The long-discussed Florida Health Choices program is moving forward with plans to run a health-insurance "marketplace" catering to small businesses, but its long-term future is more uncertain because of the federal health overhaul.
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Federal health care law creates questions about state marketplace
EDEN PRAIRIE, Minn.--(BUSINESS WIRE)--
Optum, an industry leader in health care payment integrity services, is working with SAS to further enhance its comprehensive health care anti-fraud, waste and abuse services. This enhanced solution combines detection, investigation, prevention, case development and recovery services to provide commercial health plans with a flexible approach to ensuring proper payments to care providers.
While the vast majority of health care spending reflects the actual costs of patient care and medical services, the National Health Care Anti-Fraud Association (NHCAA) estimates that $60 billion is lost annually to health care fraud, waste and abuse. This figure includes such activities as billing for unperformed medical services; performing a medically unnecessary test or procedure; billing for more expensive medical services or procedures than the one conducted; or billing each stage of a procedure in place of a bundled rate.
Health plans find it challenging to assemble the complex combination of technology and talent required to mount sophisticated anti-fraud defenses, said Nick Howell, Optums senior vice president of operational and administrative efficiency. By working with SAS, we can further enhance our support of payers seeking to access most sophisticated analytics, the largest datasets, and the largest investigative operations in the industry.
The Optum solution uses SASs Fraud Framework and Optums deep health care expertise and extensive health care claims and fraud case datasets to identify and prevent instances of fraud, waste and abuse for payers. The solution delivers broad detection capabilities including rules, flags, predictive modeling, text mining and social network analysis to identify possible instances of provider and consumer fraud, including multi-party fraud schemes and organized crime.
This solution has a proven track record of detecting improper payments early and stopping them before they negatively impact the health care system, said Julie Malida, principal for Health Care Fraud Solutions, SAS. Together, SAS and Optum are uniquely positioned to help the industry address the growing issue of health care fraud, waste and abuse, which shows no signs of abating without intervention.
Health care payers that adopt an enterprise approach to fraud prevention help their organizations realize immediate operational cost recovery, and enable greater savings over time, said Christina Lucero, principal research analyst for commercial health plans at Gartner, Inc. Partnerships that integrate both health care experience and new technologies provide the greatest opportunity for change in the way we traditionally address fraud and abuse, enabling focus on prevention vs. pay-and-chase methods.
Specific benefits of this solution include:
About Optum Optum (www.optum.com) is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum comprises three companies OptumHealth, OptumInsight and OptumRx representing over 35,000 employees worldwide who collaborate to deliver integrated, intelligent solutions that work to modernize the health system and improve overall population health.
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Optum and SAS Align to Help Prevent Health Care Fraud, Waste and Abuse
CALGARY, ALBERTA--(Marketwire - Dec 10, 2012) - The Canadian health care system was facing a $537.7 billion shortfall at the end of 2010, an amount equal to more than $32,000 for each Canadian taxpayer, calculates a new report from the Fraser Institute, Canada''s leading public policy think-tank.
"The reality of this large and growing unfunded liability is that young Canadians will likely be hit with a significantly larger tax bill in the future to pay for health care," said Nadeem Esmail, Fraser Institute senior fellow and co-author of the report, The Unfunded Liability of Canada''s Health Care System.
"In the absence of reform, governments will be forced to choose between further eroding non-health care government services, further reducing available medical services, dramatically increasing taxes, or some combination."
An unfunded liability occurs when a program has a shortfall between the expected future stream of funding and its future obligations. The Unfunded Liability of Canada''s Health Care System is based on an actuarial valuation of the Canadian health care system that examined the program''s ability to finance promised benefits given contribution rates and expected changes in demographics.
The report calculates that Medicare''s unfunded liability increased by 2.1 per cent to $537.7 billion in 2010 from $526.7 billion in 2006. That''s the equivalent of $32,834 for every Canadian taxpayer or $15,756 for every Canadian citizen.
Most Canadians think of Medicare as an insurance plan where individuals contribute to a pool of funds when they are healthy and younger, and receive benefits from that pool in later years or in times of need. But the reality is that Medicare is funded on a "pay-as-you-go" basis; that is, rather than accumulate funds in individual or even collective accounts for future payment, current contributions (taxes) are used to pay the benefits of current recipients.
"Governments at both the provincial and federal level pay for Medicare out of general revenue and neither level of government has assets or reserve funding to pay for promised future benefits," Esmail said.
The root of the funding problem facing Canada''s health care system can be found in the country''s changing demographics. The report notes that when Medicare was established, it was based on the assumption that demographics prevalent in the 1960s would persist. These assumptions have proven false. Birth rates have declined and people are living longer.
According to Statistics Canada data, the proportion of the Canadian population under 20 years of age in 1956 was 39.7 per cent, while the proportion of those 65 years old and over was 7.7 per cent. By 2010, the ratio of those under 20 years old had decreased to 23.0 per cent of the total population, and the ratio of those over 65 had increased to 14.1 per cent. Future estimates of these ratios predict that those under 20 will account for 21.1 per cent of Canada''s total population by 2061, while those 65 years and over will account for 25.4 per cent.
"These demographic shifts have created a situation where the tax rates set by governments today will no longer be sufficient to pay for the health care needs of Canadians in the future," Esmail said.
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SALT LAKE CITY--(BUSINESS WIRE)--
Health care consumers considering a physician at University of Utah Health Care now have an additional tool online access to the systems patient satisfaction scores and comments. The rankings are based on more than 40,000 patient surveys and evaluate physicians on nine questions.
Its clear patients and consumers making health care decisions want online access to trusted reviews from their peers. The ratings give visitors a powerful tool to make informed decisions about our physicians and providers, says Thomas Miller, M.D., chief medical officer for University of Utah Health Care.
The rankings use a five-star system similar to most consumer rating sites such as Yelp, Angies List, and HealthGrades. The number of stars a physician receives per question is calculated using the mean score provided on the survey. Currently, the systems lowest physician ranking is 3.9 out of 5 stars with the next lowest at 4.2. The systems overall physician satisfaction ranking is 4.7.
Comments are reviewed before being posted and only edited to remove information that might identify a patient or be considered libelous or slanderous. The majority of our patients are very generous with their comments, clearly articulating the value we provide. We understand transparency is the expectation for online rankings, and critical comments are not edited or removed, says Miller. He notes that 99.5 percent of all physician comments received so far have been posted unedited.
The health systems patient satisfaction survey is administered by Press Ganey, an Indiana-based company that provides research and business consulting for more than 50 percent of the hospitals in the United States. The survey includes nine questions that ask patients to rate their physicians on the following factors:
Miller says the idea of posting the data came after evaluating physician reviews on independent Web sites. Many of these sites typically provide a small number of unverified, occasionally slanderous, patient reviews.We recognized we were collecting hundreds of reviews each year for each of our 1,200 physicians, but only sharing the information internally. Most physician review sites have fewer than a dozen reviews. It made sense to make our data publicly available, he says.
Brian Gresh, senior director of interactive marketing and web, and Chrissy Daniels, director of strategic initiatives, worked closely with Miller to make the case to the Universitys clinical faculty to make the information publicly available online. It took some convincing, but when you look at the trends across service industries, its clear that patients wantand more importantly expectaccess to data. Health care has lagged as an industry in its efforts at transparency, and this is an important first step in delivering actionable data to our customers, says Gresh.
Both Gresh and Daniels point to research that shows more than 70 percent of consumers trust web reviews as much as personal recommendations from friends and family, but only if there are multiple reviews and only if the reviews are believed to be authentic. They also cite the growing number of consumers who say theyve used social media to access consumer reviews of physicians and treatments.
Daniels says new physicians wont have patient satisfaction scores posted until after six months of employment, and a provider must have a minimum of 30 surveys to be posted. Its important to remember what makes this information valuable to the consumer is the authenticity and volume of reviews. We think its important that our providers have enough surveys returned to make the information meaningful, she says.
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The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion. It starts at $63 per person and then declines.
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Health care overhaul includes $63 fee to cover pre-existing conditions
Education is not an industrial process; it is a human one.
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CINCINNATI, Dec. 10, 2012 /PRNewswire/ -- HORAN, a leading advisor in employee benefits and financial services, announces national health care costs continue to increase for both plan sponsors and their employees, according the 2012 Health Plan Survey conducted by its national partner, United Benefit Advisors (UBA), the nation's largest independent benefits advisory organization.
The 2012 UBA Health Plan Survey provides the best source of data for area employers to benchmark their health plan based upon plan type, region, state, number of employees and industry category.
As the only UBA firm in our region, HORAN has exclusive access to the survey data and can provide employers with a free, local benefits benchmarking report allowing access to more granular and accurate data.
"As health care plan offerings and the federal regulatory environment become more complex, benchmarking data such as the 2012 UBA Health Plan Survey have become increasingly critical for employers looking to manage their health care benefit programs effectively," says Valerie Bogdan-Powers, HORAN Vice President of Group Operations. "Providing an attractive, competitive and cost-effective health plan is critically important to local employers. In order to provide such a plan, understanding how your health plan compares to other like companies is crucial."
One noticeable trend from this year's survey is a decline in the percentage of plans offered for consumer driven health plans (CDHPs) in the United States for the first time since 2007. CDHPs growth stagnation is a critical pattern businesses should consider when making health plan purchasing decisions.
Other notable trends include:
With responses from 17,905 health plans sponsored by 11,711 employers nationwide, the 2012 UBA Health Plan Survey is the nation's largest and most comprehensive survey of plan design and plan cost benchmarks.
This unparalleled number of reported plans studied is 2.9 times larger than the next two of the nation's largest health plan benchmarking surveys combined. The resulting volume of data provides employers of all sizes (other surveys primarily target large employers) more detailed and therefore more meaningful benchmarks and trends than any other source to manage health care benefit programs.
"The intent of the survey is to provide employers of all sizes with the data they need to determine which types of plans are most popular in their area and those being phased out, average employee costs and participation, how their plans compare against competitors' plans, relevant information to negotiate their rates and communicate plan advantages to their employees," said Bogdan-Powers.
HORAN has a multi-disciplinary team dedicated to advising employers on all aspects of health benefits. The 2012 UBA Health Plan Survey as well as additional publications, compliance alerts, webinars and seminars will continue to be provided to give further guidance to clients as a part of HORAN's commitment to educate on best practice benefits strategies to support business objectives.
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HORAN Introduces Data from Nation's Largest Health Plan Survey
CAMBRIDGE, Mass. & ORLANDO, Fla.--(BUSINESS WIRE)--
The Institute for Healthcare Improvement (IHI), a leading innovator in health and health care improvement worldwide, kicked off its 24th Annual National Forum on Quality Improvement in Health Care in Orlando, FL this weekend. From December 9-12, 2012, IHI is convening more than 5,500 health care professionals from 49 different countries, with the goal of sparking defining conversations and new thinking and ideas that will accelerate the improvement of health and health care worldwide.
At the Forum, IHI will reveal the results of a new survey exploring student perceptions around the importance of quality improvement and patient safety training, whether available courses meet expectations, and what students worry about most as they anticipate entering the workforce. In addition, IHI will release a 14-page action brief for health care leaders, outlining nine crucial elements for bridging the gap between the care we have and the care we need, and featuring predictions and insights from some of the nations foremost quality improvement and policy experts.
A Defining Moment in Health Care
In the wake of both the United States presidential election and the Supreme Court decision upholding the Affordable Care Act, IHIs Forum takes place at a defining moment in health care. As Senator William Frist stated at an IHI event just two days following the election, in health care, things have radically changed in the last 48 hours. Forum participants will gather together this week to take stock of where we are, share insights on where rich opportunities lie and learn from each other at more than 140 workshops and presentations.
Issues to be addressed at the Forum include IHIs approach to reducing avoidable reshospitalizations; creating high reliability organizations; integrating palliative care in the ED; implementing accountable care organizations (ACOs); person-centered IT; and how payers can drive quality in large health systems. Sessions will also spotlight recent developments related to Project JOINTS, as well as The Conversation Project and IHIs Conversation Ready initiative.
Global Perspectives
A wide spectrum of perspectives will be represented at the Forum, including those of practicing physicians, nurses, quality leaders, health care administrators, executives, patient and family advocates, and a growing number of students training to be health professionals. Keynote and featured presenters include:
Event Details
Sunday, December 9 Wednesday, December 12, 2012 Orlando World Center Marriott Resort & Convention Center The plenary events and keynote addresses take place on December 11th and 12th. (For additional information, please visit http://www.IHI.org/Forum.)
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The patient on the bed was just a mannequin.
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Personalised medicine for all could be a possibility in the "very near future" as everybody will soon be able to have their entire DNA make-up mapped for as little as £100, a leading professor said.
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Everybody's DNA could be on genetic map in 'very near future'
By Caroline Arbanas - Our bodies contain far more microbial genes than human genes.
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Chris White Interview : Zeitgeist Ancient Aliens
Chris White, prolific producer of countless painstakingly-researched "debunkumentaries", joins me to discuss his work on #39;Zeitgeist : The Movie #39;, the teachings of David Icke, The History Channel #39;s #39;Ancient Aliens #39; series, and his documentary #39;The New Age Its Relationship to the Antichrist. #39; ...is Jesus a myth? ... are we all the products of extra-terrestrial genetic engineering? Chris White explains. Source: themindrenewed.com Interview Notes: themindrenewed.com Podcast music: Antony Raijekov #39;s #39;Jazz U #39; freemusicarchive.org (CC BY-NC 2.5) creativecommons.orgFrom:TheMindRenewedDotComViews:15 0ratingsTime:01:13:36More inEducation
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A 7-year-old pixie named Emily Whitehead has erased any remaining doubts about the power of a University of Pennsylvania gene therapy to eradicate certain blood cancers.
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Dr. Stephan Grupp, of The Children's Hospital of Philadelphia examines first pediatric patient Emma Whitehead six months after T cell therapy. (Courtesy The Children's Hospital of Philadelphia)
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A 7-year-old pixie named Emily Whitehead has erased any remaining doubts about the power of a University of Pennsylvania gene therapy to eradicate certain blood cancers.
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University of Pennsylvania gene therapy shows promise in eradicating some blood cancers
Everything Turns Everything Resolves by Hans Richter 1929 Free Music by Twin Realities Dreamers
Hans Richter (April 6, 1888 -- February 1, 1976) was a painter, graphic artist, avant-gardist, film-experimenter and producer. He was born in Berlin into a well-to-do family and died in Minusio, near Locarno, Switzerland. Germany Richter #39;s first contacts with modern art were in 1912 through the "Blaue Reiter" and in 1913 through the "Erster Deutsche Herbstsalon" gallery "Der Sturm", in Berlin. In 1914 he was influenced by cubism. He contributed to the periodical Die Aktion in Berlin. His first exhibition was in Munich in 1916, and Die Aktion published as a special edition about him. In the same year he was wounded and discharged from the army and went to Zrich and joined the Dada movement. Richter believed that the artist #39;s duty was to be actively political, opposing war and supporting the revolution. His first abstract works were made in 1917. In 1918, he befriended Viking Eggeling, and the two experimented together with film. Richter was co-founder, in 1919, of the Association of Revolutionary Artists ("Artistes Radicaux") at Zrich. In the same year he created his first Prlude (an orchestration of a theme developed in eleven drawings). In 1920 he was a member of the November group in Berlin and contributed to the Dutch periodical De Stijl. Throughout his career, he claimed that his 1921 film, Rhythmus 21, was the first abstract film ever created. This claim is not true: he was preceded by the Italian Futurists Bruno Corra and Arnaldo Ginna between 1911 and 1912 (as ...From:UKMPTVViews:1 0ratingsTime:03:27More inFilm Animation
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Maria Entraigues - Extreme Futurist Festival 2012
Promo video of the Extreme Futurist Fest 2012 where I #39;ve been invited to give a talk at and featured in the video. It is a very promising conference! And it starts the 21st of December, 2012, the end of the Mayan calendar! Lots of expectations about this day.. Some say the world ends, some say a new era starts, I predict things will only get better, at least I always like to think like that, I love the past, I love the present and can #39;t wait for the future!! See you around! Stay tuned for more SHTUFF to be uploaded into my channel ;)From:maria entraiguesViews:0 0ratingsTime:01:20More inMusic
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What makes us successful: Futurist Speaker Gerd Leonhard at TEDxCollegeBeauSoleil
Published by TedX BeauSoleil on Dec 6, 2012 see http://www.youtube.com THANKS to making this video available to me Gerd is a Futurist and the CEO of The Futures Agency, author of 5 books, former musician and a globe-trotting keynote speaker on the creative industries, media and communications, social technologies, as well as on energy, the environment and green business. Gerd is currently focussing on sustainable future scenarios and what has been called #39;sustainable economics #39;, including the idea of adapting Internet and networked-society principles to the world #39;s urgent climate and environment issues. He is based in Basel / Switzerland; his new book #39;From Ego to Eco #39; will be published in 2013. Please note: You can now download most of my videos by simply subscribing to this iTunes video feed (via Blip.tv) gerd.fm *** audio-only versions are now available here: gerd.fm or on the web at http://www.futuretalks.com My vimeo channel is here vimeo.com Enjoy! Gerd Leonhard Futurist, Author and Keynote Speaker Basel / Switzerland http://www.gerdfuturist.com CEO http://www.thefuturesagency.com Media Blog http://www.mediafuturist.com Gerd #39;s mobile apps: road.ie The Future of Business blog http://www.futureof.biz Public Speaking schedule: gerd.fm Twitter: http://www.twitter.com Need even more links? about.meFrom:Gerd LeonhardViews:0 0ratingsTime:13:05More inPeople Blogs
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What makes us successful: Futurist Speaker Gerd Leonhard at TEDxCollegeBeauSoleil - Video
The InfoSpace founder and futurist reflects on the most damaging decision he made in his career.
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Our critic salutes Oscar Niemeyer, the visionary Brazilian architect who died last week, aged 104 Oscar Niemeyer was brilliant, energetic, ruthless, by all accounts charming – and extraordinarily long-lived. He died last week aged 104 , a bridge across time to the now-historic modern movement in architecture. He was the master of the curve, the architect who could command tonnes of concrete and ...
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