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Home Page > Business > Corporate > With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

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SumTotal® Systems, Inc. (Nasdaq: SUMT), the largest provider of talent, learning and business performance technologies and services, said today that Arlington, Va.-based Pearson Government Solutions has deployed SumTotal Enterprise Suite 7.1 software to manage training for 3,000 customer service representatives (CSRs) who staff the 1-800-MEDICARE Helpline. Pearson Government Solutions manages the nationwide telephone line on behalf of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to help beneficiaries with their questions about Medicare and their Medicare health plans.

Specifically, Pearson uses SumTotal Enterprise Suite 7.1 to deliver online training to CSRs who field calls on topics such as Medicare’s prescription drug coverage plan. SumTotal’s software will also assess how well the CSRs have mastered instruction on a particular topic, as CSRs must meet a high level of proficiency on a weekly basis across a number of subject areas. With SumTotal’s talent-management software, Pearson can assess each CSR’s performance.

“Measuring our representatives’ performance is critical to success, but we also want to capture institutional knowledge and disseminate that quickly to our customer service representatives,” said Mike Bowers, senior vice president and general manager of Pearson Government Solutions’ Health division. “SumTotal’s TotalCollaboration product gives us an easy way to capture knowledge from our company experts, and transfer this knowledge for future reference.”

TotalCollaboration enables Pearson’s CSRs to get answers from company experts via threaded discussions and instant messaging. According to Bowers, the system from SumTotal will boost the 1-800-MEDICARE Helpline staff’s productivity and knowledge.

“Pearson has a reputation for delivering superior service to federal government agencies,” said Don Fowler, chief executive of SumTotal. “We’re pleased that they have chosen to work with SumTotal’s Government Solutions group to serve not only the U.S. Department of Health and Human Services, but also the American public.”

For more information about SumTotal’s products and services, visit www.sumtotalsystems.com.

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This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee’s bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under “reconciliation” procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats – hesitant to push through such a huge partisan bill in light of the Massachusetts election – urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize.”

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional billion or more, over and above the billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward.”

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

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But the Democrats’ effort to sell the law to the public may be undermined by what even some ardent supporters consider its biggest shortfall. The overhaul left virtually untouched one big element of our health-care dilemma: the price problem. Simply put, Americans pay much more for each bit of care — tests, procedures, hospital stays, drugs, devices — than people in other rich nations.

Health-care providers in the United States have tremendous power to set prices. There is no government “single payer” on the other side of the table, and consolidation by hospitals and doctors has left insurers and employers in weak negotiating positions.

“We spend fewer per capita days in the hospital compared with other advanced countries, we see the doctor less frequently, and we swallow fewer pills,” said Jon Kingsdale, who oversaw the implementation of Massachusetts’s 2006 health-care law. “We just pay a lot more for each of those units than other countries.”

The 2010 law does little to address this. Its many cost-control provisions are geared toward reducing the amount of care we consume, not the price we pay. The law encourages doctors and hospitals to join “accountable care organizations” that have financial incentives to limit unnecessary care; it beefs up “comparative effectiveness research” to weed out inefficient treatments; and it will eventually tax the most expensive insurance plans to restrain consumers’ superfluous use of health care.

Such measures could reduce redundant tests, emergency room visits and hospital readmissions, which would help control the costs of Medicare, where the government sets rates. But they are less likely to lower prices outside Medicare and stem the growth of private insurance rates.

The main reason for this is politics. Remember how drawn-out the health-care battle was? It started in the spring of 2009 and was waged for a full year. The bill’s proponents in the White House and in Congress had some inkling of how tough the fight with the insurance companies would be. Taking on hospitals, doctors, and drug and device manufacturers as well — the people you’d face in a showdown over prices — might have been fatal.

So there was no price fight. The law will go on to face a likely post-midterm Republican onslaught — and dismantling it may be easier if Americans think it does little to restrain costs. It is one of those fine political ironies: The law derided as socialism may have had an easier time winning favor from a skeptical public if it was, well, a little more socialist.

It’s pretty far from socialist as it stands. The administration decided not to seek lower drug rates for Medicare, and it didn’t press for a “public option,” a government-run insurance plan that people under 65 could buy into. While supporters of the public option sold it as a way to compete with insurers, the real target was hospitals and doctors. A public option would have created a nationwide purchaser of health care that could have exerted leverage on providers to cut prices. This would have lowered the law’s costs by reducing the subsidies needed to make insurance affordable.

To avoid the wrath of hospitals and doctors, proponents of the bill rarely emphasized this cost-control argument. Nonetheless, when conservative “Blue Dog” Democrats weakened the public option in committee, they cited opposition from providers. And when the bill’s supporters floated a close alternative to the public option — letting people over 55 buy into Medicare — the reaction from Sen. Olympia Snowe, the moderate Maine Republican, said it all: “I am talking to a lot of my providers . . . and I know they are mighty unhappy.” Snowe exposed where the lobbying strength lay: No senator ever spoke of listening to “my insurers.”

“The public hates the insurance industry and trusts doctors and hospitals,” said Richard Kirsch, head of the liberal coalition Health Care for America Now. “But what killed the public option was the hospitals, not the insurance industry.”

Politicians wanted to avoid a confrontation over providers’ prices. So a different policy argument took hold: The real reason everything cost so much was the overuse of health care, not the actual prices of treatment.
This argument came primarily from Dartmouth College researchers who had amassed data showing wide disparities in Medicare spending among different regions. Hospitals in the lower-spending areas, mostly in the Upper Midwest and the Northwest, seized on the study to argue that the key to controlling costs was to reward providers like them. The case was popularized by Atul Gawande’s widely read New Yorker article in June 2009 focusing on McAllen, Tex., one of the highest spenders in the Dartmouth rankings. If health-care delivery in places such as McAllen could be brought in line with lower-spending places such as the Mayo Clinic’s home town, Rochester, Minn. — through the formation of integrated networks of salaried doctors — costs could be reined in.

The theory caught fire at the White House. It gave President Obama and his then-budget guru Peter Orszag a way to talk about costs without taking on doctors and hospitals; instead, the White House could simply differentiate between providers that offer “value” and those that don’t.

But the Dartmouth rankings, and the concept they supported, did a “disservice” to the debate, said Robert Berenson of the Urban Institute. For one thing, he and others say, the figures overstate regional differences in Medicare spending, which shrink when socioeconomic factors are taken into account. Second, rates of Medicare spending are not necessarily representative of health-care spending for people under 65. Some of the places that do well in the Dartmouth rankings charge high prices for non-Medicare patients — and were, not surprisingly, among those pushing hardest against a public option.

More broadly, the skeptics argue that merely providing care in smaller quantities will not sufficiently lower costs. They note that Americans already have shorter hospital stays and fewer doctors’ visits than people in other advanced countries. What sets us apart is our high prices for these health-care “units” — a finding trumpeted in a landmark 2003 paper by Princeton’s Uwe Reinhardt and others titled “It’s the Prices, Stupid.” The price problem is only getting worse, researchers and antitrust investigators have found, because of consolidation among providers, and it could be exacerbated by goading them to form even bigger networks.

But the notion that we pay more, despite using health care less, never caught on during the long march to reform. The main culprits driving our health-care costs were deemed to be inefficient doctors in a few corners of the country and demanding consumers — say, people seeking unnecessary surgery or patients with unhealthy habits and chronic conditions.

The camp that believes volume is the main problem disputes the idea that bigger networks of hospitals and doctors would make the price problem worse. “The more we’re able to encourage integrated systems of care, the better,” the new Medicare director, Donald Berwick, a Dartmouth data champion, told me before his nomination by Obama.

Berwick and his allies say they never meant for overuse of care to become the sole focus. Elliott Fisher, the lead Dartmouth researcher, said he did not intend for his data to be “interpreted as letting off the hook” those providers that kept overuse in check but charged high prices. “We clearly need to do both” prices and volume, he said.

But we didn’t do both in the health-care law, which raises the question of what will happen once the overhaul proves inadequate to the price problem. Perhaps the public option will be reconsidered, as many liberals hope. Perhaps there will be a new push for lower drug prices. Or maybe there will be a return to the rate-setting that prevailed decades ago, when hospitals, insurers and state officials worked together to agree on prices. Maryland is the only state that still does this, and data suggests that it has kept its cost growth lower than average. Massachusetts is considering a similar approach.

Would such measures have a chance? Perhaps. For one thing, as skeptical as insurers are of government intervention, they are glad to discuss reform that aggressively goes after providers. “We have a major cost problem, and we have to get on with the job of attacking it — with every stakeholder who is responsible for that,” said Karen Ignagni, the insurance industry’s chief lobbyist.

And the public? The Brookings Institution’s Henry Aaron predicts that there may be support for tougher action on high prices once the principle of universal health coverage is established, since taxpayers will be on the hook for more of the cost of insurance. “If we attacked costs right at the front end, [the legislation] would have died,” he said. “Now, we’ll have a mechanism that will force us to address it. There are only so many fronts you can fight a war on at the same time.”

That’s assuming, of course, that the law survives long enough to enjoy any embellishment.

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Home Page > Finance > Insurance > Choosing the Right Health Insurance

Choosing the Right Health Insurance

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Choosing the Right Health Insurance

By: Uchenna Ani-Okoye

About the Author

Uchenna Ani-Okoye is an internet marketing advisor and co founder of Free Affiliate Programs

For more information and resource links on health insurance visit: Health Insurance Ratings

(ArticlesBase SC #441767)

Article Source: http://www.articlesbase.com/ – Choosing the Right Health Insurance

Only a few ‘health insurance’ programs are wellness insurance. Choosing the health insurance plan with the best coverage health insurance contracts may be the most complex of the insurance policies purchased by the average family. They ended up working with us to find an acceptable private health insurance plan and reimbursed her for a percentage of the cost which I didn’t even know was possible.

The handling of the premiums for life, accident and health insurance, and for service contracts, does not create a problem, if a routine is established. Finally, a few had headlines that just reiterated their life-auto-health insurance. Financed partly by the federal government, the children’s health insurance programs (CHIP) operate either as an expansion of the state’s Medicaid program or a subsidy for basic private health insurance.

If you sell health insurance, your list might include health clubs, running clubs, basketball teams or physicians. So, before you purchase health insurance for your employees or your business, make sure the insurance company you’re dealing with is legitimate. A health insurance plan premium with an 80/20 or 20% co-insurance level is much higher typically than is a 50/50 or a 50% plans.

This indicates that even those who do have health insurance aren’t always protected, said Cindy Zeldin, a report co-author and federal affairs coordinator with demo’s economic opportunity program. A college student attending school full time may be eligible for a student health insurance plan, if one is available at the student’s school. The APA has neatly classified several different types of depression (manic, bipolar, unipolar, post-partum, grief, etc – mostly for the purposes of legally making them covered by health insurance.

Why underwriting is important the majority of small-group health insurance companies use a process called underwriting. If you’re an individual who tries to keep informed and maintain a healthy condition and lifestyle, you should take a look at the revolutionary, comprehensive and highly-affordable individual health insurance solutions created by Precedent specifically for you. This is a very basic comparison of the types of health insurance plans, and further investigation into the details is advised.

We have to agree that the main reason for having health insurance is to protect ourselves from large unexpected medical bills. Enjoy it while you can, because I feel the future is bleak for Americans to continue to afford health insurance. These benefits may include health insurance, retirement savings plans, disability insurance, life insurance, dependent care reimbursement accounts, vision care, dental insurance, employee assistance plans, job counseling and educational benefits.

I’m having a bear of a time finding health insurance. In other cases, a company may offer health insurance, yet the premiums are so expensive that the individual can not afford to pay them. Some critics of health insurance plans also fear consumer-driven plans punish the sick because the sick visit their doctors more often and need more expensive treatments.

Experts say that the United States should consider a nationalized health insurance scheme, like that to be found in all countries in the world. Employee benefit plans – you may deduct contributions to employee benefit plans (such as health insurance plans and retirement plans).

Other working class citizens are able to afford the insurance premiums, but are unable to take advantage of a health care plan because such a large percentage of their monthly or yearly income is set aside to pay for health insurance.

Moreover, if you only operate in one state, you can further to ‘cheap health insurance California’. Fortunately most of the brochures and outlines of coverage that you may receive from a health insurance provider will have a similar structure.

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(ArticlesBase SC #441767)

Uchenna Ani-Okoye -
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Uchenna Ani-Okoye is an internet marketing advisor and co founder of Free Affiliate Programs

For more information and resource links on health insurance visit: Health Insurance Ratings

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