A new white paper released today from the nonprofit FAIR Health looked at medical pricing and other health care trends from 2012 to 2017 and found that people in the U.S. used more telehealth services and urgent care centers in 2017 than during the previous year.
Here’s a closer look at the report’s findings:
- Telehealth: Use of telemedicine services grew nationally by 53 percent between 2016 and 2017, with 55 percent growth in urban areas and 29 percent growth in rural areas. Oklahoma had the most telehealth usage, New Jersey the least.
- Urgent care centers: The use of urgent care centers in urban areas increased by 15 percent in 2017 compared to 2016, while staying the same in rural areas. The average price per 30-minute visit was most expensive for urgent care centers, at $213, compared to $207 in a doctor’s office and $129 in a retail clinic.
- Emergency care: Emergency department use decreased 2 percent between 2016 and 2017 — by 1 percent in urban areas and 10 percent in rural areas. Women were more likely than men to use the ED, and among adult patients not in college, the diagnosis with the most ED visits was acute respiratory infections.
Community HealthChoices (CHC) is coming in January 2020.
The counties included in the third and final phase of the program’s implementation are:
- Lehigh/Capital Zone: Adams, Berks, Cumberland, Dauphin, Fulton, Franklin, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry, York.
- Northeast Zone: Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuykill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming.
- Northwest Zone: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango, Warren.
What you need to know:
CHC information for providers or participants can be found at www.healthchoices.pa.gov. The website will be updated as events are scheduled, so please check back often.
Click here to take our online trainings and read CHC fact sheets.
Access a list of frequently asked questions (FAQs) about CHC by clicking here.
Contact a CHC managed care organization (CHC-MCO) to become part of their provider network:
AmeriHealth Caritas | Phone: 1-800-521-6007 email: email@example.com
Pennsylvania Health & Wellness | Phone: 1-844-626-6813 email: firstname.lastname@example.org
UPMC Community HealthChoices | Phone: 1-844-860-9303 email: CHCProviders@UPMC.edu
Sign up and encourage your peers to subscribe to CHC emails here. By signing up, you will receive regular communications regarding CHC distributed from the Office of Long-Term Living.
Here’s a schedule of what’s coming in 2019
Late Spring/Early Summer 2019
Save the date for our upcoming provider summits in the Northeast, Northwest, and Lehigh/Capital zones. These summits are educational conferences specifically for providers to learn more about CHC. More information regarding times and locations coming soon!
Monday, May 13: Harrisburg Area Community College
Tuesday, May 14: Shippensburg University
Wednesday, May 15: Kutztown University
Thursday, May 16 (Transportation Session Only): Kutztown University
Monday, May 20: Edinboro University
Tuesday, May 21: Lock Haven University
Wednesday, May 22: University of Pittsburgh-Bradford
Thursday, May 23 (Transportation Session Only): University of Pittsburgh-Bradford
Tuesday, June 4: East Stroudsburg University
Wednesday, June 5: University of Scranton
Thursday, June 6: Bloomsburg University
Friday, June 7 (Transportation Session Only): Bloomsburg University
An introductory flyer will be sent to participants identified within the CHC population. View the flyer by clicking here.
- Notices and enrollment packets will be mailed to participants.
- Information on the LIFE program will be sent to potentially eligible participants.
- Informational sessions will be held for participants to learn about CHC and how to select a CHC-MCO.
We’ve been reading so much about advantages that aging persons can accrue with the introduction of emerging technology, we decided to list some of the articles.
Aging In Place Technology Watch shares this in today’s newsletter: “… it’s good to see that Envoy (concierge service for independent living), Kindly Care (home care agency), Caremerge (home care platform), and Seniorlink (care coordination) are in their same businesses from 2016 – and others from the period like Envoy and CareLinx received additional investment and moved forward.
“Smart Home Technology Becomes a Must-Have in Senior Living” – Senior Housing News
“Home Instead Inc. — the international franchise company behind the Home Instead Senior Care network — is joining forces with senior-friendly tablet startup GrandPad in an attempt to reduce client loneliness and improve connectivity.” – Home Health Care News
“Where the Home Health Aide Shortage Will Hit Hardest by 2025” – Home Health Care News
OPINION | “Seema Verma: Americans have the right to know their health care and hospital costs” – STATNews
by Seema Varma. Seema Verma currently serves as Administrator of the Centers for Medicare & Medicaid Services (CMS).
“Americans are prolific shoppers, constantly on the lookout for the best price for top-quality products and services. If you are searching for a new television, it’s easy to find prices and statistics transparently and prominently displayed at just about every store.
“Yet when it comes to maintaining our health, very few of us ever know price or quality before receiving a health care service. This is true whether it’s a simple visit to the doctor, a cancer screening, or a knee replacement.
“One reason health care costs continue to skyrocket is that the prices and quality of care are largely hidden from patients. That means health care providers don’t compete on cost or quality.”
by Maria Castellucci
“About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis.
“The report, released Thursday by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.
“The frequency of unnecessary ED visits from the chronically ill is unsurprising given the fee-for-service payment environment the majority of providers remain in, said Joe Damore, senior vice president of population health consulting at Premier. On average, only 10% of providers’ payment models are tied to value-based models, he said, so providers don’t have an incentive to effectively manage patients to prevent disease progression and promote wellness.”
“The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019” – Henry J. Kaiser Family Foundation
“Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs—defined by Medicare as drugs that cost more than $670 per month in 2019—are a particular concern for Part D enrollees in this context. Part D plans are allowed to charge between 25 percent and 33 percent coinsurance for specialty tier drugs before enrollees reach the coverage gap, where they pay 25 percent for all brands, followed by 5 percent coinsurance when total out-of-pocket spending exceeds an annual threshold ($5,100 in 2019). While specialty tier drugs are taken by a relatively small share of enrollees, spending on these drugs has increased over time and now accounts for over 20 percent of total Part D spending, up from about 6 to 7 percent before 2010.”
“Figure 1: Medicare Part D beneficiaries can pay thousands of dollars out of pocket for specialty tier drugs, with the majority of costs for many drugs above the catastrophic threshold.”
“Hospitals Stopped Readmitting So Many Medicare Patients. Did That Cost Lives?” – The New York Times
“A new government program was supposed to prevent certain Medicare recipients from cycling in and out of hospitals. Now experts worry some older patients are being denied necessary care.”
Credit: Craig Frazier
by Paula Spahn
“It was a well-intended policy. Almost all parties agree on that much.
“A decade ago, when Medicare beneficiaries were discharged from hospitals, one in five returned within a month.
“Older people faced the risks of hospitalization all over again: infections, deconditioning, delirium, subsequent nursing home stays. And preventable readmissions were costing Medicare a bundle.
“So the Affordable Care Act incorporated something called the Hospital Readmissions Reduction Program, which focused on three serious ailments with high readmission rates: heart failure, heart attacks and pneumonia.
“The A.C.A. penalized hospitals — withholding up to three percent of Medicare payments — when readmissions within 30 days exceeded national averages.”
Read this New York Times article in its entirety, click here.
M. SPENCER GREEN/AP
by Karen Weintraub
“Nearly 30 years after it began, a study of prostate cancer patients shows both that the disease will not cause harm to the majority of men who have it, and that aggressive treatment is warranted for men with an intermediate risk of spread.
“The nuanced results come from a new update to a landmark study, published Wednesday in the New England Journal of Medicine, that has followed 695 Swedish men since they were diagnosed with localized prostate cancer between October 1989 and February 1999.
“The study’s duration and insights into one of the most common forms of cancer make it ‘arguably one of the most important publications of the year,’ said Dr. Adam Kibel, a professor of surgery at Harvard Medical School and chief of urology at Brigham and Women’s Hospital in Boston, who is not involved in the research.”
“The Annual Enrollment Period for Medicare Parts C & D is over, but persons with Medicare Advantage soon get another chance to switch coverage. Learn about the new MA Open Enrollment Period in this fact sheet developed by the Medicare Rights Center.” (SOURCE: National Council on Aging email)
“Beginning in 2019, there will be a Medicare Advantage Open Enrollment Period (MA
OEP) from January 1 through March 31 each year. During this time, MA-eligible
beneficiaries will be able to change their MA Plan or elect Original Medicare and
coverage under Part D. Changes are effective the first of the following month.” Read more here.