Census Says Life Expectancy is Up, But Why?

Recent census data shows that the US average life expectancy has increased to a record-breaking 78 years. The immediate thought that most people have when presented with this information is that improving medical technology and increased health is leading to longer lives. To some extent, that is true. While there is a clear correlation between life expectancy and medical advances, this number does not really mean that the average person is living a longer life.

In reality, average life expectancy is determined almost entirely by infant mortality rate. In this most recent report, the CDC listed “a record low of 6.42 deaths per 1,000 live births, a drop of nearly 3% from 2008.” This number was 100 out of 1000 as recently as 1920, creating a statistic that implies that most people are living up to twenty years longer than they have in the past. This is simply not true.

Death rates are likely to continue dropping over the next decades as medical advances remove the threat of curable disease. The increasing unpopularity of smoking adds to this number as well.  This ratio of infant-mortality and death rate will continue to influence life expectancy, but we do not need to start worrying about running out of retirement homes any time soon.

Dr. Don Berwick’s Appointment to CMS in Danger

Last July, President Obama appointed Dr. Donald Berwick to serve as the Chief Administrator of the Centers for Medicare and Medicaid Services (CMS) through a recess appointment, meaning the president is putting Berwick in place while Congress is on recess.

However, Dr. Berwick still needs Senate approval eight months later and Republicans have gathered enough support to block his Senate confirmation. This shock came with a letter signed by 42 Republican Senators. This number is large enough to defeat his confirmation because 60 “yes” votes are required to confirm Dr Berwick. This majority in the Senate has called on the administration to withdraw Dr. Berwick’s nomination citing his past statements about healthcare rationing, and his lack of experience managing an organization of CMS’s size disqualify him.

Last Tuesday, Berwick said that the administration has sufficiently gone to bat for him as Republicans make him a central political target for their opposition to the healthcare reform law enacted last year.

“You may have seen a response from the White House a few days ago,” Berwick told reporters after a speech at an America’s Health Insurance Plans conference. “It was positive. I’m very grateful for that response.”

After the Senators sent the letter, White House spokesman Reid Cherlin said the administration would not withdraw Berwick’s nomination.

“The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: Saving taxpayer dollars by cracking down on fraud and implementing delivery-system reforms that will save billions in excess costs and save millions of lives,” Cherlin said in a statement to the New York Times.

Berwick’s past statements of support for Great Britain's National Health Service and his call for "rationing with our eyes open" created controversy when he took the lead at CMS, which manages about 100 million individuals. 

Nothing  further has been heard on a possible confirmation hearing with the Senate Finance Committee.  Dr. Berwick stated he is willing to talk with any senators who signed onto last week’s letter.

President Obama re-nominated Dr. Berwick at the end of January. His recess appointment allows him to serve through the end of this year.

Changes in the industry continue to be opportunities for Merrill.  As individuals come and go in the political arena, we know we must adapt quickly to these moves and look for methods of strengthening and improving communication to our clients and their membership. Working together to inform one another of changes will help us remain informed and progressive thought leaders.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Understanding the Digital Database Idea.

Last week, we presented a few ideas about the controversy surrounding a proposed digital database for insurance consumer information. The obvious faults that experts pointed out about the plan centered on the possibility that data-miners or corporate interests could easily access consumer information. Now we are going to take a look at the legislation that inspired the concept.

Back in July of this year, the Obama administration began announcing the features of the healthcare reform plan. Part of this plan was for every citizen to have an electronic medical record by 2014. This was motivated by the desire to make the process of healthcare easier, faster, and cheaper. A nationally-accessible database would prevent much of the pointless paperwork that takes up time and money in today’s system. It is around this point that things begin to get interesting.

The primary arguments today against this system are the potential for corporate interests to access private information. In actuality, privacy was one of the founding principles of the electronic database idea. In July, when the Health Information Technology for Economic and Clinical Health (HITECH) Act cam out, it required HHS to re-write HIPAA to strengthen privacy, security, and enforcement. The language used in HITECH is very similar to the language used to promote the electronic database:

• Expanding individuals' rights to access their information and to restrict certain kinds of disclosures of protected health information to health plans
• Requiring business associates of HIPAA-covered entities to follow most of the same rules as the covered entities
• Setting new limitations on the use and disclosure of protected health information for marketing and fund raising; and
• Prohibiting the sale of protected health information without patient authorization (From FierceHealthcare).

So now we have a system devised to protect privacy and security in response to a rule-change based in those same values. As long as the digital database functions as intended, it seems like a win-win scenario. Obviously, there is always the chance that an immoral healthcare worker could sell personal information to data-miners, but isn’t that just as possible today?

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The Patient and Protection Affordable Care Act…..6 months later

While The Patient and Protection Affordable Care Act (ACA) was enacted on March 23, 2010, it didn’t officially go into effect until last week on September 23. However, despite being enacted, there are still many debates and discussions raging on about the bill.

The goal of the ACA was to reduce the cost of healthcare, improve the quality of care and improve the overall member experience. Thus ACA included the following items:

• No lifetime or restricted annual limits on benefits
• Eliminated pre-existing conditions and rescissions
• Young adults covered to age 26 on their parent's policy
• Drug discounts for seniors (starting June 15, 2010)
• Tax break for small businesses

However, there are also additional changes taking place behind the scenes that many consumers are unaware of, but could greatly alter the healthcare landscape. Most notably, changes to Medicare Enrollment Period’s and Medical Loss Ratio calculations.

With reduced enrollment periods, plans will have to alter how and when they market to their members. This constricting timeline is going to make an already trying process, an even greater strain on resources. Additionally, the 80-85% Medical Loss Ratio that plans will be mandated to operate at will force some plans to change their plan type, or worse may force them to drop certain coverage in order to comply.

On top of all of this, with November elections looming, funding may be reduced or cut and each new member of Congress will push for what they think will be the best circumstance for their delegates. Like always, Merrill Corporation will be monitoring all these changes and more from HHS, CMS and all other regulatory bodies to ensure that health plans can successfully navigate and comply with Health Reform.