What Can Value-Based Primary Care Mean to Health Plans?

The trend from volume-based to value-based medical care is intended to change the focus from individual units of care to the overall health of a patient or a patient population. In very simple terms, value-based care is intended to bring cost and quality together.

For payers, it means moving from traditional fee-for-service reimbursement to an environment where claims data can be analyzed to help identify redundancies or gaps in care – an approach we have employed for years.

For primary care physicians (PCPs), value-based care should help them focus on improving the patient’s well-being, rather than concentrating on checklists or spreadsheets. Again, the goal is to link evaluation and compensation to clinical outcomes rather than volume.

For members, basing payment on value means changing measurement from a visit or diagnosis to how all aspects of care affect a patient or patient population. The bundled payment experiment instituted by CMS for Medicare-funded joint replacements is a familiar example.

While there will be many bumps along the road to value-based primary care, the benefits should include increased cost transparency and greater employee engagement. If everyone involved – patients, physicians and hospitals – has access to the right information at the right time, better decisions about cost, quality and risk should result.

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Diversified Honored to Accept Healthcare Excellence Award

TriZetto AwardFor nine years, Cognizant and TriZetto have been honoring clients who use their technology and resources to achieve extraordinary results through their Healthcare Excellence award. Cognizant is a professional services company that helps businesses transform their operating and technology models for the digital era.

Each year, they announce the finalists and winners of the awards at their annual Healthcare Conference. The award recognizes organizations that implement TriZetto services and utilize those solutions to achieve innovation and excellence by enhancing the efficiency of operations, creating new programs or strategies to address market needs or discovering new and improved ways to better serve their members.

2017 winners were recently announced in the categories of excellence in innovation and operational excellence. Diversified Group could not be more proud or honored to be the recipient of this year’s Healthcare Excellence Award for Excellence in Operations! The image above shows two of our own accepting the award at this year’s Conference. Thank you to Cognizant and TriZetto for this incredible recognition!

At Diversified, we do all we can to provide quality, affordable healthcare plans and to design, manage and administer customized self-insured benefit plans that everyone feels good about. Visit our website to discover why Diversified Group should be Your Solution to Health Benefits!

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Health care reform: Don’t wait for the politicians

The article below is from BenefitsPRO written by Dinesh Sheth on May 16, 2017.

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Let the politicians argue about who is going to pay for health care and who is not.
Photo: Getty Images

Business owners across all industries are facing uncertainty surrounding the status of current laws and regulations. A Republican majority in Congress and the new presidential administration have created a climate of de-regulation. Luckily, or perhaps unluckily, depending on your view, U.S. employers of all sizes are currently facing a potentially major regulatory change with U.S. Republicans attempting to replace the Affordable Care Act (ACA) with their own bill: the American Health Care Act (AHCA). Now, the big question is: “What will be next?”

Aside from the implications this holds for the health care industry, enacting the ACHA would have a tremendous impact on employers by repealing the mandate that requires certain businesses to offer health insurance to their employees. While most businesses would likely support fewer regulations, repealing this mandate would do little to help them encourage healthier behaviors amongst their employees; and at the end of the day, that is the only true way to lower health care costs. Rather, repealing the mandate simply means that fewer Americans will be insured and that the cost-burden will shift to employees and their families.

Whether or not the current administration or even the public at-large wants to admit it, someone is going to pay for the costs of health care. All current or proposed laws and regulations do is juggle who is going to pay and who is not. Behind all these changes, however, it’s necessary to understand that employers need healthy, productive employees in order for their business to function, In addition, they want them to be insured at a reasonable cost, while also staying healthy and avoiding getting sick or injured. If the goal really is to lower actual costs, then this is where the real debate must be focused. Since it’s impossible to predict exactly how legislative initiatives will play out, employers should double down on their approach to employee wellbeing and examine how a holistic approach to wellness will improve the health of their workforce and bottom line, independent of laws or mandates from Washington. Continue reading

Tell your Senators to Preserve the Employer-Based System and Permanently Repeal the Cadillac/excise Tax!

The National Association of Health Underwriters (NAHU)

Operation Shout!

DGBTakeActionOn May 4, the House of Representatives passed H.R. 1628, the American Health Care Act (AHCA), a reconciliation bill to repeal and replace portions of the ACA. It will now be considered by the Senate, where it is expected to be significantly altered, including possibly addressing two critical NAHU policy priorities: the employer exclusion of health insurance and the Cadillac/excise Tax. NAHU strongly opposes any efforts that would undermine the employer-sponsored health insurance system by eliminating or placing a cap on the employer-tax exclusion of health insurance and is strongly advocating a full repeal of the Cadillac/excise Tax, which under the AHCA would only be temporarily delayed.

More than 175 million Americans currently receive their coverage through the employer-based system, largely due to the tax exclusion where employers provide contributions for an employee’s health insurance that are excluded from that employee’s compensation for income and payroll tax purposes. Proposals that would cap the exclusion would devalue the benefit and serve as one of the largest tax increases in history for middle-class Americans, forcing many to drop employer-sponsored insurance, including dependent coverage, and be forced to seek coverage in the volatile individual market, where premiums are ever-increasing. Employers would be incentivized to only offer coverage to their employees that would fall below the value of the cap in order to avoid paying any increased taxes, potentially resulting in a race to the bottom for employers to sponsor insurance that wouldn’t meet the cap’s thresholds and further shifting costs onto employees.

In addition to opposing proposals to cap the exclusion, we are strongly advocating a complete repeal of the Cadillac/excise Tax. Currently set to take effect in 2020 under a two-year delay, this tax calls for a 40% excise tax on the amount of the aggregate monthly premium of each primary insured individual that exceeds the year’s applicable dollar limit, which will be adjusted annually to the Consumer Price Index plus one percent. Given that the pace of medical inflation is well beyond that of general inflation, the tax is destined to outgrow itself in short order and many employers will be impacted by the cost of the tax and the enormous compliance burden that the tax creates. The AHCA, as passed by the House, would only delay the tax until fiscal year 2026.

Over the coming weeks, as the Senate debates the AHCA and the other healthcare-reform proposals, we urge all agents, brokers and your clients to tell your senators not to do anything that would undermine the employer-sponsored health insurance system and to fully repeal the Cadillac/excise tax. You can help us spread the message by taking action below:

  1. Contact your senators. Send an Operation Shout today asking your senators to oppose any changes the employer tax exclusion and to support a full repeal of the Cadillac/excise Tax. You can also call your senators at the numbers below.
  2. Tell your employer clients to take action. Your employer clients would be most directly impacted by the elimination or cap of the employer tax exclusion and are seeking a full repeal of the Cadillac/excise Tax. Tell them to take action here.
  3. Share your story. As a licensed insurance specialist who works closely with employers to help them offer and utilize employer-sponsored health insurance, stories about how the employer tax exclusion directly impacts your clients will demonstrate the value of the exclusion and the need to preserve it, as well as the need to fully repeal the Cadillac/excise Tax. We will share your stories with appropriate legislators and staff. You can share your story here.

Take Action today and tell your senators to preserve the employer-based system and permanently repeal the Cadillac/excise Tax!
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Don’t want to send an email? No problem, you can also reach your senators by phone:
Sen. Richard Blumenthal (D) can be reached at (202) 224-2823.
Sen. Christopher Murphy (D) can be reached at (202) 224-4041.

This call to action is designed as an email message to your legislators. You are welcome to use the prepared text as talking points to call your legislators, or to expand on the prepared message to share your personal story on how this issue will impact you and your clients.

Millennials Welcome a Personal Touch

After numerous articles advocating technology and social media as the only sources of information valued by young workers, a recent study by MetLife has shown that nearly two-thirds of millennials favored a one-on-one discussion with a benefits specialist when trying to understand their employee benefits.

Believe it or not, millennials even lead other generations in consulting with family and friends on benefit-related issues, showing that they value the personal experience when it comes to complex matters. Because they have become accustomed to the way technology streamlines information, they are looking for the facts without a lot of fluff. Nonetheless, one-on-one consultations and phone conversations are proving to be effective in giving young people the personalized information they need to understand their healthcare benefits and make informed decisions.

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New safety risks detected in one-third of FDA-approved drugs

The article below was published on May 9, 2017 by the Washington Post, written by Laurie McGinley.

A new study shows that safety issues often emerge only after new treatments have been approved by the Food and Drug Administration (Andrew Harnik/AP) (Photo Source: Washington Post)

Almost a third of drugs cleared by the Food and Drug Administration pose safety risks that are identified only after their approval, according to a study published Tuesday.

The researchers said the study, which appeared in JAMA, shows the need for ongoing monitoring of new treatments years after they hit the market.

“We seem to have decided as a society that we want drugs reviewed faster,” said lead author Joseph Ross, an associate professor of medicine and public health at Yale University. That makes it critically important “that we have a strong system in place to continually evaluate drugs and to communicate new safety concerns quickly and effectively,” he said.

To win FDA approval, medications must be shown to be safe and effective. But many pivotal clinical trials used for approval involve fewer than 1,000 patients with follow-up of six months or less, according to the study. Safety problems often crop up years later after therapies have been used by much larger numbers of patients.

“No drug is completely safe, and during premarket evaluation, we are not going to pick up all the safety signals,” said Ross.

The researchers reviewed 222 products approved between 2001 and 2010 and followed them through February of this year. With 32 percent of the medications, they found, the FDA took some kind of action to deal with safety issues that emerged after approval.

Three of the drugs were withdrawn from the market. The FDA also required 61 new black-box warnings — the agency’s most serious safety alert, included in the drug’s packaging — and issued 59 safety communications to inform doctors and consumers about newly identified concerns. Some products had more than one boxed warning added or safety communication issued over the time of the study.

The median time for an FDA action was 4.2 years after approval, according to the study.

Eric Topol, founder and director of Scripps Translational Science Institute, who was not involved in the research, said he wasn’t surprised about the safety risks, but added, “the fact that it is one out of three of FDA-approved drugs is troubling.”

Part of the problem, he said, is that clinical trials often cherry-pick patients likely to produce the best results. “We don’t get a real-world representation,” he said.

He suggested that the agency consider granting new drugs conditional approval, then collect safety data from every patient to see, early on, whether a problem emerges. “Why not have a standard where we put every new drug under watch, and see if we could catch a problem before the drug is widely advertised?” he said.

The study showed that the treatments most likely to be flagged for safety concerns were those granted clearance under the agency’s accelerated approval program, as well as medications for mental illnesses and those approved close to the deadline that had been set for the review.

An agency spokeswoman said that “FDA performs post-market monitoring to identify new safety information that may impact product labeling. In general, the FDA does not comment on specific studies, but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health.”

Nonprofit Linked To PhRMA Rolls Out Campaign To Block Drug Imports

The article below is from Kaiser Health News written by Emily Kopp and Rachel Bluth April 19, 2017.

A nonprofit organization that has orchestrated a wide-reaching campaign against foreign drug imports has deep ties to the Pharmaceutical Research and Manufacturers of America, or PhRMA, the powerhouse lobbying group that includes Eli Lilly, Pfizer and Bayer.

A PhRMA senior vice president, Scott LaGanga, for 10 years led the Partnership for Safe Medicines, a nonprofit that has recently emerged as a leading voice against Senate bills that would allow drug importation from Canada. LaGanga was responsible for PhRMA alliances with patient advocacy groups and served until recently as the nonprofit’s principal officer, according to the partnership’s tax forms.

In February, LaGanga moved to a senior role at PhRMA and stepped down as executive director of the Partnership for Safe Medicines — just as the group’s campaign to stop import legislation was revving up.

Both PhRMA and the partnership have gone to great lengths to show that drugmakers are not driving what they describe as a “grass-roots” effort to fight imports — including an expensive advertising blitz and an event last week that featured high-profile former FBI officers and a former Food and Drug Administration commissioner.

The partnership’s new executive director, Shabbir Safdar, said LaGanga resigned from the group to avoid the appearance of a conflict of interest.

“That’s why Scott’s not executive director anymore,” he said. PhRMA declined to make LaGanga available for an interview.

A Kaiser Health News analysis of groups involved in the partnership shows more than one-third have received PhRMA funding or are local chapters of groups that have received PhRMA funding, according to PhRMA tax disclosures from 2013 to 2015. Forty-seven of the organizations listed in the ads appear to be advocacy organizations that received no money from PhRMA in those years.

The Senate push to allow Americans to buy pharmaceuticals from Canada comes as more patients balk at filling prescriptions because of soaring drug prices. Prescription medicines purchased in the U.S. can run three times what they cost in Canada, data from the company PharmacyChecker.com show. In 2016, about 19 million Americans purchased pharmaceuticals illegally from foreign sources through online pharmacies or while traveling, according to a Kaiser Family Foundation poll; many survey respondents cited pricing disparities as the reason. Continue reading