Posts Tagged ‘health policy’

Fresh Health Wonk Review at medicareresources.org blog – check it out!

Friday, February 10th, 2017

Steve Anderson has posted the latest and greatest Health Wonk Review – the #alternative_facts Edition at medicareresources.org blog.

The Affordable Care Act (aka Obamacare) is not all that’s on our wonks’ minds of late, but it certainly takes up a huge portion of the mind share as evidenced by the plethora of related posts. We are a diverse crew, though, so there are also posts about a variety of other topics: the reaction to/impact of the immigration ban on healthcare industry, best cancer treatments, the process of healthcare M&As, legal liability in the form of class action suits for a data breach. and workers comp. One thing we find: the contributors are all very knowledgeable people – even if a topic is not on your radar, it’s a good way to learn something new.

Two posts we think are particularly worth calling out:

If ACA is repealed, how many will max out on restored lifetime coverage caps?

If ACA is repealed, how many are at risk of losing coverage by U.S. Congressional District? (Data covers 35 states)

Fresh Health Wonk Review posted at Joe’s place

Friday, January 27th, 2017

As we embark on the second week of a new administration, Joe Paduda has posted Health Wonk Review’s Inauguration Edition at Managed Care Matters. Rather unsurprisingly, the Affordable Care Act is much on the minds of the wonks, so there’s quite a few posts dealing with various aspects of repeal and replace.

Related to the topic of this week’s health wonkery, Joe also has a post on his blog about how the demise of the ACA would impact workers comp, specifically. A key quote:

“If ACA is repealed without a simultaneous and credible replacement, we may well see a rise in the number of workers without health insurance. The key issue to track is a cutoff of funding for Medicaid expansion – ACA added about 13 million more employed people to the insured rolls; if they lose coverage they’ll need a different payer to cover their injuries. Bad news for workers’ comp.”

And we’d point you to one other not-to-miss post at Managed Care Matters – Beware of Astroturf, the infuriating story of the American Pain Foundation, an pharma industry sponsored opioid-peddling outfit masquerading as a patient advocacy organization.

2016 White Paper Evaluates Commonwealth Care Alliance

Monday, July 18th, 2016

In April, 2016, I authored a post about Commonwealth Care Alliance (CCA), a Massachusetts HMO dedicated to serving the Dual Eligible population. Duals qualify for both Medicare and Medicaid, and CCA has been the nation’s incubator for how to do that. The Boston-based HMO operates a Senior Care Option plan for Duals over the age of 65 and an Affordable Care Act demonstration project, called One Care, for Duals younger than 65. I’ve been a CCA Director since its inception in late 2003.

Now, with the support of the Robert Wood Johnson Foundation, JSI Research & Training, Inc., has published an extensive evaluation of CCA’s visionary and groundbreaking efforts to treat the nation’s sickest of the sick and poorest of the poor.

In JSI’s words:

The provisions in the ACA were designed to achieve the Institute of Health Improvement’s Triple Aim of improving patient experience of care and the health of populations while reducing the overall cost of health care.

The 22-page White Paper’s thrust centers around CCA’s “Social ACO” model of care. JSI describes the Social ACO approach this way:

These approaches are based on the idea that improving health and cost outcomes of vulnerable populations will necessitate incorporating health, behavioral health, and social services into the ACO model. Social ACOs serve populations with complex and often unmet social and economic needs that impact health outcomes and health system utilization, including needs related to housing, food security and nutrition, legal assistance, employment support, and/or enrollment assistance.

As I noted in April, Duals represent only 4% of the nation’s population, but consume 34% of its health care dollars. They present a societal problem begging for a solution. The Affordable Care Act offers revolutionary innovators like CCA the chance to prove their worth. So far, as the JSI paper suggests, CCA’s approach is spot on. Here’s JSI’s conclusion:

As a pioneer of the social ACO approach, its (CCA’s) story offers insights into the factors and processes that promote successful realization of the Triple Aim for other emerging ACOs focused on complex patient populations.

Payment and delivery reform promises to transform care for the nation’s most vulnerable citizens. This is needed more than ever given rising healthcare costs and continued fragmentation of the care system. CCA’s social ACO model represents one approach to caring for some of the highest risk populations, though even this approach has had to be adapted extensively for the dual-eligible population under 65. Given its longevity of refining a care model, a global capitation payment model and a culture of innovation to care for high-risk, vulnerable populations, CCA’s experience is relevant to any provider organization seeking to transform care for high-risk populations.

Achieving the Triple Aim of improving the health of America’s dual population while lowering the cost of doing so is a rabbit-out-of-the-hat trick of the first order, but, at least to this point, Commonwealth Care Alliance seems to be onto something that will do just that.

One final thought: On the eve of our two presidential conventions, it would be nice if, at some point in all the bloviation, a cogent discussion regarding health care were to be had. And I’m talking about something other than, “On Day 1 we’re going to repeal Obamacare.”

But I wouldn’t bet on that happening. Would you?

Today’s must-read at Health Affairs Blog

Thursday, June 16th, 2016

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Get your health policy reading while it’s hot: Chris Fleming has posted A Pot Luck Health Wonk Review at Health Affairs Blog. The biweekly best of the health policy blogosphere usually includes many posts of interest – but this week’s edition seems particularly varied. Maybe because the health wonkers are going to take a bit of a summer hiatus – after this issue, we’ll only be up once a month in the summer, so get your fill of wonkery now.

If you are interested in health care news, then the Health Affairs Blog should be top of your reading list. It’s an adjunct of the prestigious Health Affairs, a  peer-reviewed journal of health policy thought and research. The blog regularly features commentary and analysis from noted health policy experts from a wide variety of perspectives, as well as regular Health Affairs contributors and staff. Health Affairs Blog has been cited in congressional testimony and by members of Congress. Media outlets that have cited the Blog include The New York Times, Washington Post, Forbes, National Journal, Reuters, and many others.

Please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 06/21/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

New Health Wonk Review at Boston Health News

Friday, May 20th, 2016

Cambridge, Massachusetts-based health and science journalist Tinker Ready hosts the current edition of Health Wonk Review at her Boston Health News blog: The Health Wonk Review: HIT, LGBT and ACA. Check it out! It’s an eclectic edition covering a cornucopia of health policy topics.

And please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/24/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

New Health Wonk Review at Wright on Health

Thursday, May 5th, 2016

Check out the latest & greatest from the web’s noteworthy health policy pundits: Brad Wright has posted Health Wonk Review: Pivoting Towards the General Edition at Wright on Health. We’re 186 days away from the election but his edition is complete with hilarious photos of our next president so you’ll want to check it out.  Lots of good posts, too, from the usual suspects.

Please join the wonkers for a new multimedia experience (video conversation and text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/10/2016 at 1 pm ET for half an hour. Watch it live here or click to login via Twitter.

The Sickest Of The Sick, The Poorest Of The Poor

Tuesday, April 5th, 2016

They comprise less than 4% of the nation’s population, yet consume nearly 34% of health care dollars. Sixty percent are age 65 or older. About 40% are younger people with ADL-qualifying disabilities. More than half fall below the federal poverty level. Almost half never graduated high school. Nearly two-thirds are female. Fifty-eight percent are white/non-hispanics.

They are America’s “Dual Eligibles,” our fellow citizens who qualify for both Medicare and Medicaid benefits. Technically, because they’re Duals, they are not the “uninsured.” Still, they sit smack dab in Obamacare’s bulls eye.

In 2003, here in Massachusetts, a pioneering visionary decided to create a non-profit HMO that would offer as its sole product a Senior Care Option plan aimed at the over-65 Dual population. As a former head of the Long-Term Care Division within the Commonwealth’s Medicaid Program, Mass Health, Dr. Bob Master knew a lot about the Duals and the many challenges they presented. Somehow, he convinced a few academics and business people to join his brand new Board of Directors for his Quixotic quest. I was one of them.

In the early days, the hunt for funding was all-consuming, but against considerable odds, funding was found, and, with the support of CMS and Mass Health, an incubator for the nation was born – Commonwealth Care Alliance.

Bob immediately set out to prove that Duals could achieve significantly better health and well-being at lower cost if they were cared for in a home-based regimen by highly trained teams of providers. And between 2003 and 2014, CCA produced eye-popping proof of concept results. For example, thirty-day hospital readmission rates for these sickest of the sick and poorest of the poor consistently beat Medicare’s overall rate. CCA achieved annual Medicare star ratings of 4.5 or better (Because of Senior Care Option demographics, it is statistically impossible for the company to achieve a higher rating).

CMS took note. And when medical, academic and political luminaries were crafting the Affordable Care Act, Bob was instrumental in convincing them Duals were a target not to be missed.

Consequently, the Affordable Care Act created demonstration projects in nine states from California to Massachusetts to see whether it’s possible to improve the health of all Duals, those over the age of 65 as well as under it, while reducing their health care costs. A tall order, indeed, because it had never been done before.

CMS and Mass Medicaid issued a humongously big RFP. Commonwealth Care Alliance answered it and won the right to play in the new sandbox, called One Care. The year 2014 was spent in preparing. For example, in order to be ready, the company had to double the size of staff (there are now more than 800) and train the newbies to successfully manage CCA’s unique model of care. That was not easy.

In early 2015, we opened the floodgates to the state’s thousands of Duals under the age of 65. Since then, it’s been a thrilling ride, because throughout 2015 CCA had a few near-death-experiences. But with the help of both CMS and Medicaid we were able to negotiate the potholes and speed-bumps, and now, after more than a few sleepless nights, the company cares for more than 17,000 Duals with Medicare and Medicaid premium of more than $850 million. In essence, CCA is beginning (barely) to do well by doing good. To my mind, if the Affordable Care Act, Obamacare, does nothing more than significantly improve the lot in life of the nation’s Duals while lowering their cost of care, it will be a success of the first order.

Now, it’s time to turn the reins over to a new era of leadership. Last Friday, we had a retirement party for Bob Master where CCA employees who could free themselves from work for a couple of hours came to Boston to say hail and farewell. Many came on their own time. There was a great big cake and a lake-full of diet soda and coffee, but no dignitaries, just current staff and a number of Directors. The Chair of the Board said nice things about Bob and the ride we’d all been on. I described how, after all this time, Bob and I had discovered less than a year ago over lunch that, in addition to growing up in the next town to each other, we had been comrades in arms back in the late-60s in Vietnam; in the same Division, even, at the same time. Funny, that.

Many employees read stories they’d prepared for the occasion. Honest tears were shed. Bob gave an extemporaneous speech that was heartfelt and touching. He thanked all who had joined in the noble quest, many by name. Then he rode off into the sunset.

But the work goes on.

 

 

 

 

Some Final Thoughts Following WCRI’s Annual Conference

Wednesday, March 16th, 2016

 

This year’s conference was an interesting blend of hard data and subjective debate.

On the hard data side we learned the preliminary results of some studies addressing what most in the business consider to be the key issues of the day, and they are all medical (a position with which I do not agree, but, admittedly, I am a minority of one). Some of the studies produced  results that validated what I like to think of as the “Duh!” conclusions. These are conclusions that seem totally logical and predictable, conclusions reached by mere intuition. Trouble is, policy, at least good policy, should be based on verifiable evidence, the kind that these “Duh!” studies produce, and not by intuition.

For example, workers’ compensation pays providers better than group health, in some states way better. So, it is logical and intuitive to believe that providers in those way better states would categorize soft tissue injuries as work-related rather than group health if given the chance. And, what do you know? Preliminary results from one of the studies put “You betcha” to that one.

So, cost shifting happens, and now we have proof, proof that policymakers can cite as they suggest system improvements.

Subjective debate was alive and well in the two Opt-Out panels. There were eight panel presenters, and only one of them, Elizabeth Bailey, from Waffle House, Inc., produced any data. As I wrote during the conference, Ms. Bailey presented data on cost savings Waffle House achieved since Opting-Out of Texas workers’ compensation in 2002. The savings were impressive, indeed, but, as attendees pointed out during the question period, Waffle House has made other workers’ compensation, safety and employee involvement improvements since Opting-Out, so it’s hard to say just how much Opting-Out has contributed to the cost savings. In other words, Waffle House’s cost savings may be nothing more than a painted hook on which Opt-Out enthusiasts want to hang their collective hats. More study is needed. Let’s hope it happens.

And let us not forget Bob Hartwig, the illustrious outgoing President of III, the Insurance Information Institute. Dr. Hartwig, who delivers presentations at Gatling gun speed, spoke on the Sharing Economy, or, as Hilary Clinton calls it, the Gig Economy. His formidable presentation was entertaining, educational and scary all at the same time.

For me, three things are memorable from the presentation:

  1. The Gig economy is bigger than anyone thinks, and is growing swiftly. And, as you might imagine, Millennials are deep into it. This is a movement that has the power to change an economic system.
  2. Hartwig suggested that the days of AI, Artificial Intelligence, taking over America’s jobs are farther in the distance than have been predicted by AI experts. His position is one with which I, respectfully, disagree. I think we’re closer to a cataclysmic shift than he believes. To put a point to that, Gary Anderberg, Senior VP of Analytics for Gallagher Bassett, suggested, no, pronounced, during the question period that all of the WCRI attendees could be replaced given today’s Watson-like technology. That’s heady stuff.
  3. I got to ask the last question of Dr. Hartwig, and it was this: “To what degree do you believe the Gig Economy correlates to the relative stagnation in hourly wages over the last 40 years?” His reply? “Good question. A lot.”

Bob Hartwig now moves to a professorship at the University of South Carolina, and the students in the Finance Department have no idea what is about to hit them. I predict his classes will be over-subscribed from the get-go.

Hope to see you at next year’s WCRI conference, March 2nd and 3rd in Boston.

 

Hospital Medicare Charges: You Don’t Always Get What You Want

Monday, June 8th, 2015

In early June of this year, the Centers for Medicare and Medicaid Services (CMS) let loose a treasure trove of data. One data set lists inpatient charges of 3,000 hospitals for the 100 most frequently billed diagnoses of 2013. The differences between what the hospitals billed and what Medicare paid are eye-popping, as are the differences between what hospitals within just a few miles of each other charged.

The inpatient data shows Medicare paid about $62 billion to cover more than 7 million discharges. Our good friends at Modern Healthcare have analyzed the data. This, from Modern Healthcare’s Bob Herman:

Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

The CMS data is shining a light on the process. The agency has now released data from 2011, 2012 and 2013. Charges for various inpatient and outpatient procedures differed significantly again in 2013 as they did in prior years. In many instances, charges fluctuated greatly among hospitals in the same region.

A Modern Healthcare analysis of the inpatient payment data shows Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.

Did you catch the part about the listed charges being irrelevant, because they’re only starting points for negotiations? Reminds me of the last time I bought a car.

You might be tempted to say, “That’s crazy! Why do hospitals do that?” Let me answer with a little story.

A few years ago, I was a Trustee at a major teaching hospital in Massachusetts, a tertiary care facility, one of the biggies. At one Board meeting early on in my trusteeship I asked the CEO how the hospital was compensated for uninsured people who were indigent. His answer? “We charge them the moon.” Note to reader: he’s talking about the indigent patient, here. “Then, when the state’s uncompensated care pool gets around to paying us, we’ll get a lot more than if we just charged them what the procedure cost, in which case we’d get a lot less than what the procedure cost.” I never forgot that lesson in hospital economics.

So, you see, when hospitals say their charges are “starting points,” they’re telling the truth. And that is one spooky scary example of what a first-class horrendoma the American healthcare system (if you can call it that) has become.

Health Wonk Review, “Football Is Here” Edition at Colorado Health Insurance Insider

Thursday, September 13th, 2012

Check out a fun and smart Health Wonk Review – “Football Is Here” Edition posted by Louise Norris at Colorado Health Insurance Insider.
We don’t want to step on her toes here, just go read the whole edition, which is a pretty full one — Louise always does a very thoughtful job in framing each entry — but we would echo her recommendation to be sure to visit the post from Amy Berman – the first one in this edition. It’s so very worth reading and thinking about. Thank you Amy, and best to you!