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Study: Single Payer Aftermath

Study: Single Payer Aftermath

As Americans learn more about proposed new government-controlled health insurance systems – like Medicare for All, the public option, Medicare buy-in and other similar one-size-fits-all systems – a new study on teh aftermath of Single Payer by KNG Health Consulting is providing a glimpse into the real-life consequences these systems could have on American families. 

50% of Americans would give it thumbs up according to Kaiser Family Foundation. That majority support turns to opposition once people learn Medicare for All would ban private insurance. Turns out 70% of Americans are also satisfied with their employer-sposnored health insuarnce.   The plan grants the federal government a monopoly on health insurance — no private insurers or employers would be permitted to pay for health benefits.

Many Americans would understandably switch from private insurance to the public option. As they did so, hospitals and doctors would raise prices for the privately insured to compensate. Insurers would be forced to hike premiums in response, to cover providers’ higher payment demands. That would compel even more individuals to switch to the public option.

Some employers would surely do the same, dropping their benefits programs and encouraging their workers to enroll in the public plan. Indeed, a recent study from KNG Health Consulting found that Medicare for America — a proposal that would transfer everyone who does not receive coverage through an employer to a government-run plan — would cause one in four workers to lose access to employer-sponsored insurance by 2023. More than half of employees at small businesses would lose their employer-sponsored coverage under Medicare for America.

Among the most startling findings, Medicare for America could force one-third of American workers off of their current employer-provided health care coverage, also known as employer-sponsored insurance (ESI). 

 

The KNG study on “Medicare for America” points to an unaffordable new government-controlled health insurance system that reduces Americans’ choice and control over their care.  Whether it’s called Medicare for All, Medicare for America, Medicare buy-in or the public option, Americans would pay more and wait longer for worse care.

And instead of addressing rising health care costs, the study finds that this new government-controlled health insurance system “would increase total health care spending, with the largest spending increases occurring among those who already had public coverage through Medicare or Medicaid.”

 

Hospitals would lose. Approximately 5,000 community hospitals would lose over $151 billion under a Medicare for All system, according to a recent Stanford University study. Robert Pollin — an economist at the University of Massachusetts Amherst and supporter of Medicare for All — estimates that 2 million jobs across hospitals, health care facilities and the insurance industry could disappear.

According to CBO (Congressional Budget Office) that Medicare for All could “lead to a shortage of providers, longer wait times and changes in the quality of care.”

Ultimately, the public option would be the ONLY option. The insurance market can’t function unless all the players in the market are operating by the same rules.As Seema Verma, administrator of the Centers for Medicare & Medicaid Services, rightly put it, “The public option is a Trojan horse” for Medicare for All.

So which one is it?  An added public option that doesn’t have to compete or really one costly government option? Both options seem to fall short of their ideals.   

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2020 Healthfirst Plans

2020 Healthfirst Plans

2020 Healthfirst Plans

Healthfirst has released affordable new 2020 plans for NY small businesses and not a moment too soon. The only non-profit Health Insurer owned by hospitals has kept market low rates with a 4.7% DECREASE for 2020. By integrating Hospital/Provider medical approach Healthfirst has been successfully delivering value for the 5 boroughs.

About HealthFirst

Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.4 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.

Rate Trend

2018:  +4.8%

2019:  +6.4%

2020:  -4.7%

Value

  • Members have access to a broad network of providers and dozens of industry-leading hospitals.
  • Community locations throughout New York City, Long Island and parts of Westchester.
  • Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.

All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.

Network Overview:

Healthfirst EPO Pro Network – Provider count expanded to 39,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk and Southern Westchester. 136+ Urgent Care locations and 60+ hospitals included. Examples: Healthfirst 60+ Hospitals

Hospital for Special Surgery City MD Urgent Care
NY Columbia Presbyterian Modern MD
NYU Langone Urgent Care
Mt Sinai Health System Northwell Go-Health
Montefiore PM Pediatrics
Westchester Medical Center Midtown NY Doctors
Maimonides Cure Urgent Care
Staten Island University Hospital Riverdale Urgent Care
SUNY Stoneybrook Throgs Neck Urgent Care
Northwell Health (formerly North Shore LIJ) Statcare
Winthrop Rapid MD
LI Health Network Express Medical Care
Bon Secours Excel Urgent Care

 

2020 Healthfirst Pro Plans

Additional Features:

  • Free 24/7 Telemedicine Through Teladoc –Members can speak to a doctor anytime, anywhere, with a $0 copay.Telemedicine accessed via phone call or video chat.
  • Gym Reimbursement – Annual $400/member and $200/spouse reimbursementEmerecencies vs Urgent Care vs Telemedicine
  • Accupuncture Covered Benefit
  • CVS/Caremark – 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
  • Free Flu Vaccine
  • Free HSA Account. Healthfirst will pay for set-up and monthly maintenance.
  • Pro Plus EPO plans Option
    • Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow up care and limited orthodontia.
    • Vision – Exams, Lenses, Frames or Contacts covered every 12 months
  • SHOP Credits – SMB groups can enroll on tax credit program directly with our Brokerage
    • A business must have fewer than 25 employees
    • Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Healths Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer

 


Healthfirst 2020 1Q
DOCTOR SEARCH:  
CLICK HERE

2020 HEALTHFIRST PROVIDER NETWORK

HEALTHFIRST BENEFITS SUMMARY

 


Learn how a Healthfirst on your very own Private Exchange can help your group. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.

Empire Strikes Back – 2020 Health Plans

Empire Strikes Back – 2020 Health Plans

Empire Strikes Back – 2020 Health Plans

Empire Blue Cross Blue Shield has added a 3rd network – Empire Connections to their 2020 roster. The Downstate Network will be the smallest of the 3 featuring top hospitals & providers. The discounts are 11% and 20% discount off of #1 Empire EPO/PPO and Blue Access networks respectively. The middle network Blue Access has expanded significantly adding Memorial Sloan Kettering. Blue Access shares 92% of #1 Empire EPO/PPO network. Empire Blue Cross New Network Trifecta_2020

Additionally, all 3 networks, Empire EPO/PPO, Blue Access, Empire Connections will offer access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.

Network Overview

  1.  PPO/EPO Network – a traditional non-gatekeeper large network of approximately 91,000 physicians, 160 facilities and the BlueCard PPO. This is the #1 broadest network. All major NY hospitals. National Access with Blue Card PPO. Uses the Traditional Open Formulary (except for one PPO Fair Health Plan)
  2. Blue Access Networkhybrid of broad PPO/EPO 160 facilities and 83,000 physicians network. BlueCard PPO Access from home. All of #1 Empire EPO/PPO Hospitals except Stoney Brook Hospital in Suffolk County.  Uses the Traditional Open Formulary (this is better than the Select Formulary from 2019)
  3. Connections Network-will have a 70% provider match with PPO/EPO network. Network tailored to deliver the greatest premium savings, 20% off EPO/PPO.Available in 9 downstate counties (Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester). Offers the BlueCard PPO National Access, however, Gated plans must have PCP referral for Out-of-Network coverage.  Uses the Select Formulary (mostly generic).  Examples of hospitals:

    Empire Blue Cross 2020 Participating Hospitals (Click Above)

    • NY Columbia Presbyterian
    • Mt Sinai Health System
    • Montefiore
    • Westchester Medical Center
    • Maimonides
    • Staten Island University Hospital
    • Northwell Health (formerly North Shore LIJ)
Resource:Best Hospitals – US News 2019-2020

Additional Features:

  • Telemedicine will be $0 on all products except H.S.A. which will cost $49.
  •  Vision Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
  •  Dental –  price competitive plans with 127,000 Dentists and 385,000 locations. empires-whole-health-connection
  • New Pharmacy – Empire will be using their own Ingenio Rx as Pharmacy Benefit Management. With Pharmacy becoming a 22% average expense and close second only to hospitalization its novel focus on whole-health cost management is crucial. Enhanced digital tools, 24/7 support with no intermediary is a welcome All plans use their large BCBS formulary Except Empire Connections. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
  • Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
  • Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
  •  Online Resources – wellness coaching, discounts, health assessments, and The Weight Center.
  • TravelBlueCard PPO national access and Blue Cross Blue Shield Global Core Program.
  • Sydney Health – new mobile app. Uses artificial intelligence to meet member’s needs. A personalized dashboard that recommends programs and contact based on claims. Interactive smart chat feature to help members find what they need faster.A complete view of medical, pharmacy, dental, and vision benefits.Access to the member’s well-being programs and incentives Digital ID card that can be emailed or printed.
  •  Gym Reimbursements Cash Rewards and Healthy Support – Wellness program offers easy ways to earn up to $700 per member, per year.  Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150, and $50 Tobacco-free certification online.

Empire Blue Cross Enhanced Embedded Dental and Vision Plans **New for 2020**

Empire’s new model – Enhanced Embedded Dental & Vision Plans – is a care ecosystem where plans work together seamlessly to coordinate care Empire can afford to add these benefits at 50% discount below the stand-alone plan. For example, an individual Gold Blue Access Plan with Dental/Vision is only $20/month.

 

 


DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY:  Empire Blue Cross 2020 Top Plans 

Small-Group Rates:  2020 Small Group NYC    

Drug Formulary: 

Ask us about Empire’s flexible low participation voluntary group dental, vision,  disability, and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead  for ACA, Benefits, Payroll, and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

empire-voluntary-ancillary-dental-whole-life


 

 Contact Us Now    Learn how our Agency is helping businesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
Best Hospitals – US News 2019-2020

Best Hospitals – US News 2019-2020

Recently,  U.S. News and World Report released their annual top hospitals rankings. The top ten nationally were:

1. Mayo Clinic, Rochester, Minn.
2. Massachusetts General Hospital, Boston
3. Johns Hopkins Hospital, Baltimore
4. Cleveland Clinic
5. New York-Presbyterian Hospital-Columbia and Cornell, N.Y.
6. UCLA Medical Center, Los Angeles
7. UCSF Medical Center, San Francisco
8. Cedars-Sinai Medical Center, Los Angeles
9. NYU Langone Hospitals, New York, N.Y.
10. Northwestern Memorial Hospital, Chicago

They also reported regional rankings for 200 metropolitan areas and the top five hospitals in selected specialties such as Cardiology and Heart Surgery and Cancer.

The top five NY Metro Hospitals were:

  1. New York-Presbyterian Hospital-Columbia and Cornell, N.Y.
  2. NYU Langone Hospitals, New York, N.Y.
  3. Mount Sinai Hospital
  4. North Shore University Hospital
  5. Lenox Hill Hospital

For patients and their physicians, these rankings and ratings should be seen as just a starting point. While this is helpful information to have, benefit plan participants should also research quality hospitals using transparency tools if these services are available through the health plan or benefits package.

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

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For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

$700 Million for Struggling Brooklyn Hospitals

$700 Million for Struggling Brooklyn Hospitals

$700 Million for Struggling Brooklyn Hospitals

Brookdale Hospital Kings County and Interfaith get $700 Million

Gov. Andrew Cuomo announced Wednesday that One Brooklyn Health — a conglomeration of Interfaith Medical Center, Kingsbrook Jewish Medical Center and Brookdale Medical Center — will receive a substantial share of the $700 million that the administration has held for more than two years with the promise that it would one day be used to transform health care in central Brooklyn.

Why it matters: 

Brookdale alone has cost $100-$150M annually. The state spends $250 million a year keeping the lights on in these hospitals. That’s tax money that could be spent on anything else if the state can somehow figure out how to make these three hospitals more financially sound.

With state and federal reforms they are exposed. Adapting to a reimbursement landscape in which payment is increasingly linked to performance has become a fail. Ironically, the very reason for this fail is that the State links performance with Medicaid funding.

In other words if you are a hospital already in need of a lifeline Medicaid was paying you ‘X,’ now the managed Medicaid people come and say we are going to pay you $2000 less per discharge. The new reimbursement shift to pay per performance vs a fee for service reimbursements consistent with Obamacare. Its designed to reward value over volume with financial incentives to keep patients healthy through preventive care and early disease detection rather than running up expenditures.

The downward spiral continues as Medicaid Patients are likely to select a more prestigious hospital whenever possible. See how your Hospital ranks here. 40 percent of Brookdale Hospital patients indicating that they would definitely recommend the hospital. Wyckoff Heights and Interfaith also scored poorly – less than 50 percent of their patients reported that ‘they would definitely recommend the hospital. Sadly, with such low scores a State spending strategy alone has not solved the problem in the past nor likely in the future.

Top 10 medical innovations for 2017

Top 10 medical innovations for 2017

Top 10 medical innovations for 2017

The Cleveland Clinic announced its list of the top 10 medical innovations for 2017  that have the potential to transform healthcare.cleveland-clinic

The 11th annual list was announced Wednesday during the Cleveland Clinic 2016 Medical Innovation Summit, held this week at the Huntington Convention Center of Cleveland and the adjacent Global Center for Health Innovation.

A team of more than 100 doctors and researchers assembled by the Clinic examined nearly 200 nominations to identify and rank the top 10 innovations. The panel doesn’t highlight brands or companies, but rather the innovation and its potential applications in healthcare.

The Top 10 Medical Innovations of 2017 are listed below in order of anticipated importance:

1. Using the microbiome to prevent, diagnose and treat disease

Trillions of bacteria in the body make up communities known as the microbiome. Within the last 10 years, researchers have discovered that the chemicals microbes emit can interfere with how food is digested, medicine is deployed or how a diseases progresses.

The National Microbiome Initiative has accelerated research and development, and biotech companies are looking at the microbiome’s potential to develop new diagnostics or therapies and probiotic products to prevent microbe imbalances.

Experts believe that next year the microbiome will solidify itself as “the health care industry’s most promising and lucrative frontier,” according to a news release.

2. Diabetes drugs that reduce cardiovascular disease and death

In the past, medications have fallen far short of addressing the mortality rates for type 2 diabetes. Half will die from complications from cardiovascular disease. Those odds reach 70% after the age of 65. But new medications began dropping mortality rates this year.

Empaglifozin modifies the progression of heart disease by working with the kidneys, and liraglutide has a comprehensive effect on many organs, according to the release.

2017 could bring a complete shift in the medicines prescribed and further research into new ways to target type 2 diabetes, experts predict.

3. Cellular immunotherapy to treat leukemia and lymphomas

One of the first cellular immunotherapies is about to hit the market, and early results suggest leukemia and non-Hodgkin lymphomas might be curable, even in advanced stages, according to the release.

Chimeric antigen receptor (CAR) T-cell therapies are a form of immunotherapy in which T-cells are removed and genetically reprogrammed to find and destroy tumor cells. After attacking and killing foreign cancer cells, they often remain to minimize the risk of relapse.

The treatment, results for which have been impressive, is expected to be presented to the U.S. Food and Drug Administration next year for treatment for acute lymphoblastic leukemia.

4. Liquid biopsies to find circulating tumor DNA

“Liquid biopsies” are blood tests that uncover signs of actual DNA, or cell-free circulating tumor DNA (ctDNA), which is shed from a tumor into the bloodstream and is more than 100 times more abundant in blood than tumor cells.

Several companies are developing testing kits expected to hit the market this year.

Liquid biopsies are being hailed as a flagship technology of the Cancer Moonshot Initiative, a national effort to end cancer.

5. Automated car safety features and driverless capabilities

New automatic safety features could make a dent in dangerous car accidents, which remain a leading cause of death and disability as well as a major expense. In 2015, there were 38,300 fatal car crashes in 2015, and medical costs nationwide in one year total nearly $23 billion nationwide.

The automated features include collision warning systems, drowsiness alerts and adaptive cruise control. More are likely coming.

Though legal and safety questions remain, major investments into driverless cars are being made by software, private transportation and auto manufacturing companies.

6. Fast healthcare interoperability resources

For many years, billing departments, doctors’ offices, insurance companies and more have operated with systems that couldn’t talk with each other. Experts predict that 2017 is the year to make sense of this tangled web.

An international committee called HL7 will soon release a new tool, FHIR (Fast Healthcare Interoperability Resources), which will serve as an interpreter between systems or offices. The first release will focus on clinical data while the second will look at administrative data, with the potential to end a lot of frustration.

7. Ketamine for treatment-resistant depression

For one third of patients with depression, medications don’t work. Alternatives include intensive treatment options, such as electroconvulsive therapy.

Initial studies of ketamine, a drug commonly used for anesthesia, indicated that 70% of patients with treatment-resistant-depression (“TRD”) saw an improvement in symptoms within 24 hours of a low-dose injection. Ketamine, also known in the 1960s as a party drug, was studied for its ability to target and inhibit the action of N-methyl-D-aspartate (“NMDA”) receptors of nerve cells.

The FDA granted Fast Track Status to the development of a new NMDA-receptor-targeting medications based on the ketamine profile. The FDA gave some, like esketamine, breakthrough status, enhancing the potential for these drugs to be available to patients in 2017.

8. 3D visualization and augmented reality for surgery

Two of the most intricate surgical practices, ophthalmology and neurology, began experimenting in the past year with technology that allows surgeons to keep their heads up while using high-resolution, 3D visual representations of their subjects.

Using data, stereoscopic systems create visual templates. Surgeons who’ve piloted the technology say it brings added comfort and visual information that allows them to operate more effectively and efficiently while also giving medical residents a clear picture of what they’re doing.

Augmented reality glasses that display holographic images of human anatomy could bring the end of cadaver labs at medical schools.

Along the same lines, software companies are building augmented reality glasses that display holographic images of human anatomy. Medical schools see the end of cadaver labs. The Clinic and Case Western Reserve University were among the early adopters to work with Microsoft’s HoloLens, a mixed reality device that allows users to interact with holograms.

9. Self-administered HPV test

Most sexually active woman contract the human papilloma virus (HPV), certain strains of which are responsible for 99% of cases of cervical cancer. The most common malignancy is in women 35 years and younger.

HPV prevention and treatment, which have made great strides, are restricted to women who have access to tests and vaccines.

An approach to expand that care will launch in 2017 with self-administered HPV test kits developed by scientists with the idea that women can mail samples to a lab and be alerted to dangerous HPV strains.

10. Bioabsorbable stents

In July, the first bioabsorbable stent was approved in the U.S. The stent, made of a naturally dissolving polymer, widens clogged arteries for two years before being absorbed much like dissolvable sutures, leaving behind a healthy natural artery.

Annually 600,000 people are treated for coronary artery blockage with metal coronary stents, which stay in their chests permanently most of the time. These stents may inhibit natural blood flow or cause other complications.

Experts believe the market potential for absorbable stents will approach $2 billion in six years.

Cleveland Clinic announces top 10 medical innovations for 2017” originally appeared in Crain’s Cleveland Business.