Nearly 472,000 Pennsylvanians enrolled in health insurance during the Affordable Care Act’s open enrollment period, which ended on February 15.
Some were new enrollees and some were automatically renewed; a breakdown is not yet available.
For a closer look at Pennsylvanians obtaining health insurance during the open enrollment period and the national picture, see this Central Penn Business Journal article.
“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system millions of dollars a year.
According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to the hospital at least five times in a year – while just three percent of hospital patients in FY 2014, accounted for 17 percent of the state’s Medicaid expenditures for inpatient care ($216 million) and 14 percent of Medicare inpatient expenditures ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 were for super-utilizers.
PHC4 identified the three leading reasons for these admissions as heart failure, septicemia, and mental health disorders.
Learn more about super-utilizers and their impact on hospital admissions and health care spending in the PHC4 report, which can be found here.
Along with the Wolf administration’s decision to exit the Healthy Pennsylvania Medicaid expansion in favor of a more conventional approach comes a new web site dedicated to that expansion: HealthChoices PA.
The new HealthChoices PA site features sections that describe the program and address the immediate implications of the state’s shift from Healthy Pennsylvania to HealthChoices PA. It also offers an FAQ, resources for consumers and providers, and a gateway for applicants.
The address of the new site is http://www.healthchoicespa.com. Find it here.
With the inauguration of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The fourth of those papers, released this week, addresses the importance of innovation in addressing the challenges safety-net hospitals face in leading the way to serving Pennsylvania’s growing Medicaid population.
The paper describes the new demands being made of hospitals by insurers, government, and others; tools through which to pursue innovation; the goals of future innovation; and the role that SNAP and safety-net hospitals must play in that innovation.
The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
The second paper, “The Challenges Pennsylvania Safety-Net Hospitals Face,” describes the special role safety-net hospitals play in serving low-income and medically vulnerable Pennsylvanians and the emerging challenges they face in fulfilling this vital role.
The third paper, “Transitioning Medicaid: Principles for Changing Course on Medicaid Expansion,” presents eight principles SNAP believes state officials should follow if they choose to abandon the Healthy Pennsylvania model of Medicaid expansion in favor of a more traditional approach to expanding the state’s Medicaid expansion.
Find all four SNAP papers here.
Pennsylvania Governor Tom Wolf has taken the first step to short-circuit the state’s Healthy Pennsylvania Medicaid expansion in favor of a more traditional approach to Medicaid expansion.
In a news release issued yesterday, the Wolf administration announced that it will withdraw Pennsylvania’s request for a second tier of medical benefits for Medicaid recipients because it intends to change the state’s program to offer the same benefits to all participants.
This will be the first step toward building the state’s Affordable Care Act-authorized Medicaid expansion around the state’s HealthChoices-oriented structure instead of the private market insurance plans favored by Mr. Wolf’s predecessor, former Governor Tom Corbett.
Learn more about the new administration’s first step toward changing the state’s Medicaid expansion effort in this news release from the governor’s office.
Through early February, 430,000 Pennsylvanians have enrolled in health insurance plans through the federal health insurance marketplace.
Of that number, 81 percent qualified for at least some financial assistance with their premiums. Through December, more than two-thirds obtained insurance for no more than $100.
To learn more about how Pennsylvanians are using the federal exchange to purchase health insurance, see this Central Penn Business Journal article.
The Pennsylvania Health Law Project has released its January 2015 newsletter.
Among the articles in it are pieces on the launch of the Healthy Pennsylvania Medicaid expansion; an update on the temporary extension of the state’s Select Plan for Women; information on how Medicaid recipients who believe they need the state’s new Medicaid “Healthy Plus” benefits package can seek that enhanced coverage; and news on who should consider shifting from a health insurance plan purchased on the federal marketplace to Medicaid.
Find the newsletter here.
A flaw in the implementation of Pennsylvania’s Medicaid expansion has left many of the state’s Medicaid beneficiaries with no coverage for the treatment of their drug and alcohol problems – and some providers without payment for some care they have delivered.
Under the Healthy Pennsylvania Medicaid expansion program, beneficiaries with extensive health problems, like drug and alcohol issues, were supposed to be directed into the state’s “Healthy Plus” Medicaid benefits package, which covers services that address such problems. Instead, many were places in private, state-approved insurance plans for Medicaid beneficiaries, which do not cover those services.
State officials are aware of the problem and say they will soon have a plan to fix it.
Learn more about this glitch in Pennsylvania’s Medicaid expansion and how state officials hope to address it in this Philadelphia Inquirer article.
With a growing number of Medicare programs basing portions of future reimbursement on meeting specific performance metrics, hospitals are finding that they need a scorecard to keep track of their successes and failures.
Medicare’s value-based purchasing program, for example, is rewarding 1700 hospitals this year for their performance under the program. Another 1360 hospitals are being penalized under the program.
But among those 1700 winners, fewer than 800 will see their bonuses because their losses under Medicare’s hospital readmissions reduction program and health care-associated infection program exceed their value-based purchasing winnings.
Overall, the average bonus for large hospitals for the three programs combined is nearly $213,000 while the average penalty for such hospitals is approximately $1.2 million. For hospitals with 200 or fewer beds, the average bonus is about $32,000 and the average penalty approximately $131,000.
Pennsylvania’s hospitals were divided evenly among winners and losers: of 147 hospitals assessed as part of these programs, half received bonuses and half were penalized.
Not included in the totals are the six percent of hospitals that face new penalties for failing to make enough progress in their transition to electronic health records.
For a closer look at how hospitals are faring under Medicare’s various performance-based program, as well as how hospitals in other states fared, see this Kaiser Health News story.
With the inauguration of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The third of those four papers presents eight principles SNAP believes state officials should follow if they choose to abandon the Healthy Pennsylvania model of Medicaid expansion in favor of a more traditional approach to expanding the state’s Medicaid expansion.
Those eight principles are:
The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
The second paper, “The Challenges Pennsylvania Safety-Net Hospitals Face,” describes the special role safety-net hospitals play in serving low-income and medically vulnerable Pennsylvanians and the emerging challenges they face in fulfilling this vital role.
Find all three SNAP papers here.