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Real estate

4 Most Common Reasons Why Your Home Insurance Company Will Drop Your Coverage

Originally posted on realtor.com.

Homeowners usually see their payment to their home insurance company as a necessary evil. The coverage they offer helps protect your home, belongings, and investment, but those payments can hit your wallet hard.

Shelling out thousands of dollars on an insurance policy may feel like a large financial burden, but did you know that your insurance company can choose to drop or not renew your policy? Circumstances like not paying your premiums, violating the terms of the policy, or committing fraud will obviously jeopardize your coverage, but your company can also drop coverage if it believes you and your property are too risky to insure. In these cases, an insurer may cancel, and you could have a hard time finding another company to protect your property.

Insurers may also decide to not renew your policy for many reasons that don’t ever cross your mind. Consider these common yet unapparent circumstances that could threaten your policy.

Real estate

Common Reasons Why Property Taxes Increase

Originally published on Realtor.com.

Homeownership is one of life’s great highlights, but ask homeowners about paying property tax and they’ll tell you it’s one of their least favorite responsibilities. But as much of a downer as they are, property taxes are vital for funding schools, libraries, police departments, fire departments, and public works like roads and parks.

Savvy homeowners and prudent buyers are probably aware of the property tax rates in their area, but they may not understand the factors that can drive their property tax rates up. We’re here to help! (With the understanding part, that is.)

So when tax season rolls around, if you find yourself having to shell out more than you did last year, one of these five reasons might be to blame.

1. Home improvements

Renovating a bathroom or kitchen can revitalize a home and add to its worth, but it’s also the most common reason why your property taxes rise, says David Rae, a certified financial planner and president and founder of DRM Wealth Management in Los Angeles. Why? Improving your home makes it more valuable. That, in turn, increases your property taxes.

Converting a walk-up attic or basement into a livable space is also likely to trigger an automatic reassessment, says Rita Patriarca, a Realtor® with Re/Max Encore in Wilmington, MA.

Rae suggests that homeowners run the numbers first. Calculate how much the work will cost you, how much the renovation can add to your property’s value, and whether you can afford a higher tax bill. If you find that the cost of the work is likely to leave you with too little money to pay your higher taxes, Rae recommends holding off and saving more money before you do the work.

Although your tax bill will go up when you renovate, the good news is that you will directly benefit from the update in the form of a brand-new amenity in your home. That’s not the case in some of the scenarios that we describe below.

2. Revaluation

Communities and counties periodically reevaluate properties. During these revaluations, government officials or hired appraisers review all real property to figure out its current assessed value. Revaluations are needed to make sure that the tax burden is spread equitably and accurately among the area’s homeowners.

Lorrie Beaumont, appraiser and owner of LB Appraisal Associates in Westwood, MA, says revaluations are the second most common reason that property tax bills increase.

During the evaluation, an expert will take into account a home’s location, size, and type, and any changes since the last evaluation. The expert will also review home sales and valuations in the neighborhood, changes in the economy and housing market, and any changes in the area that may have improved or reduced a home’s value. Even if the assessor doesn’t enter your home, he or she will review permits to see whether you have undertaken any improvements. So, if you’ve renovated or expanded your kitchen, you can expect higher taxes.

A revaluation doesn’t automatically mean that your taxes will go up, though. For instance, let’s say there’s been a lot of building in your community lately. Having more taxpayers in your community may help offset a tax bill increase.

3. Nearby home sales

If your neighbors sell their homes for more than the asking price, your property taxes may rise. That’s the unfortunate fact, but it’s out of your hands.

Home sales affect what other houses in a neighborhood are worth. While that’s great for your property’s value when you decide to sell, it means a higher tax bill in the meantime.

Rae points out that, for you, this is the least advantageous way your tax bill can increase, because you’re not actually benefiting from living in a nicer home. Instead, you will be paying higher taxes because your neighbors made out like bandits!

4. New schools

Building a new school is great for students and teachers, and for the community overall. However, it will come with a hefty price tag that is likely to entail higher property taxes.

There are two reasons why property taxes can increase after the construction of new schools:

  • Communities and counties often increase taxes to help pay for school projects.
  • A new school will bring new families to town, which will make your community a more desirable location. The hotter market and the greater competition for homes are likely to lead to bidding wars and higher property values. And, of course, higher property values mean higher taxes.

5. Higher government budgets

One of the main reserves on which cities and counties draw to fund their budgets is the property tax. If government employees are owed a raise, or other budgetary needs increase, the residents’ taxes may need to be increased to help foot the bill.

But rest assured that a community can’t raise taxes at whim: There are limits that require voters’ approval. For instance, Proposition 13 in California and Proposition 2½ in Massachusetts limit how much property taxes can increase.

Still, that doesn’t mean your property taxes won’t go up each year. These limits just put a cap on the increases unless the community votes to raise taxes even higher that year.

Ways to protect yourself against property tax increases

So how can you, as a homeowner, push back and lower your rates (or, at the very least, make sure they don’t reach stratospheric heights)?

One way is to appeal your home’s property assessment, Rae says. Research home sales around you and look for similar homes that are selling for less. “Most municipalities have a process to contest your property tax bill,” says Rae. “I’ve contested the value of my home in the past, and the assessor shaved $150,000 off the taxable value of the home. Definitely worth the effort.”

You should also make sure your property records reflect the property’s amenities accurately, Beaumont notes. “I have seen many instances where records say you have more bedrooms or bathrooms than you actually have, or additional living area that doesn’t exist,” she says. If you do find mistakes, notify the assessor’s office and have the record corrected.

Real estate

Supreme Court Decision Creates More Housing Benefits for Same-Sex Couples

Originally published on HSH.com.

The Supreme Court’s decision in Obergefell v. Hodges in June 2015 opened the way for same-sex marriage in the remaining states that did not allow it.

The ruling has been met with enthusiasm by not only same-sex couples and supporters, but real estate experts who believe the decision will help spark newly married same-sex couples to enter the housing market.

One reason for this optimism came in a recent joint survey by Better Homes and Gardens Real Estate and the National Association of Gay and Lesbian Real Estate Professions. The survey found that:

  • 90 percent of LGBT homeowners already see homeownership as a good investment
  • 81 percent of LGBT non-homeowners believed the ruling will make them feel more financially protected and confident

Same-sex marriage legalization will especially help couples in the areas of VA mortgages and property-ownership status.

The VA recognizes same-sex marriage of all veterans

Chris Birk, director of education at Veterans United Home Loans in Columbia, Missouri, says the VA loan process has been “more onerous and expensive” for same-sex couples.

Before the recent ruling, the VA has allowed veterans and service members to have a co-borrower who isn’t a spouse or qualified veteran, but the joint loans for same-sex couples covered only the qualified veteran’s portion of the loan amount.

“That left applicants on a joint VA loan – who were not considered spouses – with the need for a 12.5 percent down payment. Most VA buyers make no down payments, which is a significant benefit of this historic home loan program,” says Birk.

After the Supreme Court struck down the Defense of Marriage Act in June 2013, the Department of Veterans Affairs announced it would begin reviewing applications on a case-by-case basis “to determine whether same-sex married couples could proceed in the same manner as opposite-sex couples.”

In the wake of the Supreme Court’s decision in June, the VA announced that it will “recognize the same-sex marriage of all veterans, where the veteran or the veteran’s spouse resided anywhere in the United States or its territories at the time of the marriage or at the time of application for benefits,” says Birk.

“Given that, I think we’ll see more same-sex married veterans and service members look into the VA loan, which is arguably the most powerful loan product on the market,” he says.

Same-sex couples granted full ownership status

Another benefit of the Supreme Court decision will be the way married borrowers typically take title of property, says David Brennan, senior vice president at Cape Cod Five Cents Savings Bank in Barnstable, Massachusetts.

Same-sex couples will now be able to both have “tenancy by entirety” ownership status. This is the strongest form of ownership and means that a spouse automatically takes ownership in the event of the other spouse’s death.

“In many states where same-sex marriages were not allowed or recognized, there were limitations as to the legal types of property ownership status afforded to married couples. The ownership status of ‘tenancy by entirety’ is the most common way married couples take ownership of their property due to its legal advantages and protection for both owners. This form of title ownership, where offered, will now be available to same-sex married couples in all states,” says Brennan.

What will it mean to home buying?

For some real estate experts, the Supreme Court’s decision was deeply personal. Thom Schoepfer, a senior broker-associate and top agent in closed sales at William Raveis in Chatham, Massachusetts, and his partner bought their first home in New York in the early-1980s for $10,000.

“Seeing equality reign in 50 states is a dream,” says Thom Schoepfer, a senior broker-associate and top agent in closed sales at William Raveis in Chatham, Massachusetts, on Cape Cod. “I’m so thankful. Home is part of the American dream and continues to be for people of all stripes,”

Schoepfer and his partner – who have been together all of their adult lives and first bought a home together in New York in the early-1980s – have witnessed gay and lesbian couples go from the fringes of society into the mainstream.

So while Schoepfer doesn’t expect the Supreme Court’s decision to have much of an impact on his area, where same-gender couples have been buying homes Cape-wide, especially in communities with top school districts and low property taxes, he does expect a greater impact “nationally and regionally.”

Teresa Boardman, Realtor at Boardman Realty in St. Paul, Minnesota, isn’t so sure that legalization will flood the housing market with same-sex couples. Boardman says unmarried couples (same-sex and otherwise) have been able to buy homes before the Supreme Court’s decision.

“There are several groups in our society that have always been allowed to marry, but have low homeownership rates. The lack of a good job and a good credit rating holds people back from homeownership as does piles of student debt. Homeownership is lower in Minnesota today than it was in 2005 because of the crash of the housing market and the great recession. The ability to marry just doesn’t seem to have an impact on homeownership,” says Boardman.

Tough to gauge the impact

It’s difficult to gauge how same-sex marriage has affected home sales in the states that had already legalized same-sex marriage. Massachusetts was the first state to legalize same-sex marriage in 2004, for instance, but the Massachusetts Association of Realtors has not collected data concerning sexual preference of homebuyers.

Yes, there was a spike in home sales in Massachusetts that year, but it also coincided with the height of the housing bubble so you can’t say for sure whether same-sex marriage played a large part in the spike.

We’ll have a better idea next year. Adam DeSanctis, economic issues media manager at the National Association of Realtors in Washington, D.C., says the NAR will begin collecting data about same-sex married couples in its 2015 Profile of Home Buyers and Sellers.

Real estate

3 Reasons You Shouldn’t Wait to Refinance Your Mortgage

Originally posted on HSH.com.

Refinance applications are down to 2009 levels as mortgage rates have shot up past 4 percent again. Homeowners may have been scared away by recent rate increases, but now is still a good time to see whether a refinance would work for you.

Here are three reasons that you shouldn’t wait to refinance your mortgage:

No. 1: You can still take advantage of historically low mortgage rates

Mortgage rates are no longer below 4 percent, but they are still historically low. Homeowners waiting to see whether rates will drop below 4 percent again may have a long wait.

Brian Koss, executive vice president of Mortgage Network in Danvers, Massachusetts, says you shouldn’t expect a return of the sub-4 percent mortgage rates. All of the signs (a healthier U.S. economy and higher international interest rates, for instance) are pointing to higher mortgage rates.

Koss expects mortgage rates to increase in the near term, but doesn’t expect a huge jump. In fact, we may see a slight dip, but more likely a slight increase.

“Fundamentally, (the signs) are pointing to higher rates, but still in the very tight range compared to where we have been in the past,” says Koss.

Trying to time the mortgage dips is an imperfect science, but the clues show that another increase could happen later this year when the Federal Reserve may raise interest rates. The Federal Reserve does not directly set mortgage rates, but its actions can create a ripple effect on rates. On the other hand,the financial situation in Greece could shake financial markets and cause a rate decrease.

Koss warned against trying to time the next possible dip.

“Trying to time it perfectly doesn’t work,” he says.

Given the current climate, Koss suggests those ready to refinance start the process now and ask a trusted lender to lock in a low rate while you’re going through the process. Remember that rates can fluctuate at any time and often change multiple times a day.

Any rate decrease will be a “panic event” and not a “fundamental move,” he said, so you’ll want a trusted lender prepared to lock in a low rate for you.

Keith Gumbinger, vice president of HSH.com in Riverdale, New Jersey, said, “Mortgage rates rise and fall for a lot of reasons. You can look for clues about what will happen by following economic reports, such as the statements of the Federal Reserve after their meetings every six weeks and the monthly employment report that comes out on the first Friday of every month. Rates will rise or fall depending on those reports and generally follow along with the fluctuations of 10-year Treasury bills. You can also follow mortgage rates through sites like HSH.com.”

No. 2: You could save more than $200 a month

More than 6 million borrowers could benefit and qualify for refinancing, according to a recent Black Knight Financial Services Mortgage Monitor Report.

Nearly 3 million borrowers in a traditional refinance and 300,000 of the HARP-eligible population “could save at least $200 per month,” according to the report. Fourteen percent in traditional refinancing and 23 percent in HARP-eligible populations could save $400 or more, according to the report.

U.S. homeowners could save $1.5 billion each month if all eligible candidates refinanced.

To show the importance of low interest rates, Black Knight Financial Services Mortgage Monitor Report suggested that an increase of half a percentage point would cause 42 percent of borrowers (2.6 million people) to fall out of the “refinanceable population.”

Check out our Refinance Calculator to see how much you could save.

No. 3: You may be eligible for HARP

The Federal Housing Finance Agency (FHFA) announced this year it is extending the Home Affordable Refinance Program (HARP) through September 2017.

The program was created in March 2009 and geared to homeowners who are underwater but current on mortgage payments.

More than 3 million homeowners have refinanced through HARP. More than 600,000 eligible Americans have until September 30, 2017 to take advantage of this program.

To qualify for the low interest-rate program, mortgages must have been sold to Fannie Mae or Freddie Mac on or before May 31, 2009.

Real estate

Lack of Storage Forces Homeowners to Find Creative Solutions

Originally published on HSH.

Homeownership can be one of the most fulfilling (and frustrating) endeavors in a person’s life.

There are the joys of painting a room or growing vegetables in a garden. But owning a home is not all tomatoes and zucchini. There are a lot of frustrations too.

HSH.com conducted a survey of 1,001 Americans about their biggest annoyances regarding their homes. We gave respondents a list of possible issues and asked them to choose the top five annoyances and rank them from 1 to 5.

The top home-related annoyances were “lack of storage” (67 percent of respondents put it as one of their five top annoyances), which barely edged out “too much maintenance” (66 percent) with “too small” coming in third (52 percent).

Paul G. Wyman, president of The Wyman Group, a real estate company in Kokomo, Indiana, says lack of storage has become a bigger issue over the past decade not because of larger families, but instead people want more room for their stuff.

“Storage is absolutely something people ask us about nowadays. Some older homes lack the storage needed and a lot of newer homes have taken that into consideration,” says Wyman.

People are finding creative solutions to gain storage space. Homeowners are putting closets under stairwells, building larger pantries and using more attic and basement space for storage, he says.

Wyman gives the example of a home he recently visited in which the homeowner finished three-quarters of the basement and left the other one-quarter unfinished for storage. In years past, the homeowner would have likely finished the whole basement for more living area.

“Some people are intentionally making storage spaces in their homes now,” says Wyman.

Maintenance bigger concern for homeowners

Not surprisingly, our survey found that “maintenance” is a bigger program for owners while renters chose” too small.”  Maintenance becomes more of a problem with longevity, according to our survey.

“This seems to be more of a concern for the aging Baby Boomer generation. They don’t want to mow the lawn anymore or keep up with home improvement projects,” says Kimberly O’Neil Mara, CPA, Realtor at Century 21 Spindler & O’Neil Associates in North Reading, Massachusetts. “Often these empty nesters are selling their big homes and downsizing to more manageable homes or even condos where they can just lock the door and head south for the winter any time they want to do so.”

Lack of storage biggest issue for most regions

When breaking it out by region, all regions pointed to lack of storage as the biggest home annoyance except the Northeast, which picked too much maintenance.

The brutal winters, especially the 2014-2015 winter that saw record snowfalls in Northeast cities, coupled with the hot and humid summers make home maintenance a bigger problem there than in regions that don’t see such weather extremes. Plus, older housing stock likely plays a role in the maintenance headache of the Northeast.

Last winter, parts of the Northeast dealt with ice dams on roofs because of the heavy snowfall in a short period of time.  The ice dams caused external and internal damage to homes.

Wyman says it’s important to create a continuous maintenance program. Staying on top of regular home maintenance allows the home to maintain its value and the homeowners won’t be hit for a larger repair bill later.

Know what you really want before you buy

Repeat homebuyers may have more financial flexibility and know more about their own needs/wants than first-time homebuyers. A key to happy homeownership is knowing what bothers you and what you can handle.

“The real key is for the potential homebuyer to clearly define and understand what is really important to them prior to the purchase,” says John Mijac, sales manager at Long Realty Company in Tucson, Arizona. “Part of that may be discovering that what they thought was important is not material at all. It is easy for a potential homeowner, just going into the process, to believe that a pool or a fancy kitchen is the most important thing, when in reality it is a quiet neighborhood or perhaps room and storage in the house.”

Real estate

Noisy Neighbors Causing Headaches

Originally published on HSH.

Problems with neighbors can often destroy a person’s quality of life.

Slamming car doors, barking dogs, overgrown trees hanging over your roof. These are all minor in the big scheme of things, but can drive you crazy.

There are many instances in which people finally snap and wind up in the local police log, but usually these frustrations are suffered in silence. That doesn’t make the problems any less impactful to quality of life.

HSH.com surveyed 1,001 Americans about their biggest annoyances about their neighbors. We gave respondents a list of possible annoyances and asked them to choose the top five and rank them from 1 to 5.

We found that “noisy neighbors” (63 percent ranked it in their top five) edged out “too close” (61 percent) as the biggest neighbor annoyances. Both owners and renters chose noisy neighbors as their biggest complaint.

“Your neighbors want you to know a secret: Since you can’t move your house further away, you can at least try to keep the noise down to a respectful level – and that includes your kids, your vehicles and your pets too,” says Keith Gumbinger, vice president of HSH.com in Riverdale, New Jersey.

Kimberly O’Neil Mara, CPA, Realtor at Century 21 Spindler & O’Neil Associates in North Reading, Massachusetts, says noisy neighbors are more concerning for people looking to buy a condo rather than a single-family home. She says she advises condo buyers to find out what type of insulation was used in the floors, ceilings and floors.

“I also suggest checking with the management company/association about rules and regulations. Some have quiet hours, others require a certain percentage of floors to be carpeted to minimize hearing clanking shoes and especially heeled boots of your neighbors simply walking above you,” says O’Neil Mara.

It seems that noise is a problem from the start for many. “Noisy neighbors” were the biggest annoyance for those surveyed who have lived in their homes from 1 to 10 years. That frustration appears to subside with time. The top annoyance for those who have lived in their homes 10 years or more is homes being “too close.”

“You can know a lot about your home and neighborhood before you buy, but you can’t know everything, such as whether they are night owls or not, or have choppers stored in the garage they ride on weekends. You often don’t learn these things until you’ve lived there for at least a while, and you may have to learn to live with some of them,” says Gumbinger.

Regionally, all areas chose “noisy” as the biggest annoyance except for the Northeast, which picked “too close.” Noise and being too close often go hand-in-hand, but Northeast respondents chose too close likely because parts of the Northeast have some of the highest population density in the nation.

Great fences make great neighbors

When it comes to how to resolve noisy neighbors and homes being too close, O’Neil Mara gives people the old advice about fences and neighbors.

“If that is an issue, I always refer to the old saying ‘great fences make great neighbors’ and suggest installing one as soon as they move into the house. It is always much less awkward to do so as part of your original plan than it is to do once you get to know your neighbors and then decide to fence them out,” she says.

Real estate

Busy Streets, Speeders Seen as Major Quality of Life Issues

Originally published on HSH.

A home may be a person’s castle, but even a moat can’t protect you from the annoyances of your neighborhood.

HSH.com conducted a survey of 1,001 Americans about their biggest annoyances regarding their neighborhoods. We gave respondents a list of possible issues and asked them to choose the top five and rank them from 1 to 5.

Here’s what we found about neighborhood frustrations.

Nothing miffs people about their neighborhood more than busy streets and speeders. The survey found that 76 percent of respondents put “busy streets/speeders” in their top-five neighborhood annoyances. Houses being “too close” came in a close second at 71 percent, and “not enough local retail/food shopping” a distant third at 56 percent.

When broken down by owners and renters, busy streets/speeders remained the number one annoyance for owners, but the top choice for renters is houses being too close.

Frederick Ryan, police chief in Arlington, Massachusetts, says that fear about speeders and busy roads “can compromise some of our most vibrant neighborhoods.”

“A parent in fear of a family’s safety due to speeding cars is no different than a parent’s fear in an inner city urban environment due to violent crime; fear is fear. Yet citizens and officials alike sometimes minimize the impacts of traffic volume and traffic violations,” he says.

The annoyance about busy streets and speeders seems to grow the longer a person lives at a residence. Houses too close was the number one annoyance for those who lived in their homes seven or fewer years, but busy streets/speeders picked up the top spot for people who are in their homes for eight or more years.

Why the change? Respondents likely became more comfortable with the closeness of homes and began looking outward to the dangers on their streets. Plus, speeding cars might not concern you as much until you have children.

Kimberly O’Neil Mara, CPA, Realtor at Century 21 Spindler & O’Neil Associates in North Reading, Massachusetts, says some first-time homebuyers will purchase a starter home and are not concerned about a main road because they don’t see it as their forever home. They, instead, expect to live with the “nuisance in the short term,” she says.

Prospective homebuyers often don’t have the budget to satisfy every desire on their list so they sometimes need to choose a busy street to stay in their price range. John Mijac, sales manager at Long Realty Company in Tucson, Arizona, says it’s important in the process to figure out what are the most important needs. You’re going to live there so make sure it fits – and avoid as many neighborhood annoyances as possible.

What can you do about speeders?

Ryan says neighborhoods with speeding problems should work together with police to educate motorists about the harm of speeding.

“We recommend the triple ‘E’ approach to traffic management: Education, Engineering and Enforcement,” says Ryan. “If neighborhoods and officials seek out environmental and/or engineering solutions they can realize immediate results.”

One common problem is wide-open roads with little visual obstruction, which invite motorists to accelerate. Working together, police and residents can find simple ways to slow down traffic.

“By placing a few strategically located parked cars and ‘necking down’ the roadway, it will likely result in driving down the average speed of cars. In terms of traffic volume, traffic is like water; it will seek its own level. This is where sound engineering and marco-level community planning are essential,” says Ryan.

Check out what our respondents said about their biggest home and neighbor annoyances:

Lack of storage forces many homeowners to find creative solutions

Noisy neighbors causing headaches

Healthcare

Providers Go Deeper with Population Health, Weighing Social Factors

Originally published on Healthcare Dive.

The industry transition to value-based payments is leading to more population health management programs, but providers are finding it’s difficult when patients lack secure housing, access to food or a way to get to appointments.

So many are now going beyond one buzz word, population health, and taking into account the role that another, social determinants of health, play in a person’s health.

“Population health management efforts are most successful when they are tied to efforts to address social determinants of health issues, since the challenges that patients face around housing, food and transportation, for example, are completely tied to their ability to engage in the healthcare system, manage their chronic conditions and stay well,” said Dr. Amy Flaster, an assistant medical director for the Center for Population Health at Partners HealthCare in Boston, told HealthCare Dive.

Flaster, also a physician at Brigham & Women’s Hospital and vice president for health management and care management at Health Catalyst, said a population health management infrastructure, such as working with community-based nurses and organizations that help at-risk people, allows health systems to address medical issues before patients wind up in the emergency room.   

“The key to population health is truly about taking care of patients across the care continuum.”

Dr. Sarika Aggarwal, chief medical officer, Beth Israel Deaconess Care Organization

Leveraging an entire team within and beyond her office’s four walls, she gets help from social workers, community resource specialists, community health workers, pharmacists and nurses.

Across town at Beth Israel Deaconess Care Organization, Chief Medical Officer Dr. Sarika Aggarwal has seen PHM both from the provider and payer side. She’s led initiatives at both BIDCO and Fallon Community Health Plan.

“The key to population health is truly about taking care of patients across the care continuum,” she said. “I have not found a (population health management) program that hasn’t helped the patient.”

For these programs to work, they need invested partners on all sides —payers, providers and communities.

Still, ROI is difficult to prove. Potential cuts to Medicaid and an apparent lack of interest in population health at the federal government level could also stand in the way of organizations looking to go down that road.

Social determinants of health

Providers can’t ignore tackling social determinants of health in many communities.

Boston Medical Center, for example, treats a large at-risk patient population.

“They’re trying to look at patients more holistically,” said Rosemarie Day, who runs consulting firm Day Health Strategies, noting examples like physicians writing prescriptions for food and then sending the patient to the hospital’s own food pantry.

Another factor: Patients with mental health challenges may have a harder time caring for themselves, especially when they have co-morbidities, Day noted.

Some state Medicaid programs, health plans and providers are starting value-based payments for behavioral health services. Arizona, Maine, New York, Pennsylvania and Tennessee have all created Medicaid managed care organizations with value-based payments that target behavioral health.

“If you can manage mental health issues, you actually have a big opportunity to reduce medical cost spend,” said Day, who served as chief operating officer for Massachusetts’ Medicaid program and deputy director and chief operating officer at the state’s Health Connector.

Three legs of a stool

Population health programs can be considered as a three-legged stool, made up of a provider side, the payer side and community programs. Providers serve on the front line with patients, Payers use analytics to coordinate care and provide value-based payments and community programs help patients outside the physician’s office.

Payer involvement is crucial, offering claims data to match patients with the most appropriate interventions and providing contract incentives to providers.

Of course, physicians are tasked with treating patients the same regardless of the payment model, but alternative payment models can provide the extra funding to help compensate for that care coordination.

“The creation of ACOs and other alternative payment models are directly changing how health systems think about delivery care for their patients,” Flaster said.

Community programs provide services that patients can’t get during a physician visit. Community organizations help people find food and housing and resolve transportation issues for appointments.

Are they worth it?

So providers say the programs can help improve patient health and tackle social determinants.

But the big questions are: Can they save money in the long run? Are they worth it?

Aetna Chairman and CEO Mark Bertolini has touted the goals of the company’s foundation, which invests in population health projects that aim to reduce chronic diseases, provide walkable neighborhoods and improve quality of life.

An Aetna Foundation-financed study found that investments in certain areas did result in better health outcomes. For example, getting residents active is connected to decreased diabetes and cardiovascular disease; and cutting smoking rates reduced asthma and improved mental health. The study additionally found areas with the highest unemployment rates are also the unhealthiest, which goes back to social determinants of health.

With this in mind, Aetna’s Healthiest Cities and Counties Challenge provides $10,000 grants to 50 communities or organizations. Programs promote healthy foods, increase mental wellness and seek ways to decrease prison reentry. The programs that show an improvement are eligible for more funding — as much as $500,000.

A Health Affairs report recently highlighted a Colorado program called Bridges to Care, involving an emergency department and the community to promote primary care. The Center for Medicare and Medicaid Innovations funded the program through a grant.

The program offers medical, behavioral health and social care coordination services, such care coordinators, health coaches, behavioral health specialists and community health workers.

Six months after Bridges to Care intervention, there was a 28% reduction in ED visits and 114% more visits to primary care physicians compared to patients in the control group.

Digging further, the researchers found that patients with mental health co-morbidities had 30% fewer ED visits and 30% fewer hospitalizations — and 123% more primary care visits compared to the control group.

However, PHM programs aren’t always cost-effective, despite their success with patients. Aggarwal gave the example of a program that offered home visits to the more costly patients with comorbidities. She said the program was successful with patients and staff, but ultimately it was too expensive.

So instead, Beth Israel spun off the cost-effective parts of the program into one for pharmacists and disease management. Improving a patient’s medication management can result in improved outcomes quickly.

In that case, BIDCO initially connected patients with out-of-control diabetes to pharmacists, who provided recommendations to providers. Aggarwal said 40% of patients involved saw a significant decrease in their A1C levels.

Beth Israel then expanded the effort to health coaches and added similar chronic obstructive pulmonary disease and depression programs, with hopes to move into other chronic illnesses.

Potential barriers

Despite signs of success, the hurdles are many: Potential pushback from leadership, funding crunches and the difficulty in measuring what’s working are among the big ones.  

The first piece of PHM is creating a cross-disciplinary team. Each stakeholder needs to set aside territorial hangups. Respect is needed for each stakeholder no matter their background or whether they have a medical degree. “Getting a team to truly come together and flourish to reach that ideal of a patient-centered medical center is not easy to do,” Day said.

Leaders of these efforts must become “a champion of change,” she said.

“Generally, you can throw a lot of money (at population health), but if they’re not led well and they’re poorly executed, you don’t get the results you want,” she said.

They require planning, outreach to other stakeholders and physician buy-in. Health system leaders need to communicate with providers and fully explain the programs.

“You need to engage them and put in the right incentives. A lot of my work is spent with providers in our system. That is important to the core of the population health,” Aggarwal said.

Flaster said one way to get physician buy-in is through data. Physicians will buy into the program if they can see it will lead to better care.

Aggarwal said modifying patient behavior and achieving a positive ROI isn’t always easy. Programs may take 18 to 24 months to show a significant impact. And one can never be sure which part of the intervention was successful.

Plus, the care teams need to coordinate to eliminate duplications in post-acute care. Aggarwal gave the example of a discharged patient who may receive calls from multiple stakeholders. The patient becomes frustrated by the multiple calls and stops answering the phone. That doesn’t help the quality of care and is a waste of resources.

Instead, population health requires continual dialogue among the stakeholders to limit duplications.

Future of population health

Population health programs are expected to expand as payment incentives become more aligned with value rather than volume. Aggarwal said infrastructure, data, financial incentives and administrative pieces will all become better aligned, as well as the model to identify patients who would most likely benefit from the programs.

Day believes that states and the private sector will continue to innovate. Oregon and New York both have Medicaid ACOs and Massachusetts’ Medicaid program called MassHealth will soon start its own managed care ACO. Massachusetts was the first state in the nation in October 2016 to create a payment model that added SDH variables to medical diagnoses, age and sex.

Seventeen healthcare organizations are taking part in the Massachusetts ACOs, including Partners HealthCare, BIDCO and Lahey Health on the provider side and Tufts Health Public Plans, Fallon Community Health Plan and Neighborhood Health Plan on the payer side.

Starting March 1, the ACOs will be financially accountable for cost, quality and member experience for more than 850,000 MassHealth members. The program includes investments in primary care and community support services.

The federal government is providing $1.8 billion to restructure MassHealth via a five-year 1115 Medicaid waiver. ACOs will receive more than $100 million in new investments this year to support the change to value-based care.

Day said having states try these kinds of initiatives in Medicaid is a positive — as long as the federal government doesn’t cut Medicaid funding. Day doesn’t think the current administration will undermine population health, but also doesn’t think it will be a priority either.

“I don’t feel too optimistic at the moment about the national level,” she said.

Personal Finance

Credit Card Perks that Honor Active-Duty Military

Originally published on CardRatings.

As a way to say “thank you,” both the country and credit card companies offer special benefits for active-duty military members and, in some cases, their spouses.

No matter your credit card, active-duty military members and their spouses are eligible for benefits related to the Servicemembers Civil Rights Act (SCRA). The SCRA provides financial help to active-duty military personnel and their spouses (more on these benefits below); however, many credit card issuers go above and beyond the SCRA and offer additional benefits, such as waiving annual fees or even lowering interest rates beyond what the law requires.

Let’s take a look at the SCRA, five additional military credit card benefits, how to request those benefits and some top cards for active military personnel.

What is the SRCA and how does it help military members?

The SCRA protects the finances of military members (and their families) while they are on active duty. Congress passed the SCRA, which expanded the Soldier’s and Sailors’ Civil Relief Act of 1940, in 2003.

The SCRA caps active military members’ interest rate at 6 percent for financial obligations incurred before military service. The creditor must forgive interest greater than 6 percent. It can’t defer it to later and it must also forgive the interest retroactively.

SCRA deals with rental agreements, security deposits, mortgage interest rates, health insurance, income tax payments, mortgage foreclosures and, yes, credit cards.

Military members have until 180 days after their end of service to notify creditors and provide the necessary documents to benefit from the 6 percent APR cap.

To be eligible, you must meet at least one of the following criteria:

  • Be a member of the U.S. Armed Forces on active duty or a reserve component called to active duty,
  • Be National Guard personnel under a call or order to active duty for more than 30 days,
  • Be a Public Health Service and National Oceanic and Atmospheric Administration commissioned officer,
  • Be a U.S. citizen servicing with another nation, which is allied with the U.S. “in the prosecution of a war or military action,” or
  • Be the spouse of an active duty service member.

The SCRA helps those in the active military with a number of financial situations, but let’s look at how credit cards go beyond that.

4 additional credit card perks for military members

From waiving fees to cutting the APR, credit card companies thank active service members in multiple ways. Here are a few of the ways credit card companies say “thank you” to military members.

Annual fee waivers

This is largely an under-the-radar perk but can be a huge money saver, especially for cards with hefty annual fees like the CardName, which offers lucrative luxury perks but comes with a $550 annual fee (read more about this card below). If you’re active-duty military, however, you don’t have to worry about the $550 fee.

American Express isn’t the only issuer to waive annual fees for active duty military. ChaseCapital One and Citi all waive annual fees for active military members (and, yes, you must be active duty to qualify for the fee waivers).

Lower APR

The SCRA requires creditors cap their APR at 6 percent for active service members; however, some card issuers drop it even further.

Citi completely removes the APR during active duty time. USAA and Capital One lower the APR to 4 percent. USAA even goes beyond that and extends the 4 percent APR until a year after active duty ends.

No late fees

American ExpressCapital OneUSAA and Chase will waive late fees for active military members.

A word of caution — late payment information will still go to credit bureaus, which can affect your credit score. So, it’s not a good idea to miss a payment even if your card may waive the fee.

Wipe out all fees

Some credit card companies remove all fees while you’re on active duty. For instance, Capital One and USAA cut foreign transaction, balance transfer, cash advance and all other card-related fees.

How to request SCRA, additional military-based benefits

Now that you know about all of these benefits let’s talk about how you notify credit cards about being an active military member.

You must provide the creditor with a copy of your military orders. Contact your credit card company either via phone or online. Don’t be deterred if the customer service representative isn’t familiar with these benefits. Just request to speak to a supervisor. You should also expect to answer a series of questions about your military service.

Once your creditor receives your information, it will review your SCRA eligibility to confirm you are an active duty military member or the spouse of an active service member. The creditor will examine the provided documents and check the Department of Defense Manpower Data Center.

Each credit card has a similar process to verify SCRA benefits and to get other active military-related card benefits.

Top cards for military members

All credit cards will give you the benefits that are part of the SCRA, and some cards will provide added benefits. If you’re ready to start taking advantage of these benefits available to you, keep reading for some of the top cards from issuers offering special military benefits.

Before you apply, however, remember that being active duty military doesn’t automatically mean you’ll be approved for a credit card; your credit history and score will still be factors in whether you’re approved.

To see the list of best cards, head over to CardRatings.

Personal Finance

5 Credit Card Trends for 2018

Originally published on CardRatings.

Credit cards usage is nearing pre-Great Recession levels as Americans feel more confident about their jobs and economy.

The Consumer Financial Protection Bureau recently reported that the average credit line, number of accounts and outstanding card debt are all on the upswing. There isn’t quite as much credit card debt (yet!) compared to before the recession, but it’s increased 9 percent over the past two years.

The credit card upswing has led credit card companies to think up new ways to woo customers. They’ve diversified rewards programs, expanded technology like mobile payments and implemented better account security.

The already active credit card market will get another jolt when the tax cut goes into effect in 2018, which could mean more disposable income over the next year.

Economists and consumers are optimistic about 2018, but what can you expect for credit cards? Here are five things to watch in 2018:

Less signing when you make purchases

You’ve probably noticed that you don’t have to sign for as many purchases you did just a couple of years ago. Credit card companies and businesses have lowered the hassle of signing after you swipe or insert your card. These policies are about making things easier at checkout.

And the “no-signing” trend continues to gain steam. American Express, Discover and Mastercard have all announced that they are doing away with signatures for domestic purchases (and, in some cases, for purchases abroad as well).

You’re probably wondering: How will credit card companies prevent fraud if you don’t have to sign? Well, first off, your signature at check out is likely a squiggly line anyway, so it’s not exactly helping prevent fraud at present.

Plus, more and more shopping each day is done online where you don’t sign for your purchases. And lastly, credit card companies have improved fraud prevention through better technology (see below for more on that) and customer alerts, so they believe the signature isn’t needed anymore.

Not signing for your credit card purchases may seem off-putting at first, but once you get used to it in 2018, you’ll likely not pine for the days of signing for those purchases.

More chip technology

Anyone who has used a credit card outside of the U.S. knows that shopping with a credit card is quite different outside of the American borders.

EMV technology, which stands for Europay, MasterCard and Visa, is standard in other parts of the world, but Americans continue to occasionally swipe for purchases even if you have noticed a significant increase in the “insert your card” EMV technology closer to home in the past few years. The EMV technology can feature chip and signature or chip and PIN, which offers it a little bit of added protection.

EMV stores credit card data on a computer chip embedded on the card rather than on the magnetic stripe you’re used to. Card readers that utilize chip technology don’t need to be connected to a phone or the internet to approve the charge. That’s different from the classic magnetic stripe card that continually communicates with the credit card company.

Also, hackers can tap into magnetic stripe card by attaching a reader over the existing card reader. That means a cardholder who swipes for a full tank of gas may not realize that a hacker just got their credit card information. Overall, American consumers with magnetic stripe cards are much more at risk of being the victim of credit card fraud. In fact, a 2013 Nilson Report study found American consumers accounted for one-quarter of credit card purchases, but half of the world’s credit card fraud.

Chip technology is designed to change that stat.

U.S. credit card companies are moving more into EMV technology, though many are still in the chip and signature world with future plans to move into the chip and PIN world. Cayan reported that 73 percent of credit card purchases on Black Friday in 2017 were with chip technology. That’s an increase from 55 percent in 2016. Credit card companies have issued 462 million chip cards to cardholders, and more than half of U.S. storefronts now accept cards with the technology.

The added fraud protection seems to be working. Visa reported that counterfeit fraud at U.S. chip-enabled merchants decreased 66 percent in June 2017 compared to two years ago.

If you don’t have a card with chip technology yet, your credit card company could very well be sending you one in 2018. If you already have a chip card, be aware that your company could be moving in the chip and PIN direction very soon.

More metal cards

Credit cards are not just a tool to make purchases. In many ways, they’ve become a status symbol.

Credit card companies now offer special cards that set you apart from other consumers. Sure, plastic rewards cards are great, but metal cards can impress.

Beyond the look and feel, a metal card’s benefits vary by card – just like plastic cards. Some metal cards specialize in travel rewards, while another might give cash back. Some have hefty annual fees, while others are more affordable.

Plastic credit cards remain more common than metal cards, but that’s the point. Metal cards are meant to stand out.

Offering a metal card gives credit card companies another way to tempt top customers and high spenders. In many cases, the metal cards offer similar rewards and perks as regular plastic cards, but with the added benefit of a special card that will get a second look by store employees and friends alike. Furthermore, those metal cards just might hold up better in your wallet.

If you want a side of prestige with your credit card, you’ll likely have more opportunities to get a metal card in 2018 if you’re a top customer.

More rewards for balance transfers

There was a time not too long ago when credit card companies were focused on fairly bare-bones balance transfer credit cards. The thought was that consumers interested in these cards solely cared about getting a temporary lower APR and maybe even not paying a balance transfer fee. It was great for consumers, but it meant that many of them just put the card in a drawer after taking advantage of that balance transfer offer – not exactly what credit card issuers want you to do with the card they send you.

Now, more companies are sweetening their balance transfer cards by adding rewards programs and perks. It’s a win-win for consumers and credit card issuers. Suddenly that awesome rewards credit card that you want to use every day might also come with a sweet balance transfer or 0 percent interest deal as well.

With Americans feeling confident about the economy and spending more as a result, many consumers will likely look for ways to consolidate debt and pay a lower interest rate. Wouldn’t it be nice to have a balance transfer card that allows you to do all that, but that you want to keep in regular rotation because of the rewards it offers?

A better economy means more available money for consumers; therefore, look for credit card companies to offer more cards and added perks as they try to lure more consumers to their brand.

More emphasis on mobile wallet

Despite credit card and technology company efforts, mobile payments remain a small percentage of credit card-related purchases. Companies will continue to look for ways to increase mobile payments in 2018. In fact, Chase Freedom® cardholders who activate the bonus categories for the first quarter of 2018 will earn 5 percent back on up to $1,500 spent in mobile payments with Chase Pay®, Apple Pay®, Android Pay™ and Samsung Pay (and on gas station and phone/cable/internet purchases).

More users have mobile wallet technology these days. For instance, Apple Pay® doubled its users in 2017 with one estimate saying the service could have reached 86 million customers by the end of the year. Starbucks also saw a 10 percent increase on its Mobile Order & Pay service in 2017. In fact, 30 percent of Starbucks payments in June were done via its mobile app.

Despite those numbers, mobile payments still are just a small portion of credit card payments.

However, as cardholders look to offer easier ways to use their credit cards and smartphones continue to play a larger part of our lives, look for credit card and mobile phone companies will continue to push mobile payment offerings in 2018.