The Number

The Number: 189%

Submitted by Rob Wyse on Sun, 09/16/2018 - 19:13

What will the population of America look like in 2050 – and how will that affect the cost of Medicare? That’s one of the questions Politico looked at in a recent article by Tucker Doherty, which described the “Medicare time bomb” coming, with 7 charts.

One chart, showing expected age distribution by year according to U.S. Census estimates, shows 16% of the population, 52+ million people, eligible for Medicare. By 2050, estimates are that 23.6% of the population will be of Medicare-age, at more than 98 million people.

But the real distribution change is at the very top, of the oldest Americans. While 65-years-old or older Americans will grow by 67% from now until 2050, 85-years-old or older Americans will grow by an astronomical 189%.

And with more Americans living longer, than older group will make up for a large percentage of overall Medicare spending. As we’ve previously written about, 74% of Medicare spending goes to beneficiaries with four or more chronic conditions. According to politico, “by age 85, nearly 1-in-4 has more than five chronic conditions.”

The Number 74%

Submitted by Rob Wyse on Sun, 08/26/2018 - 18:31

What’s the future of Medicare Advantage? It’s a question many constituencies are increasingly curious about – and working to change. From politicians on both sides of the aisle to the seniors who will be most affected by the developments, Medicare Advantage is a major talking point in 2018, and looking ahead to the future.

Starting in less than two years, by 2020, Medicare Advantage plans will have flexibility to target non-medical health-related services for members with chronic conditions. This could have major implications – as 74 percent of all Medicare spending goes to Medicare beneficiaries with four or more chronic conditions, according to the Bipartisan Policy Center.

[Medicare Advantage] plans are popular with both those who sign up due to the additional benefits they offer, and with insurers that have realized profits and decreased costs through narrow networks and aligned incentives,” writes Susan Morse in Healthcare Finance News.

The Number: $375 Million

Submitted by Rob Wyse on Sun, 08/19/2018 - 08:02

Alphabet, the parent company of Google, has announced plans this week to invest $375 million in healthcare start-up Oscar Health. This is the “latest big bet on the privatization of Medicare,” writes Bruce Japsen of Forbes.

The investment comes on the heels of Amazon getting into the healthcare game in a big way – both in relation to prescription drugs and in private healthcare.

Oscar Health will use the big tech investment to jump into Medicare Advantage, an increasingly-popular form of health insurance for seniors.

The Number: 83

Submitted by Rob Wyse on Tue, 08/14/2018 - 10:45

This July, the Centers for Medicare & Medicaid Services (CMS) proposed the 2019 Medicare Physician Fee Schedule and Quality Payment Program, which includes expanding Medicare-covered telehealth services to include prolonged preventive services. 

While coverage of telehealth services is expanding, it appears that 83 percent of Medicare Advantage members either do not know if they can connect via their plan to telehealth providers, or do not think telehealth is offered at all through their plan. Our June/July 2018 HealthMine survey found 46 percent of Medicare members were unsure if their plan offers telehealth, while 37 percent said it is not offered.

Plus, the respondents were computer literate, as the survey was fielded online. And they are connected: 77 percent of respondents use a smart device (a smartphone or tablet). 

The Number: 16

Submitted by Rob Wyse on Fri, 08/03/2018 - 15:22

Just sixteen percent (16%) of Medicare plan members with chronic conditions said they had a follow-up on quality of care after a provider visit, as reported to HealthMine in a recent study.  Only ten percent (10%) of plan members surveyed said their health plan offers guidance about these chronic conditions.

“If members feel that their health plan knows them, but doesn’t actively communicate with them or help them manage their chronic conditions, it is an opportunity for plans to take action,” Bryce Williams, CEO of HealthMine, told Managed Healthcare Executive.

“Actively managing care enables payers to check off which patient services were completed and which are still needed so they can proactively identify gaps in care as well as adhere to HEDIS quality measures,” continues Williams.

The Number: 317 Billion

Submitted by Rob Wyse on Fri, 07/27/2018 - 07:32

Chronic disease is prevalent in a huge portion of  the Medicare Advantage population, reportedly 70% of members have at least one chronic condition.  Topping the list is cadiovascular diseases estimated to cost $317 billion per year.

These conditions are, according to the Centers for Disease Control and Prevention, “among the most common, costly, and preventable of all health problems.” An estimated $3.2 trillion was spent on healthcare in 2015 as calculated by Centers of Medicare and Medicaid Services, which also predicts healthcare spending to grow 5.5 percent through 2025, with a significant amount going towards chronic disease treatment.

So, which chronic conditions are the most expensive? Read the breakdown from HealthPayer Intelligence of the top ten most expensive chronic diseases to treat per year in the United States:

The Number: 23%

Submitted by Rob Wyse on Wed, 07/18/2018 - 08:11

Medicare Advantage beneficiaries had twenty-three (23%) percent fewer inpatient stays than those enrolled in Traditional Fee-for-Service (FFS) Medicare, found a report released this week by Avalere Health. Though Medicare Advantage has a higher percentage of beneficiaries with chronic conditions enrolled due to disability than FFS, Medicare Advantage members experience better health outcomes at similar or lower costs then FFS.

The study, funded by Better Medicare Alliance (BMA), also found that Medicare Advantage had a lower rate of avoidable hospitalizations, higher rates of preventative screenings and fewer emergency room visits than FFS beneficiaries.

"This study adds to the growing body of evidence showing the ability of Medicare Advantage to align incentives to better manage the care for a high-need population with multiple chronic conditions," said Allyson Y. Schwartz, BMA President and CEO.

Adds Avalere founder, Dan Mendelson, “Our findings present new evidence for Medicare Advantage's value proposition, especially for high-need beneficiaries."

The Number: 54%

Submitted by Rob Wyse on Mon, 07/09/2018 - 10:28

Fifty-four (54) percent of beneficiaries of Medicare Advantage believe their health plan is working with them to limit out-of-pocket spending, according to a new JD Power consumer survey. This survey was the focus of a recent HealthPayerIntelligence article on customer satisfaction with Medicare Advantage plans.

Medicare Advantage satisfaction as a whole dropped slightly from 2017 to 2018, JD Power found. On a 1000-point scale, Medicare Advantage satisfaction scores for all plans fell from 799 to 794,” writes Thomas Beaton.

While satisfaction declined slightly, providers are also presented with an opportunity. The survey found that the Medicare Advantage market is on the rise, with a growth of 7.5% year-over-year, with more than 1.5 million new beneficiaries.

As technology availability and communication options increase, providers have ample opportunity to connect with their consumers in a way that works for all sides.

The Number: 3%

Submitted by Rob Wyse on Fri, 06/22/2018 - 14:59


Just 3 percent of Medicare beneficiaries represent 25 percent of Medicare expenditures.

According to a Bloomberg BNA report on June 18, even with this sizable share of funds, the three percent, made up of the advanced illness population, isn’t properly cared for by the current health care system. Now a proposal has been made for a new payment model just for this group with the most serious illnesses.

Alternative payment models were presented to HHS Secretary Alex Azar this month, who favored options serving those in various stages of serious illnesses, but ineligible or unwilling to enroll in hospice, according to Bloomberg BNA.

“The idea of these alternative payment models is to get away from Medicare’s strict reimbursement requirements and allow for a flexible payment structure; in this case to support the different types of services needed by very sick patients and their caregivers,” reported Mindy Yochelson for Bloomberg BNA.

No formal government announcement has been made yet, but the initial reaction to the plans have been very promising. “This is the strongest response from HHS yet to a proposal,” the co-chair of Coalition to Transform Advanced Care told Yochelson.