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Category Archives: Health Care

Family Medicine On Air: What Med Students Need to Know About Cost of Care – Video

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Family Medicine On Air: What Med Students Need to Know About Cost of Care
AAFP President Robert Wergin, MD, will discuss the cost of care and its implications on individual patients and the health care system as a whole. He will also explain how family medicine is...

By: FMIG Network

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Family Medicine On Air: What Med Students Need to Know About Cost of Care - Video

Health care, retirement changes looming

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The Military Compensation and Retirement Modernization Commission is urging President Barack Obama to endorse and Congress to enact sweeping changes to military health insurance and retirement options to empower service members to make choices that would drive down compensation costs.

The panels final report makes 15 recommendations that, if fully implemented, would cut personnel spending for the Departments of Defense and Veterans Affairs by $12 billion a year. The most surprising idea is to replace the triple-option TRICARE program for military families and working-age retirees with a selection of commercial health insurance plans.

On retirement, current force members could stay under their High-3 plan. But the commission forecasts 40 percent of them, if given a chance, would replace that plan, offering no benefits before 20 years service, with a blended plan that lowers annuities for careerists, but offers some retirement savings to the 83 percent of service members who leave short of 20 years.

Sweeping changes may be in store for military retirement and health insurance options. (Courtesy of Tom Philpott)

That menu of health insurance offerings to the military would be similar to the Federal Employees Health Benefits Insurance Program for civilians. Indeed, the Office of Personnel Management, which administers FEHBP, would also run the military plans. But rather than saddle active-duty families with the same costs paid by civilians roughly 28 percent as premiums they would receive a new, two-part Basic Allowance for Health Care to cover at least most of their new health insurance costs.

One part would be paid to the selected insurance plan directly and cover member premiums for an average-priced plan. Part two of BAHC, to cover co-pays and deductibles, would go to members to use as they choose. The intent of those dollars is to incentivize military families to be careful consumers of health care. Today they are not, the report says. TRICARE Prime users, for example, make 55 percent more outpatient visits than do civilians enrolled in HMOs who have to cover co-pays out of pocket.

Participating insurance plans would have to include military treatment facilities in their provider networks. Patients and plans would be enticed to use on-base care with offers of reduced co-pays and fee reimbursements, particularly for complex medical cases that keep wartime skills sharp.

TRICARE administrative costs are excessive, the report says, and yet too many beneficiaries dont get timely or quality care. Also, TRICARE provider networks have coverage gaps because contractors set physician fees too low. Relying on commercial insurance would improve access, speed referrals for specialty care, save millions of dollars in administrative costs and leave beneficiaries more satisfied, the commission predicts.

The commission would leave unchanged TRICARE for Life, the golden supplement to Medicare that elderly retirees have prized for a dozen years.

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Health care, retirement changes looming

Health care records make fertile field for cyber crime – Quincy Herald-Whig | Illinois & Missouri News, Sports

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By TOM MURPHY and BRANDON BAILEY AP Business Writers

Those seemingly harmless medical forms everyone fills out before seeing a doctor can lead to identity theft if they get into the wrong hands.

Names, birthdates and - more importantly - Social Security numbers can help hackers open fake credit lines, file false tax returns and create false medical records. And health care businesses can lag far behind banks, credit card companies and retailers in protecting such sensitive information.

"It's an entire profile of who you are," said Cynthia Larose, chair of the privacy and security practice at the law firm Mintz Levin in Boston. "It essentially allows someone to become you."

The danger of cyberattacks was highlighted last week when Anthem, the nation's second-largest health insurer, said hackers broke into a database storing information on 80 million people. That hack led to a particularly valuable trove of data because it exposed Social Security numbers, a key to a range of identity thefts.

Those numbers were created to track the earnings history of workers in order to determine Social Security benefits. Now, health care companies are, in some cases, required to collect the numbers by government agencies.

They also use them because they are unique to every individual and more common than other forms of identification like driver's licenses, said Dr. Ross Koppel, a University of Pennsylvania professor who researches health care information technology.

But the protection health care companies have for that information can be lax compared with other industries. In fact, the FBI warned health care companies a year ago that their industry was not doing enough to resist cyberattacks, especially compared with companies in the financial and retail sectors, according to Christopher Budd at the security software company Trend Micro. He said the warning came in a government bulletin to U.S. companies that cited research by a nonprofit security institute.

Avivah Litan, a cybersecurity analyst at the research firm Gartner, estimates that the health care industry is generally about 10 years behind the financial services sector in terms of protecting consumer information. She figures that it may be twice as easy for hackers to get sensitive financial information out of a health care company compared with a financial services business.

Litan, who studies fraud-detection technology, says she sees gaps in several areas of spending on cybersecurity for health care companies. Banks, she said, are much more likely to use advanced statistical models and behavior analytics programs that can spot when someone's credit card use suddenly spikes. That's a sign of possible fraud that may be worth investigating.

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Health care records make fertile field for cyber crime - Quincy Herald-Whig | Illinois & Missouri News, Sports

Washington State Health Care Authority Utilizes CNSI Technology to Integrate Provider Payments

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State Becomes First to Migrate Social Services Payments to ProviderOne Medicaid Management Information System

GAITHERSBURG, Md., CNSI, in partnership with the Washington State Health Care Authority (HCA), announced that as of January 15, 2015, the ProviderOne Phase-II 1099 Track has been implemented, making it the first state in the nation to integrate social service and provider payments into the federally- certified Medicaid Management Information System (MMIS).

Utilizing CNSI's ProviderOne system technology, the state of Washington has successfully transitioned more than 4,300 social service providers to the online payment and claims management system. The latest updates will affect providers who receive a 1099 tax form and are currently paid by the Social Services Payment System.

"Changing from a 30-year-old phone and paper billing system to an online, electronic system will offer convenience, greater ease of claims management and more frequent payment options. In addition to being the first to become fully compliant with federally mandated operating rule requirements, this platform is also the first in the country to integrate social service provider payments to serve the businesses and organizations that support clients in home and community-based settings in Washington," said B. Chatterjee, CEO of CNSI. "This means there will be no more claiming Medicaid services by phone or paper. Social service providers that provide care to clients who receive Medicaid can now submit claims online using the ProviderOne system. We are proud that by utilizing our state-of-the-art technology the department is closer today -towards achieving its mission to improve the quality of life for individuals and families in need."

ProviderOne was implemented in Washington in 2010 and now effectively processes more than $8 billion annually in provider payments, about $2 billion of which are social services payments.

"This implementation fulfills a long-time vision of integrating social service and medical claims payments into one system and will improve coordination of client care across programs," said Cathie Ott, HCA division director of Program and Payment Integrity. "This system will help providers manage their claims better so that they can spend more time focused on care and less on paperwork."

The system updates provide a modern payroll-like system that meets federal requirements and supports increased management efficiencies through better utilization and expenditure data across Medicaid. In addition, providers are now able to choose between weekly or monthly payments, adjust or correct claim submissions and view authorizations and payment history.

"We are very pleased with the implementation of ProviderOne," added Bill Moss, Department of Social and Health Services assistant secretary for the Aging and Long-Term Support Administration. "The enhanced functions of ProviderOne will reduce provider overpayments and duplicate payments, improve client care coordination and provide more data about cost and utilization."

About CNSI CNSI delivers a broad portfolio of information technology (IT) and business process outsourcing (BPO) solutions to a diverse base of federal, state and local government agencies, and commercial enterprises. The firm helps clients improve business performance and align IT with their mission and business objectives. CNSI has established strong domain expertise in prominent industries, including Health, Defense and National Security, Government IT and Enterprise Mobility. CNSI employs a world-class team of technologists, program managers, and subject matter experts, all of whom have experience with large scale mission-critical IT implementations. Formed in 1994, CNSI is headquartered in Gaithersburg, Maryland, with locations throughout the U.S. and India. CNSI's website is: http://www.cns-inc.com.

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Washington State Health Care Authority Utilizes CNSI Technology to Integrate Provider Payments

FY 2015 Primary and Behavioral Health Care Integration (PBHCI) RFA Pre-applicant webinar – Video

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FY 2015 Primary and Behavioral Health Care Integration (PBHCI) RFA Pre-applicant webinar
This is a recording of SAMHSA #39;s Primary and Behavioral Health Care Integration Request for application pre-applicant webinar, held on January 15, 2015. For m...

By: SAMHSA

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FY 2015 Primary and Behavioral Health Care Integration (PBHCI) RFA Pre-applicant webinar - Video

ObamaCare: Why Must Hard-Working Americans Bear the Burden? – Video

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ObamaCare: Why Must Hard-Working Americans Bear the Burden?
The Affordable Care Act, aka "ObamaCare" was supposed to make health care affordable for Americans. Instead, it #39;s posing a huge burden on hard-working people who have suddenly seen their own...

By: News Talk Florida

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ObamaCare: Why Must Hard-Working Americans Bear the Burden? - Video

Universal Health Care: From Private Coverage to Public Care – Video

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Universal Health Care: From Private Coverage to Public Care
Social movements are questioning the market-friendly version of "universal health coverage" (UHC) promoted by global health institutions, which is opening the door for privatization of public...

By: Ontario Council for International Cooperation

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Universal Health Care: From Private Coverage to Public Care - Video


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