ICYMI yesterday: US health spending to top $7.2T by 2031
About health insurance/insurers
KFF Survey of Consumer Experiences with Health Insurance “Key Findings
Most insured adults give their health insurance positive ratings, though people in poorer health tend to give lower ratings. Most insured adults (81%) give their health insurance an overall rating of ‘excellent’ or ‘good,’ though ratings vary based on health status: 84% of people who describe their physical health status as at least ‘good’ rate insurance positively, compared to 68% of people in ‘fair’ or ‘poor’ health. Ratings are positive across insurance types, though higher shares of adults on Medicare rate their insurance positively (91%) and somewhat lower shares of those with Affordable Care Act (ACA) Marketplace coverage give their insurance a positive rating (73%).
Despite rating their insurance positively, most insured adults report experiencing problems using their health coverage; people in poorer health are more likely to report problems. A majority of insured adults (58%) say they have experienced a problem using their health insurance in the past 12 months – such as denied claims, provider network problems, and pre-authorization problems. Looking at responses by health status, two-thirds (67%) of adults in fair or poor health experienced problems with their insurance, compared to 56% of adults who say they are in at least ‘good’ physical health. Notably, about three in four insured adults who received mental health care in the past year, or who use a lot of health care (defined as more than ten provider visits in a year) experienced insurance problems. At least half of adults across insurance types say they experienced a problem, though the nature of problems people experienced varied somewhat more based on their type of coverage.
Nearly half of insured adults who had insurance problems were unable to satisfactorily resolve them, with some reporting serious consequences. Half of consumers with insurance problems say their problem was resolved to their satisfaction. Among the 58% of insured adults who had a problem with their insurance in the past year, about one in six (17%) say they were unable to receive recommended care as a direct result of their problems; 15% say they experienced a decline in their health and about three in ten (28%) say they paid more than they expected for care all as a direct result of their problems.
Among those with the greatest mental health needs, many adults across insurance types find their coverage lacking and report forgoing needed care. Among insured adults who report being in ‘fair’ or ‘poor’ mental health, four in ten (43%) say there was a time in the past year when they did not get mental health services or medication they thought they needed, and a similar share (45%) give their insurance a negative rating when it comes to the availability of mental health providers. One in five of this group (19%) say there was a time in the past year when a particular mental health service or treatment they needed was not covered by their plan. People with Medicare – who are less likely overall to say they are in fair or poor mental health – are also somewhat less likely than adults with other types of insurance to say a needed mental health therapist or treatment was not covered by their insurance. Adults with Marketplace and Medicaid coverage are more likely than those with employer-sponsored insurance (ESI) or Medicare to negatively rate their insurance when it comes to the availability of mental health providers.
Affordability of premiums and out-of-pocket costs are a concern, particularly for those with private health coverage, and for some, contributed to not getting care. About half of adults with Marketplace plans (55%) or ESI (46%) rate their insurance negatively when it comes to premiums, compared to 27% of people with Medicare and 10% of Medicaid enrollees. Four-in-ten insured adults say they skipped or delayed some type of care in the past year due to cost. One in six insured adults (16%), including larger shares of those at lower income levels, say they had problems paying medical bills in the past year.
Insured adults overwhelmingly support public policies to make insurance simpler to understand and to help them avoid or resolve insurance problems. About nine in ten say they support requirements on insurers to maintain accurate and up-to-date provider directories, provide simpler, easier-to read EOBs, disclose their claims denial rates to regulators and the public, and provide in advance, upon request, information about whether care is covered and their out-of-pocket cost liability. Nearly eight in ten say they would be likely to use the services of a publicly established consumer assistance program (CAP) when they encounter insurance problems. All of these public policies have already been enacted, though not all have been fully implemented or funded. The survey did not probe trade-offs that might be involved in implementing existing or future consumer protections in these areas, such as administrative costs.”
Look at the graphs as well.
At Least 1.7M Americans Use Health Sharing Arrangements, Despite Lack of Protections “Under the arrangements, members, who usually share some religious beliefs, agree to send money each month to cover other members’ health care bills. At least 11 of the sharing plans that reported data operated in or advertised plans in all 50 states in 2021.
Sharing plans do not guarantee payment for health services and are not held to the same standards and consumer protections as health insurance plans. Sharing plans are not required to cover preexisting conditions or provide the minimum health benefits mandated by the Affordable Care Act. And unlike health insurance, sharing plans can place annual or lifetime caps on payments. A single catastrophic health event can easily exceed a sharing plan’s limits.”
Comment: These plans do not meet even the most basic definition of insurance— indemnification against catastrophic loss.
About hospitals and healthcare systems
AdventHealth becomes latest health system to exit skilled nursing “AdventHealth had 10 facilities — eight in Florida and one each in Kansas and Texas. Over the last month, California-based CareTrust REIT announced acquisitions of two of those nursing homes.
But AdventHealth confirmed to McKnight’s Long-Term Care News on Tuesday that it is exiting the skilled nursing sector all together.”
Comment:Is this action part of a de-vertical integration strategy?
About pharma
JUNE 2023 CANCER DRUG PRICES REPORT “The analysis found [that as a result of the Inflation Reduction Act]:
Out of the 61,968 people with traditional Medicare who get a brand-name cancer drug through Medicare Part D, 99% will experience savings from the $2,000 out-of-pocket cap.
On average, this group of people on Medicare will save $7,590 annually, with some saving as much as $19,296.
Of the blockbuster medications studied in this report, people who take Revlimid and Pomalyst will realize the greatest annual savings ($8,989 and $8,635 respectively).”
About the public’s health
Youth, young adults are dying from suicide and homicide at highest rates in decades, CDC report says
“In 2021, suicide and homicide rates for children and young adults ages 10 to 24 in the US were the highest they’ve been in decades, according to a new report [will be publicly released 6/19]from the US Centers for Disease Control and Prevention.
Suicide and homicide were the second and third leading causes of death for this age group, both causing about 11 deaths for every 100,000 people ages 10 to 24. The homicide rate for this age group in 2021 was the highest it’s been since 1997, and the suicide rate was the highest on record, since 1968.
Suicide rates surpassed homicide rates for this age group in 2010 and have continued rising for the past decade. But a large spike in homicide rates during the first year of the Covid-19 pandemic brought the rates for both types of violent death together for the first time in a decade.”
In-home Visits and Subsequent Health Outcomesin Medicare Advantage Beneficiaries With Coronary Artery Disease, Diabetes, Hypertension, and Depression “Among those eligible to receive an in-home visit, a total of 48,566 patients had an in-home visit in 2018 (the ‘Exposure’ group), and 36,549 beneficiaries constituted the ‘Wait List’ control group. Receiving an in-home visit early was associated with a greater decrease in inpatient stays for all 4 conditions (change score range for any stay: −5.22% to −2.47%) (P<0.001, depression <0.05); decrease in emergency visits (change score range for any stay: −4.39% to −3.67%) (P<0.0.001, depression <0.05); and fewer major adverse cardiovascular events for coronary artery disease and depression (P<0.001 and <0.025, respectively) 1 year later. Minimal differences were noted for change in ambulatory and primary care visits, with no consistent increase in quality-of-care metrics. Time-to-first primary care visit was shorter for the ‘Exposure’ versus the Wait List control group in all conditions (difference between 2.45 and 4.95 d).”
About healthcare IT
Just a reminder that these large breaches are still occurring:
—Trinity Health hit with class action alleging 'inadequate safeguarding' to blame for March data breach
—Lawsuit accuses Harvard Pilgrim of 'negligently failing' to protect members' data following breach