Archive for January, 2012

A Principled Approach to Better Care for Seniors and People with Disabilities

Tuesday, January 31st, 2012

Efforts to improve care for seniors and people with disabilities across the country are speeding forward as states take advantage of funding and flexibility offered by the federal government. These initiatives to serve people eligible for both Medicaid and Medicare – the so-called dual eligibles – have great potential to improve the lives and independence of millions. Since the initiatives are also driven by a federal mission to contain health care costs, consumer advocates need to raise their voices to ensure the initiatives live up to their potential.

Fortunately, many advocates are already speaking up. Disability advocates from across the country have come together to produce a set of national advocacy principles to help guide their colleagues. The principles stress the importance of robust community-based long-term supportive services, such as help with daily activities including eating, bathing and dressing, managing medication, maintaining a residence, managing money, and getting out and about. These services are critical to enabling people to stay healthy, live well and maximize their independence.

The principles also emphasize consumer protections and control, and have broad applicability to work on Medicaid managed care and services for dually eligible seniors as well as people with disabilities. The principles are a joint effort of the Disability Rights and Education Defense Fund, the National Council on Independent Living, Tri-County Independent Living Center of Utah, Boston Center for Independent Living and Community Catalyst.

The principles are largely grounded in ongoing advocacy in Massachusetts, which has released its detailed draft proposal for the initiative, becoming the first of 15 states with federal planning grants to do so. Massachusetts disability advocates have testified at public hearings and submitted comments that are helping to shape the final plan. They have also issued specific suggestions on long-term supportive services.

Now is the time for advocates to get involved in all the states that are working on similar changes. Besides Massachusetts, the states that received federal planning grants are California, Connecticut, Colorado, Michigan, Minnesota, North Carolina, New York, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin More information on their initial plans can be found here. They are expected to submit detailed proposals to the federal Centers for Medicare & Medicaid Services this spring.

In total, 39 states are exploring new ways to finance care for people who are enrolled in both Medicaid and Medicare. You can find out if your state is involved by checking this list.

Please stay tuned for more news and resources.

–Alice Dembner, Deputy Policy Director

 

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Posted in care coordination/quality, Medicaid | 2 Comments »

Recent Developments in Nutrition Policy Affecting Child Health: A Roundup

Friday, January 27th, 2012

The end of 2011 and beginning of 2012 saw significant developments—mostly positive but some negative—in nutrition policy affecting children’s health. From new school meal requirements to food marketing guidelines to evidence supporting the effectiveness of sugar-sweetened beverage (SSB) taxes, the landscape of nutrition policy affecting children’s health has been changing in important ways.

School Nutrition Standards: Would You Like (Sweet Potato) Fries with That?

First Lady Michelle Obama and Agriculture Secretary Tom Vilsack unveiled the new standards for school meals on January 25 in the form of a final rule, marking the first substantial changes to school meals in 15 years. The standards, a product of the Healthy, Hunger-Free Kids Act of 2010, have drawn significant public attention. People have strong feelings about school meals, as evidenced by the nearly 132,000 public comments the United States Department of Agriculture (USDA) received on the issue.

On the whole, the new standards promise to significantly improve the nutritional value of meals served in schools. Some positive developments in the final rule include:

  • • An increase in the amounts of fruits and vegetables served every day
  • • An increase in the amount of whole grains served
  • • A requirement to provide only no- and low-fat milk options
  • • A requirement to reduce the amounts of sodium, trans fat and saturated fat
  • • A requirement to focus portion sizes to reflect appropriate calorie amounts for children based on age

Despite these positive improvements, some important provisions were removed from the initial proposed rule (after Congress required this), which is disappointing. These include limiting the USDA’s ability to regulate the amount of starchy vegetables provided in school lunches as well as preventing the USDA from increasing the amount of tomato paste required in order to allow it to count as a vegetable serving within the new framework.

These changes will have a significant impact, as nearly 32 million children participate in school meal programs every day. The new standards will be phased in over a three-year period, starting in the 2012 to 2013 school year. To see what a sample elementary school lunch menu could look like both before and after the new standards take effect, click here.

Voluntary Food Marketing Principles: Further Setbacks or Ronald McDonald is Here to Stay

On a less positive note, important progress toward the development of voluntary principles for marketing food to children came to a standstill at the end of 2011. The voluntary guidelines, developed by an Interagency Working Group (or IWG, consisting of the Federal Trade Commission, Food and Drug Administration, Centers for Disease Control and Prevention, and USDA) have received enormous criticism from the food and beverage industry. Initial opposition to the voluntary guidelines in October resulted in a narrowing focus to reduce advertising targeted at children under the age of 12 rather than all children under the age of 17 and provided exemptions for holiday promotions and established marketing characters. Further setbacks occurred in December when Congress required the IWG to conduct a cost-benefit analysis of the proposed guidelines, significantly delaying finalization of the proposal. At this stage, the ultimate fate of the guidelines remains unclear at best.

New Article Adds Further Evidence to Support Taxation of Sugar-Sweetened Beverages

A new article published in Health Affairs adds to the overwhelming evidence that supports the idea of SSB excise taxes as a key public health measure aimed at addressing obesity. The study authors found that a penny-per-ounce excise tax on SSBs would reduce SSB consumption by 15 percent for adults ages 25 to 64 and a 1.5 percent reduction in obese adults as a result. From 2010 to 2020, the study projected that this decrease in consumption would prevent 26,000 premature deaths while avoiding over $17 billion in medical expenses. While this study focused on adults, it’s consistent with a previous report by the USDA that has demonstrated the similarly positive health benefits for both children and adults resulting from SSB excise taxes.

It’s exciting that addressing child health through nutrition policy is being seen as a major priority. Now, it’s up to child health advocates to continue to educate policymakers about the importance of this issue to keep it front and center amidst a range of competing priorities in the coming months.

—Patrick M. Tigue, Senior Policy Analyst and
Kyle Bogaert, Intern, New England Alliance for Children’s Health

 

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Posted in children's health | 1 Comment »

Does the United States spend enough on health?

Tuesday, January 24th, 2012

You are surely familiar with the numbers. The U.S. spends much more per capita on health care than any other industrialized country; recent data indicate that the U.S. spent $7960 per capita annually, about $2500 more than its closest contender, Norway. Yet, over 30 countries have a longer life expectancy; this includes Japan, Portugal and England which spend less than half as much per capita on health care. Not only do we not live as long, we are also less healthy when you compare infant mortality rates, adult diabetes prevalence and a range of other serious health problems.

It’s obvious that spending lots of money on health care is not resulting in better health. Why is this so? One key reason is that the United States spends far less than many other countries on the many other factors that affect our HEALTH. Research consistently shows that people’s health is deeply influenced by their jobs, their income, educational opportunities and the social support their families can draw upon. According to a recent study published by Yale’s Global Health Institute, that was cited in The New York Times, the U.S. trails far behind other industrialized countries in its per capital expenditures on social services that can extend and improve life, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support, etc. So when you total the amount spent on health care and social services, the U.S. falls to 10th. And, as noted above, much of this spending is on health care not on other key approaches to improve health.

This is why health and public health advocates, as well as community members and policymakers, are joining together to improve how people live, learn, work and play as a means of achieving better health. We are forming partnerships in states and communities to increase access to education, secure jobs, community safety and other dimensions that improve lives and health. On the federal level, we are joining the fight to protect prevention funding in the Affordable Care Act from ‘raids’ to cover other budget items. We are expanding our sights and expanding our partners to improve health care and to improve HEALTH.

– Deborah Katz, Associate Director
Roadmaps to Health: Community Grants

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States of Innovation

Friday, January 6th, 2012

states of innovation logo

Paying Pharmacies Honest Prices for Prescription Drugs

As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates.

Community Catalyst and Georgetown University Health Policy Institute Center for Children and Families created the States of Innovation blog series to shine a spotlight on states that are trying to find a better way. We will highlight states that are pioneering new approaches to making Medicaid more sustainable without harming – and often by improving – care for the millions of vulnerable seniors, people with disabilities, children and low-income parents that rely on Medicaid.

SOI intro line

The state of Alabama has pioneered a way to save millions of dollars in its Medicaid program by changing how it pays pharmacies for the drugs they provide to Medicaid patients.

Like 40 other states, Alabama used to reimburse pharmacies based on a pricing benchmark generated by prescription drug manufacturers, called Average Wholesale Price (AWP).

But documents made public in court cases have shown that drug manufacturers and others sometimes inflate their AWP list prices to incentivize pharmacies to buy their drugs. The manufacturers actually charge the pharmacy less than the published list price that Medicaid uses to reimburse the pharmacy for the drugs. For example, in Massachusetts from 1995 to 2003 the drug maker Warrick reported widely inflated list prices for an albuterol drug that was nearly seven-times the actual sales price. The pharmacies often reap a profit from this price “spread.”

Use of inaccurate, sometimes almost fictional list prices like AWP has led not only to overpayment but to outright fraud when companies lure pharmacies into favoring their products over competitors by increasing the profit margin. As a result of litigation on such pricing fraud, the main publisher of the AWP list (First Databank) ceased publishing it in September, 2011. However, this list price continues to be published by others, and as of now, 40 states and many private health plans continue to use this or other manufacturer generated list prices.

Alabama paves the way for a fairer – and more cost-effective – system

Alabama recently began reimbursing pharmacies based on an “evidence-based” benchmark, called Average Acquisition Cost (AAC.) It is based on an ongoing average of actual invoices of pharmacy purchases from drug manufacturers and wholesalers, which best reveals the actual cost of the drugs to the purchasing pharmacies. A dispensing fee is also paid to the pharmacy to cover the cost of pharmacist services and overhead.

Alabama’s Medicaid program has projected a 6.1 percent savings on its fee-for-service drug expenditures — that amounts to $30 million in the first year –without affecting prescription drug benefits provided to Medicaid beneficiaries or impacting quality of care. Indeed, the president of the Medical Society of the State of Alabama affirmed that changing to AAC should not affect patients’ access to care.

Three other states have followed Alabama’s lead: Oregon has implemented AAC pricing and expects to save $1.6 million, or 1 percent of its $160 million fee-for-service Medicaid drug expenditures. Idaho is in the process of implementing AAC, and expects to save $2 million in state general funds. And California has authorized a shift to AAC pricing as well.

CMS itself has also begun collecting drug cost data from pharmacy invoices nationally in order to assist states in evaluating their current payments systems. If CMS shares such information, it could help reduce the implementation costs to states, since they may not have to collect their own invoice data.

Private sector benefit

Alabama’s drug price information is available online here, and Oregon’s is published here. By making these regularly audited drug prices available to the public, these states and CMS can also make it easier for private insurance plans to adopt AAC and reduce their costs. Private plans will also be selling their products through the Affordable Care Act mandated Exchanges, often to low-income people not eligible for Medicaid or employer coverage. Since lowering pharmaceutical costs could help play a role in controlling premium costs, this would be of particular benefit to these low-income purchasers, and to the government, which will pay a sliding scale percentage of their premiums.

Pharmacy resistance

Some pharmacies have fought AAC pricing, claiming they cannot survive without the “spread” between what they paid for the drug and what they’re reimbursed from Medicaid. However, as court documents have revealed, many have been overpaid for years in a system with no transparency. If pharmacies were transparent about their actual cost of doing business—something they typically resist—and they could prove actual losses, the per-prescription dispensing fee Medicaid pays could be increased to cover those costs.

To find out more, see the AAC section of Community Catalyst’s new Medicaid Report Card.

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Posted in Medicaid, prescription drugs | No Comments »

Oh so close…

Thursday, January 5th, 2012

While the New England states are leaders in the nation in reducing the number of uninsured children, with coverage rates from 94 to 98 percent across the region, there is one area where New England is falling woefully behind. According to a new report from the Center on Budget and Policy Priorities only half the New England states, Maine, New Hampshire and Vermont, offer online applications and renewals for families trying to enroll their children in Medicaid or CHIP. This places the region squarely behind other parts of the country including the South and Northwest. With online applications available for everything from credit cards to colleges, it seems hard to believe that applications for vital health services are not available on such an efficient and accessible platform.

Many families live in rural areas without easy access to local government offices. These families would benefit from the remote access offered by online applications. Making applications available online would also reduce the potential for incomplete and misplaced submissions. Through questions, prompts and blocks that do not allow incomplete forms to be submitted, online applications provide useful feedback in a way paper applications cannot.

Given the high tech business sector in many New England states and with all the efforts states have put into achieving such high enrollment numbers, it is surprising that they have not taken advantage of this common-sense extra push. Online applications, along with other streamlined application and renewal procedures may be just what New England needs to get to 100 percent enrollment of eligible children in health coverage. Hopefully New England will make 2012 a year of great advances in coverage and consumer access starting with online applications and renewal for health benefits.

– Nicole Tambouret, Project Director
New England Alliance for Children’ Health

Please note, this blog was updated to reflect Maine’s policy on electronic applications, which was not originally reflected in the report.

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Posted in children's health, Medicaid | No Comments »