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Health Management Technology News
  May 9, 2014
In this issue:

 Health Management Technology’s Resource Guide sign-up

 Fixing would be top priority, HHS nominee Sylvia Mathews Burwell says

 The 22 states that exceeded PPACA exchange enrollment expectations

 What the United State can learn from Brazil's healthcare mess looks like a bargain compared with state exchanges

 The key to surviving the new brutal world of healthcare

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Fixing would be top priority, HHS nominee Sylvia Mathews Burwell says

Sylvia Mathews Burwell emerged mostly unscathed Thursday from the first of two hearings on her nomination to head the Health and Human Services Department, even though her chief role will be to continue implementing the president’s controversial health-care law.

Burwell, whose confirmation is likely, did not get much of a grilling and even received strong vows of support from two influential Republicans: Sen. John McCain (Ariz.), who introduced her warmly to the committee, and Sen. Richard Burr (N.C.), who promised to vote to confirm her at her next hearing before the Senate Finance Committee.

But the wide-ranging hearing also touched on some of the more contentious aspects of the law that she would be mired in: the technical problems that continue to plague the federal health insurance Web site, the unfinished job of expanding Medicaid and the president’s broken promise that people who liked their old plans could keep them.

Burwell also would inherit an agency that underwent major turmoil because of the rocky rollout of the health-care law last year.

“The position for which she is currently nominated is perhaps the most thankless. That’s why I advised her against taking the leadership position at HHS,” joked McCain, who called Burwell a friend. “After all, who would recommend their friend take over as captain of the Titanic after it hit the iceberg?”

Read the full article from The Washington Post here  

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The 22 states that exceeded PPACA exchange enrollment expectations

Last week, HHS released a data brief showing the state-based and federally facilitated exchanges had enrolled just over 8 million people.

Based on that data, healthcare advisory firm Avalere Health conducted an analysis and found 44 percent of the states will have met or exceeded their enrollment expectations for the first open sign-up period under the Patient Protection and Affordable Care Act, even if not everyone who enrolled in a plan will complete the enrollment process by making the first premium payment.

Avalere's analysts assumed only 85 percent of the people who signed up for a health plan will complete the enrollment process by making the first premium payment, in line with public comments made by health insurers participating in the exchanges and America's Health Insurance Plans. That means the overall enrollment total would be around 6.8 million people, still higher than the Congressional Budget Office's estimate of 6 million. In some states, the enrollment total will be much higher than the CBO predicted.

Elizabeth Carpenter, a director in Avalere's health reform practice, says it's hard to pinpoint why the top-performing states did so well. While the performances in some states that experienced significant problems with their exchange sites (such as Hawaii, which ranked 50th and enrolled only 46 percent of the expected amount after accounting for unpaid first premiums) predictably fell short of the benchmark, the top-performing states are a mixed bag in terms of whether the exchange was run by the state or by the federal government, as well as political inclination.

Ms. Carpenter says the analysis suggests other factors such as community assistance and outreach efforts played a part in exchange success. "Unfortunately, there isn't a common thread," she says of the top states. "The message it does deliver is there was more than a website and more than politics in play when it came to exchange enrollment."

From the analysis, here are the 22 states that exceeded expectations, after factoring in the assumed 85 percent attrition rate for the exchanges.

Read the full article from Becker’s Hospital Review here  

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What the United State can learn from Brazil's healthcare mess

On a recent afternoon in Boa Vista, a lower-middle-class neighborhood of Sao Paulo, Brazil, Noranei Oliveira Miranda waited patiently on a small couch for the local community health workers to arrive.

Her aging father, Dirceu, was seated next to her, not as patiently. Trembling and non-verbal, he reared up from the couch and reached in vain for the front door. She held him down with a pillow, her strong arms forming a seatbelt across his torso.

“Sit still, dad!” she cried in Portuguese.

Dirceu was a professional driver until Alzheimer’s robbed him of his mental faculties and an HIV infection further depleted him. Now he’s delirious and desperate to get back onto the hilly, narrow streets where he made his living as a younger man. His face is riddled with wounds from falls he incurred during past escape attempts. Noranei, the youngest child, has quit her restaurant job to help take care of him.

At last, the health workers arrived, clad in matching sky-blue vests. “Look, it’s Daiana and Gabriela!” Noranei told her father.

Dirceu smiled and stopped flailing.

The two health workers are middle-aged women who live in the community. They aren’t doctors, nor do they have any medical training. But they spend their days making the rounds through the 180 or so local families that have been assigned to them, asking, essentially, “How’s life?” They make sure Dirceu feels okay on his HIV medications. They admonish kids not to drink standing water and diabetics not to eat too many cookies. If one of their charges is having a personal problem—say with domestic abuse or alcohol—they try to help. They’re armed with exercise and nutrition tips, but they don’t dispense medication.

Overall, they help ensure no one gets lost in Brazil’s enormous state-sponsored healthcare system. “I feel good because they help me,” said Maria Camargo, a wheelchair-bound 68-year-old woman, when Daiana and Gabriela dropped in for a visit. “No one forgets about me.”

Read the full article from The Atlantic here  

Return to the table of contents looks like a bargain compared with state exchanges

Sometimes there really are economies of scale. And the nation's health insurance exchanges may be a case in point.

As rocky as the rollout of was, the federal exchange was relatively efficient in signing up enrollees. Each one cost an average of $647 in federal tax dollars, an analysis finds. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.

The findings, released Wednesday, were drawn from federal enrollment and funding figures for the exchanges. The author is Jay Angoff, a former Missouri Insurance Commissioner and one-time director of the Health and Human Services office in charge of getting the health exchanges going.

Even Covered California, the most efficient of the state-run exchanges at $758 per enrollee, still spent more than the average for the federal exchange. And California was the only state-run exchange with a per-person average under $1,000.

Hawaii, with a combination of a poorly functioning website, a small population overall, and a small population of uninsured, brought up the rear in the study. It cost the Aloha State an average of $23,899 per enrollee covered. Washington, D.C., came in next to last at $12,467 per person.

Read the full article from here  

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The key to surviving the new brutal world of healthcare

Today the healthcare industry is experiencing a period of rapid change. Over the next ten years, we’re going to add more than 1 billion people on earth, and half will be over the age of 50. This, combined with other demographic shifts such as the rise in chronic diseases, is expected to drive healthcare costs to double in the next decade. This spending will put additional pressures on the healthcare industry to cut costs. Healthcare companies need to look at what it is going to take to be successful in our industry 10 years down the road and build businesses that will win in this new, brutal world.

We are already seeing willingness from the healthcare industry to break the mold and rethink the business model. Just consider the flurry of deals announced so far this year. It is estimated that global M&A across industries is at about $1.2 trillion to date in 2014, the highest level since 2007. Of these deals, based on deal value 13.5% are in the healthcare sector, and this trend does not seem to be slowing down soon. In this new M&A environment, I believe that there are three things that need to be considered.

First, companies need to focus on what they can do best. What I call “precision M&A” enables this. Precision M&A is the antithesis of mega-mergers, where you acquire some good businesses along with others that are not great fits for your company. Precision M&A means picking and choosing only those assets that would be most valuable in your hands. These types of laser targeted deals bolster areas of strength through acquisitions, while at the same time pursuing divestments of or partnerships for businesses that you cannot maximize to their fullest potential. These exchanges are very complex, and can be hard to execute, but they can be effective. At Novartis, we just executed agreements to enter into precision M&A deals through which we would strengthen our already strong pharmaceuticals business with the acquisition of oncology products from GlaxoSmithKline. At the same time, we have agreed to create a consumer healthcare joint venture with GSK, which would establish a global consumer healthcare leader and allow Novartis to keep a stake in the fast-growing self-pay segment. Additionally, we would divest Vaccines to GSK and AnimalHealth to Eli Lilly, companies that are already leaders in their respective segments. These transactions would allow Novartis to focus on its core. In terms of resource allocation, we expect to be able to feed our big growth engines a lot more than we can now with six divisions, half of them subscale.

Read the full article from Forbes here  

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