How Obamacare will effect this year's Medicare Enrollment Period

How to judge Medicare plans

While much of the nation is preoccupied with Obamacare and picking new health insurance at work, older Americans have deadlines of their own coming up — involving Medicare.

We're just a few days away from the two-month period when the nation's 54 million Medicare beneficiaries have a chance to change their Medicare Advantage and prescription drug plans.

Every year, seniors should review their options and compare plans even if they're happy with their current coverage. Experts want people to avoid being surprised after it's too late to change. The deadline is Dec. 7.

The process of shopping can be daunting, and many seniors simply don't heed the advice.

"It's the same advice we give every year, but it's hard to get people off the dime," says Ross Blair, senior vice president of eHealthMedicare.com, which provides tools and information on Medicare insurance issues.

Medicare Advantage plans. Nearly 16 million people — or about 30% of the Medicare population — are enrolled in Medicare Advantage plans. These cover hospitalization, outpatient care and, often, prescription-drug coverage under one plan.

According to the Centers for Medicare and Medicaid Services, the average premium for Medicare Advantage plans will increase less than $3 next year, to $33.90 per month. Residents of Los Angeles County will see average costs of just $13.74 per month. The vast majority of enrollees will face little or no premium increase for next year.

 But out-of-pocket costs, such as deductibles and co-pays, are expected to rise. Looking beyond the monthly premium will be important for shoppers wanting to save money.

Be aware that some Advantage plans will be terminated this year. Be certain yours will continue;

Pay attention to networks, experts stress. Medicare Advantage plans are also reducing the size of their provider networks — in some cases quite dramatically.

If your physician will no longer be participating in your current plan, your insurer is required to send you notice of that fact and help you find another doctor in the network.

Nationwide, the average monthly premium in 2015 will be about $31, the federal government estimates. In California the figures vary, but the average is $58.91.

Although the number of these plans has dropped for 2015, there will still be 1,000 available nationwide. In Los Angeles County, Medicare participants will have 31 plans from which to choose for 2015, down from 34 this year.

As with Medicare Advantage plans, insurers are shifting more costs onto beneficiaries in the form of higher out-of-pocket costs, such as deductibles, co-pays and co-insurance, so you need to look beyond premiums.

Also, many plans have "preferred" status pharmacies, whose costs can be lower than other in-network pharmacies, says Elaine Wong Eakin, executive director of the Medicare advocacy organization California Health Advocates. In fact, 70% of Medicare drug plans had preferred pharmacy networks this year, and the expectation is there will be more in 2015.

Also, pay attention to the ratings. To help consumers determine the value of both Medicare Advantage and prescription drug plans, Medicare created a quality rating system. A plan can receive one to five stars, with five being the best, based on the agency's assessment of medical services and customer satisfaction.

Experts urge consumers to be alert for possible changes since last year's Medicare Advantage and prescription plans.

To review your plan options: Medicare plan finder at http://www.medicare.govor call (800) MEDICARE; eHealthMedicare.com.

For free personalized counseling services: State Health Insurance Assistance Programs, shipnpr.shiptalk.org or call (800) 677-1116; In Los Angeles, California Health Advocates: http://www.cahealthadvocates.org/HICAP

NY Times Article

Venture capital in healthcare is flowing, but how long will it last?

Despite the lingering slow recovery of the economy one sector that is booming is in health care financing and funding of health information technology, ranging from electronic data storage, evolutionary development of current technology which includes, EHR HIX, telehealth, health information exchanges, and mobile health apps. 

Much of the financing of these are not through conventional funding, but depends upon venture capital and startups from young entrepeneurs just entering the work-force.  Some are triggered by well funded, successful companies such as Google, Microsoft, and Apple.  Apple and Google have recently entered the health space in a more visible manner. Both Apple and Google have already developed many moble health apps,  now both companies are launching a more visible presence as Google Health, and Apple's Healthkit.With so much venture capital being foisted onto the digital health space, it’s beginning to beg the question: how long will this last, can it sustain itself, and what’s an entrepreneur to do? And, what are the implications for emerging companies versus traditional healthcare companies and systems?

Those were just a few of the burning questions discussed at Health 2.0‘s Pre, Post, M&A IPO panel held in Santa Clara.

"In the current landscape, larger-than-average sums of seed and early series funding is available to startups across a wide spectrum within the healthcare space. While that may seem like an obvious benefit, entrepreneurs need to be mindful of what’s reasonable and what’s actually needed, so as not to over-promise with a big initial raise and under deliver with a sub-par series b or c.

“You need to be careful to not overreach on your first round,” said Johh de Souza of MedHelp. “It can be very hard then on the second round. It matters on who the investor is, too.”

Frank Williams, of Evolent, agreed: “ You can overreach and then under deliver, and that creates a lot of issues.”

Sage advice, to be sure, but the entrepreneur should also capitalize on the current market conditions, and shouldn’t necessarily be faulted for the seeming glut of capital being heaped upon healthcare startups, Glen Tullman of 7wire Ventures cordially countered.

“I don’t think you can blame, nor should the entrepreneur be conservative, in terms of how big the raise is,” he said. “It doesn’t matter what you raised at a valuation – either you’re performing or you’re not.”

The venture capital funds are increasingly shifting away from life sciences and biotech and toward the digital health realm, with investors realizing that much less capital is needed to get off the ground for the latter while a return is still enticing, said Milena Adamain of Azimuth Partners.

To that end, on the M&A side, much of it’s a seller’s market, certainly as it relates to digital health, Williams said.

“It’s really hard to buy thinks now,” he said. “Everything is really expensive because of the competition.”

But the overall M&A landscape of healthcare in general will continue to be much more varied, with a good deal of late-comers merging as a means of survival. Yet at the same time, the different types of buyers, including nontraditional players like big consumer companies, bodes well for activity.

“As far as M&A, it looks incredibly attractive because of a broad base of buyers that you’ve never had,” Adamain said.

On the IPO side, everyone still looks to Castlight as what might be, but it’s still too soon to say whether long-term stability can be achieved, the panel said. Although at the moment, being a billion dollar company certainly appears to be working in Castlight’s favor.

“I would say the jury is still out,” Williams said. “Right now it’s a massive success. The question is do they continue to grow.”

So what does that mean for companies pondering the IPO? It’s hard to say exactly, but Tullman, of 7wire Ventures, said one gauge is to see how feasible it is for investors to sell within a year and what sort of return they can get.

All told, while it’s speculative to insist a bubble will burst around the available capital for digital health, and tech in general, the healthcare space is likely big enough to sustain a significant share of investor interest."

“Everyone is looking at something that is a fifth of the economy and so there’s a lot of strategic thinking to get a piece of that,” Williams said.

attributions:  Medcity News, Dan Verel, Marc O'Connor

The Affordable Care Act and the Internal Revenue Service

Part I

In October 2013 enrolllment  for the Affordable Care Act became available.  It's introduction and enrollment were plagued with unanticipated challenges.

It is one year post-enrollment apocalypse. Some are happy, some are not happy, all are confused. Despite problems, and delays almost 7 million people have enrolled.  How many are still enrolled and how many have actually seen a doctor are still unanswered questions.

In addition to the delays the Los Angeles Times reports that 30,000 ACA enrollees from Octobr 2013 were never enrolled or had eligibility issues undetetced at the time of enrollment.

California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.

Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage.

Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said.

C alifornia's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall.

Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage.

Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said.

At a time when many taxpayers have lost faith in the IRS' ethics do we let the IRS be involved in our health care?

An unlikely partnership, will it work, and do we have a choice?

In transition

Todd Park, the former CTO in the Obama administration has been replaced by Megan Smith, following his resignation several months ago.  Todd, during the rapid growth of HIT including Health Information Exchanges, and in conjunction with the Office of the National Coordinator of HIT (ONCHIT) was responsible for the successful role out of Health Information Exchanges, and later with the challenge of implementing Health.gov .

Megan Smith Named CTO of the United States!

Today +Megan Smith (formerly VP at Google[x]) joins President +Barack Obama as the Chief Technology Officer of the United States of America. Megan co-founded Women Techmakers in 2012 with +Stephanie Liu, and seeing the potential for building on the movement to empower women in technology, Megan and I created my current role as Google's Women in Technology Advocate. Megan has been an advisor to Women Techmakers despite her busy schedule advocating for women and children globally, and I'm honored to have worked side-by-side with her to enact change. I'm proud of my friend and mentor, and look forward to seeing the impact she'll make in her new role.

More from +Barack Obama and the White House blog http://goo.gl/xqbs10.

Covered California Executive Director Gets $52K Bonus for Role in Exchange Launch

Tuesday, August 26, 2014

RELATED TOPICS:

• Covered California

Covered California has announced it will give Executive Director Peter Lee a one-time,  $52,528 bonus related to the launch of the state's health insurance exchange. Anne Gonzales, a spokesperson for the exchange, said that an estimated 1.2 million state residents enrolled in coverage through the exchange during its first open enrollment period.

• "Covered California's Peter Lee Nets Bonus, Obamacare Site Nets 1.2 Million Enrollees" (Rauber, 

Comments:

DISGUSTING.

$52,528 for his role in launching the Golden State's exchange? That's tax payer money, folks, and, you know what, I would have thought that the roll-out of the exchange would be part of the job description of the director, and his annual salary would cover that. Furthermore, the roll-out wasn't without its problems, though not as bad as the federal exchange. Just imagine, if it had been that bad, Mr. Lee might have had to be content with just his meager $262,644 pay packet.

You will find additonal information about Covered California 2015 on Digital Health Space today

A Black Box for the Operating Room

Surgical 'black box' could reduce errors According to Dr. Chethan Sathya, Special to CNN ;

Airliners have them, trains have them, and now,even automobiles have them. How many 

times have we heard about the search for the black box?

It may be coming to an operating room near you.

Researchers in Canada have created a surgical "black box" that tracks surgeons' movements during an operation

  So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.  Teodor Grantcharov, a minimally invasive surgeon at St. Michael's Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters occur, the surgical black box Grantcharov is creating will be used proactively to prevent major patient complications.

 Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

Read the entire article 

A work in progress

Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating room microphones and cameras that record the surgery, the surgeon's movements and details about team dynamics.

It will allow surgeons to hone in on exactly what went wrong and why.

The black box will eventually assess everything from how surgeons stitch to how delicately they handle organs and communicate with nurses during high-stress situations. Error-analysis software within the black box will help surgeons identify when they are "deviating" from the norm or using techniques linked to higher rates of complications.

So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.

The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in the next few months. Talks are also under way with a number of American hospitals.

If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug Administration.

But the litigious medical environment may make its implementation problematic. If the recordings were used in court, they could open the floodgates to a new wave of malpractice concerns, which would be counterproductive to surgeons and patients, Grantcharov says.

"We have to ensure the black box is used as an educational tool to help surgeons evaluate their performance and improve," he says.

Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made me a safer surgeon and a better teacher."

Read the entire article 

Hidden Costs of the Affordable Care Act

HEALTHCARE.GOV COST $1.7 BILLION

"The federal government issued sixty contracts from 2009 to 2014 in efforts to build Healthcare.gov, the federal insurance marketplace. According to a report issued today by the inspector general (OIG) of the Department of Health and Human Services (HHS), the government had already paid out just under half a billion dollars by February 2014, five months after the beginning of open enrollment. The government is already under obligation for another $300 million, and the estimated value of the sixty contracts totals $1.7 billion. The OIG provided a summary of its findings:
“The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.”
A few familiar names appear on the list of contracts, such as Northrop Grumman and Lockheed Martin. Also appearing are CGI Federal, widely blamed for the botched roll out of the site last October, and Accenture Federal Services, which has taken over for CGI in hopes that this year’s open enrollment will go better than 2013.