Health System Review – October 25th, 2012

Growth of patient navigation companies could impact traditional healthcare business

Growth of patient navigation companies could impact traditional healthcare business
Healthcare Finance News – October 18, 2012
Our complex healthcare system is often challenging for those who work in it. For those who don’t – patients – a new brand of companies is rising up to help. Patient navigation companies may be patient-centric but they will impact the way the traditional healthcare system does business.

Payer Transformation Survey finds that 87% believe health insurers must transform to survive
Payer+Provider – October 25, 2012
Payer+Provider Syndicate, the consulting firm which brings health services research into practice, today released findings from its comprehensive Payer Transformation Survey. The survey found that 87% of the health insurance employees surveyed believe that the industry must undergo a transformation in its business model to survive. To assess the degree to which transformation is taking place, the survey also examined the industry’s self-perceived degree of preparedness for reform.

More Health-Law Changes Coming in 2013
WSJ – October 21, 2012
Health-care reform is here to stay—for the foreseeable future. So for the millions of Americans with health insurance at their workplaces, this fall’s “open enrollment” period will be one of the most important in years. Next year will see some of the many significant changes brought on by the Affordable Care Act, including easy-to-read plan summaries and caps on flexible spending accounts. The ability of health insurers to place limits on annual spending is also on its way out, while earlier reforms such as adding adult children to their parents’ plans offer new options to consumers.

Settlement Eases Rules for Some Medicare Patients
NYT – October 13, 2012
Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration. In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.

Higher BMI Raises Hospitalization Risk in Study
Reuters – October 21, 2012
Data on nearly 250,000 Australian participants showed every additional BMI point was tied to up to a 4% higher risk of being hospitalized for a variety of conditions within a two-year period. The study was published in the International Journal of Obesity.