated future long term care costs
* Conduct an informed discussion with family members to address future long term care needs and preferences
* Negotiate more effectively with providers of long term care services
Negotiating With Care Providers: It Never Hurts to Ask
Some consumers may be surprised to learn that they have the power to negotiate with care providers to help contain costs. Care providers, particularly assisted living facilities and home care agencies, often face stiff competition in their local markets. Consumers should feel comfortable addressing the issue of costs, and the opportunity to lower them, when discussing care options with a provider of long term care services. Genworth's Cost of Care Survey provides localized cost data that empowers families to confidently discuss care costs and options with service providers.
Know What to Ask: Tips for Reducing Caregiving Costs
While nursing homes generally do not discount their rates because they are strongly influenced by the effect of Medicare/Medicaid on their overall business plans, assisted living facilities and home care providers are more apt to do so. Tips on where to start when negotiating with a long term care provider include:
* Know Local Costs: Genworth's Cost of Care Map provides the median cost of long term care across the U.S., including 15 regions in Georgia, to help consumers plan for the potential costs associated with the various types of long term care available in their preferred location and setting.
* Fee Waivers: Assisted living facilities often charge a one-time fee when a client first moves in. If the facility is in a competitive market, or has a surplus of vacant units, they may discount or waive this fee (or offer other discounts such as free rent for a period of time).
* Special Rates : Facilities will sometimes have a special rate if residents move in at the first of the month or during a time that is known to have higher vacancy rates.
* Vacancy Rates : Facilities may allow a resident to choose a more expensive room, at a lower price, if vacancies are currently high.
* Lower Hourly Rates: Home care agencies may lower their hourly rate if the services needed are easy to staff and long term, such as a weekday schedule that is predicted to last several months.
* Shop Around: If a home care agency's fees are at the high end of the local range, they may lower rates if they know the client is interviewing several agencies and cost is an important factor. Let care providers know if a lower rate has been quoted elsewhere for the same services.
* Premium Waivers: Agencies usually charge a premium for weekend services. For a client that also engages services for a significant amount of weekday hours, the agency may waive this premium.
* Ask for an Upgrade: Nursing homes generally do not discount their rates, however, certain extra amenities, or a private room upgrade, may be available under certain circumstances.
It is important to note that most of these price concessions are based on the availability of staff, or residential units, which is a factor that fluctuates often for some businesses. Contacting several providers before making a final decision offers the best chance of securing safe, appropriate services at a reasonable rate.
"While consumers should seek out quality and value when shopping for long term care, it is crucial that they have a financial plan in place to pay for long term care," said Stinson. "The cost of long term care remains one of the biggest risks to one's retirement security, especially with ever-increasing healthcare costs."
For consumers interested in learning more about the cost of care in their local market, Genworth offers an interactive map of long term care costs in 437 regions across all 50 states, including 15 regions in Georgia, at www.Genworth.com/CostofCare. The site offers a range of educational tools that help consumers compare costs across geographies, project future costs and share comparisons and calculations with family, friends or a financial professional.
Additional Resources:
* Genworth's "Let's Talk" campaign was developed to help families initiate conversations about long term care preferences, options, and strategies.
* Genworth Celebrates Caregivers Facebook Page: Caregivers can have their questions about caregiving challenges answered by a professional care advocate.
* An interactive Cost of Care press release containing downloadable content is available at:
http://multivu.prnewswire.com/mnr/genworthfinancial/49612.
About Genworth's 2011 Cost of Care Survey
Genworth's Cost of Care Survey, is the most comprehensive study of its kind, covering nearly 15,500 long term care providers nationwide. The survey includes 437 regions which cover all Metropolitan Statistical Areas defined for the 2010 U.S. census. Genworth annually surveys the cost of long term care across the U.S. to help Americans plan for the potential costs associated with the various types of care available in their preferred location and setting. CareScout®, part of the Genworth Financial family of companies, has conducted the survey since 2004. Located in Waltham, Massachusetts, CareScout has specialized in helping families find long term care providers nationwide since 1997. Genworth's 2011 Cost of Care Survey was conducted during January, February and March 2011.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Thursday, May 05, 2011
Blue Cross and Blue Shield of Georgia Extends Grace Period on Premium Payments for Members Affected by Tornados
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGa) today announced it is extending the grace period on premium payments to help members directly impacted by Georgia tornados on April 27 and 28. Extensive property damage, injuries and death are attributed to these storms.
A Governor's State of Emergency remains in effect, and a Presidential Disaster Declaration has been made for Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup and Walker Counties. Additionally, the damage caused by the tornados and storms have had a significant impact on transportation throughout the state, including disruptions in mail service.
Mail delivery disruptions may have caused delays in BCBSGa receiving premium payments, and as a result, BCBSGa has extended the grace period on premium payments for Georgia members for payments due in April and May. Members impacted by the tornados that may receive a delinquency notice or cancellation notice need to contact BCBSGa to have the delinquency notice waived. Policies will not be cancelled for this timeframe if premium payments were delayed due to disruptions in mail service.
"This is a very tragic time for many Georgians and it is of the utmost importance that our members not experience additional hardships," said Morgan Kendrick, President, BCBSGa. "We are taking every precaution possible, including extending grace periods and shifting staff roles to assist in the processing of any premium payment backlogs."
If members have questions about their premium payment status due to mail disruptions caused by recent inclement weather conditions, they should call the customer service number on the back of their Member ID card, and if they do not have their card, they should call 1-866-417-7107.
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Click to read MORE news:
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A Governor's State of Emergency remains in effect, and a Presidential Disaster Declaration has been made for Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup and Walker Counties. Additionally, the damage caused by the tornados and storms have had a significant impact on transportation throughout the state, including disruptions in mail service.
Mail delivery disruptions may have caused delays in BCBSGa receiving premium payments, and as a result, BCBSGa has extended the grace period on premium payments for Georgia members for payments due in April and May. Members impacted by the tornados that may receive a delinquency notice or cancellation notice need to contact BCBSGa to have the delinquency notice waived. Policies will not be cancelled for this timeframe if premium payments were delayed due to disruptions in mail service.
"This is a very tragic time for many Georgians and it is of the utmost importance that our members not experience additional hardships," said Morgan Kendrick, President, BCBSGa. "We are taking every precaution possible, including extending grace periods and shifting staff roles to assist in the processing of any premium payment backlogs."
If members have questions about their premium payment status due to mail disruptions caused by recent inclement weather conditions, they should call the customer service number on the back of their Member ID card, and if they do not have their card, they should call 1-866-417-7107.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
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