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How Health Expenditures Vary Across the Population (Slideshow)

January 5, 2015 Comments off

How Health Expenditures Vary Across the Population
Sourvce: Kaiser Family Foundation

In a given year, a small portion of the population is responsible for a very large percentage of total health spending. This slideshow explores the variation in health spending across the population through an analysis of the 2012 Medical Expenditure Panel Survey (MEPS) data. The analysis shows that the 1% of the population with the highest spending accounted for almost one quarter of health spending (23%) and that the top 5% of the population is responsible for almost half of all spending. It also examines spending variation across different demographic and health factors, including age, gender, race, insurance status and presence of certain health conditions.

The slideshow is part of the Peterson-Kaiser Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system. More information about the analysis leading to the slideshow is available through the tracker.

Coverage of Preventive Services for Adults in Medicaid

January 4, 2015 Comments off

Coverage of Preventive Services for Adults in Medicaid
Source: Kaiser Family Foundation

The Affordable Care Act (ACA) added emphasis to the importance of preventive services in improving lives. As of January 1, 2013, per Section 4106 of the ACA, states can receive a one percentage point increase in their federal Medicaid match rate for preventive services if they cover without cost sharing all the adult preventive services (see Table A1) recommended by the federally-convened U.S. Preventive Services Task Force (USPSTF) and Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). As of the time of the survey, four states had submitted state plan amendments (SPAs) to receive the 1% increase and since then, 4 additional states (8 total) have submitted SPAs for the enhanced match. States must cover preventive services for adults newly eligible for Medicaid under the ACA, but this is not required for the group of adults enrolled in or eligible for traditional Medicaid prior to the ACA’s expansion of the program.This brief highlights data from a survey of state Medicaid programs conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) on coverage of preventive services recommended for non-elderly adults before the ACA was enacted.1,2 The survey asked states about coverage and cost sharing in their fee-for-service Medicaid programs as of January 1, 2013 for 40 adult preventive services rated grade “A” or “B” by the USPSTF and immunizations recommended by the ACIP. The survey also asked about coverage for seven additional preventive services for women that are recommended by the Health Resources and Services Administration (HRSA) (see Table A2).3 In total, 39 states and the District of Columbia replied to the survey.

What Drives Spending and Utilization on Medicaid Drug Benefits in States?

December 20, 2014 Comments off

What Drives Spending and Utilization on Medicaid Drug Benefits in States?
Source: Kaiser Family Foundation

Medicaid is one of the country’s biggest payers for prescription drugs, but because prescription drugs have accounted for a small share of total Medicaid spending, Medicaid’s pharmacy benefit policies have not been at the top of mainstream healthcare policy debate. However, with the approval of new specialty drugs, such as the Hepatitis C treatment Sovaldi, states are mindful that the price tag for the Medicaid drug program could increase significantly. While states have implemented many cost-saving policies targeting their Medicaid prescription drug benefits, there remains room for additional cost savings, better management, and improved health outcomes. To ensure appropriate policy for this central benefit and achieve these goals, it is important to understand which drugs are most frequently prescribed and which drive spending.

Using state drug utilization data, as well as an industry drug database, this issue brief examines trends in Medicaid drug prescriptions and drug spending before rebates from 2010 through 2012.1 As part of the Medicaid drug benefit, manufacturers provide rebates to the state and federal government. However, rebates are based on proprietary data and they are not available to the public at the drug level. As a result we are unable to include them, or use this data to calculate total Medicaid drug spending. After presenting this analysis, we place these findings in the context of policy discussions. Key findings of the analysis include:

  • Comprising 35% of prescriptions and 34% of spending before rebates in 2012, Central Nervous System Agents, a class of drugs that include pain killers, antidepressants, and antipsychotics, constitute the largest share of Medicaid drug utilization and spending. Within this drug class, pain killers and fever reducers represent a third of utilization.
  • Specialty drugs account for just two percent of drug utilization in 2012, but they comprise 28% of drug spending. This share increased from 2010 when they totaled 24% of drug spending before rebates. The specialty drug share of total drug spending varies at the state level.
  • Brand-name drugs account for a disproportionate amount of drug spending. In 2012, they accounted for 20% of Medicaid drug prescriptions but 76% of spending. In the past three years, the share of Medicaid drugs that are generic has risen slightly, possibly due to a number of blockbuster brand drugs losing their exclusivity and facing generic competition in the past several years.

The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America

December 19, 2014 Comments off

The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America
Source: Kaiser Family Foundation

Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (below age 65). A majority of the nonelderly receive their health insurance as a job benefit, but not everyone has access to or can afford this type of coverage. Together, Medicaid and the Children’s Health Insurance Program (CHIP) fill in gaps in the availability of coverage for millions of low-income people, in particular, children. However, Medicaid eligibility for adults remains limited in some states, and few people can afford to purchase coverage on their own without financial assistance.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact also can be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.

Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker

December 15, 2014 Comments off

Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker
Source: Kaiser Family Foundation

States design and administer their own Medicaid programs within federal rules, and states and the federal government share Medicaid costs and have shared stakes in the program. One of the most important programmatic decisions that states make is how they will deliver and pay for care for Medicaid beneficiaries. Historically, states purchased services largely on a fee-for-service basis. However, since the early 1980s and particularly in recent years, states have increasingly used various models of managed care. The dominant model is comprehensive risk-based managed care, in which states contract with managed care organizations (MCOs) to provide comprehensive acute care, and in some cases long-term services and supports as well, to Medicaid beneficiaries, and pay the MCOs a fixed monthly premium or “capitation rate” on behalf of each enrollee. This model is called risk-based managed care because, through contracts, states shift the financial risk for serving their Medicaid beneficiaries to MCOs.

Today, 39 states contract with a grand total of about 265 MCOs to provide comprehensive Medicaid services; over 90% of Medicaid beneficiaries live in these 39 states. As of September 2014, more than half of all Medicaid beneficiaries nationwide were enrolled in MCOs, and the role of MCOs in Medicaid continues to grow, as an increasing number of states adopt risk-contracting programs, and states with existing programs expand them to include larger geographic areas and beneficiaries with more complex needs, shift from voluntary to mandatory enrollment in MCOs, and move long-term services and supports into capitated arrangements. In addition, states expanding Medicaid under the Affordable Care Act (ACA) are relying largely on MCOs to serve the millions of newly eligible adults. More broadly, the ACA expansions of both Medicaid and private health insurance are fueling dynamism in the managed care market as MCOs and large managed care companies position themselves to take advantage of new opportunities.

Medical and Prescription Drug Deductibles for Plans Offered in Federally Facilitated and Partnership Marketplaces for 2015

November 26, 2014 Comments off

Medical and Prescription Drug Deductibles for Plans Offered in Federally Facilitated and Partnership Marketplaces for 2015
Source: Kaiser Family Foundation

Most health plans require enrollees to pay a portion of the cost of care when they seek services. While there are lots of forms of cost sharing — deductibles, copayments, coinsurance – people often focus on the deductible amount because it often provides the simplest indication of how generous a plan may be. A deductible is the amount that an enrollee must pay toward the cost of covered services before the plan will start paying for most types of care covered by the plan. Certain preventive services must be covered without cost sharing in all plans in the Affordable Care Act’s Marketplaces, and insurers sometimes pay towards other services, usually physician office visits or prescription drugs, before the enrollee has met his or her deductible. Still, people need to be prepared for the fact that they may need to pay the entire deductible amount out of pocket if they need a significant amount of care during a year.

The slide show provides an initial look at the deductibles for medical care and the specific deductibles applied to prescription drugs for the plans offered in the federally facilitated and partnership Marketplaces available healthcare.gov. The amounts are simple averages of the plans available (see Methods). The amounts are shown separately by metal level (“Bronze,” “Silver,” “Gold,” and “Platinum”). Deductible amounts are shown separately for plans where medical spending and prescription drug spending are both subject to the same deductible (called “combined) and for plans where there are separate deductibles for medical spending and prescription drug spending (called “separate”). Not surprisingly, deductibles tend to decrease as one moves from the levels with lower actuarial values (“Bronze” and “Silver”) to the higher levels.

The slides do not show the deductibles for silver plans that provide reduced cost sharing for people with low incomes (e.g., people receiving cost-sharing subsidies). Many people in Marketplace plans receive these subsidies, and would not be subject to the deductible amounts shown in the slides. We will be releasing a more complete analysis that has information for these plans and for the other types of cost sharing (e.g., copayments, coinsurance amounts) in the near future.

Map: How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?

November 20, 2014 Comments off

Map: How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?
Source: Kaiser Family Foundation

This map based on Foundation analysis of Congressional Budget Office estimates of Marketplace enrollment provides a state-level breakdown of the number of Americans who in 2016 could be denied financial assistance to help pay insurance premiums for plans purchased in the Affordable Care Act’s federally operated insurance exchanges.

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