In the News
Unable to Meet the Deductible or the Doctor
- October 17, 2014
Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans, according to Margaret A. Nowak, the research director of Breakaway Policy Strategies, a health care consulting company. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year.
The Future of State Regulation Under Obamacare
- September 29, 2014
WASHINGTON, D.C.- While the Affordable Care Act (ACA) significantly expanded the reach of the federal government in regulating private health insurance, state health insurance commissioners have had a major role in shaping implementation from the first moment the ACA was signed into law.
In fact, the ACA includes about a dozen directives to the National Association of Insurance Commissioners (NAIC), the umbrella organization representing state insurance regulators, to make recommendations to the Department of Health and Human Services (HHS) on key provisions of the statute, including, but not limited to, rate review, appeals, reinsurance and risk adjustment, age bands, and the Exchange enrollment form. Specifically, the ACA directed the NAIC to create a working group of “health insurance-related advocacy organizations, health insurance issuers, health care professionals, patient advocates, and other qualified individuals” to provide expertise in the implementation of ACA.
Trio of Top-Flight Health Policy Experts Join Breakaway
- July 29, 2014
WASHINGTON, D.C. (July 29, 2014) – Breakaway Policy Strategies is adding three accomplished health experts to its talented team. Each brings decades of experience in government, business, and health policy analytics.
A former top official at the Office of Management and Budget under President George W. Bush, Donald Dempsey joins Breakaway from the Marwood Group, where he was Senior Vice President and a senior team leader responsible for providing federal legislative and regulatory analysis to corporations and institutional investors needing analyses of the reimbursement, legislative, and regulatory climate and risks associated with investing in health care services, life sciences, and device companies. [...]
Laura Tollen joins Breakaway after fourteen years with the Kaiser Permanente Institute for Health Policy, whose mission is to shape policy and practice with evidence and experience from the nation's largest private integrated health care delivery system. [...]
Joining Breakaway's Medical Advisory Board is Dr. Michael Miller. For over 25 years, Mike has been supporting the development, reimbursement and appropriate use of health care and life sciences innovations. He comes to Breakaway after working most recently at the National Governors Association where he supported state-level health transformations, as well as prescription drug abuse prevention, maternal and child health, and other issues important to state government health leaders.
Senior Administration Official Chiquita Brooks-LaSure Joins Breakaway
- June 16, 2014
WASHINGTON, D.C. (June 16, 2014) – Chiquita Brooks-LaSure, a senior Obama Administration official responsible for overseeing major aspects of the Affordable Care Act's (ACA) implementation, has joined Breakaway Policy Strategies as a Senior Policy Advisor.
Most recently, Chiquita served as Deputy Center and Policy Director at the Center for Consumer Information and Insurance Oversight (CCIIO) where she played a leading role in developing policy and regulations for the private health insurance marketplace. Before joining CCIIO, she was Director of Coverage Policy in the Office of Health Reform at the Department of Health and Human Services (HHS). From 2007 to 2010, she was a professional staff member for the U.S. House of Representatives Ways & Means Committee, where she worked on Medicare legislation and helped craft core ACA provisions.
"Chiquita is one of the most respected and knowledgeable health policy experts I know," said Dean Rosen, Breakaway's President and CEO. "She has had a front row seat for the past decade in developing and implementing the most sweeping health reform law of our time."
Also joining Breakaway is Amanda Ledford, an attorney who was most recently the Regulatory Affairs Specialist at the American Society of Anesthesiologists (ASA). There, she focused on physician payment issues, clinical quality improvement and ACA implementation. Prior to her role at ASA, Amanda also spent three years as a Health Insurance Specialist at CCIIO. At CCIIO, she advised senior leadership, prepared economic impact analyses, drafted regulatory guidance and helped bring state insurance departments into compliance with ACA requirements.
Obamacare Plans' Unexpected Sticker Shock
- May 08, 2014
Alarming predictions that the premiums for individual health plans would skyrocket in the first year of Obamacare turned out to be largely unfounded. But the roughly 8 million people who bought insurance through the Affordable Care Act exchanges may suffer some sticker shock as they begin using their benefits.
That’s because many of the plans make consumers shoulder a lot of the costs of their medical care through deductibles, co-pays, and co-insurance—payments the newly insured may not have grasped when they signed up. Research suggests that most people don’t understand those terms.
“Most people, as soon as they have health-care coverage, they expect to go to the drug store and pay whatever their co-pay is for their prescription, not have to meet a deductible,” says Gina Boscarino, senior policy director at Breakaway Policies. She helped produce a new report (pdf) with the Robert Wood Johnson Foundation examining the new health plans. [Read More]
Studies Examine ACA Enrollment Goals, Premium Rates
- May 05, 2014
Some exchange enrollees who selected silver-level plans could spend thousands of dollars more for prescription drugs and other health costs because such plans -- unlike most employer-sponsored plans -- have high deductibles and typically do not cover prescriptions or primary care visits, according to a recent study by Breakaway Policy Strategies and the Robert Wood Johnson Foundation, CQ HealthBeat reports. [Read More]
Exchange Plans Could Saddle Enrollees With Thousands of Dollars in Costs, Study Shows
- May 02, 2014
A database of all of the so-called silver plans sold on health law insurance exchanges finds that some enrollees may shell out potentially thousands of dollars for prescription drugs and other medical costs before their new coverage kicks in.
That's because the plans often require paying high deductibles. And unlike the way benefits often are designed in employer sponsored health coverage, silver plans in many cases don't pick up prescription costs before the deductible is met, said Dean Rosen, a former White House health aide who helped found the firm that conducted the analysis.
The data on all 7,027 silver plans sold in the exchanges was assembled and analyzed by Breakaway Policy Strategies in a partnership with the Robert Wood Johnson Foundation. Breakaway is a separate policy analysis and research firm formed as a joint venture by Rosen's Washington, D.C. lobbying firm, Mehlman Vogel Castagnetti.
The analysis reinforced that deductibles and other forms of cost sharing are important features to consider in shopping for coverage — not just premiums.
Silver plans are part of the menu of "metal" plans sold in the new marketplaces. On average, they pay 70 percent of the costs of covered benefits while the policy holder pays the other 30 percent. Gold and platinum plans pay higher percentages while bronze plans pay a lower one.
The silver plans are the most popular variety of plan. About 65 percent of the 8 million people who signed up in exchanges chose silver plans.
The study looked at various types of payments consumers must make if they have insurance, including premiums and deductibles, co-insurance and co-payments. They also looked at the caps the plans had on out-of-pocket spending.
"Many exchange plans subject health care services such as primary care physician visits and prescription drugs to the deductible, a benefit design feature which is less common in employer sponsored insurance plans," the study states.
An analysis of the silver plans found that about half had combined deductibles under which medical and prescription drug expenses both counted toward meeting a single deductible that averaged $2,267 for a 27-year-old individual. The other half had separate deductibles for medical costs and prescription drugs. For those plans, the medical deductibles ranged as high as $6,250 while the drug deductible was as high as $2,500. The median separate deductible for medical costs was $2,500, meaning half the plans charged higher deductibles and half charged lower. The median separate deductible for prescription drug expenses was $400.
Silver plan premiums varied widely among states and by age. The national average silver plan premium was $265 a month for a 27-year-old, $435 for a 50-year-old, and $878 for a family of four.
The monthly premiums ranged from a low of $126 for a 27-year-old in Minnesota to a high of $1,858 in Virginia. For a family of four, monthly premiums ranged from a low of $215 in Minnesota to a high of $1,848 in Colorado.
There's an important caveat to the analysis: It didn't take into account the fact that many, but not all, silver plan buyers are eligible for subsidies to help pay premium charges as well as out of pocket costs.
The subsidies to help pay out of pocket costs apply to people with incomes less than two and a half times the federal poverty level. The poverty level for a single person in 2013 was $11,490 (See related story «CQ»«HealthBeat», August 9, 2013).
The report states, however, that even some of the people who qualify for cost sharing subsidies "may find it difficult to afford the amounts that they will have to pay out-of-pocket before their exchange plans begin to pay benefits."
Rosen said the data, which is being made publicly available, may have policy implications, as well as marketplace implications. Neither Rosen or the study elaborates on the policy implications, though it underscores the importance of outreach workers counseling exchange visitors to consider costs in addition to premiums.
It also raises the question whether a large number of policy holders affected by the high out of pocket costs will be so turned off by the experience they won't renew next year.
In terms of the marketplace implications, Rosen noted that "benefit designs that happen in one place often migrate to other parts of the market."
NPR: Opting Out Of Your Insurance Plan's Network Can Be Costly
- March 18, 2014
The health law generally limits how much consumers can be required to pay out of pocket for medical care (not including premiums). In 2014, the limit for an individual plan is $6,350 and for a family plan, $12,700.
But those limits apply only to care provided by doctors and hospitals in a plan's approved network. There may be a separate out-of-pocket maximum for services provided out of the network in marketplace plans, or no cap at all, says Margaret Nowak, research director at Breakaway Policy Strategies, a research and consulting firm.
Jane Horvath Joins Breakaway Team As Senior Policy Advisor
- February 18, 2014
WASHINGTON, D.C. (February 18, 2014) – Breakaway Policy Strategies announced today that veteran health policy leader Jane Horvath has joined the firm as a Senior Policy Advisor. Jane joins Breakaway's team after a decade of leading policy development efforts at Merck & Co., and a career that has included service in high-level federal government positions in both Congress and the Executive Branch.
"I am thrilled that Jane is joining our senior team," said Dean Rosen, Breakaway's President and CEO. "Jane brings to Breakaway an unbeatable combination of experience in the biopharmaceutical industry, federal government service, and the non-profit sector."
Community Health Centers: Bring on More Medicaid
- January 23, 2014
FQHCs receive additional federal funding to assist with their mission to provide primary care to underserved areas and populations. The additional money helps offset Medicaid's low reimbursement rates.
Additional help is also on the way. Community health centers will receive a $700 million increase in federal funding in fiscal 2014 -- about a 25% increase in support, according to Breakaway Policy, a health policy consulting firm in Washington. About half the money will go toward creating 450 new community health centers and expanding services at existing centers.
A challenge will be for FQHCs to better integrate with other ambulatory providers such as hospital emergency departments, Velez said. Newly covered Medicaid patients may seek their care from hospital emergency departments rather than FQHCs when they lack access to a primary care provider. [More Here]
ACA boosting competition between insurers
- November 19, 2013
A major goal of the Patient Protection and Affordable Care Act is to foster greater competition between health insurers to drive down premiums and improve the quality of coverage. A new report by the McKinsey Center for U.S. Health System Reform suggests that it's working so far [....]
"What is interesting to folks, and a little probably surprising, is how many new entrants there are to the market," said Margaret Nowak, director of research at Breakaway Policy Strategies, a health research firm that has done its own study of exchange plans. "There are a lot of new players who have chosen to enter this market." [More here]
MNsure plans have highest deductibles of 15 states, lowest premiums in U.S.
- November 13, 2013
ST. PAUL, Minn. — The health plans offered on Minnesota's online insurance marketplace have the highest deductibles of those in 15 states, according to a new study.
The Robert Wood Johnson Foundation and the Breakaway Policy Strategies consultancy determined the average annual deductible for a MNsure plan - the amount consumers must pay before a plan pays for a medical expense -- was $4,061. That's more than twice the deductible for a comparable plan in Massachusetts or Maine. [More here]
MNsure deductibles highest in 15 states
- November 13, 2013
Low rates = high deductibles. (And vice versa). Elizabeth Stawicki of MPR says: "The health plans offered on Minnesota's online insurance marketplace have the highest deductibles of those in 15 states, according to a new study. The Robert Wood Johnson Foundation and the Breakaway Policy Strategies consultancy determined the average annual deductible for a MNsure plan — the amount consumers must pay before a plan pays for a medical expense — was $4,061. That's more than twice the deductible for a comparable plan in Massachusetts or Maine. It is key reason why MNsure plans also have the lowest premium rates in the United States." Just as long as I can keep my high-deductible, high-co-pay, no-real-coverage plan if I like it. [More here]
InVentiv Health launches policy shop
- October 29, 2013
WASHINGTON: InVentiv Health has launched a health policy firm called Breakaway Policy Strategies.
The shop is a joint venture with the partners of Washington-based government affairs firm Mehlman Vogel Castagnetti.
Breakaway provides strategic policy guidance, research, and analysis to healthcare stakeholders dealing with new guidelines from federal and state policymakers.
Dean Rosen, former health policy director for Sen. Majority Leader William Frist (R-TN), will lead the joint venture. Rick Smith, former EVP for policy and research at the Pharmaceutical Researchers and Manufacturers of America, and former Walgreens head of policy Margaret Novak have also taken positions at the firm.
AGENCY SPY: InVentiv and Mehlman Vogel Castagnetti launch Breakaway
- September 23, 2013
Healthcare services company, inVentiv Health, has launched its new health policy firm, Breakaway Policy Strategies, a joint venture with the partners of D.C.-based government affairs firm, Mehlman Vogel Castagnetti. [More]
POLITICO: InVentiv, MVC Team Up on Breakaway
- September 23, 2013
INVENTIV, MVC TEAM UP ON BREAKAWAY: Healthcare consulting firm inVentiv Health and lobbying shop Mehlman Vogel Castagnetti are partnering on Breakaway Policy Strategies. MVC launched the specialty healthcare shop earlier this year — and inVentiv will now partner with MVC on the firm. The new joint venture aims to help clients address the major changes to the health care system. Dean Rosen — a former health policy director to former Senate Majority Leader Bill Frist — will serve as president of the firm. Rick Smith and Gina Boscarino will join Breakaway. Smith comes to the group from PhRMA and AHIP, while Boscarino was at Highmark Health Services. The rest of the team includes Margaret Nowak, Colette Desmarais, Erica Pereira and others. "Federal and state policymakers are reshaping the future of healthcare daily,” said Rosen in a statement. “No matter what policies are written or how healthcare may change, Breakaway understands policy details, knows the decision makers and is closely connected to the system in which these decisions are taking place. By Byron Tau.
OUTSOURCING-PHARMA: InVentiv launches health policy JV with DC lobbying firm
- September 17, 2013
CRO inVentiv on Monday announced a joint venture with the partners of the US lobbying firm Mehlman Vogel Castagnetti to help pharma companies further understand the health policy and regulatory landscape. [More here]
InVentiv Health and Mehlman Vogel Castagnetti Announce their Joint Venture Partnership in Breakaway
- September 16, 2013
Washington, D.C. – inVentiv Health, offering best-in-class clinical, commercial and consulting services, today announced the launch of its new policy arm, Breakaway Policy Strategies, a joint venture between inVentiv and the partners of Mehlman Vogel Castagnetti, a leading, bipartisan lobbying firm.
Breakaway helps companies address the diverse challenges posed by a nationwide healthcare system being reshaped by increasing government regulation and dramatic shifts in the private healthcare market. The firm provides strategic analysis and policy guidance to help healthcare stakeholders navigate transformative changes arising from decisions made daily by Federal and state policymakers.
Changes already underway include the emergence of Accountable Care Organizations, Health Insurance Exchanges and bundled payment arrangements. Additional changes will take effect next year, leading to dramatic expansions of health coverage for American consumers and increasing government influence over hospitals, health plans, employers, doctors, patients, employers, biopharmaceutical firms, and device companies.
"Now more than ever, clients must have a sophisticated understanding of the sweeping changes taking place in America's healthcare system," said Paul Meister, CEO of inVentiv Health. "Navigating this new landscape requires seasoned experts with historical knowledge, a deep understanding of political context, and the ability to anticipate what's next. Through Breakaway, we offer experts with an unmatched level of health policy expertise."
The collaboration expands inVentiv's presence in Washington, D.C. and enhances its broad portfolio of services. For Breakaway, the investment enables an expansion of research capabilities and the addition of top-notch talent.
Health Policy Leaders Join Breakaway
- September 09, 2013
Washington, D.C. – Breakaway Policy Strategies announced today that it is adding two senior leaders to its team that will significantly expand the breadth and depth of its services at this time of enormous transformation in the health care system.
Richard I. Smith, formerly Executive Vice President for Policy and Research at the Pharmaceutical Researchers and Manufacturers of America (PhRMA), is joining the Breakaway team as Executive Vice President. Gina M. Boscarino, former Associate Counsel for Highmark Health Services, one of the largest Blue Cross Blue Shield affiliates in the country, also has joined Breakaway as Senior Policy Director.
"Better than anyone I know, Rick understands both the near term and long range business threats and opportunities facing the biopharmaceutical industry," said Dean Rosen, Breakaway's President and Chief Executive Officer.
CQ HEALTHBEAT NEWS: Grapevine
- September 09, 2013
Breakaway Policy Strategies has snagged for its shop Richard I. Smith, formerly a top policy analyst at the Pharmaceutical Research and Manufacturers of America and before that at America's Health Insurance Plans.
Breakaway is the health policy consulting firm founded earlier this year by Dean Rosen, formerly health policy aide to Republican Sen. Bill Frist of Tennessee when he was majority leader.
It's a high profile hire for Breakaway, a name Rosen said he picked as "a reference to my life long love of ice hockey." Rosen says "I am going to split my time forever" between Breakaway and Mehlman, Vogel and Castagnetti, where he is a partner. A second new hire for Breakaway is Gina Boscarino, former associate counsel for Highmark Health Services, a large Blue Cross Blue Shield affiliate.