Study: HDHPs Result in Delayed Care for Low Income Families

A study of lower- and higher-income families on high deductible health plans (HDHPs, with deductibles over $2,000): lower income families were more likely to forego or delay care (57 percent) compared to higher income families (42 percent). The study found no differences in plan understanding between family groups, and did not differentiate between foregone care of little and great benefit. (Source: Kullgren, et al. November 22, 2010. “Health Care Use and Decision Making Among Lower-Income Families in High-Deductible Health Plans.” Archives of Internal Medicine. Vol. 170:21.)

More on MedPAC and ACOs

Accountable care organizations (ACOs) may help correct some of the “undesirable” financial incentives in Medicare's fee-for-service payment system, but the Centers for Medicare & Medicaid Services (CMS) should consider structuring the program so providers share financial risk with Medicare for the cost growth of their patients over an established target, according to the Medicare Payment Advisory Commission (MedPAC).

In a November 22 letter to CMS, MedPAC recommended a two-sided risk model in addition to a bonus-only model in a proposed rule establishing ACOs expected later this year from CMS. MedPAC observed, “the incentives in a bonus-only model for controlling spending are relatively weak and become weaker as the threshold is raised. This will likely be a particular concern to smaller ACOs because they may face higher thresholds. But even larger ACOs may find thresholds discouraging.”

Per MedPAC, ACO metrics could include population-based outcomes measures such as emergency room use, potentially preventable admission rates,

Humana Collaborates for ACO Pilot

Humana and a local health care system in Louisville (Norton Healthcare) have been named one of the 5 pilot ACOs in the country as selected by the Brookings Institute and Dartmouth:

http://www.healthleadersmedia.com/content/LED-259411/Norton-Healthcare-Humana-Launch-ACO-Pilot##

Key paragraph:

Norton-Humana ACO already have identified several initial areas of emphasis, including improvements in preventive screenings and tests, such as mammograms, and vaccinations, better management of chronic illnesses, such as heart failure, more effective treatment of common problems, such as back pain, use of generic drugs, and improved access to the appropriate level of care, rather than emergency department treatment.

The Brookings-Dartmouth team will evaluate the pilots to see how ACOs can impact payment reform, with the hope that a model can be replicated across the nation, building on health reform legislation which will likely make ACOs a voluntary option with Medicare participation in 2012.

MedPAC Thinks ACOs Have Potential

I have blogged quite a bit about ACOs and their potential to lower the cost and raise the quality of health care. Well it looks like MedPAC agrees w/me:

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2010/Nov/November-29-2010/Accountable-Care-Organizations.aspx

Key paragraph:

The commission said in a letter to the Centers for Medicare and Medicaid Services (CMS) that in order to work, ACOs can't simply be given bonus payments if they meet goals for controlling costs and improving quality. They must also pay for some of the overruns if they exceed the spending target they are given.

HHS Provides Clarification on Health Insurance Exchanges

From HHS:

A key point: states can construct an "active purchaser" exchange that bargains with health plans for the best deal and excludes those offering lousy deals, or they can follow an "open marketplace" model that basically posts plan offerings and leaves to marketplace forces rather than regulators the process of producing good deals.

Republicans may tilt strongly toward the latter model in the many states in which they will wield greater influence over state lawmaking after the recent November elections. But Jost notes that they won't be able to pass laws requiring the open marketplace model. Rather, the exchanges themselves will have the power to make that determination, so GOP leaders would have to make sure they have enough control over the exchanges to make sure they adopt the open marketplace approach happen.

The guidance documents the various powers states will have to shape exchanges the way they want. For example, they can decide whether to make the exchange a government agency or a non-profit entity; take part in a regional exchange rather than have just their own state exchange; limit access to employer groups of 50 or less until 2016; require competitive bidding for plans; require additional benefits; extend some or all exchange-related requirements to the outside market.

The guidance document also notes what states must do under the federal law, including certifying and decertifying plans; exempting individuals from the requirement that they carry coverage; rating plans on quality; putting benefits in a standardized format to ease comparison shopping; add determining eligibility for Medicaid and the Children's Health Insurance Programs, among a number of other responsibilities.

Regarding the NAIC model act—forwarded this week by the subcommittee that drafted it to a larger NAIC committee—perhaps the most controversial issue relates to the subject of requiring benefits in addition to those to be spelled out in federal rulemaking to meet the essential benefits standards. "Consumers are concerned that the states not be encouraged to repeal mandates before the essential benefit package is in effect," Jost blogged. Additional drafting may address the concern, he said.

Jost also noted that NAIC has left open the question of whether insurers in exchanges for small employers can offer traditional group coverage. If insurers were allowed to do so, and the employer shopping at the exchange picked traditional group coverage, the employer's workers would not individually have the freedom to pick their own plan from the exchange's menu of offerings—a freedom often touted by exchange advocates as a major advantage of these marketplaces.

McKinsey Study: Insureds Owe More Than Uninsureds

Who would have thought this? (https://www.mckinseyquarterly.com/Health_Care/Strategy_Analysis/The_next_wave_of_change_for_US_health_care_payments_2585):

According to our modeling of the 2010 flow of health care funds, consumers now pay more in health care costs than do employers. This cost is split among direct payment of noncovered services, out-of-pocket expenses after insurance, and the consumers’ share of premium expenses. Uncompensated care from 46 million uninsured Americans continues to be an issue, but one that will be mitigated by reform. In fact, the fastest-growing portion of bad debt stems from what insured patients fail to pay after insurers have paid their portion of medical bills. This category will likely grow as more insured patients enter the market following passage of the new health care law. For example, at one multifacility hospital system, we found that, for insured patients, “balance after insurance” is growing at 30 percent a year; for patients without insurance (those who pay for services from their own pockets), that figure is only 19 percent.

Will Health Exchanges Add High Admin Fees to Premiums?

As states develop their health insurance exchanges one of the unresolved issues is how they will become self-sufficient by 2015. Here is an article from AIS that looks at the question:

Analysts are at odds about whether health insurance exchanges being set up for individuals and small groups will result in significant premium hikes to consumers — because the entities will be required under the reform statute to handle numerous administrative functions.

John Sheils, the vice president of consulting firm The Lewin Group who conducts reform analyses, says it only stands to reason that exchanges, which are required under the reform statute to perform about a dozen functions now handled by insurers and brokers, “can’t run for free. If you’re going to have exchanges perform functions not performed today, it will increase costs.”

“It’s possible to have huge economies of scale to get 10,000 people [enrolled in a plan] at once, but the exchange would have to absorb costs and pass them on to consumer cost,” Sheils asserts to HRW. “The only argument that exchanges can save money is [when] insurers get a list of 10,000 people, and don’t have to put 10,000 together [themselves]…but the costs haven’t disappeared.”

Among its administrative duties, an exchange must enroll people for coverage — “and there’s no reason to think an exchange will sign people up for less,” he says. “It may be more expensive if the insurer still has to maintain some part of the process to sign up people. The insurance company may get a list, but still has to set people up in their system, so there’s a possibility of duplication of services.”

Exchanges Will Have Unprecedented Functions

Exchanges also must make arrangements for collecting premiums, handle premium subsidies, certify that participating health plans meet federal and state requirements, inform employers of termination of coverage, run a toll-free information line and offer a rating system that allows a comparison of plan quality and cost. “We’re talking about functions that have never been performed before,” Sheils says of some of them.

In making his argument, Sheils points to the history of a now-defunct private exchange called the Health Insurance Plan of California (later called PacAdvantage), which ended up adding 4.5% to premium costs to cover its administrative expenses. “I’m concerned it could be much higher, though,” he says. “Like processing eligibility for premium subsidies: That’s a cost that’s going to be heaped on the exchange.”

Rick Curtis, president of the Institute for Health Policy Solutions, a nonpartisan organization giving technical assistance to California and other states on exchange design, disagrees about the potential impact. “I think [administrative] functions of the exchange, other than the eligibility function, should be a wash,” he tells HRW.

Curtis contends that states’ newly created exchanges should be “considerably bigger” than was PacAdvantage because small employers will want to participate in them in order to get tax credits. The now-defunct California exchange, he notes, was for small groups, so its 4.5% premium cost add-on may not translate to individuals. He says pricing for that exchange was difficult because it couldn’t rate for health status although the outside market could do so, and there were inefficiencies and duplicative administrative efforts because only a small portion of participating small groups’ employees chose it as an option. He asserts that the Connecticut Business and Industry Association’s Health Connections exchange is a more instructive model.

Brokers represent another question mark, Sheils says. “The state can decide not to use brokers [for the exchange], and that can save them 8% [on typical small-employer group commissions] on some of these numbers,” he says. “But taking brokers out also will reduce the numbers enrolled.” Moreover, employers, who rely on brokers for various kinds of insurance beyond health, may balk at the idea of not using them, according to Sheils. He asserts that by using brokers, “You insert a layer of bureaucracy, and you’ll pay more for that bureaucracy.”

Some people may think that the exchanges will save money if they somehow regulate the industry a little more, eliminating high-cost health plans, Sheils tells HRW. “But there’s nothing more efficient about running the exchange, particularly if you’re going to keep brokers….It’s hard to see how exchanges will save costs.”

We Don't Get What We Pay for When It Comes to Health Care

Do we have the best health care system that money can buy? That is true for a small minority of Americans but it certainly not the case overall in you examine the results of a recent Commonwealth Fund survey. The survey compared the United States to 10 other industrialized countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

While we do have centers of excellent health care, the fact is that the U.S. too often falls far behind these other industrialized nations on many measures of access, quality, efficiency and health outcomes -- despite spending more than twice what other countries spend on average, or more than $7,500 per person in 2008.

Examples:

• One-third of U.S. adults did not see a doctor when they were sick or skipped recommended medications or follow-up care because of costs -- by far the highest rate compared with the other countries and in stark contrast to low rates in the Netherlands and the United Kingdom.
• U.S. adults were more likely than those in the 10 other countries to have gone without care because of costs in the past year; to report serious problems paying medical bills; and to spend $1,000 or more out of pocket for medical care, even when insured, and to spend a lot of time on paperwork and disputes with insurers or to be surprised that their insurance did not pay as expected.
• One-fifth of U.S. adults reported serious problems paying their medical bills -- more than double the next highest country. More than a third of U.S. adults said they spent $1,000 or more in the past year on medical costs --the highest rate in the survey. Notably, it was similarly high among those insured all year.
• Only 58 percent of U.S. adults were confident they would be able to afford the care they needed -- the lowest rate in the survey. U.K., Swiss and Dutch adults were the most confident they would be able to afford needed care. This finding reflects stresses families face in the current recession, fear that they will lose their insurance if they lose their job, as well as often inadequate health insurance.

The 11 countries in the survey represent a diverse mix of insurance and coverage systems. With the exception of the United States, all of these countries achieve universal or near universal coverage of their populations with diverse systems that range from mainly public, to public supplemented by private insurance, to competition among insurers.

Profits Up for Publicly Traded Health Insurers

The country's largest health plans celebrated a strong third quarter led by results from UnitedHealth Group, WellPoint and Aetna, whose profit rose 53 percent, leading company to raise its year-end earnings forecast.

Conditions have been favorable for health plans, which realized an up-tick in investment income in recent months and benefited from lower medical loss ratios—the portion of revenue spent on medical expenses.

Health plans also appear to be reaping benefits from efforts they began several years ago to encourage members to seek more outpatient care rather than expensive in-patient services, according to Analyst Sophie Snyder of market research firm IBIS World.

"For many services, insurers [have been] reimbursing hospitals at a higher rate for ambulatory care than in-patient care," she said. "The amount they've had to pay out is slightly decreasing and likely having a greater impact than in previous years."

Next year the minimum medical loss ratios become effective. So this may be the last year of big profits for these publicly traded companies.

CRS Report on ACOs

A new Congressional Research Service (CRS) report offers clarification about accountable care organizations (ACOs) and the Medicare Shared Savings Program (PPACA Section 3022). The Congressional Budget Office (CBO) estimates that the Medicare Shared Savings Program would reduce Medicare expenditures $4.9 billion from FY 2013 through FY2019 period. Key findings in the report include:

1. Physicians will play a key role in ACO performance:
   CRS defines ACOs as collaborations that integrate groups of providers, such as physicians (particularly primary care physicians), hospitals, and others around the ability to receive shared-saving bonuses from a payer by achieving measured quality targets and demonstrating real reductions in overall spending growth for a defined population of patients. Note: CRS bases this definition on the Aaron McKethan, Mark McClellan, Elliott Fisher, et al., definition, and CRS puts emphasis on physicians’ involvement noting “physicians’ control (directly or indirectly) affects 87 percent of all personal health spending.”
   Source: Lawton Robert Burns and Ralph W. Muller, “Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical Integration,” Milbank Quarterly, vol. 86, no. 3 (2008), p. 377, citing A. Sager and D. Socolar 2005. Health Costs Absorb One-Quarter of Economic Growth 2000-2005. Boston: Boston University School of Public Health
2. ACOs should be provider-led:
   According to the report, although the composition of ACOs may vary geographically, reflecting local market conditions, analysts conclude that the effort needs to be provider-led. Insurers may be involved but the CRS report suggests their role is supportive rather than primary.
3. There may be difficulties with replicating existing ACO models and market conditions will dictate optimal models:
   The report notes that ACOs have somewhat limited experience in dense urban areas, where the insured have the ability to obtain services more easily from a non-ACO provider and in large rural areas, where the ACO may be a virtual entity and there may be a limited sense of shared commitment across providers spread over a large geographic area.
4. It is not clear how savings would be distributed:
   The CRS report indicates the methodology whereby Medicare savings will be calculated and shared with ACOs remains unclear. Note: CMS is expected to provide details in the next two to three weeks.
5. The impact of ACOs depends on alignment of incentives by the right combination of providers:
   The impact of ACOs on quality improvement and cost reduction will depend on the structure of the ACO to accommodate optimal alignment (physician-hospital, primary care-specialists) and execution of medical management and health coaching of Medicare enrollees.
6. Hospitals are likely to drive ACO development:
   Building on Berenson et al. (2010) analysis, the CRS report noted that hospitals are likely to be drivers of ACO development since physicians are not inclined to share risk or collaborate effectively.

IOM to Deterrmine Essential Health Benefits

PPACA allows individuals and businesses to purchase health insurance directly through exchanges that will offer qualified health plans (QHP) that consumers can compare starting in 2014. QHPs vary in standardized coverage levels and have limits to patient cost-sharing. PPACA Section 1302 stipulates that QHPs will cover general categories of care including: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.

Last week, HHS announced that the Institute of Medicine (IOM) was commissioned to make recommendations on the criteria and methods for determining and updating the essential health benefits. It will review how insurers determine covered benefits and medical necessity and recommend policies and procedures to HHS on how to evaluate QHPs based on the health care needs of diverse segments of the population (including nondiscrimination based on age, disability, or expected length of life).

New Risk Pool Premiums to Drop

Initial good news but as membership increases I wonder if premiums will start to skyrocket. From the Health Affairs blog:

Premiums for new high-risk pools established under the Affordable Care Act will decrease roughly 20 percent in January in the 23 states and the District of Columbia in which the federal government operates the pools, Karen Pollitz, head of the Health and Human Services Office of Consumer Support, said at a Health Affairs media breakfast this morning.

The pools, established under the Act’s Pre-existing Condition Insurance Program, are designed as a coverage stopgap for people with pre-existing conditions until 2014, when insurers will be barred from discriminating against these Americans. Premiums are tied to market rates, and the rates will be recalculated as a result of the massive amount of insurance-industry data Pollitz’ office has gathered, much of which is available at the healthcare.gov Web site. The pools have gotten off to a markedly slow start, but “we expect we’re going to see enrollment really grow,” Pollitz said.

As head of the Office of Consumer Support within HHS’s Office of Consumer Information and Insurance Oversight (OCIIO), Pollitz has two major responsibilities: promoting transparency in private health insurance coverage, which she called the “secret sauce” to implementation of health reform, and providing direct consumer services. (The federal high-risk pools are actually run by a different division of OCIIO.) At the breakfast, Pollitz talked at length about these tasks, and Health Affairs Blog will return in more detail to her presentation in a subsequent post.

VA Report:: Better on Process But No Difference in Mortality

I have mentioned in previous posts the excellent care provided by the Veterans Administration. Well a new article shows that the VA does a better job in providing consistent care but despite this record there is no difference in its mortality rates.

A new study," published in the journal Medical Care, "shows its health outcomes are ... about like everybody else's." The VA recently highlighted the study as evidence of the quality of its system, "[h]owever, the study -- which synthesized the results of three dozen other studies that compared VA health care with care provided by non-VA providers -- concluded the VA performed well on many measures of medical care, but also found that the VA had little impact on the key question of whether the patient lived or died. ... What the latest study shows is the VA performs well on what are known as 'process' measures, whether a certain test was ordered, for example. But studies that compare health outcomes -- do patients in the VA system better or live longer? -- are equivocal".

HHS to Seek New Health Plan Data

From the Congressional Quarterly:

"The Department of Health and Human Services is working on regulations that would allow it to publish additional in-depth health insurance data, including the number of people enrolled in each insurance plan." An official at HHS said "transparency is what's needed to best help consumers understand their choices among insurance plans as the health care law is implemented." That will entail adding new data on insurance companies to www.healthcare.gov, a Web portal that already allows consumers to "compare plan premiums, benefits, and more" under the new health care law. HHS is planning to increase the number of plans included on the site to 8,000, and may include the enrollment numbers of each plan at some point in the future--currently, plans are ranked by enrollment but do not reveal the number of participants in a plan".

I am all for more data but I am not sure what the enrollment numbers will tell a prospective member. I also hope they provide info on customer satisfaction, customer service response and other factors that would be of interest to consumers.

Below is a link from the Commonwealth Fund that provides more detail:

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2010/Nov/November-15-2010/HHS-Will-Seek-to-Publish-Data-on-Health-Plan-Enrollment.aspx

Data Mining: The Future of HC Insurance

http://www.businessinsurance.com/apps/pbcs.dll/article?AID=/20101111/NEWS01/101119985/1245

Encouraging Advancement for Nursing Home Care

Early in my career I was the Director of Planning at a multi-level care facility in Massachusetts that included a nursing home. While the NH provided excellent care, it was still an institution. I always have thought since then that there has to be a better way. This link describes a very promising concept in MA that provides the same level of care but in a more home-like setting:

http://www.stateline.org/live/details/story?contentId=527585

Key excerpt:

Klein’s nursing home lifestyle is also notable for what it isn’t. There's no long gray linoleum corridors with doors that open onto shared rooms with nothing but a curtain between the beds. No beeping monitors or carts full of soiled linens and no patients in wheelchairs parked in the hallways. Few rules govern when, what and where residents can eat.

The brand new facility is one of a new breed of small, homey nursing facilities cropping up around the country, thanks to state collaborations with the nursing home industry, federal regulators and advocates for the elderly and disabled. It looks like a place only wealthy families could afford, but about half of its residents get their bills paid by Medicaid, the federal-state health care program for the poor.

MS Insurance Commssioner's Take on the ACA

From the Commercial Appeal in Memphis, TN:

The top insurance official in Mississippi said Wednesday that the volume of changes under the federally mandated health care reform are "mind boggling" and partly come from "pure socialist-communist ideas."

"Some of the ideas are Republican. Some of the ideas are Democratic. Some of them are pure socialist-communist ideas," state Insurance Commissioner Mike Chaney told the Olive Branch Chamber of Commerce. "It is taking money from one class of people and giving it to another. It is a socialist system and it's not going to work."

Healh Insurers Role in the ACO

As I have noted in previous posts, Accountable Care Organizations or ACOs are being heavily promoted as a way to both increase the quality of care while at the same time lowering its costs. It is a given that ACOs will have to include at least one hospital and a group of physicians. But what about health insurers? Are they guaranteed a place at the table and if they are, what will it be?

How about facilitator? With all of the stakeholders engaged in one form or another with the health plan, the health plan has the potential to be the hub for the ACO should they adopt that role. In a comment on a blog I read recently, the author suggested that an ACO is just an “HMO on steroids”. If that is the case, the health plan is certainly at the center. Unlike the HMOs of the 1990s though, an effective ACO relies on the provider physicians to police and optimize their own work rather than the payors. In a recent article by Mr. Jamie Gooch in Managed Healthcare Executive, he believes the success of an ACO is dependent upon the partners that are engaged. He suggests starting small and working with strong partners that can advance the ‘better-care-at-lower-cost’ model. Using this crawl/walk/run scenario, partners can be selected, and the program can be clinically integrated to optimize the cooperation. Again, the health plan has the opportunity of adopting a leadership role and facilitating these relationships and subsequent outcomes to meet the overall goals of the ACO program.

Additionally, I have talked previously about the critical role of evidence-based medicine in the healthcare reform debate. If we have the information from which best practice can be established, documented and communicated, we all stand to benefit by delivering better healthcare to the patients with greater efficiency and at a lower cost. Again, the health plan can play a key role here. With their reach and access to aggregated clinical information, evidence-based data can be collected, analyzed and made available for the physician and associated clinical organizations to better administer care to the patient. Models that are continuously referenced include Geisinger[3], Mayo Clinic[4] and Intermountain Healthcare[5] – they have integrated care and have created very effective ACOs.

The health plan also stands to be at the center of the operation in that it can recruit and retain members. Gaining membership in commercial health plans is a sales function. Whether they sell to employers or to individual members, membership must be recruited and becomes part of the administrative overhead of the plan. Quasi-governmental plans like Tricare, Medicaid and others may still need to recruit membership. For many ACOs, the initial covered lives are likely to come from the employers within the ACO’s provider panel. For example, a 300 bed hospital with 400 physicians and post acute care facilities may have 5000-6000 employees. If you add dependents, a ready made 10,000 member population is available. This represents lives that likely come out of an existing health plan. This is more than enough to meet the minimum requirements of an ACO. Additional membership may be driven by the community affiliation and demonstrated outcomes.

it will be interesting to track what roles health plans play in the development of ACOs, particularly the major national carriers.

Good Article on Formation of CA Health Exchange

California is one of the first out of the gate in forming its health insurance exchange. This article is a good summary of a conference that talked about the lessons learned by CA officials:

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2010/Nov/November-8-2010/Lessons-from-the-California-Exchange.aspx

Good summary paragraph:

So what does California's experience thus far suggest? Among the lessons from a recent forum on the subject: If possible, get outside advice to help with the highly technical process of creating an exchange; be careful how you pick its board; make it easy for the public to understand what the exchange is doing, and spur the kind of competition that is going to make premiums affordable.
On Sept. 30, California became the first state in the nation to pass a law creating an exchange under the health care overhaul law.

VA Anthem Leads the Way for Health Care Reform

The VP of PR at Anthem VA must be thrilled about this puff piece of an article:

http://www2.timesdispatch.com/business/2010/nov/07/anth07-ar-636179/

The Anthem CEO said that his company is moving away from just being a payer of claims to one that helps its members manage their health. He also talked about the need to become more efficient. The end of the article also mentions the strength of the BC/BS brand which i s going to be a huge advantage for Blues Plans as the market shifts more and more to individual coverage in the coming years.

Update on MA's Cost Control Efforts

As I have noted many times, the health care scene acts as an excellent bell weather on how health care reform will play out throughout the country, This article from the Boston Globe provides the latest update (http://www.boston.com/news/health/articles/2010/11/05/us_watching_mass_fight_on_health_costs/?rss_id=Boston.com+--+Health+news )

Interesting excerpt:

Patrick is ready to move forward with a “global payment’’ plan that is supported in principle by most of the state’s health care companies, though they have yet to agree on the elements.

The plan, in broad form, would put hospitals and doctors on an annual budget for each patient’s care. Providers would be expected to assemble into partnerships — known as accountable care organizations — to coordinate care and distribute payments. It would replace the current “fee for service’’ system in which providers are paid negotiated fees for each visit and procedure.

Your Pharmacist: The Center of Your Medical Care

I saw Walgreens present this concept at an AHIP Conference two years ago:

Walgreens will "step up investments in services to help Americans manage chronic diseases," the drugstore chain's CEO announced, because "the company wants to capitalize on what he called the 'retailization' of the nation's health care system." The pharmacy giant "increasingly has been lobbying to give pharmacists a greater role in medical care such as providing immunizations in its stores as well as establishing retail health clinics staffed by nurse practitioners." Walgreens' health professionals could help "provide certain primary medical care service amid a national shortage of primary care doctors" and assist patients in managing chronic conditions like diabetes, hypertension, and high cholesterol, the company's CEO said.

Given the predicted stress on the primary care network once ACA kicks in beginning in 2014, this actually makes some sense. Of course I am sure the AMA would disagree.

CMS Must Launch Physician Comparison Site by 1/1/11

This is a great article on the issues that CMS faces in launching its website on physician comparison (http://www.healthleadersmedia.com/page-2/PHY-258341/CMS-Under-the-Gun-to-Launch-Physician-Compare-Site). It is not going to be easy. The biggest concern continues to be risk adjustment. According to an AMA official:

"But our concern is that individual doctor level data right now is not read for prime time, especially in complex situations. The attribution of who's really responsible for that care is not worked out."

Risk adjustment is still a big problem as well. "Some elective claim submission forms are limited in the number of co-morbid conditions they'll accept. Some take 4, 6, but the patient has 10."

This is really going to be interesting.

State Mandates: Do They Increase the Cost of Health Insurance?

This article examines what effect mandates have on health insurance costs in a particular state (http://www.aishealth.com/Bnow/hbd110410.html). One health insurance executive believes that mandates add 17% to the cost of coverage in Maryland. mandates vary from 13 in Idaho to 69 in Rhode Island. The most expensive mandate is fertility coverage. Coverage for autism has also increased nationwide.

Rhode Island Hospital Payment Innovation

The Providence Journal (http://www.projo.com/news/content/LIFESPAN_BLUE_CROSS_CONTRACT_10-29-10_KVKKJMB_v17.1ebf635.html) has an interesting article on payment agreement between BCBS of RI and hospitals in the state:

Rather than paying for each procedure or each day in the hospital, Blue Cross will provide a flat fee to cover all care for a given condition. That way, the hospital doesn’t make more money if it does more tests and procedures or keeps the patient longer.

Other insurers in the state will also be making similar arrangements.

Update on State Health Exchange Funding

In another bid to help states implement the new healthcare law, the Obama administration Friday unveiled a new competitive grant program that will give five states money to develop Internet-based insurance exchanges. ... Administration officials said they hope the winning states will come up with systems that could serve as models for the remaining states. The grants follow awards of $1 million to 48 states and the District of Columbia to help set up the online market places -- Minnesota and Alaska refused the money.

I can understand Alaska returning the money but what is up w/MN?