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Here's where you can find out about what CHS is up to, what's coming in the future and events. Keep up to date with CHS happenings and find out what's on our calendar.

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CMS ANNOUNCES QUALITY MEASUREMENTS FOR INSURERS

By: Nicola Heredia, CHS Marketing Coordinator

Earlier this month, the Centers for Medicare and Medicaid Services and America’s Health Insurance Plans released seven sets of clinical quality measurements that will be utilized by insurers to help measure the quality of care patients are receiving. The new set of measurements is the industry’s first attempt to create a standard to measure patient care by in an effort to prepare for value-base reimbursement plans.

"In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality," said CMS Acting Administrator Andy Slavitt in a news release. "This agreement today will reduce unnecessary burdens for physicians and accelerate the country's movement to better quality."

The lack of standards within the healthcare system has created a complex situation where providers are unaware of how they are being judged. In addition, patients and insurance consumers cannot compare one plan to another if each one uses a different set of measurements to judge quality of care.

Core Quality Measures Collaborative is the group that was created and tasked with developing a set of quality measurements that can be implemented by insurance providers. The collaborative was comprised of members from the CMS, AHIP, American Academy of Family Physicians and the National Partnership for Women and Families.

​"Our health care system urgently needs measurements that drive improvements in quality, supports information, consumers' decision-making and ensures we're paying for and incentivizing high-value care," said Debra Ness, National Partnership for Women & Families president, in a press release. "What we released today is a start at achieving a consensus on the best measures, but we need to continue pushing for even better ones."​

The push towards standardizing quality of care measurements will not only help insurers, especially those moving toward value-base plans, but it will also allow physicians to understand how they are being evaluated.

Instead of standard practice, procedures and documentation in order to satisfy one insurance plan's requirements over another, physicians can now be judged by a set of standards that all payers will eventually utilize.

​"The AAFP is well aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care," said Academy CEO and EVP Douglas Henley, M.D. in an AAFP article. "A major part of this is the burden of multiple performance measure in quality improvement programs with no standardization or harmonization across payers."

The collaborative team identified seven different fields that received their own separate set of quality measurements to promote alignment throughout individual specialties. The fields are accountable care organizations, patient-centered medical homes and primary care, cardiology, gastroenterology, HIV and hepatitis C, medical oncology, obstetrics and gynecology, and orthopedics. Pediatrics will be another set of measurements added at a later time.

The publication of these standards will also affect the public. The standards will make it easier to compare insurance plans, physicians and hospitals.

Jessica Greene, a professor at George Washington University, reports that research shows consumers have not yet begun to dig into and rely on data that reports on doctors and hospitals performance as expected. This may be due in part to the complexity and variety of data reported since there has been no consistency in the past, making it difficult to compare.

"So far, however, consumers have rarely done so, in part because the measures are typically complex and described technically," said Greene, in a Modern Healthcare article. "With one set of quality measures, we can conduct research to identify effective ways to describing the measures so that consumers understand and value them."​

The set of standards, which were officially released this month, will be a rolling change throughout the industry. Private insurers will include the measurements in future contracts. As more plans shift to value-based coverage, the quality standards will be essential to judge providers level of care.

ENROLLMENT IN HMO PLANS ARE ON THE RISE

By: Nicola Heredia, CHS Marketing Coordinator

In a time when individuals are becoming increasingly cost conscious, enrollment reports suggest that there is a rising trend towards health maintenance organization, or HMOs. Although insurers and employers had shifted away from these types of plans in the past, price-driven consumers have recently showed interest in these plans through the exchanges and private insurance.

Traditionally thought to provide low quality of care, HMOs developed a somewhat negative stigma that made employers shy away from offering this type of coverage. Insurers have essentially been rebranded as a plan that provides a narrow network in an effort to contain costs.

“What’s interesting to me is the new types of health systems and plans that are being rolled out are seemingly nothing more than H.M.O.s on steroids,” said Larry Boress, the chief executive of the Midwest Business Group on Health, in a New York Times’ article. “We’re clearly seeing an interest among employers.”

The McKinsey Center for U.S. Health System Reform reported that 43 percent of mid-level plans on the exchanges as essentially a type of HMO coverage. Although insurance companies may not be directly categorizing the plans as such, the core details of the coverage are similar.

In the past, HMOs have essentially placed restriction on what doctors their consumers can see and still receive insurance coverage. Although the plans were not expensive up front, individuals had high deductibles and seeing physicians outside their network would result in hefty bills.

“A lot of employers don’t feel comfortable limiting their employees’ options,” said Paula Wade, an analyst at Decision Resources Group, in a New York Times’ article. “They’re going to be very reluctant to put them in a network that seems to be too limited or limited in the wrong ways.”

Insurance companies are noticing that consumers are more price conscious than ever, especially as medical costs continue to rise. In an effort to provide affordable coverage options, insurers have revamped the HMO system aiming at maintaining a high level of care, while still keep costs down.

“It’s not as hard to get referrals like it use to be,” said Jack Hooper, CEO of Take Command Health, in TheStreet article. “Older generations have scary stories about HMOs, and they are much more set on wanting to see doctor so-and-so that they’ve been seeing for 30 years. For emergencies, you can go anywhere.”

Late last year, Blue Cross Blue Shield of Illinois announced a partnership with Advocate Health Care to offer an HMO plan that would feature Advocate physicians and specialists. The plan was a less expensive option than others offered, and was well received by customers. In fact, approximately 60,000 enrolled in the plan last fall.

Instead of making individuals feel like they are unable to select their physician, Blue Cross Blue Shield of Illinois has created an extensive network of doctors to choose from, while still containing the choices. This shift toward narrowing networks has been a trend among insurance offered throughout the exchanges in an effort to lower costs.

Some experts believe that Millennials shopping on the exchanges have been the driving force behind the reprise of HMOs. Often healthy in nature, these individuals are looking to enroll in a lower cost plan without any concern for networks and additional coverage.

“Younger people who are healthy and rarely see the doctor may find plans with lower premiums and high deductibles a good option – so long as they can afford the full deductible in case of an emergency,” said Nate Purpura, vice president of consumer affairs at eHealth.com.

Although HMOs may be picking up steam in popularity, they still have a long way to go in order to overcome the stigma put in place in 1990s. Employers and some individuals are still reluctant to commit to these plans in case the level of care is poor. The revamped style of HMOs may be the way to go in order to attract more Americans moving forward.

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