In the News: May 11–17

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources.

House-Passed AHCA Could Impact Large Employers Nationwide

A recent Brookings article considers how the American Health Care Act (AHCA) may allow large employers in every state to impose annual or lifetime limits for services. Currently, the Patient Protection and Affordable Care Act (ACA) bans these limits for services included under essential health benefit standards. The House-passed AHCA would allow states to seek waivers to redefine or eliminate these standards, thereby altering the scope of services protected under the ACA. A given state’s waiver may have a far-reaching impact for large employers, as the article points out “current regulations and guidance permit large employer plans to apply any state’s definition of essential health benefits.”

Wondering what’s next now that the House passed the 2017 AHCA bill? Sg2 is excited to introduce a new interactive way for members to get their health care policy questions answered. Register now for our first Experts Live: Q&A With Sg2’s Health Care Policy Team on May 25 for an open dialogue as we explore the latest on the health care policy front.

Fountain House Programs Impact Medicaid Utilization and Expenditures

A recent New York University Health Evaluation and Analytics Lab study examined the Fountain House Programs “Clubhouse” model impact on Medicaid utilization and expenditures. The model engages members in daily facility management tasks and offers wellness skills, educational and employment opportunities, and care management. A comparison of individual’s medical expenses from a 12-month period before and after enrollment in Fountain House Programs shows a reduction of $637 per month in medical care expenses for those enrolled.

Sg2 experts continue to follow the development of innovative models that address the growing unmet need of behavioral health services across the nation. Learn more about another innovative model featuring UnityPoint Health’s Robert Young Center for Community Mental Health on page 17 of the Sg2 report Reconsidering Behavioral Health.

Out-of-Pocket Costs Pose Major Financial Burden for Medicare Beneficiaries

A recent Commonwealth Fund report analyzed out-of-pocket costs for Medicare beneficiaries, finding that over a quarter spend 20% or more of their income on premiums and out-of-pocket costs. Medicare’s benefit design omits services heavily utilized by the elderly (eg, dental, vision, hearing) and exposes beneficiaries to high cost-sharing with no out-of-pocket cost ceiling. This leads to more than $3,000 per year in average out-of-pocket costs, a significant portion of which is spent on dental, hearing and other uncovered services, possibly creating serious access issues for nearly half of the Medicare population earning less than $24,000 a year.

Sg2 understands that as consumers face high-cost burdens, health care access and affordability will be more important than ever. To learn more about how your organization can create an effective enterprise-wide consumerism strategy, read the Sg2 report Reinventing the Patient Journey: A Consumerism Update and Outlook.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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