Business Insurance reports that ‘Walgreen Co., the largest U.S. drug- store chain, is looking to sell its pharmacy-benefits management business [which is the ninth largest in the U.S.] and has hired an adviser to run an auction, said three people with knowledge of the matter.”
The AMA News offers a report on the medical community’s perspective on “‘physician payment reform'” [which the AMA News describes as] “a catch phrase that refers to paying physicians based on quality measures and episodes of care, rather than a fee-for-service system.”
This AMA News article discusses the “National Committee on Quality Assurance’s annual State of Health Care Quality report. The 162-page report [available here], which looked at claims data from more than 1,000 health plans representing 118 million Americans, declared that spending more money on health care did not automatically lead to better health.” Actually, the NCQA press release explains
Health plans that spend the most on care don’t always deliver the best quality
News that high-spending health plans don’t always deliver the best care comes from findings on relative resource use (RRU) – documented for the first time in the report across five common, costly and chronic diseases.
RRU indicates how intensively health plans use health care resources (such as physician visits and hospital stays), compared with other plans in the same region, serving similar members. When used alongside quality measures, RRU makes it possible to talk about quality and cost simultaneously.
Given the definition of value as the intersection of health plans’ spending (resource use) and their results, RRU reveals the value that plans offer.
RRU analysis shows that many plans that deliver below-average quality use above-average levels of resources. More care is not always linked to better results, confirming that the saying “you get what you pay for” does not apply to health care.
Last week, HealthGrades issued its 13th annual report on U.S. hospital quality. The report finds a large quality gap between the hospitals awarded five stars by HealthGrades versus the hospitals awarded one HealthGrades star. This blurb from the press release caught the FEHBlog’s attention: “On average, one in nine patients developed a hospital-acquired complication, across the nine procedures evaluated for inhospital complications, from 2007 to 2009.”
The Affordable Care Act will require health plans, including FEHB plans, to provide enrollees with a four page standard benefit summary beginning in 2013. This four pager will supplement the FEHB plan brochure or the ERISA summary plan description. The National Association of Insurance Commissioners (NAIC) is responsible for providing the HHS Secretary with a template. The Politico offers a report on the NAIC’s work. According to the article, the NAIC is aiming to send its template to HHS in November.