Posts Tagged ‘Healthcare Reform’

13 States Cutting Medicaid Benefits

August 3rd, 2012 by Cheryl Miller


Despite a new study from the Harvard School of Public Health (HSPH) reported here touting the benefits of expanded Medicaid for the elderly and disabled, many states are cutting Medicaid benefits in order to balance their budgets.

The findings, drawn from a recent 50-state survey by Kaiser Health News for USA Today, show that 13 states have taken steps to make the cuts, now that the Supreme Court has ruled that states have the option to do so. The states are cutting Medicaid either by lowering fees paid to medical providers, reducing benefits, or tightening eligibility for the health insurance program for the poor and disabled. Most changes went into effect July 1, though some take effect later this year and some are pending federal approval.

The states that have cut, or will cut, benefits are:

  • Alabama
  • California
  • Colorado
  • Connecticut (potential cuts this fall)
  • Florida
  • Hawaii
  • Illinois
  • Louisiana
  • Maine
  • Maryland
  • New Hampshire
  • South Dakota
  • Wisconsin

As states cut Medicaid payments to hospitals and physicians, some are concerned it could make it that much harder to expand the program in 2014 under the ACA, news reports state, with some providers unwilling to accept new Medicaid patients.

In the first published study since the Supreme Court’s ruling on the effect of recent state Medicaid expansions on mortality among low-income adults, HSPH suggests that expanding coverage to the uninsured may save lives. The groups that benefited from the expansion the most are those that traditionally had higher mortality rates and faced greater barriers to care. Since states have the option to expand their Medicaid coverage, researchers hope this study will help state policymakers in their decisions.

New Video Documents ACO Activity: Accountable Care Doubles in Last Year

July 17th, 2012 by Patricia Donovan

Along with bundled payments, the accountable care organization would be the healthcare model to watch in 2012, predicted healthcare consultant Steven T. Valentine late last fall.

And as this new ACO video from the Healthcare Intelligence Network can attest, The Camden Group president knew what he was talking about. According to 200 healthcare companies who took the HIN ACO survey in May, participation in accountable care organizations doubled in the last year.

The survey also found that today’s ACO is leaner and more efficient, with more physicians at the helm than hospitals and less time necessary to get the ACO up and running.

For the uninitiated, ACOs create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. Built into the ACO model is a business opportunity: provide a focal point of care while attaining health and cost containment goals.

The bundled payment method referenced by Valentine refers to the practice of aligning payments for services delivered across episodes of care or “bundled” care.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s second annual ACO analysis delves into ACO administration, size, and the model’s impact on healthcare utilization and care delivery. And in case you missed Valentine’s forecast last fall, his comments are included here.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.

Federally Funded Clinics as Effective as Private Practices on Most Quality Measures

July 17th, 2012 by Cheryl Miller

Federally qualified health centers (FQHC) and their “look-alikes” are as effective as primary care practices, and better on some quality measures, according to a new study from the University of California, San Francisco. Because they serve the poor and uninsured, there have been concerns that they provide less effective care because they are serving more medically and socially complex patients. Researchers refute this, and the clinics will receive $11 billion from the federal government to expand their operations in the wake of anticipated primary care shortages as an estimated 32 million people seek healthcare under the ACA.

Family and primary care physicians could receive as much as 7 percent increases in payments under a proposed ruling from the CMS. The ruling is Intended to help primary care doctors improve patient care and lower healthcare costs long term by helping to transition patients back into the community following a hospitalization or SNF stay. If passed, CMS will make separate payments to a patient’s community physician or practitioner to coordinate the patient’s care after they are discharged.

More good news for primary care: of the 89 new ACOs selected to participate in the Medicare Shared Saving Program (MSSP), half are physician-driven, serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. This correlates to our research, conducted in March 2012, that found that physician-led ACOs were the most common.

Following several years of slowing growth, global spending on pharmaceuticals could reach nearly $1.2 trillion by 2016, according to a report from the IMS Institute for Healthcare Informatics. Studies indicate that the market for drugs will nearly double by 2016, reaching $1.2 trillion compared with about $956 billion in 2011, an annual growth rate of 3 to 6 percent. Suggested factors for the growth are volume increases in the pharmerging markets and an uptick in spending in developed nations.

Looking for new ideas on cost reductions in the ER? We present several stories on this topic, from Mina Chang’s detailed pre-ER interventions, to those presented in our blog post on the nonelderly Medicaid’s use of ER.

It’s not too late to participate in our survey on asthma management. Describe your organization’s efforts to manage asthma in your population by July 27, 2012 and you’ll receive a free e-summary of the survey results once it is compiled

Most Patients Want to Self-Manage Healthcare

July 9th, 2012 by Cheryl Miller


Most Americans want to manage their healthcare information electronically, but not at the expense of losing face time with their doctors.

At least that’s what the results of a new survey from Accenture Health show: a hefty 90 percent of patients prefer to monitor their medical information, refill prescriptions and book appointments online via e-mail, Web sites, and mobile devices.

Not only aren’t the majority of Americans willing to sacrifice personal interactions with their physicians, but they aren’t sure how they want their records managed. And a third admitted that they didn’t know if they could access electronic tools like ‘bill pay.’ More results from this survey inside this week’s issue.

Closer management is also key to a new tool from the Joint Commission Center for Transforming Healthcare, designed to improve patient handoffs. Data shows that an estimated 80 percent of serious medical errors result from miscommunication between caregivers when patients are transitioned from one facility to another. In addition to patient harm, defective handoffs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. This new tool, which monitors current organizational handoff processes and provides proven solutions, has been effective in reducing readmissions and hospitalization time, and increasing patient, family and staff satisfaction.

Managing costs is at issue in a new global survey from Towers Watson, showing that the cost of providing employee medical benefits is rising at double-digit levels everywhere in the world but Europe, which is anticipating only single-digit increases. The survey goes on to state the reasons for these increases, and avenues that medical insurers are taking to contain their costs, including implementing wellness programs and health promotion strategies.

And young adults are letting their parents manage their healthcare coverage. According to a new study from Indiana University economists, children ages 19 to 25 are taking advantage of the ACA ruling that private insurance policies offer to cover dependents’ children up to age 26. The report goes on to cite other findings, including the gender, marital status and ethnicity of children being covered; details in this week’s issue of Healthcare Business Weekly Update.

And how do you manage your asthmatic population? Asthma accounted for nearly half a million hospitalizations in 2009 and nearly 2 million ED visits; the estimated total cost of asthma in the United States in 2007 amounted to $56 billion. Describe your organization’s efforts to manage what is one of the most common, lifelong chronic diseases by July 27, 2012 and you’ll receive a free e-summary of our survey results once it is compiled.

Aftermath of SCOTUS Healthcare Reform Ruling: The Country Reacts

June 29th, 2012 by Patricia Donovan

From retailers to religious groups to every sector of the healthcare industry, reactions were immediate, passionate and divided to yesterday’s Supreme Court validation of the Affordable Care Act — a.k.a. Obamacare.

The highest court in the country upheld the constitutionality of the individual mandate built into the healthcare reform bill, but rejected the law’s right to penalize states that choose not to participate in new Medicaid programs by taking away their existing Medicaid funding.

Many states and healthcare organizations were waiting for the ruling before deciding whether to implement the many programs spelled out in the Affordable Care Act.

Here are excerpts from official statements published around the Web yesterday:

American Medical Association

“…We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy….This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents’ health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans…” (Jeremy A. Lazarus, MD, president)

Restore America’s Voice Foundation

“The Court threaded a Constitutional needle in redefining the individual mandate as a federal tax. It’s disappointing but not the final recourse for the American people. Now it is time for the legislature to do its job representing the will of the American people for full and final repeal of this ill-considered legislation…It must be repealed in its entirety or Senate Democrats will have to go home and explain their flawed definition of faithful representation. If they won’t represent the will of the people, then how have they earned the right to serve?” (Ken Hoagland, chairman)

Kaiser Permanente

“Today’s Supreme Court decision on the federal healthcare reform law resolves much of the legal uncertainty over implementation of the law’s provisions. While acknowledging that political uncertainty still remains, in the interest of our members we plan to continue our extensive reform implementation efforts, which began two years ago when the law first became effective. We want our members to know that they need not be concerned about any disruption of their coverage resulting from the Supreme Court’s decision today…” (Unattributed, published as “Our Point of View”)

America’s Health Insurance Plans’ (AHIP)

“…Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.” (Karen Ignagni, AHIP president and CEO)

Primary Care Development Corporation (PCDC)

“We are enormously pleased that the Supreme Court recognized the importance of the Affordable Care Act to millions of Americans and upheld the law, though it is disappointing that the ruling also weakened a provision supporting Medicaid expansion. (Ronda Kotelchuck, CEO)

National Association of Public Hospitals and Health Systems (NAPH)

“We are pleased by the Court’s decision today to uphold the Affordable Care Act’s (ACA’s) individual mandate, which will broadly expand health care coverage. We also are pleased that the decision retains other positive elements of the ACA, including initiatives to promote innovation, preventive care, and community-based collaborations. But our initial assessment of the decision leaves us concerned by its potential to limit Medicaid expansion, which could strand millions of our most disadvantaged people without access to basic health care coverage.” (Bruce Siegel, MD, MPH, NAPH president and chief executive officer)

National Retail Federation:

“As the voice of retailers of all types and sizes, we’re disappointed by today’s ruling. The Court missed an opportunity to redress the many shortcomings of the law. As it stands, the law wrongly focuses more on penalizing employers and the private sector than reducing health costs. For these reasons, NRF has been a consistent skeptic of the Affordable Care Act….Although the Court upheld the law’s constitutionality, many problems remain: it penalizes employers too much; it doesn’t do enough to reduce the cost of healthcare; and it is unreasonably complicated and difficult to implement and administer…This law will have a dramatic, negative impact on every employer and employee in the United States and further constrain job creation and economic growth.” NRF President and CEO Matthew Shay

National Lutheran Church — Missouri Synod

“In light of today’s ruling by the U.S. Supreme Court on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), we remain opposed to the controversial birth control mandate, which is one of the requirements included in the law. The Court’s decision today guarantees that we will continue to bring awareness to the threat to religious liberty represented by the birth control mandate, which requires virtually all health plans, including those of religious organizations, to cover birth control drugs and products that could cause the death of the unborn. We are opposed to the birth control mandate because it runs counter to the biblical truth of the sanctity of human life and creates a conflict of conscience for religious employers and insurers, who face steep penalties for non-compliance based upon their religious convictions. (Rev. Dr. Matthew C. Harrison, president)

American Hospital Association (AHA)

“Today’s historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality. The decision means that hospitals now have much-needed clarity to continue on their path toward transformation.” (AHA President and CEO Rich Umbdenstock)

Blue Cross Blue Shield Association (BCSA)

“BCBSA has long been committed to ensuring everyone has high quality, affordable healthcare coverage. We will continue to implement the law while working with policymakers to fix provisions that will increase costs, such as the health insurance tax that will add hundreds of dollars to families’ premiums each year. On behalf of our 100 million members, Blue companies will continue to lead efforts in their local communities — partnering with doctors, nurses, hospitals and others — to rein in costs, improve quality, help people stay well and better manage their care when they need it.” (President and CEO Scott P. Serota)

7-Step National Action Plan Promotes Prevention, Wellness: HHS

June 18th, 2012 by Cheryl Miller

Plans to make Americans healthier continue, with a new national action plan from the HHS.

Seventeen federal departments and agencies are currently on board to enact a seven step national plan, including initiatives to clean up the air and water, renovate or create safe outdoor spaces for physical activity, make healthier foods more accessible, and assure violence-free environments. This is part of a comprehensive effort to tackle such issues as obesity, tobacco use, health disparities and chronic disease.

One federal initiative that has helped to keep young adults healthy was the ACA’s ruling that youths could stay on their parents’ health plans until they are 26. According to a new study from the Commonwealth Fund, millions of young adults stayed on or joined their parents’ health plans in 2011 who wouldn’t have been eligible prior to ACA passage. However, nearly 40 percent of young adults aged 19 to 29 went without health insurance at some time in 2011 primarily because their parents did not have healthcare coverage, and affordability of healthcare remains a crucial issue for young adults.

Keeping older adults comfortable, while at the same time minimizing their hospitalization and healthcare costs, is behind a new study from UCSF and published in Health Affairs. The study finds that creating specialized hospital units for elderly people with acute medical illness could reduce national healthcare costs by as much $6 billion a year. Researchers suggest that minor changes in current healthcare models can yield significant results. Leaving patients in their hospital beds, for example, or constantly interrupting them in the middle of the night for disruptive evaluations, often lead to longer recovery time and longer hospital stays. Creating interdisciplinary teams that specialize in the care of older patients, and that tend to elderly patients daily, can do much to minimize their discomfort and shorten their stays.

And one healthcare model that will likely stand the test of time, and a potential Supreme Court challenge, is the ACO. According to our latest market research, ACO activity has doubled in the last 12 months. Also in our white paper: data on how many ACOs participate in the CMS Shared Savings Program, and which kinds of ACOs were the most common.