Healthcare Business Week in Review: Expanding Medicaid; Avoiding Readmissions; Rates of Uninsured

Monday, May 6th, 2013
This post was written by Cheryl Miller

The good news: Medicaid coverage has increased diabetes diagnoses by more than 3 percent and diabetes-related medication compliance by more than 5 percent; it has also reduced rates of depression by over 9 percent, and virtually eliminated out-of-pocket catastrophic medical expenses.

The bad news: Medicaid coverage has not significantly impacted the prevalence of such chronic diseases as diabetes (despite catching more occurrences of it), cardiovascular disease and high blood pressure.

Researchers from the Harvard School of Public Health conducted the first study of Medicaid coverage on previously uninsured, low income adults by polling more than 12,000 people who won a lottery for coverage (90,000 residents applied for 10,000 slots) and those who were not selected. This first such study of the impact of Medicaid coverage is particularly timely given upcoming Medicaid expansion in 2014, researchers say, and is part of an ongoing research program examining the many different effects of Medicaid, representing a collaboration between non-profit and academic researchers and state policy makers. More of this detailed study inside.

More good news: the rates of uninsured young adults between 19 and 25 decreased by nearly 8 percent between 2010 and 2012, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey. The drop is attributed to the 2010 ACA provision allowing parents to claim their children on their health insurance until they are 26.

But there is bad news as well: nearly half of all working age adults in the United States — or 84 million people — went without health insurance for a time last year, or had out-of-pocket costs that were so high relative to their income they were considered underinsured. An estimated 80 million people reported that they did not go to the doctor when they were sick or did not fill a prescription due to cost. and 41 percent of working-age adults, or 75 million people, had problems paying their medical bills or were paying off medical bills over time, up from 58 million in 2005. More details on this comprehensive report inside also.

More good news: a new initiative called ARC (Avoid Readmissions through Collaboration) has helped participating San Francisco Bay Area hospitals reduce the number of discharged patients readmitted to hospitals in 2011 and 2012 by more than 3,300, saving an estimated $32 million in medical costs, according to ARC officials. This is an 11 percent reduction compared to 2010, putting ARC more than one-third of the way to its goal of reducing readmissions 30 percent by the end of 2013.

ARC has played a key role by supporting hospitals as they improve the transition of care process. This includes ensuring patients understand discharge instructions and encouraging closer collaboration between hospital staff and post-hospital medical care providers.

In other news, a new reimbursement program between Trinity Health-Michigan and Blue Cross Blue Shield of Michigan will move hospitals away from traditional fee-for-service (FFS) payments towards a value-based reimbursement arrangement, according to officials from both healthcare organizations.

The focus of the new healthcare model will be on creating better hospital-specific efficiency and population health outcomes, to be achieved by the hospitals working in close concert with affiliated physicians. The arrangement rewards the hospitals with a share of the savings achieved when hospitals and physicians successfully coordinate the delivery of care to enable efficient and effective treatments, eliminate redundancies and errors in care and prevent re-hospitalizations.

The arrangement will provide hospitals funding for infrastructure improvements needed to better coordinate care between the hospitals and their physician partners.

And lastly, we’d like you to share your news on your case management strategies with us in our fourth annual Healthcare Case Management Survey. Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. If you take our survey by May 17 you will receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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