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Category Archives: Health Care

Blues sets light on health care exchange

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The new health care exchange set up under the federal Affordable Care Act is worth a look for North Dakotans eligible to apply, according to representatives of Blue Cross Blue Shield of North Dakota.

BCBSND, North Dakota's largest health insurer, sponsored a workshop in Minot Wednesday to explain the exchange and the plans that it has available there. Other companies offering plans on the exchange are Sanford and Medica. Sanford has been in North Dakota's insurance market since 2010 and Medica since 2008.

The exchange opened for applications Oct. 1.

Wednesday's workshop was geared toward people curious about individual coverage. People with access to employer-sponsored plansalthough they can drop those plans in favor of the exchange are not eligible for government subsidies through the exchange unless the cost of a single policy at their jobs eats up more than 9.5 percent of their incomes. People eligible for Medicaid or Medicare also would remain on those programs and would not use the exchange.

For many people, though, there's a chance for advance tax credits and government cost sharing to reduce both premiums and medical expenses. It all depends on family size and income, said J.D. Nichol, manager of consumer sales for BCBSND.

Price quotes vary because premiums change with age and factors such as whether someone is a smoker. However, BCBSND presented a scenario for one of its upper level plans in which a couple with four children and an income of $43,900 paid a monthly premium of $119 after the advanced tax credits. The same family would pay $529 with an income of $78,975 or $1,000 with an income of about $126,000 after the advanced tax credit. Without tax credits, the cost would have been $1,028.

Nichol explained that the tax credits are available to people with incomes up to 400 percent of the federal poverty level. For a family of four, that income limit is $94,200.

People get the credits in advance to reduce their monthly premiums. Once they complete their tax forms and their actual adjusted gross incomes are known, they may get additional money or may have to pay back, depending on how their actual incomes compared with their estimates.

Nichol added that people will get at least one opportunity to update their estimated incomes during the year.

The cost-sharing assistance is available to people at 250 percent of federal poverty level, or 300 percent if Native American.

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Blues sets light on health care exchange

Health Care and Productivity

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Arguably, the United States has the highest share of world-class hospitals. Ask health care professionals about the best hospitals in the world and you will hear names such as John Hopkins, MD Anderson Cancer Center, Harvard Medical School and the Cleveland Clinic.

With $800 billion spent annually on U.S. hospitals, the United States has the best-funded hospital infrastructure in the world.

Why, then, does the United States only manage to have the same life expectancy as Cuba, an economically underdeveloped nation? Is the U.S. health care system doing its job right? To put the question more broadly, how can we judge the performance of a health care system?

Health care systems have one primary purpose to keep people healthy and to do this cost-effectively. In 1996, McKinsey introduced a metric called health care productivity to quantify this.

This metric measures the reduction of disease burden achieved for every dollar spent in health care. Simply put, a good health care system will have a high level of health care productivity.

Stunningly, among the 34 OECD member countries, the United States has the lowest health care productivity. At first glance, this could lead one to conclude that the U.S. health care system is a total failure.

But if we measure productivity by disease condition, a slightly different and more nuanced picture emerges. The United States has the highest productivity in the world for managing breast cancer, but the lowest productivity in diabetes!

We see this duality in almost all high-income countries. Switzerland is the most productive country in the world for treating strokes, while being very poor at breast cancer. Canada is most productive in managing high blood pressure, but very poor in schizophrenia. The UK is world leader in managing diabetes, but does a poor job at handling asthma.

I am not arguing that the United States health care system does not have systemic issues. Issues such as defensive medicine (in response to a highly litigious legal environment) and lack of care coordination are well recognized.

In fact, all health care systems around the world have systemic issues. The point here is that, even within these constraints, they can do well in managing some diseases. The question then becomes, why do some countries succeed, while others do not?

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Health Care and Productivity

Historically Low Health Care Price Inflation Holds Health Spending Growth to 3.8% in August

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ANN ARBOR, Mich.--(BUSINESS WIRE)--

National health care prices in August 2013 were 1.0% higher than in August 2012, down one-tenth from the July 2013 level and equal to the May 2013 rate, which was the all-time low in our series that extends back to January 1990. The 12-month moving average, at 1.5%, is a new low for our data. Hospital price growth fell to 1.5%, its lowest rate since 1.3% in December 1998, while physician prices grew a scant 0.3%. Hospital price growth plays a dominant role in the total index via its spending weight, and its low August reading was complemented by a decline in home health prices (-0.2%) and durable medical equipment (-0.1%), plus moderate growth otherwise.

National health expenditures (NHE) in August 2013 grew 3.8% over those of August 2012 and kept the annualized growth rate at 3.8% for 2013 to date. The health spending share of GDP was 17.4% in July 2013, the same as at the conclusion of the Great Recession in June 2009. (This is well below the 18% share that has been previously reported over the past few years and is strictly due to a change in GDP accounting that occurred in July 2013.)

These data come from the monthly Health Sector Economic IndicatorsSM (HSEI) briefs released by Altarum Institutes Center for Sustainable Health Spending (www.altarum.org/HealthIndicators). Due to the federal government closure, labor data for September, scheduled for October 4 release, were not reported. (When new labor data are ready, we will issue an updated HSEI Labor Brief.)

Health care prices have been growing more slowly than prices in the rest of the economy for 4 consecutive months, said Charles Roehrig, director of the center. If this continues for the rest of 2013, we may find that spending growth for 2013 has dropped below the record low 3.9% growth experienced since 2009.

Altarum Institute (www.altarum.org) integrates objective research and client-centered consulting skills to deliver comprehensive, systems-based solutions that improve health and health care. Altarum employs more than 400 individuals and is headquartered in Ann Arbor, Michigan, with additional offices in the Washington, D.C., area; Portland, Maine; and San Antonio, Texas.

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Historically Low Health Care Price Inflation Holds Health Spending Growth to 3.8% in August

"If Barack Obama has a BLT sandwich tomorrow…": Alan Grayson on Health Care Reform – Video

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"If Barack Obama has a BLT sandwich tomorrow...": Alan Grayson on Health Care Reform
The West Wing writer and producer Eli Attie based the character of Matt Santos (portrayed by Jimmy Smits) on Obama. At the time the politician was only a sta...

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"If Barack Obama has a BLT sandwich tomorrow...": Alan Grayson on Health Care Reform - Video

New Book Highlights Baylor Health Care System's Quality Journey

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Newswise Reaching Americas true potential to deliver and receive exceptional health care will require not only an immense and concerted effort, but a fundamental change of perspective from medical providers, government officials, industry leaders, and patients alike.

Achieving STEEEP Health Care, a new book published by CRC Press, highlights Baylor Health Care Systems (BHCS) efforts to improve health care quality along the six aims of health care improvement outlined by the Institute of Medicine and embraced by BHCS leadership: safety, timeliness, effectiveness, efficiency, equity, and patient centeredness (STEEEP).

This is the future of health care, says Joel Allison, president and CEO for BHCS. These aims and strategies are not only making it better for our patients, they are helping us remain a leader in health care during this time of uncertainty.

Achieving STEEEP Health Care features perspectives of senior leaders in the areas of corporate governance, finance, and physician and nurse leadership; strategies for developing and supporting a culture of quality, including systems and tools for data collection, performance measurement, and reporting; service-line examples of successful quality improvement initiatives such as reducing heart failure readmissions; and approaches to accountable care and improved population health.

This book offers practical strategies and lessons for other organizations in the areas of people, culture, and processes that have contributed to dramatic improvements in patient and operational outcomes at Baylor Health Care System, says David J. Ballard, MD, PhD, BHCS senior vice president and chief quality officer, president of the STEEEP Global Institute, and the books editor. We hope that sharing the challenges and successes we have encountered in our STEEEP care journey will educate and encourage other health care delivery organizations embarking on their own quality improvement endeavors.

For more information, visit http://www.achievingsteeephealthcare.com

About Baylor Health Care System Baylor Health Care System is a not-for-profit, faith-based supporting organization providing services to a network of acute care hospitals and related health care entities that provide patient care, medical education, research and community service. Baylor recorded more than 2.8 million patient encounters, $3.8 billion in total net operating revenue, $5.3 billion in total assets and $539 million in community benefit in fiscal year 2012 (as reported to the Texas Department of State Health Services). Baylors network of more than 360 access points includes 30 owned/operated/ ventured/affiliated hospitals; joint ventured ambulatory surgical centers; satellite outpatient locations; senior centers and more than 200 HealthTexas Provider Network physician clinics.

About STEEEP Global Institute The STEEEP Global Institute is a division of Baylor Health Care System dedicated to helping other organizations improve health care quality. For more information, visit http://www.steeepglobalinstitute.com

STEEEP is a registered trademark of Baylor Health Care System.

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New Book Highlights Baylor Health Care System's Quality Journey

Patrick's health care narrative skips over some blemishes

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Gov. Deval Patrick is bullish about the 2006 health care access law, the 2010 federal Affordable Care Act and a 2012 state law to control cost increases.

In a Huffington Post op-edMonday, Patrick, a Democrat finishing his second term and considered a potential national office seeker, unsurprisingly focused on the upsides of Massachusetts experiments with health care reform without addressing some of the more recent, gloomier developments. Patrick described Massachusetts as the first state to achieve universal health care, the model for the ACA. And he ticked off other achievements in a piece targeted for a national audience and intended by the governor to let people know how Obamacares prototype has been doing.

Patrick wrote that the insurance expansion added only 1 percent of spending to the state budget, that unemployment in Massachusetts has remained lower than the national average and economic growth higher, that more private companies are offering insurance to employees than ever before, that virtually every resident is insured, and that average base rate increases are less than 2 percent today after rising more than 16 percent three years ago.

As the ACA is implemented this month, the entire country will begin to enjoy the benefits that we have seen from health care reform here in Massachusetts, and much more, Patrick wrote.

The governor did not mention some of the other storylines that have been playing out in Massachusetts.

Small businesses fearful of sharp health insurance rate hikes remain opposed to ratings factors being forced upon states under Obamacare. At the direction of the Democrat-controlled Legislature, Patrick sought a waiver from the ratings rules, but the Obama administration rejected it, allowing a three-year phase-in period instead. One major business group said it was mulling legal action.

As the state and nation crawled out of the Great Recession, Patrick administration officials maintained a faster and stronger mantra to distinguish growth in Massachusetts from other states, a narrative that has since been abandoned following mixed economic reports and data showing the state growing more slowly compared to the nation from April through June after a strong first quarter.

Last week, economists who are part of the University of Massachusetts Benchmarks project reported, After coming out of the recession more quickly than the nation, in recent months the Massachusetts economy has been growing sluggishly. The state unemployment rate has been rising even as the national rate has been falling.

The state unemployment rate held steady at 7.2 percent in August, a hair below the nation's 7.3 percent unemployment rate. The government shutdown prevented the release of an updated national rateon Friday. A year ago August, the national jobless rate was 8.1 percent and the Massachusetts rate was 6.8 percent.

The state Center for Health Information and Analysis (CHIA) reported in August that based on 2011 data, 97 percent of Massachusetts residents were insured, with nearly 200,000 uninsured. Massachusetts has consistently registered a high insured rate, a fact that policymakers say has made insurance expansion efforts more achievable and the job of keeping together a broad coalition behind reform more doable.

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Patrick's health care narrative skips over some blemishes

Health Care Reform Insurance Marketplaces Add New Options and Questions for Employees as Open Enrollment Season Begins

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BOSTON--(BUSINESS WIRE)--

Under the Affordable Care Act (ACA), consumers will be making history this fall as the first generation mandated by the government to have individual health care coverage. One market segment, the working insured, will now have more choices beyond their employer-funded health care plans as insurance marketplaces come online. However, before making any choices, HighRoads, the leading benefits plan management system provider for Fortune 1000 employers and key payers, suggests consumers thoroughly research all options to make sure their new choices meet their health and financial needs.

We first suggest employees read their Summary of Benefits and Coverage (SBC) documents as a benchmark from which to compare all options in employer-provided plans and marketplaces, said Cynthia Weidner, vice president, HighRoads. SBCs, which HighRoads provides through its benefits plan management system, are ACA-required documents detailing essential benefit coverage and distributed to each participant. SBCs will help consumers pinpoint what exactly theyre getting in coverage, and will help in making comparisons, said Weidner.

HighRoads recommends these tips for consumers as they make open enrollment choices:

About HighRoads

For more than 14 years, HighRoads has been an industry leader in benefits plan management and health care compliance. Its patented SaaS-based technology, The Source, streamlines dynamic data management, optimizes workflow across the enterprise and ensures regulatory compliance. The privately held company is headquartered in Woburn, Mass. For more information, visit HighRoads.com, become a fan on Facebook, a follower on Twitter (@HighRoadsHR), or read the HR Compliance Connection Blog http://hrcomplianceconnection.com.

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Health Care Reform Insurance Marketplaces Add New Options and Questions for Employees as Open Enrollment Season Begins

Missing Inaction: The National Health Care Workforce Commission – Health Stew – Boston.com

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Way before the fight over creating the Affordable Care Act, broad agreement existed on one vital national health reform issue: the nation's health care workforce shortages. Even without the ACA, America faced serious problems with deficits of physicians, dentists, pharmacists, mental health professionals, and many more. With passage of the ACA, these issues assumed more urgency because of the pending expansion of health insurance to 30+ million formerly uninsured Americans.

The ACA sought to address these needs. Title V of the law is devoted entirely to measures to address America's health care workforce needs. No other title of the law received such broad support and so little controversy as did Title V. During the legislative debate on the ACA, I heard condemnation of nearly every part -- except for Title V. Here's the description of the Title from healthcare.gov:

"The Act funds scholarships and loan repayment programs to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, the Act combats the critical nursing shortage. And through new incentives and recruitment, the Act increases the supply of public health professionals so that the United States is prepared for health emergencies.

"The Act provides state and local governments flexibility and resources to develop health workforce recruitment strategies. And it helps to expand critical and timely access to care by funding the expansion, construction, and operation of community health centers throughout the United States."

The marquee provision of Title V is the establishment of a National Health Care Workforce Commission to be composed of 15 non-governmental health workforce experts and professionals to do data collection, analysis, and recommendations to help the nation to meet its ever-growing and changing workforce needs. The Commission was the brainchild of former Senator Jeff Bingaman (D-NM). The ACA directs the U.S. comptroller general to appoint the 15 members and he did so in the fall of 2010, six months after the ACA was signed. And it is an impressive group -- here's the list:

Not too shabby, ready, willing and able to get to work.

Today, nearly 30 months after their appointment, the Committee has been unable to hold its first meeting. As Robert Pear reports in today's New York Times, the Commission is legally prohibited from convening -- and members are legally prohibited from communicating with each other -- because the Republican-controlled House of Representatives refuses to release the $2 million or so necessary to fund the commission's operations.

Why? Because the Commission was established in the ACA, (aka: ObamaCare) and Republicans in Congress are unwilling to support anything that is part of ObamaCare, even if everyone of them agrees that workforce shortages represent an urgent national, state, county and local need.

If the political temperature on the ACA can moderate so much that at least 7 Republican governors can embrace a huge expansion of Medicaid, is it too much to hope that Congressional Republicans can allow the National Health Care Workforce Commission to get to work?

(Correction -- original text modified to delete reference to workforce shortage of nurses. Out of date reference, my error.)

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Missing Inaction: The National Health Care Workforce Commission - Health Stew - Boston.com

Governor Quinn Honors Public Health Care Pioneer Carmen Velásquez as Part of Latino Heritage Month – Video

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Governor Quinn Honors Public Health Care Pioneer Carmen Velásquez as Part of Latino Heritage Month
CHICAGO -- Governor Pat Quinn today proclaimed "Carmen Velásquez Day" throughout Illinois in honor of the pioneering public health advocate who founded Alivi...

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Governor Quinn Honors Public Health Care Pioneer Carmen Velásquez as Part of Latino Heritage Month - Video

Ticking all the boxes for a health care upgrade at Strata Rx

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Heres what we all know: that a data-rich health care future is coming our way. And what it will look like, in large outlines. Health care reformers have learned that no single practice will improve the system. All of the following, which were discussed at OReillys recent Strata Rx conference, must fall in place.

Although this cocktail of treatments is complex, all commenters concur on the ingredients importance to a remarkable degree. There is no Greek or Jew, no Democrat or Republican in the consensus over health care: anyone who has looked at the system comes up with the same vision.

Ill warrant you cant find a single doctor who says, It works great to wait for people to get sick and then come to me to be fixed up. No insurer will say, Were happy taking our cut from the 18% of gross national product that goes to health care, and were looking forward to it reaching 24% (a figure Ive heard batted around for future costs). Everyone realizes the system will collapse, taking their livelihoods with it, unless we change.

In modern statistics, a model is not just a way of approaching problems mentally, but a set of directions to a computer program for solving those problems Tuan Dinh, who wrote a recent article on new medical practices, traced the history of model-based medicine at Strata Rx. Dinh rang up most of the themes of modern health reform: collecting data from multiple sources, patient engagement, analytics.

In the 1970s and 1980s (when the casual meaning of model applied), models were based on clinical judgment and expert opinion. They were not supported by well-established evidence, but were based on gross oversimplifications and errors.

Then evidence-based medicine (EBM) emerged in 1990s, based on systematic reviews of available evidence, of which randomized clinical trials are the gold standard. EMB is seen everywhere now: pay for performance, care processes, EHRs, etc.

But EBM was designed for the pre-computer era, to let doctors focus on one variable at a time. Dinh said there are already 10 established models for treating cardiovascular disease, 50 for diabetes, etc. But most are poor because they are based on a small and inappropriate selection. And different models give different advice, so what do doctors trust?

The upcoming stage of analysis, model-based medicine, requires the analysis of large numbers of variables, and huge sets of patient information that are not obtainable through clinical trials. Model-based medicine can handle information on real patients (clinical trials used idealized patientspeople who are healthy except for a single condition) and gather up complex inputs: lab information, genetic information, family history, comorbidities, and patient preference.

A number of talks at Strata Rx dealt with reducing readmissions shortly after a hospital discharge. Why the obsession with this particular cost reduction? Well, Medicare fairly recently announced strong penalties for hospital readmissions, so it catapulted suddenly to the health care fields favorite application of data analysis.

In one such talk, Miriam Paramore and David Talby showed the value of big data. There have been models for predicting readmissions for some time, but they were based on a single institution, or at best a single geographical area, and did not necessarily apply to other locations with different demographics. The older models were based on a few thousand to at most 1,700,000 samples. Paramores and Talbys was based on 4.7 billion medical claims, from 120 million patients seeing 500,000 providers.

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Ticking all the boxes for a health care upgrade at Strata Rx


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