Health insurance premiums going down in Massachusetts for individuals? State says end of federal subsidies will “challenge” this trend.

From the Massachusetts Center for Health Information: 

PMPM: Payment per member per month

CHIA found that, overall, the individual purchaser market segment experienced decreases in average premiums (-3.4%) and cost-sharing (-8.0%) between 2015 and 2016. CHIA also found that unsubsidized plans experienced higher premium growth and larger cost-sharing increases than ConnectorCare Plan.  (State’s subsidized health insurance exchange.)

…Overall financial trends for individual purchasers were
driven, in large part, by enrollment growth in ConnectorCare plans with lower
premiums.Between 2015 and 2016, enrollment in unsubsidized individual
plans in Massachusetts increased by 6.5% to over 97,000 members, while
ConnectorCare enrollment grew by 51.4% to nearly 170,000 members

Enrollment and cost trends for individual plans purchased outside
the employer-sponsored insurance system reflect a combination of
individual purchasing decisions, population health characteristics, policy
and regulatory measures, and broader trends in health care spending.
Between 2015 and 2016, unsubsidized individual plan premiums grew
more slowly than the statewide average premium, and ConnectorCare
premiums actually decreased. For unsubsidized plan members, modest
premium growth was offset by increased cost-sharing obligations.
Members enrolled in ConnectorCare plans would have experienced higher
cost-sharing were it not for subsidies that preserved low out-of-pocket
spending. In the coming years these trends will be challenged by the
discontinuation of CSR subsidies in late 2017 and other potential changes
at the federal level. which may have a substantial effect on enrollment,
premiums, and cost-sharing for individual purchasers, depending on how
states offset these changes.


Kings, dogs and Burwells: The latest policy posts from the Health Wonk Review #HWR

BHN is hosting this week’s round-up. In anticipation of the King v. Burwell decision, we offer kings and Burwells. The content of the images is not meant as a BHN endorsement for either position. Same goes for the opinions in these posts. Some say the ruling may come down today, others bet on 6/29. SCOTUS Blog is the site to watch. (For actual posts on the pending decision, see the 6/3 edition.)

Finally, our thoughts are with the members of Emanuel African Methodist Episcopal Church and the staff at one more hospital that had to brace for victims of a mass shooting.

The posts:

  • 512px-BBKing07
    By Roland Godefroy

    Joseph Paduda at Managed Care Matters writes:  Health care cost drivers; or, here’s where you’re getting screwed. Two studies published in Health Affairs shed much light on hospital costs and the societal implications of physician practice consolidation.  Both are a bit scary.

  • A post from Health Affairs analyzes the major elements of the final rule recent Medicare Shared Savings Program Final Rule.Lawrence Kocot, of Ross White,
    HHS photo

    and Mark McClellan at KPMG  offer alternatives for CMS and the possible future of the program

  •   From David Willams at the Health Business Blog notes: Long term care insurance -narrow framing is not the problem. Why don’t people buy long term care insurance? Because for many it’s not a good value
  •  David Harlow at the HealthBlawg: Outsourced Chronic Care Management Service256px-King_Kong_1933_French_posters Can Help Physicians and Patients. I wrote this post with a client about Chronic Care Management, a newly-reimbursable service under Medicare as of January 2015, and a service that is specifically non-face-to-face. The federales are dedicating significant funds to this service based on the belief that it will reduce expenditures on other services for multiply-chronically-ill elders.
  • From Boston Health News, links to stories on telemedicine and hospitals as step-down units.
  • From Roy Poses at Health Care Renewal: Health Care Professional Societies Whose Leadership Betrays Their Own Members – the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money. Health care professionals need to be extremely skepticburwellneonal of the leadership and governance of all health care organizations.  True health care reform requires organizational leaders who understand the health care system, uphold its values, and are willing to be accountable.
  •  Tom Lynch of Workers Comp Insider offers “the word of the week: horrendoma. That’s a description he applies to the healthcare system after looking at billed vs paid hospital data and the concept of charges as a “starting point.” See his post: Hospital Medicare Charges: You Don’t Always Get What You Want.
    By Metro-Goldwyn-MayerReproduction Number: LC-USZ6-2067 Location: NYWTS -- BIOG [Public domain], via Wikimedia Commons
    By Metro-Goldwyn-Mayer, Inc.
  • Henry Stern at InsureBlog asks “What carrier in its right mind would cover” sex change surgery? Transjenner Insurance: In case you were wondering: Yes, ObamaPlans *do* cover sex-changes. InsureBlog has the, er, straight scoop.
  • From Health System Ed: Decrying the End of Private Physician Practice? Not so fast!  Experts have been saying that the private physician practice is no longer sustainable under managed care but then along comes ACOs and perhaps that tune is changing when the focus turns from volume to outcomes.
  • This Health Affairs post focuses specifically on the provisions of the rule dealing with benchmarkingBWburwell2 and distribution of shared savings and losses and suggests that CMS consider the possibility of graduated rates of sharing savings and loss distribution.y Carrie Colla, Scott Heiser, Emily Tierney, and Elliott Fisher at Dartmouth
  • Finally, Brad Wright asks : This Father’s Day, Give 1 For Dad
    In honor of his father, he’s donating to “Give 1 For Dad campaign to fund an important clinical trial for prostate cancer at the Duke Cancer Institute. At issue is that the treatment uses a safe generic drug, which is great because it isn’t toxic like other current treatments, but not so great because no major pharmaceutical companies are willing to fund a clinical trial of a generic drug.”

What does your king look like? king-cobra-405623_640(Click on images for credits, rights.)


State nixes health insurance rate hikes plus reform in review


The Globe reports that the state is rejecting health insurance rate hikes for the first time.

Making good on Governor Deval Patrick’s promise to reject health insurance rate hikes deemed excessive, the state Division of Insurance this morning turned down 235 of 274 increases proposed by Massachusetts health insurers for small businesses and individuals.

The ruling, stemming from emergency regulations the governor unveiled in February, marks the first time state government in Massachusetts has used its authority to deny health premium increases

More from the Boston Business Journal


 Catch up here on the Caritas sale and conversion to a for-profit company.


Cerberus, known for its $7.4 billion buyout of Chrysler LLC in 2007, is acquiring a hospital chain that has struggled in a medical marketplace dominated by large teaching hospitals such as Massachusetts General Hospital, which has links to Harvard Medical School. Turning the system around and making a profit for investors will be a challenge, said Stuart Altman, professor of national health policy at Brandeis University in Waltham, Massachusetts.

“The buyout firm isn’t walking into an easy situation,” said Altman. Massachusetts is also contemplating tighter financial regulation of hospitals, which could be a “wild card” for a new buyer, Altman said.

And catch up on the arrival of health reform with  Health Wonk Review, hosted this week by Health Technology News.

 His compilation of the latest from the policy blogs features an array of  flying pigs.

 Health care has never been so center stage and so enmeshed with policy and politics.  It took 100 years, starting with Teddy Roosevelt’s 1912 presidential campaign. Seven presidents tried including two Republicans and five Democrats. 
Who won? Patients won’t be denied coverage for pre-existing conditions (eventually) and are no longer subject to lifetime caps.  Physicians will benefit from the coverage expansion and increasing fees for Medicare primary care. Government trims the rate of growth of the deficit. Small business gets a tax break. Students can stay on their parent’s plans until age 26. Seniors see the close of the Medicare prescription drug doughnut hole.  And hospitals receive payments for more of the care delivered. 

Not all of the “winners” improve access/health/costs:  Pharma doesn’t have to negotiate for drug prices. Payers will still find reasons to deny care and are permitted medical loss ratios of 80-85%.  

NEJM: New way of paying for care in Mass?


longwood mapFor the uninitiated, I apologize for exposing you to this piece of jargon: “risk-adjusted capitation.” 




It means paying hospital/doctor/clinic groups a set amount per patient based on that person’s risk of getting sick.  It would replace the “fee-for-service” system of paying separately for every injection, visit, anesthesiologist, etc.  Policy makers promise this plan is more sophisticated than the blunt 1980s HMO model of capitation. Sounds like a grown-up idea to me. We’ll see. Again, many moving parts.  

From NEJM: A special commission has…proposed that Massachusetts effectively end fee-for-service medicine, the predominant form of payment for health care services, and replace it with a system of global payments that combines the approaches of risk-adjusted capitation and pay for performance with a strong focus on primary care…Although global payments are a form of capitation (payments are per patient), the Massachusetts commission sought to distinguish its model from previous capitation models. In the commission’s view, global payments would benefit from health information technology, a “careful transition period,” and monitoring to prevent “unintended consequences,” such as poor access to physicians or denial of needed care.

More from the state on global payments.

Former Globie Richard Knox reported on this for NPR.

 More on “pay for performance” here