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	The national uninsured rate for U.S. adults has reached a record low and is holding steady, according to new 

 from the Gallup-Healthways Well-Being Index.

	So far in the second quarter of 2014, the uninsured rate is resting at 13.4%-the lowest level recorded by Gallup since 2008. The uninsured rates for both April and May as individual months also average out to 13.4%. This is an improvement upon the uninsured rate in the fourth quarter of 2013, and the first quarter of 2014, which were 17.1% and 15.6%, respectively. 

	The uninsured rate seems to be leveling off since the open enrollment period came to a close in mid-April. The Obama administration extended the original March 31 deadline for those who had begun the enrollment process but had not completed it. 

	"I don't believe many people will drop coverage since they elected to purchase it initially," says Don Hall, principal of DeltaSigma LLC, a consulting practice specializing in Medicaid and Medicare Special Needs Plans. "Additional impacts on reducing the uninsured rate could come from an uptick in hiring and bringing some of the currently uninsured into employer health plans."

	Medicaid expansion has also played its part in boosting insured individuals. One in five Americans are now covered by Medicaid, or about 65 million people. According to new federal 

, enrollment is up 15% in states that expanded under Medicaid. 

	"I would expect to see further reductions if the states that opted out of the Medicaid expansion find ways to opt in," says Hall. "If Texas and Florida joined it could have a huge impact on reducing the rate, which is sadly why they won't do it. The tools to have a dramatic impact on giving access to care to millions more low-income Americans-including many veterans-rests in the hands of state legislators."

Articles

Uninsured rate dips to record low, holds steady

	Implementing data and analytics-no matter how big or small-can be a challenge, therefore having a plan of action is key, according to a survey of chief information officers and executives.

	The survey, by eHealth Initiatives (eHI) and the College of Health Information Management Executives (CHIME), assessed how healthcare organizations are using data and analytics. 

	"If data is king, an analytics strategy is a kingmaker," says Jennifer Covich Bordenick, Chief Executive Officer of the eHealth Initiative. "Organizations must have a plan to put insights into action, no matter how small or big of a dataset they're working with." 

		Healthcare organizations are relying upon increasingly diverse types and sources of electronic data for analytics;

		Analytics are still in early stages of maturity;

		Organizations recognize the importance of data and analytics, but many have not committed to its investment or use;

		New barriers to analytics are emerging beyond staffing, interoperability and cost; and 

		Consumer engagement is a growing business area.

	Survey results showed that analytic capabilities and practices vary significantly across healthcare organizations with 72% of organizations using more than 10 electronic interfaces to collect data. 

	Additionally, although 96% of those surveyed said they use analytics, only 20% reported that analytic operations are regularly integrated and coordinated at an institutional level. Furthermore, only 42% responded that a plan has been implemented that can scale and adapt to increasing data demands. 

	Bordenick says that integrated analytics are essential to understanding the health, needs and preferences of new patient populations that enter the healthcare system through Medicaid or exchange marketplaces, and that organizations can no longer rely on just one source of information.

	"We're just touching the surface of what analytics can truly accomplish in healthcare," she says. "Organizations are starting to break free of siloed analytics and leverage information in exciting ways in the consumer and retail space."

	Consumer engagement is becoming an increasingly critical strategy across healthcare. According to Bordenick, eHI research indicates that provider organizations are in the early stages of consumer-focused analytics.

	"To date, the majority of providers focus on basic satisfaction measures, while less than a third apply analytics to targeted communication, services or programs to improve patient acquisition and retention," she says. "This suggests a key business service for health insurers to offer as they form partnerships with provider organizations given their longstanding history of working in more of a consumer-focused environment."

	The survey also found that 79% of organizations lack a trained staff for collecting, proccessing and analyzing data. Insufficient funding and a lack of return-on-investment have also emerged as barriers to widespread analytics implementation. 

72% of organizations use more than 10 electronic interfaces to collect data

Study: Interoperability remains a challenge in using data, analytics

	Off-exchange plans are almost half as expensive as exchange plans, according to a new 

	Across bronze, silver and gold metal plans, the least expensive premiums offered by UnitedHealthcare, Aetna, Cigna and Assurant were more than 40% more expensive on average than the least 

		Exchanges had the lowest cost bronze plan option in 36 states;

		Exchanges had the lowest cost silver plan option in 35 states; and

		Exchanges had the lowest cost gold plan option in 35 states. 

	"The increased price competitiveness of the exchange plans may increase enrollment in these plans," says Kev Coleman, head of data and research at HealthPocket.

	For premium comparisons, HealthPocket assumed that the enrollee was a 40 year-old nonsmoker. Platinum plans were not included because many areas did not have platinum plan options. 

		Off-exchange plans may believe they are in a less competitive market;

		Plans with broader hospital networks are associated with higher premiums; and

		Premiums could be influenced by the expected differences among risk pools and their attendant rates of medical usage.

	"The possible entry of large off-exchange carriers into exchanges in 2015 may not have any significant effect for consumers with respect to greater premium competition," he says. "However, off-exchange carriers may look to adjust their healthcare provider networks to become more cost competetive with the exchange plans."

The least expensive plans offered by UnitedHealthcare, Aetna, Cigna and Assurant were over 40% more expensive on average than the least expensive plans on the exchanges

Exchange plans beat out premiums of off-exchange plans by 40%

	A decision has been made by the Centers for Medicare and Medicaid Services (CMS) for Medicare to cover hepatitis C virus (HCV) testing for adults. Testing will include a single screening for all adults born between 1945 and 1965, and repeat screenings for adults considered high-risk because of drug use or a blood transfusion prior to 1992.

	Increased demand for HCV testing began in late 2013 after the U.S. Preventive Services Task Force recommended that all Baby Boomers be tested regardless of risk factors, as 4.3% of people between 40 and 49 years old have the virus. 

 became a topic of debate upon the release of two new drugs in 2013. For example, Sovaldi (sofosbuvir) costs $1,000 per pill, or $84,000 for a 12-week treatment regimen and $168,000 for a 24-week treatment regimen. The drug generated a whopping $2.3 billion in revenue for its first quarter 2013 sales. Olysio (simeprevir), another new HCV treatment, costs $800 per pill with treatments lasting 24 to 48 weeks. 

, the pricing of Sovaldi has created uneasiness amongst activists and payers. Because only 11% of all HCV patients develop liver cirrhosis within 20 years, industry experts question whether the high cost of treatment is beneficial to patients and health plans.

	“Escalating drug prices are forcing all of us, whether families, employers and drug plans, to make impossible choices,” says Larry McNeely, policy director for the National Coalition of Health Care. The nonprofit organization recently launched the Campaign for Sustainable Rx Pricing, which aims to find affordable solutions for expensive treatments such as Sovaldi.

	“When faced with a $1,000 a pill or $100,000 a year price tag, families, patients and plans are forced to consider everything. But what’s really needed is a new path that can reward innovation without completely busting the budgets of families, employers, and public institutions,” McNeely says.

	At a recent forum on drug cost and value, Karen Ignagni, president of American’s Health Insurance Plans (AHIP), said that Gilead, the manufacturer of Sovaldi, is “asking for a blank check" from health plans. 

	"It will blow up family budgets, state Medicaid budgets, employer costs and wreak havoc on the federal debt," she continued.  

	Steven Flamm, MD, medical director of the liver transplant program for Northwestern Medicine discusses the hepatitis C drug pipeline.

	While drug manufactures are feeling the heat to offer additional hepatitis C treatments at lower prices, insurers fear that coverage decisions for Sovaldi will prompt similar pricing of treatments moving through the drug pipeline.

	"Managed care executives will have to closely examine their budgets to determine whether or not they are able to handle the financial costs that may be incurred with providing these hep C treatments to patients, while also factoring in improved quality of life for those patients who are ultimately able to receive this treatment," says Abimbola Farinde, PharmD, MS, who serves on the faculty at Columbia Southern University, Orange Beach, Alabama.  

	On the other side of the issue, Robert Goldberg, Ph.D., vice president and co-founder of the Center for Medicine in the Public Interest says that focusing on cost only obscures the medical milestone achieved in the prevention, treatment and cure of HCV. According to Dr. Goldberg, the National Viral Hepatitis Roundtable estimates that without any major changes in current testing practices, the cost of HCV care and treatment to Medicare will increase five-fold over the next 20 years, from $5 billion to $30 billion.

	"This one-time test, in combination with other targeted treatments, would result in identifying more than 800,000 cases and avoiding as many as 121,000 deaths," he says. 

	According to Goldberg, each person treated with Sovaldi could live an additional 15 years.

	"Assuming $100,000 value for each additional life per year, that's worth $1.5 million for every individual, meaning every healthcare dollar spent curing hep C generates $17 of value to each patient," he says. "The cost is outweighed by the value of reducing the impact of this disease." 

	For more coverage on this topic, look for 

 upcoming Politics & Policy column: Insurers challenge high drug prices. 

Industry experts question whether the high cost of treatment is beneficial to patients and health plans

Medicare increases hepatitis C testing, despite high treatment costs

	The Health Care Cost Institute (HCCI) has developed a partnership with Aetna, Humana and UnitedHealthcare to provide a free online tool that will offer consumers comprehensive information on price and quality of health services.

	The new tool will aggregate pricing data from commercial plans, as well as Medicare Advantage and Medicaid plans, if the states agree, says David Newman, executive director, HCCI. HCCI will create and administer the information portal, which is expected to be available in early 2015.

	“While the details are not yet known about the HCCI initiative, we are pleased with any development that brings more useful information to consumers, and look forward to seeing how it progresses,” says Robin Gelburd, president of FAIR Health, a national independent, not-for-profit corporation created in 2009 to bring transparency to healthcare costs and insurance information.  

	“When we were created, cost transparency was not mentioned everyday in the newspaper, on the web or in various media outlets,” says Gelburd. “We sort of came onto the landscape with a set of mandates to create the consumer website, which was really one of the first of its kind at that time.”

	FAIR Health’s claims database contains more than 16 billion records contributed by more than 60 insurers and claims administrators. It’s accessible online and is free to the public. 

	Over the last several years, stakeholders have recognized  the marketplace paradigm shift, Gelburd says. 

	“You cannot change to the reimbursement design and various models of cost-sharing for the consumer; change network design and all these other elements that are critical to the health plan and not keep pace with the kind of education and transparency they need,” she says. “Providing transparency is a win-win for all stakeholders, and the water level rises for everyone when there is a shared set of data points that are actionable and allow people to make sound decisions.”

	For example, she says, if a beneficiary is unsure about cost-sharing requirements and what a certain procedure will cost, it doesn’t benefit a plan to have a confused or angry member on the phone with customer service or lodging an appeal based on having insufficient information. This only creates time and resources spent on what could have been resolved at the front-end with the proper dissemination information.

	“Each minute, literally, that a customer service representative is dealing with a member, that’s money spent by a plan and frustration for the consumer,” she says. “Much greater goodwill is created between members and their plans if there’s [better] information.” 

	Transparency is often not enough. ‘Clarity’ better respresents the overall goal of contextualizing information for consumers, Gelburd says.  

	For example, dirty dishes chaotically piled up in a sink is transparent to the eye, but does not provide clarity. Taking the dishware and assembling it on a table does. 

	FAIR Health offers a reimbursement 101 segment on its website to help consumers with difficult healthcare terms, offering definitions in plain language.

	“We took the time to create clarity about what the meaning of those terms are, because you can’t just provide cost information to a consumer and expect it to be clear,” Gelburd says.

	In the new B2C environment, plans are seeing an appetite for rich information. Educational content and data provide opportunities for plans to reach out to the consumer and determine how to make plan designs digestible so members can maximize benefits appropriately. 

	“Health insurance information can be intimidating and impenetrable,” she says. “[Plans] must be sensitive to the need to create information that’s actionable but also makes sense.

	Additionally, consumers don’t always realize the three-dimensional nature of healthcare costs. For example,  needing a colonoscopy might translate to simply paying the gastroenterologist performing the procedure. It’s important to prompt  the consumer with data about anesthesia or pathology, Gelburd says, because they may need to consider associated costs. 

	With health reform taking place in real time, Gelburd says it’s too early to determine what methods will ultimately work best. Certain ways of presenting information will gain traction, but transparency will likely evolve over the next few years. 

	Similarly, not all transparency tools are created equal. What makes one valuable is the data supporting it. 

	“It’s like ingredients to any meal,” she says. “You want to be certain that they are of top quality and are rich and robust in order to ensure data integrity, and that it’s independent and reliable so greater confusion isn’t introduced into the marketplace.”

Price transparency comes to the forefront

	UnitedHealthcare, Humana and other plans have sent mass termination notices to their provider partners, indicating that Affordable Care Act (ACA) payment cuts to Medicare Advantage have forced their hand in making reduction to their networks. More than $200 billion in payment cuts are expected.

	“What United is doing is narrowing their network to reduce the amount of contracts and really focus their efforts on the providers that’ll work with them to help them improve their star ratings,” says Don Hall, principal, Delta Sigma LLC, in Littleton, Colo., and MHE editorial advisor. “For a plan that has a large network, they’re not going to be able to control that network nearly as well. High quality can be achieved by focusing on the providers that are willing to work together to provide the appropriate information, communicate and so on-they’re going to be critical to a good star rating."

	Narrow networks are already an industry trend, he says, adding that Accountable Care Organizations (ACOs) are narrow networks by definition. According to Hall, plans will be requiring their narrow networks to have better communication and to be more attentive to certain protocols and procedures. Although providers nationwide are going through appeals processes in order to force insurers to reconsider, Halls says that providers are actually in a position to determine what networks they want to be part of and to understand the specifics of what risks are required to be part of a specific network.

	“Providers need to determine where they want to fall in all of this,” he says. “Going forward, we’re going to see much more replacement of large networks with narrower networks. It’s a reality that’s coming.”

Payment cuts to Medicare Advantage prompt plans to narrow their networks.