Health Beat: Aetna to narrow participation in Affordable Care Act

Editor’s note: Each Wednesday, Talk Business & Politics provides “Health Beat,” a round-up health-related topics.  –––––––––––––––

AETNA TO NARROW PARTICIPATION IN ACA, CEO SAYS
Healthcare giant Aetna announced on Monday (Aug. 15) it will reduce its individual public exchange participation from 778 to 242 counties for the 2017 plan year, maintaining an on-exchange presence in Delaware, Iowa, Nebraska and Virginia. The company will continue to offer an off-exchange individual product option for 2017 to consumers in the vast majority of counties where it offered individual public exchange products in 2016.

In a statement regarding the company’s participation in the Affordable Care Act individual public exchanges, Aetna Chairman and CEO Mark T. Bertolini said “following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward.”

Bertolini also said More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states.

“As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision,” he said.

U.S. RANKS FIRST IN HEALTH CARE SPENDING, BUT CANCER OUTCOMES DO NOT REFLECT INVESTMENT, STUDY FINDS
The U.S. health care system is characterized – on a global level – by its unsustainable health care spending, which does not necessarily correlate to better outcomes in patients with cancer, according to researchers at The University of Texas MD Anderson Cancer Center. With $2.9 trillion spent on U.S. health care in 2013, the U.S. ranks first in health care spending among the world’s leading economies.

To investigate the implications of socioeconomic status (SES) and health expenditures on cancer outcomes and mortality, researchers at the University of Texas conducted an ecological study at the state level for three distinct patient populations: breast cancer, colorectal cancer, and all-cancer populations. The study, “Wealth, Health Expenditure, and Cancer: A National Perspective,” was published in the August issue of JNCCN – Journal of the National Comprehensive Cancer Network.

CMS UPDATES NURSING HOME FIVE-STAR QUALITY RATINGS
The Centers for Medicare & Medicaid Services (CMS) has updated its popular Nursing Home Compare Five-Star Quality Ratings to incorporate new measures, giving families more information at their fingertips to help them make important decisions about care. These new measures look at successful discharges, emergency visits, and re-hospitalizations, and complement other nursing home measures previously announced in April.

Nursing homes receive four different star ratings on the Nursing Home Compare website (each ranging from 1 to 5 stars): one for each of the components – health inspections, staffing, and quality measures – and one for an overall rating, which is calculated by combining each of the three component star ratings. With the new quality measures added to the calculations, the quality measures star rating for each nursing home, as well as the overall rating, will likely change.