Insurance Claims on Interim Agenda

The Interim Public Health, Behavioral Health and Human Services Committee conducted its final hearing in late October. The only topic of debate was the preliminary draft language that was offered by the chair, Sen. Patricia Miller (R-Indianapolis). The committee also prepared its final report for the Indiana General Assembly.

Senator Miller’s proposal addressed problems that she believes are occurring related to the handling and denial of health insurance claims. Her proposal would require the Department of Insurance to post on its web site information concerning internal and external grievance procedures for health insurance contracts. Examples include the process that a consumer should follow in filing a grievance along with a contact phone number of the department for the consumer. These provisions were generally accepted as reasonable provisions of the draft.

Controversy arose over the quarterly requirements that will be imposed on insurers regarding the denial of claims and additional burdens placed on them. The Indiana Department of Insurance testified that there really isn’t a problem regarding health claim denial in Indiana and while there have been problems among property and casualty insurers, that has not been the case with health insurers. Further testimony reflected that the department has the ability to do market conducts (on the distribution and sale of insurance), which determine problems with carriers.

Furthermore, the department conducts financial audits once every five years on every Indiana domestic insurer to make certain of insurer solvency and the ability to pay claims. Representative Matt Lehman (R-Berne) commented that the claim problem was .0004 of one percent – implying that there really isn’t any need to impose further requirements. The language passed the committee, with Sen. Jean Breaux (D-Indianapolis) and Rep. Lehman voting against the draft.

Look for Sen. Miller to draft legislation in the 2016 session similar to the language proposed in the draft. A bill may even move through the Senate, but may find more difficulty getting traction in its current form in the House. Still, there will be a fairly good chance that the grievance procedures and the web site information will find their way through the legislative process. The Chamber will be involved in the debate during the upcoming legislative session.

Carter: Biopharmaceutical Industry Supports Tens of Thousands of High Pay, High Skill Jobs for Hoosiers

Our VP Cam Carter recently spoke with We Work for Health (WWFH) about the importance of Indiana’s biopharmaceutical sector. WWFH is a grassroots initiative that shows how biopharmaceutical research and medical innovation work together to create a strong, vibrant economy and a healthier America.

Medical Malpractice in Spotlight in Study Committee

The Courts and Judiciary Interim Study Committee has been charged with looking at Indiana’s medical malpractice (med-mal) system. The statute was written in 1975 to protect the health of the citizens of Indiana by preventing a reduction of health care services. Prior to the enactment, seven of the 10 insurance companies writing med-mal business at the time either ceased or limited writing the insurance because of unprofitability. Premiums for med-mal skyrocketed at that point. In some cases, physicians were hard pressed or unable to purchase coverage. Likewise, services were discontinued in some locales.

To stabilize the market, the Med-Mal Act created a medical review panel consisting of an attorney and three health care providers. The parties agree to a panel chair, each party chooses one health care provider to be on the panel and the two health care providers choose a third provider to fill out the panel. Parties send submissions to the panel and the providers review the information and determine if there was malpractice. The panel makes an opinion based upon whether or not the provider failed to comply with the standard of care; whether the conduct complained of was a factor of the resultant damages; and whether the health care provider should be reported to the applicable licensing agency. The medical review panel must render its decision before any court action may take place, unless the claim is less than $15,000 or both parties agree to bypass this step.

The system has damages capped to a patient for an act of malpractice at $1.25 million. That cap has been raised twice since 1975. The system is voluntary, but to participate in the protections of the act, physicians purchase a commercial insurance policy to cover the first $250,000 and pay a surcharge to the Patient’s Compensation Fund (PCF) to cover the remaining $1 million in potential liability. Surcharges vary based upon the specialty of the provider. In 2014, nearly $138 million in claims were paid from the PCF.

The Courts and Judiciary Interim Study Committee has entertained testimony on two separate occasions. The debate now concerns whether or not the caps on med-mal need to be raised for the first time since 1999. The balancing act is between trying to maintain the med-mal system in this state, with maintaining access to care and low premium costs for physicians, and the fear of having the Indiana courts determine the system unconstitutional because the caps haven’t been raised in over 15 years. The committee is also entertaining discussion on the consideration of increasing the bypass threshold (currently $15,000) of the medical review panel – regarding those claims exempt from the medical review panel process.

Committee chairman Sen. Brent Steele (R-Bedford) has asked committee members to review the documentation presented and offer proposals to improve the process. The Indiana Chamber expects there will be a proposal for some increase to the cap.

Chamber Promotes Life Sciences in D.C.

7324001The Indiana Chamber is a proud partner in Hoosiers Work for Health, which promotes the biopharmaceutical and life sciences industry, and visited with Indiana’s elected representatives in Washington, D.C. July 15-16 to discuss issues such as patent
reform, taxation and FDA regulatory procedures.

The Chamber joined several other Hoosiers Work for Health representatives for office visits on Capitol Hill. The group met with Reps. Susan Brooks (R-5th District) and Larry Bucshon (R-8th District), both members of the House Energy and Commerce Committee, as well as Rep. Todd Young (R-9th District), who serves on the House Ways and Means Committee. The group also visited with key staff members for Sens. Dan Coats (R) and Joe Donnelly (D) while the Senate held floor votes on an education bill.

It is clear from the conversation with Indiana’s elected officials that they understand the importance of the biopharmaceutical/life sciences sector to the economic health of Indiana. This sector directly supports more than 20,000 jobs across the state and generates $19 billion in economic output. By creating high paying jobs, biopharmaceutical companies build a strong foundation from which we can grow our state economy – providing stability and prosperity into the future.

Dan Evans: Early Childhood Education a Key to a Healthy Indiana

Dan Evans, President and CEO of Indiana University Health, explains why early childhood education and expanding preschool opportunities for families of all income levels is so critical to the health of our state.

Chamber on Federal Approval of HIP 2.0 to Satisfy ACA Requirement

Indiana Chamber of Commerce President and CEO Kevin Brinegar comments on the federal Centers for Medicare & Medicaid Services giving the green light to the Healthy Indiana Plan expansion (HIP 2.0), which is in lieu of traditional Medicaid expansion required under the Affordable Care Act (ACA).

“We are very pleased that the Centers for Medicare & Medicaid Services (CMS) appreciated Indiana’s unique brand of addressing the needs of our uninsured population and recognized HIP 2.0 as the best option for Indiana to expand health care coverage. The Indiana Chamber had reviewed HIP 2.0 and urged CMS to approve it.

“HIP provides reimbursement to health care providers at Medicare rates. Otherwise, health care providers recover such losses by increasing prices for private sector employers and their employees through cost shifting. Any attempt to lessen that cost shift is welcome.

“What’s more, the approval of HIP 2.0 will provide health care coverage for tens of thousands of additional Hoosiers and bring billions of dollars into Indiana’s economy.

“We applaud Gov. Pence and his administration for recognizing that HIP 2.0 was the best course for the state and for staying firm in that belief.”

Poll: Almost One in Four Americans Open to Separating from U.S.

CAlthough Scotland’s movement to secede from the United Kingdom fell a bit short at the ballot box, it appears it’s not just 45% of Scots who have separation on their minds.

And frankly, it’s no secret most Americans aren’t enthusiastic about the federal government these days. Between gridlock, behemoth budgets and trying to solve the health care puzzle, many have grown frustrated. Poll results explained in this Reuters article, however, are still a bit alarming.

Whoever takes the White House in 2016 may have his/her hands full in trying to unify the country. 

Congress Can Do It, But You Can’t

An interesting blurb in a recent Kiplinger newsletter on one of the privileges of congressional service:

Congress can do what employers can’t when it comes to health coverage: use tax-advanced funds to reimburse workers who buy individual health care policies on exchanges. Employers face a tax penalty of $100 a day per worker for violations.

Yet the government gives lawmakers and Capitol Hill staffers tax free contributions to help offset insurance premiums, covering about 72% of exchange-bought insurance. The government allowed the payments because of concerns about higher premiums and the loss of the government subsidy for insurance for both lawmakers and staff.

The IRS restated its view that such subsidies aren’t permitted in the private sector after some vendors told employers that the pretax payments would allow them to meet the mandate to provide insurance. The double standards isn’t likely to change.

Study: Time for Docs to Advise Patients to Kick the Habit

Indiana maintains its unfortunate top 10 ranking as a state with one of the highest levels of people who smoke. A goal of Indiana Vision 2025 is to reduce that 24% adult rate.

A recent study says doctors can help, but many are skipping the opportunity to guide their patients.

Nationally, less than half of adult smokers report that their physicians advise them to stop smoking, while about two-thirds of physicians say lack of patient motivation to quit smoking is a barrier to medical interventions.

The JAMA Internal Medicine study, titled “Patient Engagement During Medical Visits and Smoking Cessation Counseling,” examined the relationship between patient engagement — or how involved people are in their health care — and the likelihood that physicians would counsel patients to stop smoking.

The study by Peter Cunningham, Ph.D., of Virginia Commonwealth University, was conducted for for the National Institute for Health Care Reform while he was a senior fellow at the former Center for Studying Health System Change. Based on a 2012 survey of 8,656 current and retired autoworkers and their spouses younger than 65, the study included 1,904 current smokers and assessed their engagement levels depending on whether they had ever talked with their physician about health information they found on the Internet, had someone accompany them to a medical visit for support, had taken notes during a medical visit to help remember what was said, and had brought a list of questions to ask during a medical visit.

Highly engaged patients were more likely to report that their physicians had advised them to stop smoking, the study found. And, highly engaged patients whose physicians counseled them to stop smoking were the most likely to attempt to quit (75%), while patients with low engagement levels who did not receive counseling were the least likely to attempt quitting (46%). However, if counseled by their physician, 60 percent of smokers with low engagement levels attempted to quit smoking, the study found.

“Clinicians should not misinterpret lack of patient engagement during medical encounters as unwillingness to quit because the results of this study suggest that counseling of even less engaged patients is effective in getting them to attempt quitting,” the article states.

The findings strongly suggest “that clinicians respond differently to patients who are highly engaged during medical encounters than they do to less engaged patients in terms of advising patients to stop smoking. Nevertheless, even patients with low levels of engagement can benefit from this counseling,” the article concludes.

It’s a Big Fat Global Problem

It’s been well documented that Indiana has an obesity problem. It doesn’t diminish that challenge to know that we’re not alone.

According to a recent ABC News story, “almost a third of the world is now fat, and no country has been able to curb obesity rates in the last three decades.”

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington reviewed more than 1,700 studies (that took place between 1980 and 2013) from 188 countries. A few findings:

  • Two billion people worldwide are overweight or obese
  • In the Middle East and North Africa, nearly 60% of men and 65% of women are heavy
  • About two in three adults in the United Kingdom are overweight, making it the fattest country in Western Europe

The research showed a link between income and obesity — as people obtain more money, their waistlines also expand.

As we’ve been telling you the last two-and-a-half years, the Indiana Chamber’s Indiana Vision 2025 plan has a goal — reduce obesity levels to less than 20% of the population — as part of its Attractive Business Climate driver. We’re focusing on workplace wellness this summer during our free Connect & Collaborate luncheons.

It’s a big, global challenge — one that each of us needs to try to tackle in our state by working together.