OPM said rising medical costs have also hit many private-sector plans. [OPM Associate Deputy Director Daniel] Green said consultants have told OPM that private-sector health care premiums will go up between 8 percent and 11.8 percent in 2010.
Green said OPM is trying to bring down health care costs by requiring pre-authorization before a patient can receive expensive drugs, to make sure there isn’t a cheaper generic drug that is equally effective. [This is known as step therapy.] OPM also is requiring pre-authorization for expensive imaging examinations, Green said.
OPM plans to encourage patients to seek out care to better manage chronic conditions such as diabetes before they develop into bigger problems.
Because FEHB plan carriers, not the Government, bear the plan's underwriting risk and there are no pre-existing condition limitations on FEHB plan coverage, carriers typically are out front on these cost containment efforts.
America's Health Insurance Plans ("AHIP"), the managed care trade association, announced today
a landmark initiative to make delivering and getting health care easier forMany other health plans, including CIGNA, Aetna, and United Healthcare, as well as provider organizations are participating in this initiative. The initiative will be rolled out first in Ohio beginning next month.
patients and their physicians by reducing the time, effort, and expense for the
“paperwork” required for each patient office visit. The initiative, which will
simplify information flow between health plans and doctors’ offices, and later
between health plans and hospitals, is comparable to what ATMs did for banks and
consumers.
Beginning in early November, AHIP and the Blue Cross and Blue Shield Association (BCBSA) will sponsor regional and statewide initiatives to assess how best to offer physicians access to multiple insurers through the same information channel (e.g., a web portal) in a given region of the country for the purpose of conducting key office tasks. Savings are estimated in the hundreds of billions of dollars as the entire
health care system achieves efficiencies through similar moves to automation and
consistent business practices.
- The Ohio initiative offers opportunities to simplify the work associated
with patient visits and achieve savings, including providing physicians with
information in “real-time” that: - Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), minimizing time and expense needed for such purposes;
- Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers. This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
- Tests real-time referrals and timely pre-authorization of services; and
- Provides for the online submission of healthcare claims.
Business Insurance reports that the Obama Administration is considering whether or not to propose an extension of the legislative initiative which lowered the cost of self-pay continuation coverage for laid off employees, known as TCC in the FEHB Program and COBRA in the private sector.
Finally, the Wall Street Journal reports on the success of a Pennsylvania state program that has been controlling hospital costs by reporting hospital quality information for the past twenty years. "For two decades, a state agency has published "medical outcomes" -- death and complication rates -- from more than 50 types of treatments and surgery at hospitals. The state has found that publishing results can prompt hospitals to improve, and that good medical treatment is often less expensive than bad care." An alliance of hospitals and insurers has built on this state initiative with this website. Interesting.
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