1.16.12CrainsHealthPulse
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Reporters Barbara Benson - (718) 855-3304, [email protected] Gale Scott - (646) 201-9194, [email protected] Crain's Health Pulse is available Monday through Friday by 6 a.m. Reproduction, forwarding or reuse in any form is prohibited. For customer service, call (877) 824-9379. Today's News Monday, January 16, 2012 Surge in Medicaid Managed Care New York state ended 2011 with 3,036,100 people in Medicaid managed care, with 2,047,205 of them concentrated in New York City. Family Health Plus enrollment was 420,156, with the majority, 268,808, living in New York City. In comparison, the state had 163,369 fewer Medicaid managed care enrollees in 2010, and 26,468 fewer New Yorkers insured by FHP. Last year, Healthfirst dominated the Medicaid managed care market, with a 17% share (396,205 enrollees), according to state Department of Health data. MetroPlus was in second place, with 357,434 enrollees. UHF Favors ʻActive' Exchange Role In a new report on health insurance exchange markets, the United Hospital Fund said an exchange should not merely be a clearinghouse for whatever products insurers decide to offer. UHF suggested that New York policymakers "chart a course somewhere in between the passive market organizer and active purchaser approaches." UHF looked at exchanges set up in Utah, which takes a passive approach, and in Massachusetts, which takes an active role in deciding what plans must offer to be allowed on the exchange. Passive is easier and cheaper to set up, but not necessarily better, the report concludes. The document is at http://www.uhfnyc.org/news/880811. MSSNY Focus: SGR The Medical Society of the State of New York has a long legislative agenda for 2012, but its top item of business is the Sustainable Growth Rate formula fix, an issue for organized medicine for years. Congress' latest temporary fix froze Medicare physician reimbursement rates for two months, through Feb. 29, avoiding a 27% cut under the SGR formula. Gerald Conway, the group's legislative counsel, emphasized the need for a permanent solution. "When the fix expires, doctors could see a 30% drop in reimbursements, which could have a major impact on their ability to care for older patients," he said. Mr. Conway added that the New York Congressional delegation has agreed to again push for a better solution than the temporary "patches" that have become the norm. Plans see unwelcome mandates The new year has brought with it signs that the New York Health Plan Association once again will face efforts by the state Legislature to mandate coverage for certain services. "We're just beginning to see the bills being introduced," said an HPA spokeswoman. "What we'd describe as ʻprocess' mandates from special interests providers” are of particular concern, she said. “These are proposals for how plans can operate their business, all of which add cost without consumer benefits." In addition, two bills have been reintroduced that affect insurers. One of them (S.4597-B) would mandate payment of a facility fee, plus the physician's professional services fee, for office-based surgery. The other bill (S.5068-A) would require plans to calculate their out-of- network reimbursement rates as a comparison to the FAIR Health database. The bill also mandates that state regulators only approve out-of-network fee schedules that substantially cover out-of-network costs. That measure would set the standard for health plans' out-of-network reimbursements at 80% of the FAIR Health database. HPA expects to see more proposed mandatory coverage issues, she said. "This is just the beginning." At A Glance HEART SATELLITE: Hackensack University Medical Center is opening its 14,000-square-foot Heart Center at Glenpointe, a mixed-use commercial complex in Teaneck, N.J. The outpatient center is the first of its kind in the Garden State, a facility where patients can get high-tech tests in a more relaxed atmosphere than provided in a hospital setting, said cardiologist Greg Simonian, co-chairman of the Heart and Vascular Hospital at HUMC. The satellite center has 12 exam rooms and two rooms for echocardiograms. Patient records will be shared electronically with the hospital, located four miles away. HUMC could not provide the cost of building out the facility, which is leased. DIABETES: MagnaCare will start offering a wireless-enabled blood glucose meter, the Telcare BGM. The product automatically transmits readings to a privacy-secured online database that can be accessed via Web browser or smartphone app by patients, physicians, caregivers or family members, as authorized by the patient. The product was launched last week at the Consumer Electronics Show in Las Vegas. ADVERTISEMENT
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HPA expects to see more proposed mandatory coverage issues, she said. "This is just the beginning." The new year has brought with it signs that the New York Health Plan Association once again will face efforts by the state Legislature to mandate coverage for certain services. "We're just beginning to see the bills being introduced," said an HPA spokeswoman. Today's News Monday, January 16, 2012 ADVERTISEMENT
Transcript of 1.16.12CrainsHealthPulse
ReportersBarbara Benson - (718) 855-3304, [email protected] Scott - (646) 201-9194, [email protected]'s Health Pulse is available Monday through Friday by 6 a.m.Reproduction, forwarding or reuse in any form is prohibited.For customer service, call (877) 824-9379.
Today's News Monday, January 16, 2012
Surge in Medicaid Managed CareNew York state ended 2011 with 3,036,100 people in Medicaid managedcare, with 2,047,205 of them concentrated in New York City. FamilyHealth Plus enrollment was 420,156, with the majority, 268,808, living inNew York City. In comparison, the state had 163,369 fewer Medicaidmanaged care enrollees in 2010, and 26,468 fewer New Yorkers insuredby FHP. Last year, Healthfirst dominated the Medicaid managed caremarket, with a 17% share (396,205 enrollees), according to stateDepartment of Health data. MetroPlus was in second place, with 357,434enrollees.
UHF Favors ʻActive' Exchange RoleIn a new report on health insurance exchange markets, the UnitedHospital Fund said an exchange should not merely be a clearinghousefor whatever products insurers decide to offer. UHF suggested that NewYork policymakers "chart a course somewhere in between the passivemarket organizer and active purchaser approaches." UHF looked atexchanges set up in Utah, which takes a passive approach, and inMassachusetts, which takes an active role in deciding what plans mustoffer to be allowed on the exchange. Passive is easier and cheaper to setup, but not necessarily better, the report concludes. The document is athttp://www.uhfnyc.org/news/880811.
MSSNY Focus: SGRThe Medical Society of the State of New York has a long legislativeagenda for 2012, but its top item of business is the Sustainable GrowthRate formula fix, an issue for organized medicine for years. Congress'latest temporary fix froze Medicare physician reimbursement rates for twomonths, through Feb. 29, avoiding a 27% cut under the SGR formula.Gerald Conway, the group's legislative counsel, emphasized the need fora permanent solution. "When the fix expires, doctors could see a 30%drop in reimbursements, which could have a major impact on their abilityto care for older patients," he said. Mr. Conway added that the New YorkCongressional delegation has agreed to again push for a better solutionthan the temporary "patches" that have become the norm.
Plans see unwelcome mandatesThe new year has brought with it signs that the New York Health PlanAssociation once again will face efforts by the state Legislature to mandatecoverage for certain services. "We're just beginning to see the bills beingintroduced," said an HPA spokeswoman.
"What we'd describe as ʻprocess' mandates from special interests providers”are of particular concern, she said. “These are proposals for how plans canoperate their business, all of which add cost without consumer benefits."
In addition, two bills have been reintroduced that affect insurers. One ofthem (S.4597-B) would mandate payment of a facility fee, plus thephysician's professional services fee, for office-based surgery.
The other bill (S.5068-A) would require plans to calculate their out-of-network reimbursement rates as a comparison to the FAIR Health database.The bill also mandates that state regulators only approve out-of-network feeschedules that substantially cover out-of-network costs. That measurewould set the standard for health plans' out-of-network reimbursements at80% of the FAIR Health database.
HPA expects to see more proposed mandatory coverage issues, she said."This is just the beginning."
At A GlanceHEART SATELLITE: Hackensack University Medical Center is opening its14,000-square-foot Heart Center at Glenpointe, a mixed-use commercialcomplex in Teaneck, N.J. The outpatient center is the first of its kind in theGarden State, a facility where patients can get high-tech tests in a morerelaxed atmosphere than provided in a hospital setting, said cardiologist GregSimonian, co-chairman of the Heart and Vascular Hospital at HUMC. Thesatellite center has 12 exam rooms and two rooms for echocardiograms.Patient records will be shared electronically with the hospital, located fourmiles away. HUMC could not provide the cost of building out the facility, whichis leased.
DIABETES: MagnaCare will start offering a wireless-enabled blood glucosemeter, the Telcare BGM. The product automatically transmits readings to aprivacy-secured online database that can be accessed via Web browser orsmartphone app by patients, physicians, caregivers or family members, asauthorized by the patient. The product was launched last week at theConsumer Electronics Show in Las Vegas.
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