Results of a national study that identifies nationwide costs associated with home health care, assisted living facilities, and skilled nursing facilities suggest that living at home for people of retirement age is a viable financial option, according to the “2010 Cost of Care” report issued by Univita, a company that provides service and support for patients receiving home-based medical care.

That’s because the annual cost of a private room in a Medicare-certified skilled nursing facility averages $90,155. The average daily rate for a single-occupancy private room amounts to $247.

“Studies have shown that the vast majority of people of retirement age wish to remain in their homes indefinitely, and our annual study reiterates that staying at home is a financially viable option,” says Hugh Lytle, president and chief executive officer of Univita.

The researchers contacted more than 2,000 nursing homes, 2,000 assisted living facilities, and 2,000 home health care agencies to complete more than 6,000 surveys in April and May 2010. They obtained private-pay rates for single occupancy rooms in Medicare-certified skilled nursing facilities, hourly rates for home health aides for Medicare-certified and non-certified home health care agencies, and monthly rates for assisted living facilities.

Additional findings include:

  • The region with the most expensive average daily rate for a private, single-occupancy room in a Medicare-certified skilled nursing facility is Anchorage, Alaska and costs $576 per day.
  • The region with the least expensive daily average rate for a private, single-occupancy room in a Medicare-certified skilled nursing facility is Lafayette, La. and costs $143 per day.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.