PA Safety Net Admin, Author at Safety-Net Association of Pennsylvania

Insurance Expansion Won’t Hurt Access to Primary Care, Study Finds

Fears that significant increases in the numbers of Americans with health insurance as a result of Affordable Care Act policies would overwhelm the health care system and lead to access to care problems are unfounded, according to a new Commonwealth Fund report.
According to the new report “How Will the Affordable Care Act Affect the Use of Health Care Services?”, the country’s current supply of primary care providers is more than adequate to meet any demand for primary care services. The study found that

… primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally.

The study concludes that

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold.

While the study’s findings appear encouraging, its methodology involved examining the supply of physicians and the expected increase in the demand for care only on a state-by-state basis and did not attempt to differentiate supply and demand in individual areas within states. Consequently, it did not specifically evaluate the prospects for access to care in medically underserved parts of Pennsylvania, including communities served by the state’s private safety-net hospitals. Such places have long had difficulty attracting primary care physicians (and specialists) because large numbers of their residents are uninsured or insured by Medicaid, which pays physicians poorly for their services, thereby discouraging doctors from establishing practices in such communities.
For a closer look at the study’s methodology and findings, see the research brief here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2015-03-02T06:00:34+00:00March 2nd, 2015|Uncategorized|Comments Off

States Seek to Reduce ER Use Among Medicaid Patients

Even though the rate at which non-Medicaid recipients inappropriately use hospital emergency rooms exceeds the rate of inappropriate use among Medicaid patients, a number of states are launching efforts to reduce ER overuse among their Medicaid recipients.
Medicaid patients currently use – as distinguished from inappropriately use – hospital ERs at twice the rate of privately insured patients, typically for a number of reasons: they are less healthy than insured patients; they have a more difficult time finding primary care physicians who will treat them; and they have jobs that prevent them from going to doctors during ordinary office hours.
To address overuse, states are trying a number of approaches. Nearly half of the states are imposing or increasing Medicaid co-pays for ER visits. Some are identifying Medicaid patients among their frequent ER users and making primary care appointments for them before they leave the ER. Some Medicaid managed care plans are doing the same, analyzing ER data among their users and making an extra effort to connect them to primary care physicians.
Some of these approaches are showing promise. When Washington state ER personnel started setting up appointments with primary care patients for Medicaid-insured ER visits, ER use among Medicaid patients fell 9.9 percent in the first year. When a Medicaid managed care plan in St. Louis tried a similar approach, ER use among its members declined 9.5 percent.
To learn more about what states and insurers are doing to reduce ER use among Medicaid patients, see this Stateline report.

PA Safety Net Admin2015-02-27T06:00:17+00:00February 27th, 2015|Pennsylvania Medicaid policy|Comments Off

Administration Blocks No-Hospitals Insurance Plans

Health insurance plans that do not include hospital benefits fail to meet employers’ obligations under the Affordable Care Act and will leave companies that provide such insurance vulnerable to fines of $3000 a year for every worker covered by such a plan, the Centers for Medicare & Medicaid Services (CMS) announced last week.
But in recognition that some employers had arranged such coverage well in advance, the federal government is permitting companies that committed to such plans by November 4 to use them for the next year, after which they must be replaced. In addition, employees who seek to compensate for that shortcoming in their coverage by purchasing supplemental insurance will be eligible for tax credits based on their income.
Such plans have been favored by many companies that employ large numbers of low-wage workers.
In a regulation issued last week, CMS wrote about health insurance without hospital benefits that

A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose of the MV [minimum value] requirement to ensure that an employer-sponsored plan, while not required to cover all EHB [essential health benefits], nonetheless must offer coverage with minimum value at least roughly comparable to that of a bronze plan offered on an Exchange.

For a closer look at the new regulation, why it was issued, and what it means for employers and their workers, see this Kaiser Health News article. Find the regulation announcing the policy here.

PA Safety Net Admin2015-02-26T06:00:21+00:00February 26th, 2015|Affordable Care Act|Comments Off

472,000 Pennsylvanians Sign Up for Insurance

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.

PA Safety Net Admin2015-02-23T06:00:16+00:00February 23rd, 2015|Affordable Care Act|Comments Off

“Super-Utilizers” Costing PA Millions, Report Shows

“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.

PA Safety Net Admin2015-02-20T11:06:56+00:00February 20th, 2015|Uncategorized|Comments Off

New Web Site for PA Medicaid Expansion

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.

PA Safety Net Admin2015-02-18T14:40:15+00:00February 18th, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

SNAP Looks to the Future

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.

PA Safety Net Admin2015-02-12T10:43:14+00:00February 12th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Wolf Administration to Shift Gears on Medicaid Expansion

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.

PA Safety Net Admin2015-02-10T06:00:13+00:00February 10th, 2015|Pennsylvania Medicaid policy|Comments Off

More That 400,000 Sign Up For Health Insurance in PA

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.

PA Safety Net Admin2015-02-09T06:00:51+00:00February 9th, 2015|Affordable Care Act, Health care reform|Comments Off

New Pennsylvania Health Law Project Newsletter

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.

PA Safety Net Admin2015-02-04T06:00:34+00:00February 4th, 2015|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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