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Health care exchange problems continue

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WASHINGTON - Two weeks into the launch of the federal health insurance exchange, the website is still plagued with problems, leading critics to wonder if the problem is worse than it appears.

There are two key issues at the core of the problem, said Dan Schuyler, a director at Leavitt Partners, a health care group. One is the volume, which Health and Human Services estimates at 14.6 million unique visitors, and the second is the platform's design.

The main problem, Schuyler said, could be "core fundamental design flow," but it's impossible to know because HHS is saying so little. "Only the contractors and HHS know that," he said.

They need to figure out the problem soon, Schuyler said, if the government is to meet its goal of 7 million new health customers signing up on the exchanges by March 31. "That's 39,000 enrolled a day, and we're not seeing anywhere near that volume," Schuyler said. "If they don't get it fixed within two or three weeks, we may have a backlog of consumers who won't be able to enroll by January 1."

HHS didn't have enough time to test its system for "one of the most complex IT platforms undertaken by the feds or the states," Schuyler said.

HHS did not respond to a request for information, and its website states that there are too many media requests now to answer all of them. However, at the end of the first two weeks, HHS issued a statement:

"We won't stop improving HealthCare.gov until its doors are wide open, and at the end of the six-month open enrollment, millions of Americans gain affordable coverage," said HHS spokeswoman Joanne Peters.

President Obama criticized the problems in a Tuesday interview with KCCI, a Des Moines TV station. "I am the first to acknowledge that the website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable and we've got people working around the clock to do that," he told the Iowa station. "We've seen some significant progress but until it's 100% I'm not going to be satisfied."

Tuesday, Millward Brown Digital released an analysis showing that 36,000 of the 9.47 million people who visited the site the first week made it to the enrollment page at healthcare.gov, with the assumption that only a small percentage of the visitors were able to enroll. HHS has not released enrollment numbers. Millward Brown is an international market-research group.

"I will be the first to tell you that the web site launch was rockier than we wanted it to be,'' HHS Secretary Kathleen Sebelius said Wednesday morning at Cincinnati State Technical and Community College. She did not give an update on numbers, but said people still have plenty of time to enroll before the Dec. 15 deadline for coverage to begin January 1.

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Health care exchange problems continue

Coventry Health Care Will Now Offer Medicare Beneficiaries More Choice in More Regions across the United States

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BETHESDA, Md.--(BUSINESS WIRE)--

Coventry Health Care today announced the expansion of its Medicare Advantage service area to 26 counties across Louisiana and West Virginia and in 48 additional counties in 16 other states for 2014. The low-cost Medicare Advantage HMO and PPO plans offer beneficiaries more choice for affordable and convenient coverage alternatives with attractive benefits, including $0-premium plans in some areas, low copayments for primary care physician visits and fitness programs.

Coventrys Medicare Advantage plans are some of the highest quality rated plans in the country by the Centers for Medicare & Medicaid Services (CMS),* and are designed to provide members affordable and convenient coverage alternatives. Most plans offer extra benefits not covered under Original Medicare (like prescription drug coverage and comprehensive dental, eyewear and hearing-aid benefits), and several plans offer extras, such as fitness club memberships.

This expansion marks Coventrys commitment to provide Medicare beneficiaries with more benefit options and greater provider choice, said Armando Luna, Jr., vice president, Medicare Marketing and Sales for Coventry Health Care. We are excited about the opportunity to offer more beneficiaries access to convenient, quality health care at prices they can afford.

There are more than 311,000 Coventry Medicare Advantage members in 16 states. For the upcoming 2014 annual enrollment period, Coventry Medicare Advantage plans will be available to seniors in 26 counties across Louisiana and West Virginia and in additional counties throughout Arkansas, Florida, Georgia, Illinois, Iowa, Kansas, Nebraska, North Carolina, Missouri, Ohio, Oklahoma, Pennsylvania, South Dakota, Texas, Utah and Wyoming.

Medicare beneficiaries can enroll in Coventrys 2014 plans during the annual enrollment period, which begins October 15, 2013, and ends December 7, 2013.

Coventry offers several resources to help beneficiaries find the best plan for them. Benefit plans, service areas and a schedule of complimentary education seminars are available at News.MyCoventryMedicare.com.

Coventry expanded its Medicare Advantage service area into the following counties for 2014:

About Coventry Health Care

Coventry Health Care, an Aetna company, provides a full portfolio of risk and fee-based products, including Medicare and Medicaid programs, group and individual health insurance, workers compensation solutions, and network rental services. Coventry Health Care is a Coordinated Care plan with a Medicare contract and a Medicare-approved Part D sponsor. For more information, see http://www.coventryhealthcare.com.

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Coventry Health Care Will Now Offer Medicare Beneficiaries More Choice in More Regions across the United States

Balanced, But Not Very Useful, Health Care Info – CounterSpin – Air Date: 9-27-13 – Video

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Balanced, But Not Very Useful, Health Care Info - CounterSpin - Air Date: 9-27-13
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Balanced, But Not Very Useful, Health Care Info - CounterSpin - Air Date: 9-27-13 - Video

The Costs Of Health Care with Dr Paul Song – David Feldman Show – Air Date: 7-29-13 – Video

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The Costs Of Health Care with Dr Paul Song - David Feldman Show - Air Date: 7-29-13
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The Costs Of Health Care with Dr Paul Song - David Feldman Show - Air Date: 7-29-13 - Video

Health care law could inflate insurance costs for Pinellas schools

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LARGO Businesses across the nation, including the Pinellas County school district, are adjusting their health care plans to comply with the Affordable Health Care Act, but one variable may end up costing the school district millions: substitute teachers.

By 2015, the act requires the school district to provide health care benefits to all employees who work at least 30 hours a week. The school district has provided health care for employees who may work two different jobs in different school district departments that add up to 30 hours a week but not substitutes or other part-time employees who work randomly at different locations, Ted Pafundi, director of risk management and insurance for the school district, said at Tuesdays School Board workshop.

Last school year, there were 1,798 part time employees, including substitute teachers, working in instructional and administrative positions, according to the school district.

We have substitutes that work on a regular basis and over a certain period of time may average that 30 hours that will be eligible for benefits at an additional cost to the board, Pafundi said. Were looking at potentially millions of dollars of additional benefits coming in.

The school district does not have a way to track how many substitute work 30 hours a week but will begin working on projections of how the health care law will affect it, said Superintendent Michael Grego.

That information would also help identify where substitutes are working for long periods of time, the school system can fill that spot with a full-time teacher, said School Board member Rene Flowers.

Paying for substitute teachers health care is an issue that has left school districts across the nation scrambling. Many school districts have resolved the problem by hiring one or two permanent substitutes per school and ensuring that others who work in emergency situations do not work a full 30 hours, Pafundi said. Others in Nevada, Tennessee and New Jersey are limiting substitute teachers to only working four or fewer days a week.

Officials are working on a report about what to do next. Its an officials school administrators say they need to figure out.

A good substitute you can work every single day somewhere, said School Board Chairwoman Carol Cook.

School district officials also discussed other changes that will take effect in 2014, when all U.S. citizens will be required to have health coverage or pay a penalty that will rise in following years unless they receive qualified coverage from an employer, such as the school district. Next year, waiting periods for employer-sponsored health plans will be limited to 90 days, and there will be no annual limit on what a health plan pays for essential benefits, although daily and frequency limits may still apply.

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Health care law could inflate insurance costs for Pinellas schools

Local Health Care Changes Limited So Far, Doctors Say

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VOL. 128 | NO. 201 | Tuesday, October 15, 2013

The Oct. 1 start of enrollment in health care exchanges may be the most visible part of the Affordable Care Act so far.

But changes to insurance and health care nationally already are about something other than lowering health care costs or widening access to health care and health insurance coverage.

I think for most people, they assumed that this was all about providing care for the poor, said Church Health Center founder Dr. Scott Morris on the WKNO-TV show Behind The Headlines. What I think people will find jaw-droppingly unbelievable is that at the Church Health Center, which sees effectively 100 percent of our patients working and uninsured, 80 to 90 percent of our patients it will have no impact on whatsoever.

Thats because so far, the impact is on health care exchanges and doesnt involve a Medicaid expansion.

Tennessee Gov. Bill Haslam initially said no to the expansion, which would be funded fully by the federal government for the first three years and then be 90 percent federally funded for three years after that. Haslam has been negotiating terms for an expansion since initially turning it down.

So health care exchanges whether federal or state apply to those who are at least 138 percent above the federal poverty index.

If youre a single individual and you make less than $16,000 a year, or you are a family of four and your income is less than $32,000 a year, when you go to the exchanges and you pop in your data, what will come back is that you will get nothing. The poorest people get nothing, Morris said. The assumption was absolutely that every state would expand Medicaid. So if you are working in a near-minimum-wage job, youre going to have to pay full bore, same as you would today, for health insurance. And they just cant afford it.

Dr. Richard Thomas, a consultant to several local hospitals, estimated 25,000 to 30,000 Memphians without health insurance could be covered through the exchange. And he added that if the state had taken the Medicaid expansion, the uninsured with access could have increased by another 80,000.

Thomas said the Affordable Care Act has made some difference with adult children remaining on their parents insurance and payments of several hundred dollars each to consumers from insurance companies who in the past did not allocate 80 percent of the premiums paid them to health care costs.

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Local Health Care Changes Limited So Far, Doctors Say

VNA Health Care helps residents navigate new requirements

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Fox Valley residents appeared to put a timid toe into the new pool of insurance coverage options offered during the first week of the exchanges created by President Barack Obama's new health care law.

VNA Health Care hosts one of the larger contingents of "navigators" in the Fox Valley. The organization has about 25 trained, background-checked navigators who are assisting local residents in determining their medical coverage options now that the exchanges are open for business. VNA hopes to eventually have 50 navigators in the field assisting residents.

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Interviews with some of the current navigators show local residents have been somewhat slow to come to the exchanges, but the pace is building as more information becomes available.

Nadia Daley is one of the VNA's navigators. She helped about 10 individuals and families in the first week of the exchanges.

"When people come in, most say, 'I heard I can get insurance, and I really, really want insurance. So, I'm here for you to help me get insurance,'" Daley said. "That's their main concern, especially if they have somebody ill their family or have a pre-existing condition. Basically, the door to insurance has been opened, and everyone is just pushing to get in."

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VNA Health Care helps residents navigate new requirements

Dignity Health and Optum Launch Company to Simplify Patient Billing, Modernize Health Care Administration

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MINNEAPOLIS & SAN FRANCISICO--(BUSINESS WIRE)--

To meet the growing demand for greater transparency, simplicity, and value in health care billing, Dignity Health and Optum have formed Optum360, a major new venture that combines the companies industry-leading revenue cycle management capabilities. Optum360 is dedicated to transforming the registration, documentation, billing, and payment system so it works better for hospitals, health systems and other care providers, and delivers a better patient experience.

With a workforce of more than 3,000 employees from Dignity Health and Optum, Optum360s revenue cycle management services can meet the large-scale needs of major hospitals and health systems, and enable new care delivery and risk-sharing models, such as Accountable Care Organizations. The venture joins Dignity Healths proven revenue cycle operations expertise and scale with Optums market-leading technology, expertise in ICD-10 readiness, and a client base of thousands of hospitals and physician groups. Optum serves more than 300 commercial and public health plans, and its deep payer operations expertise will be applied to making administrative processes between payers and providers more direct, faster, and simpler.

Optum360s patient-centric approach to revenue cycle management has the potential to fundamentally transform both administrative processes and revenue yield and accuracy from patient registration to financial resolution of payments in ways no other solution can. It is designed to reduce costs and make medical costs more transparent while helping hospitals, health systems, clinics, and physicians modernize administrative processes and ensure appropriate revenue yield. Importantly, the Optum360 solution provides a complete view of the care experience from the patients perspective, helping providers deliver a simpler, more satisfying experience to their patients.

The health care billing process is too often a source of stress during a time when healing should be the primary focus, and together through Optum360 we are committed to being part of the solution, said Lloyd Dean, president and chief executive officer of Dignity Health. Our goal is nothing less than to modernize the revenue cycle so that it is intuitive and easy to manage, and allows patients and providers alike to focus their attention on healing.

Approximately 1,700 employees from Dignity Health and 1,300 employees from Optum make up the initial workforce of Optum360, which will be the exclusive revenue cycle services provider to Dignity Healths hospitals, clinics, and physicians. Optum360 is also working with additional major health care provider partners nationwide and plans to announce these relationships in the months ahead.

Optum360 is singularly focused on helping care providers nationwide transform the registration, billing and payment system so it works better for them and their patients, said Larry Renfro, chief executive officer of Optum. The unique combination of Optums leading technology and Dignity Healths proven expertise in revenue cycle management will allow us to partner with hospitals, health systems, clinics and physicians across the health care system to significantly improve performance and the patient experience.

Bringing Simplicity to Patients and Providers

Optum360 is focused on improving the patient experience through a unique combination of technology and superior customer service. For example, patients can expect a more streamlined admission process and access to secure online and mobile applications for benefits information, health management tools and financial statements. Optum360 service representatives will educate patients about their insurance benefits, provide financial counseling, and help them understand what they can expect from the payment process.

Dignity Health has always been committed to simplifying the billing process and helping our patients understand their health benefits, said Michael Blaszyk, senior executive vice president and chief financial officer for Dignity Health. With Optum360, we are taking these efforts to the next level by implementing Optums proven technology. We are excited to bring these resources to the patients we serve as well as to the broader health care marketplace.

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Dignity Health and Optum Launch Company to Simplify Patient Billing, Modernize Health Care Administration

Health Care Reform Paving the Way for New Technologies

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NEW YORK (TheStreet) -- "Obamacare" may not please everybody, but Americans of all political stripes already benefit from at least one by-product of the new law: innovative health care technologies that make it easier and cheaper to access quality health care.

A key driver for technology creation within Obamacare is the idea of "accountable care," where providers receive financial incentives for delivering high quality care at a lower cost. If the old economic model was to build a hospital and fill it with paying patients, the new model rewards medical professionals for keeping people healthy and out of the building as much as possible.

Accountable care requires that "hospitals defend the perimeter against avoidable admission," said George Pace, a health care industry executive based in North Carolina. "If I'm there because of a heart attack, okay, but it's not okay if it's because I forgot to take my medications. You have to expand the continuum of care into the community and identify and address symptoms, illnesses, and behaviors before they escalate."

That's where technology comes in. Just as doctors and hospitals leverage "physician extenders" such as nurse practitioners and physician assistants to provide a broad range of services, said Pace, "technology extenders" such as mobile telemedicine, real-time collaborative tools and electronic monitoring systems will increasingly be used to maximize the reach of medical professionals, all while lowering costs.

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Health Care Reform Paving the Way for New Technologies

Physician assistants fill in at the fringes of health care

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10 hours ago

Courtesy Venice Family Clinic

Carrie Kowalski, a physician assistant at the Venice Family Clinic in Venice, California, checks "Tarzan", one of the homeless patients she seeks out to care for.

Editor's note: This storyis part of NBC'sseries "Quest for Care" exploring the shortage of health care providers as the Affordable Care Act rolls out.

Ben Olmedo traveled from Afghanistan to Alaska to find the gaps he wanted to fill. Wisconsin-born Carrie Kowalski found her niche in Venice Beach, Calif. And Vicki Chan-Padgett found her space full of needy women and children in Las Vegas 30 years after she first trained as an Air Force medic.

The three physician assistants are already helping to fill the many holes in the U.S. health care system, providing tests, counseling and other basic care when a doctor is unavailable. They expect to get busier as health care reform starts making it easier for people to pay for medical care.

The three are deployed at the very edges of the U.S. health care system, where its already hard to find physicians. Groups such as the Association of American Medical Colleges project a shortage of 90,000 medical doctors by 2020 as the population increases and ages -- and as more people gain the ability to pay for treatment through new insurance marketplaces and expanded Medicaid programs.

Physician assistants trained in medicine and able to provide care with minimal supervision by a physician are already seeking expanded roles to help fill the gap.

Some of our patients wait six months or more to get specialist care, says Kowalski, who just graduated from her physician assistant program at the University of Southern California in May. The Venice Family Clinic sends Kowalski in a van to scour the streets of the southern California city, finding the homeless and near-homeless who need help.

Kowalski and her team provide basic care, tending to injuries, testing and counseling for HIV, and trying to persuade patients to come in for more comprehensive care. As the changes mandated by the 2010 Affordable Care Act take hold, Kowalski expects her job to get busier because California has embraced Obamacare wholeheartedly, expanding its Medicaid program and setting up its own exchanges where people can buy health insurance.

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Physician assistants fill in at the fringes of health care

REVEALED! Canadian Company Responsible for THEIR Health Care ALSO Responsible for OBAMACARE! – Video

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REVEALED! Canadian Company Responsible for THEIR Health Care ALSO Responsible for OBAMACARE!
Visit our blog... http://www.ppsimmons.blogspot.com See article from examiner.com here... http://washingtonexaminer.com/canadian-firm-hired-to-build-troubled...

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REVEALED! Canadian Company Responsible for THEIR Health Care ALSO Responsible for OBAMACARE! - Video

KISD health care decision draws ire of teachers

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When it came to picking a health care provider, Killeen Independent School District employee Laura Dunnells did her homework.

I agonized. I researched, said Dunnells, an assistant principal at Cedar Valley Elementary School.

Dunnells was one of 2,900 district employees who cast votes to indicate which provider they would prefer for the current school year. Just more than 1,000 of those employees voted for TRS ActiveCare, a health care program run by the Teacher Retirement System of Texas.

But the school board didnt agree.

Four members of the districts board of trustees Shelley Wells, JoAnn Purser, Ken Ray and Susan Jones voted instead to select another provider, Blue Cross Blue Shield, during a Sept. 26 meeting.

Their decision was met with a strong reaction from employees, who said premiums under ActiveCare would be cheaper. District employees said they will have to pay hundreds of dollars more every month under Blue Cross Blue Shield.

ActiveCare actually allows employees to get insurance through a number of providers under its umbrella, including Blue Cross Blue Shield. Comparisons of similar plans showed that TRS Blue Cross Blue Shield coverage was still a cheaper option.

Broker fees

The vote for Blue Cross Blue Shield also means that a local insurance agency, Killeen-based Bigham Kliewer Chapman & Watts, will likely get thousands of dollars in fees from Blue Cross Blue Shield. The Killeen insurance company has been doing business with the board for the past 10 years.

William Kliewer, a former school board member who ended his time on the board in 2005, is a managing partner with the company. Killeen ISD documents show that another managing partner, Ken Chapman, conducted business with the board on behalf of the company.

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KISD health care decision draws ire of teachers

Health care law creates challenges for local doctors

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Several local doctors with small, private practices have mixed feelings about the Affordable Health Care Act, but most agree it will cause many family doctors to consolidate or leave the field.

Practices like mine wont survive, said Dr. Dave Webster, who has operated the Webster Family Practice Clinic in Killeen since 1999.

Clinics not prepared for the Affordable Health Care Act and even some that are will find themselves consolidating, merging or being bought out, said Chris Strickland, the office coordinator for Lampasas and Copperas Cove Family Medicine Clinics.

While ensuring staff at the Lampasas and Cove clinics are well trained on the Affordable Health Care Act, often referred to as Obamacare, and not going anywhere, most smaller practices are going to feel a financial burden to keep up with regulations required by the federal government.

The Affordable Health Care Act requires stricter guidelines on documenting and reporting how doctors do their jobs, Dr. Karen Harrison said.

She runs Harrison and Harrison Internal Medicine in Copperas Cove with her husband, Dr. Raymond Harrison. They have been preparing for Obamacare, which opened for enrollment Oct. 1. Coverage starts Jan. 1.

You are going to have to report these numbers and you are going to take some time away from patient care so you will have time to do that, or hire someone to do that for you, Harrison said. The mergers will kind of help, because you have a system then to help accomplish whatever we are asked to do.

Some clinics wont be able to take patients with the government insurance because they will not be able to offset lost revenue as people start to find the loopholes in the Affordable Health Care Act, Strickland said.

(Small clinics) dont have the negotiation power to get good prices from that plan, he said.

Power of merging

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Health care law creates challenges for local doctors


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