Archive for the ‘care coordination/quality’ Category

« Older Entries

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

 

Tags: ,
Posted in care coordination/quality, Medicaid | No Comments »

IOM releases its long awaited EHB Guidance: Tough Medicine

Tuesday, October 11th, 2011

As the Institute of Medicine (IOM) unveiled its report on Essential Health Benefits (EHB) on Friday, there were few surprises.  The panel delivered a high level outline for selecting benefits with a strong recommendation that cost consciousness be its guiding principle.

Learn more about EHB process here and strategy here.

The IOM panel was tasked with outlining what criteria should be used to determine a minimum set of benefits for new health plans in the individual and small group market starting in 2014; these benefits serve as the benchmark for new Medicaid plans. The 300-plus page report recommends a framework for Health and Human Services (HHS) to use as they build the EHB package. The headline from this report is: cost before benefits. 

This is a disappointment for advocates. Shifting the focus from robustness to predefined cost parameters could leave many Americans underinsured. In recognition of the difficult task presented to the panel, cost is an important factor in determining health benefits. As correctly noted in the report, “the more expansive the benefit package was, the more it was likely to cost and the less affordable it would be. How to balance the competing goals of comprehensiveness of coverage and affordability was “key.” However, making cost the guiding decision point rather than a factor of many alters the conversation from what is a good package for consumers to how much does that benefit cost?

Affordability doesn’t just mean lowest cost. Rather, getting people what they need at a price that they can afford is paramount. Too much emphasis on costs risks achieving the lowest premium possible without regard to the health needs of consumers. 

The report guides HHS through five areas: 1) defining the EHB and developing a target premium; 2) public deliberation; 3) monitoring the EHB; 4) allowance for state variation; and 5) updating the EHB.

Consumer advocates will play an important role in each of these areas – particularly in defining priorities through public input. The IOM recommends that HHS hold public hearings or small group discussions throughout the country in order to aid in priority development. This is an opportunity for consumer advocates to voice their concerns and offer recommendations to HHS about services to include in the EHB package. 

The panel also recommends that the package be released for comment to HHS by late spring 2012.  For consumer advocates, this means a short time frame of influence.

A second priority for consumer advocates that is next in the development of the EHB package is how states will respond to it. By encouraging state-tailored options, the IOM suggests that there can be some state variation in the package. This may alleviate some stress regarding the many state mandates that exist in states – ranging from 13 in Idaho and 69 in Rhode Island – yet raises other concerns about exclusion of benefits.

Many challenges lie ahead for consumer advocates, including coordinating state- based consumer health care coalitions to respond to EHB. These coalitions can play a pivotal role in protecting consumers: a voice at public forums, a watch dog of EHB implementation from 2014 and beyond, and a feedback loop for HHS. The EHB will continue to change over time and advocates can play a key role in influencing EHB development.

IOM suggested timeline:

May 2012:  HHS has developed an EHB package with a national premium target based on typical small and individual market plans

January 2013:  HHS should develop a framework for data collection and analysis for purposes of monitoring implementation and updating the EHB package.

January 2016: The Secretary should update the EHB to make it increasingly more specific, and update annually.

-Eva Marie Stahl, Policy Analyst

Tags: , , ,
Posted in Affordable Care Act implementation, care coordination/quality, Uncategorized | No Comments »

Bundle of Hope?

Wednesday, August 31st, 2011

Last week’s announcement by the Center for Medicare and Medicaid Innovation – a.k.a. The Innovation Center – about the launch of the Bundled Payments for Care Improvement Initiative offers hope in the battle against out-of-control health care costs. Doctors, hospitals, and other health care providers can apply to participate in this new initiative, which will test four different models of paying for services delivered across an “episode of care.”

What’s this all about? Mostly, it’s about shaking up the status quo in the way we pay for health care services. Today, most health care is paid for on a fee-for-service basis. Under this system, doctors, hospitals and clinics are paid “a-la-carte” for care, meaning that they get paid for each individual service they provide — a lab test, an office visit, an MRI – without regard to whether the patient’s health improves. This system gives providers full decision making power, along with the financial incentive to order whatever services they choose regardless of efficacy or expense. The incentive also tends to undervalue lower-paying services such as primary care and important patient supports such as care coordination, home visits, and 24/7 access .

The new initiative seeks to change the status quo by paying providers a fee for all the services a patient receives over the course of an “episode” of care, for example, a hip replacement, rather than paying each provider separately for every service related to the episode (e.g. inpatient stay, lab tests, post-discharge services). The Innovation Center spelled out four models it wants to test. These models vary in terms of episode length, services in the bundle and payment type.

The idea of bundling payments gained traction during the health reform debate primarily based on the experience at Geisinger Health System, a health system out of Pennsylvania (and where it should be noted, the head of The Innovation Center used to work). Years ago, Geisinger launched an episode-based care model for its heart bypass patients. Under this program – called “ProvenCare” – the health system calculated the total cost for all of the preoperative, post-operative and rehabilitation services associated with bypass surgery and paid providers this price. It also created new systems to ensure that doctors were following best clinical practices for the surgery. As a result of implementing this program, there was a 21 percent reduction in all complications from the surgery, a 25 percent reduction in surgical site infections and a 44 percent decrease in hospital readmissions. Geisinger has since expanded this program to other episodes of care such as hip replacement surgery, cataract surgery, obesity surgery, prenatal care for babies and mothers, and heart catheterization.

While the results of this new initiative are still a few years away, bundling payments clearly represents a step toward better care at lower cost. If done well, it will improve the quality of care by encouraging coordination and the use of care management services, such as transition planning, home visits or social service supports. However, if done without strong measures of transparency and accountability for improved quality, it could be a failed experiment. Advocates have a unique role to play in ensuring that the voices of patients and their families are represented in shaping this program, especially in making sure the right quality measures are used.

Given the current pressures in Washington and in the states to reduce health care costs, we hope this bundling program results in lower costs and better care, making it a true bundle of joy.

– Renée Markus Hodin, Project Director

Tags: , ,
Posted in Affordable Care Act implementation, care coordination/quality | No Comments »

The Insider: The Choices We Make

Wednesday, July 20th, 2011

The current political debate in Washington suffers from a narrowing of the political space that is considered “serious.” The problem extends well beyond the relative importance and urgency of reducing the national debt and addressing the persistently high unemployment rate (with the former all but eclipsing the latter). It also affects the acceptable outlines of a debt ceiling deal—with prominent moderate Senate Budget Chair Kent Conrad ‘s proposal for an equal split between cuts and revenue increases deemed a non-starter.

As we look at the ideas to reduce federal health spending, we see the same phenomenon. First, we see a total failure to look beyond direct federal spending to take into account the important contribution rising private sector health spending growth and the deteriorating underlying health of the U.S. population make to growth of federal health spending. (High unemployment also plays a role, but let’s not even go there.) Second, we see a very constricted range of “acceptable strategies” to reduce federal health spending.

On the Republican side, Congressmen Boehner and Cantor have proposed about $350 billion in health care cuts with over one-third coming in the form of cost-shifting to states and Medicare and Medicaid beneficiaries. In addition to direct cuts to state Medicaid programs, proposed increases in Medicare cost-sharing would also raise costs to states, since Medicaid picks up where Medicare leaves off for low-income seniors and people with disabilities.

What is the Democratic response? Most Congressional Democrats have voiced their opposition to radical proposals to restructure Medicare and Medicaid, but resistance to cost shifting onto states (and indirectly onto Medicaid beneficiaries) seems more muted.

A better way is possible

Meanwhile, alternative health policies that could reduce the deficit by a similar amount without harming beneficiaries have been pushed off the table or, at best, onto the fringes of the debate. We offer here a brief list of progressive health care deficit reduction measures – not so much because these ideas are politically viable at the moment, but to clarify that the damaging and dangerous policies that policymakers are now pursuing in Washington stem from the choices of political leaders.

Better cost containment agenda:

  • – Require a drug rebate for low-income Medicare beneficiaries: (somewhat on the table in the talks). When Medicare Part D was created, pharmaceutical companies received a windfall – the elimination of the requirement to pay rebates on drugs prescribed for Medicare beneficiaries who had previously had their drugs covered by Medicaid. Requiring the drug companies to pay the Medicaid rebate for low income Medicare and Medicaid dual eligibles would yield an estimated $112 billion according to CBO.
  • – Quality care pricing in Medicare and Medicaid: Although the ACA takes some small steps in this direction, more could be done to reduce low-quality health care in Medicare and Medicaid, such as potentially avoidable hospital readmissions and complications, and to promote efficiency in the system. After reviewing the literature, Community Catalyst has estimated over $100 billion in savings are available over the next 10 years from payment reforms that would target wasteful or harmful spending.
  • – Public option: The idea of having a public insurer compete with private insurers in the Health Insurance Exchanges enjoyed public support throughout the ACA debate. It also surfaced in the Bowles-Simpson debt reduction talks. (Though unlike other ideas less objectionable to special interests it has not gained traction in the political debate.) The CBO estimated ten-year savings of nearly $90 billion.
  • – Tax on sugar-sweetened beverages: The nation is suffering from an epidemic of childhood obesity, leading to increased rates of Type II diabetes in children (the kind that used to be called “adult onset” diabetes). A penny-per-ounce tax on sugar sweetened beverages would yield $79 billion over five years according to a recent analysis. To be conservative, cut that amount in half over a second five years and you still get deficit reduction of $120 billion over 10 years, while helping to improve the underlying health of the population and reducing future health care costs.

And there you have easily over $350 billion in available federal health care savings that can be achieved by weeding out low-value spending and improving public health without shifting costs onto Medicare and Medicaid beneficiaries or state Medicaid programs. Not only that, but there is no doubt that this agenda would be much more attractive to the American people than the one that is currently being pursued. Yet with few exceptions, these ideas languish on the political margins while federal cost-shifting onto states and harmful and unpopular cuts to Medicare and Medicaid beneficiaries are given serious consideration. Fortunately, people are becoming increasingly vocal in their support for maintaining public health insurance programs.

We can only hope that political leaders will start listening.

– Michael Miller, Policy Director

Tags: , , ,
Posted in care coordination/quality, Health Reform Insider | 2 Comments »

Paving the Way for New Models of Care

Thursday, July 14th, 2011

Providing insurance to low-income populations, as Medicaid does, improves their overall health and helps maintain financial stability. A new study by the National Bureau of Economic Research, says that Medicaid recipients, on average, were more likely to seek preventative services, be healthier and overall feel better than people without insurance.

Of course, there are ways to improve care especially for people with complex conditions. A new initiative in New Jersey provides a great example: policymakers, advocates, and consumers are hoping new legislation will lead the way to deliver quality care and save costs. The Medicaid ACO Demonstration Project nearly unanimously passed in the NJ Legislature in June and awaits Governor Chris Christie’s signature. This legislation would authorize the Department of Human Services to create a three-year Medicaid ACO (Accountable Care Organization) Demonstration Project where community-based, non-profit coalitions can apply for recognition by the State of New Jersey as a Medicaid ACO. The Medicaid ACO Demonstration Project intends to:

  1. Increase access to primary, behavioral and dental care, in specific regions where Medicaid recipients reside
  2. Improve health outcomes and quality by measuring patient experience
  3. Reduce unnecessary and inefficient care without interfering with patients’ access to their health care providers or the providers’ access to existing Medicaid reimbursement systems.

One of the poorest cities in New Jersey, Camden, led the way to create a system to improve the delivery of care to the sickest and poorest population, while lowering costs. The innovative care delivery system in Camden is led by Dr. Jeffrey Brenner and the Camden Coalition of Healthcare Providers. The critical issue in Camden and cities across New Jersey is to reduce readmissions to hospitals and better address the needs of the Medicaid population.

Atul Gwande highlighted the work in Camden in his “The Hotspotters” article in the New Yorker, and groundwork has been set for two similar citywide healthcare coalitions in Trenton and Newark, as well. And now New Jersey has legislation that will hopefully spread this new model of care across the Garden State.

Another great example of innovative care is the Boston-based Commonwealth Care Alliance (CCA). CCA has created a comprehensive system of care that not only improves their members’ health, but also has been proven to lower costs by keeping people out of the hospital and out of nursing homes. The organization has created a system of care and support for the neediest population on Medicare, Medicaid or so-called “dual eligibles” who receive support from both programs.

At a time when states are facing severe budget deficits, states need to explore options within Medicaid to help sustain state budgets while creating an efficient and coordinated system of care for patients. Community Catalyst has highlighted alternatives for states:

We know that Medicaid matters. If we can curb cost by addressing the needs of the high utilizers of Medicaid by coordinating better care, we can create a system that works for everyone. Massachusetts has shown us through the work of CCA, and now New Jersey is paving the way for their Medicaid population.

– Leena Sharma, Field Coordinator

Tags: ,
Posted in care coordination/quality, Medicaid | No Comments »

Less pain, more gain: defining an alternative to harmful Medicaid cuts

Monday, February 28th, 2011

(please note most links below are pdfs)

On Friday, Community Catalyst sent a letter to Secretary Sebelius, outlining eight policies states could implement to cut Medicaid costs. We were inspired to weigh in by a series of letters between the Secretary and Republican Governors that contrasted two very different approaches to reducing Medicaid expenditures.

Cutting Coverage vs. Cutting Waste
Republican Governors wrote a letter to Congress and the Administration in January, asking them to lift the Maintenance of Effort (MOE) requirement – the provision in the Affordable Care Act (ACA) that prevents most states from reducing Medicaid eligibility between now and 2014. The basic premise of their letter was that states need to cut low-income children, parents, seniors, and/or people with disabilities off coverage in order to “responsibly manage [their] state budgets.” We anticipate Republican Governors will reiterate this argument at the Energy and Commerce hearing Tuesday about the impact of the ACA on Medicaid.

Secretary Sebelius responded with a letter explaining why that basic premise simply isn’t true (see our blog and summary of her letter.) She outlined dozens of ways states can trim costs in their Medicaid programs without eliminating coverage for vulnerable families. By tackling the inefficiencies in our fragmented health care delivery system, many of the policies she suggested not only cut costs but they also have the potential to improve care for beneficiaries in the process. Sebelius also made it clear that her department remains open to suggestions of additional policies states can pursue to accomplish those dual goals.

When Secretary Sebelius Calls, We Answer
We took the Secretary up on that challenge. Our letter to the Secretary highlights eight additional policies states can pursue to lower Medicaid costs and maintain or improve care. More details about these options can be found in the text of our letter, but here are the highlights:

  • Recalibrate provider payment rates, shifting dollars from inpatient care to outpatient care, to give providers an incentive to treat patients in the lowest-cost settings.
  • Rebalance long-term care dollars away from institutions and towards home- and community-based settings by taking advantage of more funding opportunities created by the ACA to help states front the cost of this readjustment.
  • Better integrate care for those who are eligible for both Medicaid and Medicare by expanding existing programs such as the Program for All-Inclusive Care for the Elderly (PACE) and fully-integrated Special Needs Plans (SNPs) that provide a comprehensive and patient-centered model of care.
  • Reduce preventable hospital readmissions and complications by tying hospitals’ payment levels to their preventable complication and readmission rates.
  • Increase the use of generic drugs by making it easier for pharmacists to substitute equivalent generics when the patient was prescribed a brand name drug.
  • Improve evidence-based drug selection and purchasing by expanding utilization management and the use of state Preferred Drug Lists (PDLs) created by an evidence-based evaluation of available therapies. It’s important to include measures to protect access and quality, especially when applied to classes of drugs or medical conditions that have traditionally been excluded from PDLs (such as mental health, HIV/AIDS and cancer).
  • Improve prescriber education by creating an “academic detailing” program that provides prescribers with up-to-date information about the effectiveness of different medications and alternative treatments, serving as an unbiased alternative to pharmaceutical industry promotion.
  • Combat off-label drug promotion and inappropriate prescribing by requiring that physicians inform their Medicaid beneficiary patients whenever the physician prescribes a drug for an unapproved use, and that the patient consents to the treatment.

A Better Path to Savings
These policies — coupled with the consumer-friendly options offered in Sebelius’ letter — offer a clear alternative to cutting low-income children, parents, seniors and people with disabilities off Medicaid; they illustrate why Congress does not need to lift the Maintenance of Effort requirement for states to make their Medicaid programs more efficient.

They also offer clear alternatives to some of the more harmful cost-cutting tools that states already have at their disposal: imposing higher cost-sharing and eliminating or restricting “optional” benefits such as prescription drugs. Those tools just shift costs onto vulnerable beneficiaries, and risk harming their health. And research suggests they result in fewer savings than states might assume: when patients delay or forgo certain services because of cost-sharing or benefit restrictions, their illnesses can worsen and eventually require more expensive care, canceling out some of the state’s savings.

Our letter lays out a better path — one that not only saves money but also can improve the lives of vulnerable Americans. If Governors are serious about fiscal responsibility, they should jump at these opportunities to cut waste and improve the sustainability of the Medicaid program.

-Katherine Howitt, Policy Analyst

Tags: , , , , , , ,
Posted in Affordable Care Act implementation, care coordination/quality, Medicaid | No Comments »

Health Homes: Creating a Stronger Medicaid Program While Reducing Costs

Friday, December 17th, 2010

Arizona’s decision to eliminate coverage for some heart, liver, lung, pancreas and bone marrow transplants has received a lot of attention because of its immediate life-and-death implications: potentially denying organs to 100 adults currently on the transplant list.

And it’s not just conservative states turning to these types of drastic measures. Under immense fiscal pressure, states across the country are cutting Medicaid benefits and reducing already-low Medicaid provider reimbursement rates. These cuts harm access to needed care for America’s most vulnerable citizens.

There Is a Better Approach
CMS recently released guidance on a new state option created by the Affordable Care Act that could lower Medicaid costs and bring in additional federal dollars while improving patient care. Beginning in January 2011, states can qualify for two years of enhanced federal funding to set up health homes for Medicaid beneficiaries with chronic physical or mental illnesses.

Unlike benefit restrictions, the health homes initiative tackles a root cause of unnecessary Medicaid spending: our fragmented health care delivery system. We know about five percent of Medicaid beneficiaries account for nearly 60 percent of Medicaid spending. Who is this small section of the population? It’s people with complex health care needs whose care is too often split between multiple providers who are not paid to communicate with one another. This lack of coordination leads to avoidable ER visits, hospital readmissions, and duplicated tests and procedures. To reduce these unnecessary costs, the new health homes option simply reimburses providers for coordinating the care of high-risk enrollees.

The evidence is clear: states can lower health care costs through health home initiatives. In North Carolina, a Medicaid medical home program saved the state between $154 and $170 million in 2006 alone. Illinois saved $220 million in the first two years that its Medicaid medical home program was fully implemented.

Given the severity of state budget crises, the health homes option on its own may not create enough savings to get states out of the red. But it’s just one of many options to reduce Medicaid spending while improving patient care. As long as options like this are on the table, there is no excuse for denying access to needed services for vulnerable Americans.

– Katherine Howitt, Policy Analyst

Tags: , ,
Posted in Affordable Care Act implementation, care coordination/quality | 1 Comment »

Stuck in the Middle with You

Tuesday, November 16th, 2010

A few weeks ago, Time magazine included a short essay that caught the eye of several of us here at Community Catalyst. In “The Coping Conundrum,” author Nancy Gibbs gently, but insistently, spotlights the unique issues faced by Americans in the sandwich generation — those among us who are simultaneously raising kids even as they are pulled deeper into caring for our aging parents.

“As they age, our parents need constraints, but the context shifts,” writes Gibbs. “Just as with teenagers, we put limits on their freedoms: No, you can’t wear those heels, drive at night, explore that city alone. But this involves taking away freedoms they’ve had, not preparing them for new ones. […]If you are a wife, mother and daughter or son, father and husband and all those ties are pulled taut, you are no longer a net. You are a sieve, and the first thing to slip through is peace of mind.”

Gibbs points to statistics from just one illness — Alzheimer’s — to illustrate the impact care giving has on family members’ lifestyles, relationships, and even career opportunities. Citing the Shriver Report, she states that one in every three caregivers reports being “responsible [for providing care] around the clock — and four in ten say they had no choice about taking on the role.” Over a third of family caregivers struggle with depression, and 40 percent say care giving strains their marriage.

This is troubling, and it speaks volumes about the way our current health care system works — or doesn’t — for the frail elderly, many of whom have one or more chronic illnesses, and the people who love them. Ironically, incentives in many states actually work against keeping people in their homes and communities, pushing them into institutions like nursing homes. Not that nursing home care is an easy solution. As Gibbs notes, Medicare doesn’t cover long-term care services, and “you have to burn through your savings to qualify for Medicaid [which may cover long-term care].” In addition, many providers don’t routinely coordinate patient care with one another. That burden falls to patients and family caregivers, who may get conflicting diagnoses and treatment plans without the benefit of a point person to help them make sense of it all.

All of this makes for a system that’s disjointed, confusing, and frustratingly complex. None of it makes for easy care giving.

That’s not to say there are no bright lights shining. Tomorrow, November 17 marks the launch of the “Year of the Family Caregiver” — a year-long celebration that will recognize family caregivers for all that they give, and all that we ask of them. (It’s also the 10th anniversary of the National Family Caregiver Support Program, created by the Older Americans Act to support family caregivers.) And, the Affordable Care Act (ACA) includes a number of provisions intended to improve the way patients — and their family caregivers — experience care.

Despite politicians’ midterm posturing on the ACA, there’s no question that we need to take advantage of the opportunities it presents to address what’s not working well for patients and family caregivers. Red state, blue state, purple, green — no matter what the political landscape looks like, focusing on what’s not working for our ever-aging population and the people who care for them is one issue that should cross party lines. To quote Nancy Gibbs, “If anything should be a postpartisan issue, this is it. Liberal or conservative, we all get old; we all care about the people we love; and in the years ahead, the support needs to come without being summoned if our families are going to stay strong.”

After all, we’ll all be there, someday.

– Jessica Curtis, Integrated Care Advocacy Project and the Campaign for Better Care

Tags: , , ,
Posted in care coordination/quality | No Comments »

The Future of Health Care

Friday, September 17th, 2010

How are we going to change the cost curve in health care and provide the highest quality of care? Dr. Bob Master – one of the country’s leading health care visionaries – has a great answer.

Six years ago, Bob came to Community Catalyst as a fellow of the Institute of Medicine as a Profession. Our idea was that he would use the fellowship to incubate a care delivery system that would serve Massachusetts’ most vulnerable people, including frail older adults with chronic conditions, people with significant physical disabilities and people who are dually eligible for Medicaid and Medicare. By focusing on primary care and prevention, this system would deliver high quality care and reduce costs.

After two years at Community Catalyst, Bob launched the Commonwealth Care Alliance (CCA) upstairs from our offices on 30 Winter Street. We wanted to ground CCA closely to consumers, so Health Care For All and the Boston Independent Living Center became CCA’s corporate members and I became president of the board.

Six years later, Bob and his committed staff at CCA have created a comprehensive system of care that not only improves their members’ health, but also has been proven to lower costs by keeping people out of the hospital and out of nursing homes. Last year, NCQA, widely viewed as a national leader in driving healthcare improvement and quality, honored Bob for his efforts to successfully reform health care delivery by improving quality and reducing cost for Medicare and Medicaid Patients.

Recently, WBUR’s (Boston’s National Public Radio affiliate) CommonHealth blog ran a nice piece on Bob and CCA. So what does CCA’S care model look like? Here’s how the WBUR bloggers describe it:

The organization is essentially a full-service provider of medical care and social support for chronically sick, elderly and sometimes disabled people on Medicare, Medicaid, or both. From the moment a patient signs on, he or she has access — 24 hours a day, 7 days a week — to a nurse practitioner who is armed with up-to-date electronic medical records and has the authority to call in other specialists as needed. Patients can choose from 25 primary care sites around the state, and for the homebound, house calls are also part of the plan. For those who need to get to the hospital, Commonwealth Care contracts with 8 hospitals in the state, but will only use providers who agree to Medicare reimbursement rates.

Continuity of care is essential. So the program offers non-traditional assistance to patients at no extra cost, including transportation to medical appointments and help with daily chores and activities. Commonwealth Care tries to rescue patients from the kind of fragmented, procedure-driven care that can leave them feeling like “an anonymous piece of baggage on a never ending airport conveyor belt, always tagged for the wrong destination,” as one senior put it.

This is precisely the kind of care that Community Catalyst and our partners at the Campaign for Better Care are pursuing as the Campaign works to implement the delivery and payment reform provisions of the new health law in ways that benefit older adults and their families.

Community Catalyst is proud to be able to highlight the good work at CCA, and we encourage Hub readers to get to know them better. To paraphrase an old saying, “We’ve seen the future of health care, and it is CCA.”

– Robert Restuccia, Executive Director

Tags: , , , ,
Posted in affordability, care coordination/quality | 1 Comment »

Are we speaking the same language? The problem with medical jargon

Wednesday, July 28th, 2010

Today, many families are struggling not only with the cost of and access to health care, but also with the quality of care they receive. A recent article in the Wall Street Journal, “Taking Medical Jargon Out of Doctor Visits”, articulates an incredibly important issue that sometimes gets swept under the rug in the talk about cost and quality of care: patient health literacy.

According to the Centers for Disease Control and Prevention, about nine out of 10 adults find it hard to follow routine medical advice, mostly because they don’t understand what their care providers are saying. The complex instructions and jargon that doctors use make patients more likely to skip necessary medical tests or not take their medication as prescribed. This confusion leads to poorer health outcomes and increased health care costs currently estimated at $238 billion a year.

There is a common assumption that lack of health literacy is limited to racial and ethnic minority populations. While these populations are disproportionately affected by low health literacy, according to a report from the National Patient Safety Foundation, Low Health Literacy: Implications for National Health Policy, the majority of people with low health literacy skills are white. Older people, recent immigrants and those with chronic conditions are likely to have low health literacy, as well.

Of particular note from the WSJ article is the federal strategy around health literacy entitled the National Action Plan to Improve Health Literacy. The plan seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multi-sector effort to improve health literacy

We are headed in the right direction. However, there is still a fundamental need for greater change in the health care system – particularly in the areas of how care is delivered and paid for – if we are truly to achieve better access to quality, affordable care.

As our population grows older and larger, the impact on the health outcomes of patients and the costs to the health care system will only increase. These problems are compounded by the lack of care coordination for those with multiple chronic illnesses. People with multiple chronic diseases have increased interaction with the health care system, leading to more opportunities for confusion surrounding their medical care – which is in turn influenced by the number of doctors they see and what they hear from their doctors.

An older person with five or more chronic conditions (e.g. diabetes, hypertension, heart disease, arthritis, obesity), has an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year. How incredibly confusing would it be for that person to manage his or her own health? Older adults and their caregivers should be full partners in their care, and they should be provided with the information and support to manage their conditions so they can make informed health care decisions.

With the advent of the Patient Protection and Affordable Care Act (PPACA), the Campaign for Better Care, led by the National Partnership for Women and Families, Community Catalyst and the National Health Law Program, is working to ensure the needs of older adults and their families are highlighted and addressed.

Helping patients and providers communicate effectively with each other will be a crucial component to the quality of care that patients receive. The Campaign’s national consumer coalition has developed a “Yardstick” for Better Care, which identifies key elements of patient-centered practice for inclusion in new models of care

The Campaign for Better Care hosted a public event today in Washington, D.C. – the “Building Better Care” forum – and the forum webcast will be available online Friday. Special guests included Senator Sheldon Whitehouse, award-winning author Gail Sheehy, UCLA Geriatrics Division Chief David Reuben, journalist and activist Jonathan Rauch, HHS Director of Delivery System Reform Peter Lee, and more.

To learn more about these issues and how the Campaign is tackling them please visit www.campaingforbettercare.org.

– Jenelle Holder Williams, Field Director, Integrated Care Advocacy Project

Tags: , , , ,
Posted in care coordination/quality, national health reform | No Comments »

« Older Entries