Archive for the ‘Syndicate to AP’ Category

Biggest Insurer Shocked With Hepatitis C Costs

UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday. The news helped drive down the biggest insurance company’s stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C.

“We’ve been surprised on the volume — the pent-up demand across all three businesses” — commercial insurance and private Medicare and Medicaid plans, said Daniel Schumacher, chief financial officer of UnitedHealth’s insurance wing. Schumacher and other executives discussed the company’s first-quarter results on a call with financial analysts.

Made by Gilead Sciences, Sovaldi costs more than $80,000 per treatment and is seen as highly effective against hepatitis C, a chronic virus infection that often leads to liver failure. But the high cost, and what increasingly looks like high demand, is straining budgets for the government-financed Medicare and Medicaid programs as well as for private insurers that had not priced the drug into this year’s premiums.

UnitedHealth bosses discussed other pressures on first-quarter profits, especially from customers who renewed 2013 policies for 2014. To avoid premium increases associated with Affordable Care Act rules that became effective this year, many customers extended their plans late last year.

President Obama also expanded the ability of policyholders to keep their plans. The result is that UnitedHealth has many more customers than expected on older plans at lower rates, squeezing profits.

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Thursday, April 17th, 2014

Hospital Visits Fell When Seniors Got Drug Coverage

Eleven years ago Bob Bennett, then a Republican senator from Utah, made a fiscal sales pitch for including prescription drugs in Medicare coverage for seniors.

“Medicare says if you go to the hospital and run up a bill of however many tens of thousands of dollars to stay that many days, we will pay for it,” he said in June 2003. “But if you take the pill that makes the hospital visit unnecessary, we will not. That clearly doesn’t make sense.”

Researchers at the University of Illinois and the Johns Hopkins University have made the broadest test yet of Medicare Part D prescription drug program’s promise — that covering drugs would keep seniors out of the hospital.

Comparing national records from before and after 2006, when Part D kicked in, they found that drug coverage was associated with an 8 percent drop in hospital admissions and nearly as much in hospital-cost savings — an amount they calculate to be $1.5 billion a year.

But here’s what they didn’t find: any difference in death rates between the seniors who had access to drugs under Part D and those who didn’t. They thought broader drug coverage might reduce mortality.

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Wednesday, April 16th, 2014

Health Law Push Brings Thousands Into Colo. Medicaid Who Were Already Eligible

The big marketing push to get people enrolled in health coverage between October and March resulted in 3 million people signing up for Medicaid.

Colorado capitol by Jesse Varner via Flickr

Hundreds of thousands of those people were children who were already eligible and could have signed up even before the Affordable Care Act made coverage much more generous.

They came “out of the woodwork” to get enrolled, analysts say, thanks to the Affordable Care Act’s individual mandate and publicity around its new marketplaces.

In Colorado, nearly 23,000 such children are now getting Medicaid. Their numbers grew Colorado’s Medicaid rolls by 3 percent over last year.

Colorado is one the first of the states that are expanding their Medicaid programs to report how many people coming into the health insurance program for low-income residents could have had coverage before the health law was implemented.

State officials in Washington say 91,000 previously eligible but not enrolled residents got on Medicaid between October and March.

State Medicaid Director Sue Birch said Colorado enrolled 22,784 previously eligible kids in Medicaid and the Children’s Health Insurance Plan (CHIP) from Oct. 1 — when the state marketplace opened — until Feb. 28. Overall, including people who were eligible because of the expansion, Colorado’s Medicaid rolls grew by 23 percent during that period.

The health law called for states to expand Medicaid to anyone earning up to 138 percent of the federal poverty level (about $11,670 for an individual and $23,850 for a family of four), but the Supreme Court said that had to be voluntary. About half the states have opted not to expand.

It was widely assumed that there would be a woodwork effect, but estimates of how many previously-eligible people enrolled around the country are just now starting to come in.

The Centers for Medicare & Medicaid Services last week released a preliminary tally of Medicaid enrollment by state from October through Feb. 28.

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Wednesday, April 16th, 2014

Survey: Health Insurance Enrollment In California More Complex Than Anticipated


Newly insured Californians felt relieved after signing up for health coverage but encountered numerous obstacles with technology and communication during the enrollment process, according to a report released Monday by the California HealthCare Foundation.

Surveyed in interviews and focus groups, consumers said they had trouble getting through to the call center, choosing a health plan and calculating their income. They also had problems with the online chat program, and many were surprised by the amount of documentation required to enroll, according to the report.

The problems were worse for Medi-Cal applicants than for those seeking private coverage through the health insurance exchange, the report said.

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Tuesday, April 15th, 2014

State Exchange Directors Offer Enrollment Snapshots


This post was corrected and updated at 4:50 pm, April 11.

The Obama administration is touting the success of the health law’s open enrollment, which signed up  at least 7.5 million Americans for health coverage through the online insurance marketplaces. But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion.

Bill Nold, deputy executive director at the Office of the Kentucky Health Benefit Exchange, said that there were 2,000 new enrollments on March 31 alone. So far, his office has counted 400,000 new enrollees, 315,000 of whom signed up for Medicaid. He expects those numbers to continue to go up until April 11 — when his state’s enrollment extension ends. In a last-ditch effort to up enrollment, he added, the state sent out 30,000 emails to people who had started an application but had not finished.

He said 33 percent of the Kentuckians who bought plans on the exchange were younger than 35.

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Friday, April 11th, 2014

Alzheimer’s Disease Support Model Could Save Minn. Millions


As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services.

The New York University Caregiver Intervention (NYUCI) program offers caregivers six sessions of individual and family counseling within four months of enrollment, the opportunity to participate in a weekly support group and telephone counseling when needed. Minnesota mimicked that effort with a five-year pilot program offered to 228 participating caregivers in urban and rural areas.

The study, published in the April Health Affairs, found the Minnesota program could save $966 million by 2025 if it were implemented state-wide. Cost savings were mainly achieved by keeping Alzheimer’s patients in the community and at home. The authors found that 5 percent more people would stay in these settings if the project was expanded, and 19.3 percent fewer people with dementia would die in an institution.

“These findings suggest that broader access to enhanced caregiver supports could produce a positive return on investment or be cost-effective—assuming widespread implementation, reasonable program costs and substantial caregiver participation,” study authors write.

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Thursday, April 10th, 2014

A Call For Pricey Treatment For Millions With Hepatitis C

Authors of the first-ever global hepatitis C guidelines went big Tuesday, advocating for worldwide use of two of the most expensive specialty drugs in the world.

The new guidelines, from the World Health Organization, give strong endorsement to the two newest medicines. Gilead Science’s Sovaldi costs $1,000 per pill/$84,000 for a 12-week course of treatment and Olysio, Janssen Pharmaceuticals, $66,360 for its three-month course.

The high prices have ignited a firestorm of objection. In the United States, doctors and insurers argue that the cost of the drugs will make their widespread use impossible. And critics say even if the prices are heavily discounted in other countries, the drugs will still be unaffordable in most of the world.

The WHO endorsement of treatment with Sovaldi and Olysio was made without taking the cost of the two drugs into consideration. That’s because the price of the drugs outside the U.S. was unknown in December, when the WHO panel wrapped up its work.

But the price of the drugs isn’t the only issue. The WHO recommends that all 150 million or so people around the globe with chronic hepatitis C infection be assessed for treatment — a gargantuan task in itself. Authors of the report are quick to acknowledge that neither the assessment of people’s health status nor actual treatment will happen anytime soon.

“A lot has to happen for this to really take off in a big way,” says the guidelines’ chief architect, Dr, Stefan Wiktor. “Even if prices came down dramatically tomorrow, that doesn’t mean there would be an immediate rush to treatment.”

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Wednesday, April 9th, 2014

Primary Care Shortage? Not For The Insured, Study Shows

Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year.

What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system.

Dr. Karin Rhodes, from the University of Pennsylvania and a lead author on the study published this week in JAMA Internal Medicine, says when researchers said they had insurance, they were able to make an appointment about 85 percent of the time — on the first try, no less.

“Capacity exists. I think this is a very optimistic message,” Rhodes says, adding that researchers were usually able to get scheduled within a week. The median wait in Massachusetts was about two weeks.

Rhodes acknowledges the study did not examine the quality of care received, the accessibility for returning patients or the role of cost in determining patients’ real access to services. (more…)

Tuesday, April 8th, 2014

Report: Jails House 10 Times More Mentally Ill Than State Hospitals

In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.

Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.

That’s similar to the mental health system in 1830, before Dorothea Dix and other advocates pushed to shift people with mental illnesses out of the prisons and into hospital care instead, says Dr. E. Fuller Torrey, a psychiatrist and lead author of the report.

“We’ve basically gone back to where we were 170 years ago,” says Torrey, a prominent critic of the widespread effort to deinstitutionalize psychiatric patients beginning in the 1960s. “We are doing an abysmal job of treating people with serious mental illnesses in this country. It is both inhumane and shocking the way we have dumped them into the state prisons and the local jails.”

The report includes a survey of each state’s mental illness treatment laws in prisons, as well as background on the percentage of prisoners with mental illnesses in each state.  Since 1970, Torrey says that percentage has risen from an average of about 5 percent to 15-20 percent.

“There is not a single state in the United States where you want to go to a jail or prison and be severely mentally ill,” says Torrey.  He adds that many jails and prisons are trying to improve their care of prisoners with mental illnesses, but they are hampered by state laws that make forced treatment difficult.

In 31 states, prisons can administer treatment over a prisoner’s objections by requesting a special treatment review committee, but the process is often difficult and the report calls such efforts “grossly underutilized.” Some people with mental illness refuse treatment, often because they are not aware that they are sick.

“This causes major problems,” the authors write in the report. “Jail officials can thus be legally sued in many states if they forcibly medicate mentally ill prisoners without their consent, yet can also be held legally responsible for the consequences of such prisoners’ psychotic behavior,” including suicide.

Torrey adds that there is often a fundamental mismatch between guards and prisoners with mental illnesses. “People who work in jails and prisons signed up because they wanted to take care of bad people. So you get some personality types that are not compatible with taking care of people with serious mental illnesses,” he says.

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Tuesday, April 8th, 2014

Medicaid Enrollment Increased By 3 Million From October To February

The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services.

States that expanded Medicaid eligibility under the health law saw an average 8 percent increase in enrollment, with enrollment leaping almost 35 percent in Oregon and almost 34 percent in West Virginia. The health law expanded the program to include all legal residents with incomes under 138 percent of the federal poverty level, or $15,800 for an individual.

States that chose not to expand the program saw an average increase in enrollment of 1.6 percent, the report found. Florida saw the biggest increase – 8.2 percent — as people who were previously eligible but not enrolled signed up. Montana ranked second with a 6.9 percent increase and Idaho was third with a 6.6 percent jump.

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Friday, April 4th, 2014

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