Posts Tagged ‘care coordination’

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

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In Washington and Beyond, It’s Go Time for Keeping Hospital Patients Safe

Monday, April 25th, 2011

“[The doctor] literally grabbed me by the hand and took me out into the hallway. He said, ‘Your mother is very sick. Her health is failing.’ I said, ‘Sir, it’s not her blood levels. It’s whatever she has caught in this hospital.’ He said to me, ‘Look, do you think I’d just discharge your mother to let her die in a nursing home?’ And I said, ‘Yes, sir, that’s exactly what I think you are doing.’” The doctor left without another word about discharge. […] My mother’s life was far too valuable to have ended this way.”

- Reverend Sally Jo Snyder, Pennsylvania Campaign for Better Care

By now, our readers may have heard about the recent launch of the Obama Administration’s Partnership for Patients: Better Care, Lower Costs (the Partnership), a new public-private initiative aimed at improving care quality and coordination. But did you also know about the Healthy Hospital Initiative? It’s the other new kid on the block — courtesy of the Campaign for Better Care — and it’s working to make sure this new effort to improve care goes down with adequate community representation and patient perspectives. Here’s the skinny on both efforts and what they might mean for your community.

First, the Facts
Past data shows that almost one in every 20 patients will experience an infection related to their hospital care. That’s about 1.7 million people nationwide. Of those, almost 100,000 people will die as the result of a medical error this year. Older Americans are even more susceptible: One of every seven Medicare beneficiaries is harmed in the course of their care, and one in five Medicare patients discharged from a hospital will be readmitted within 30 days, due partly to lack of appropriate coordination and support for people transitioning into rehab or other facilities. The cost to Medicare for readmissions alone runs upwards of $26 billion every year.

We can’t afford to pay for this kind of care. And as patients and community members, we shouldn’t accept exposure to infections and poor care as an unavoidable risk within our health care system.

The Partnership for Patients: A Smart Move in the Right Direction
Fortunately, the Partnership takes several steps to address these problems.

First, it will work with stakeholders — including patients, community groups and advocates — to lower the rates of preventable hospital-acquired conditions by 40 percent and hospital readmissions by 20 percent, all by 2013. (Not coincidentally, the Affordable Care Act includes provisions that will reduce Medicare payments to hospitals for hospital-acquired infections in the coming years. The Partnership will give hospitals an opportunity to take early steps to improve care and skirt financial penalties.) As an initial step, HHS is looking for hospitals, employers, payers, community groups, state and local government officials and others to sign a pledge to improve care coordination and quality.

But there’s more. HHS is currently accepting applications on a rolling basis for the Community-Based Care Transitions Program (CCTP) a new Medicare demonstration project authorized by the ACA. To apply for some of the $500 million in CCTP funding, acute-care hospitals have to partner with community-based organizations, such as area agencies on aging, that offer care transition services and include adequate consumer representation on their governing boards.

The Healthy Hospital Initiative: Demanding Better Care at the Bedside and Beyond
The Partnership is an important step to improving care and quality. But it’s not the only step. And it certainly won’t reach its full potential without engaging communities, patients and families to collaborate with and — where necessary — hold hospitals, providers, and government accountable for achieving Partnership goals.

That’s why we, along with other state and national organizations involved with the Campaign for Better Care , decided to launch a Healthy Hospital Initiative. We’ll build on the new federal initiative to ensure that patients, family members, and communities have the tools they need to participate fully in the Partnership and to push the envelope with providers and others, when necessary. Over the coming weeks, the Healthy Hospital Initiative will be rolling out more tools to help community groups gear up for this level of involvement.

How You Can Become Involved
What can you do right now to support the Partnership for Patients?

  • – Link up with the Healthy Hospital Initiative.
  • – Identify families in your networks who’ve been harmed by hospital-acquired infections, and let them know how their stories can be powerful tools to increase awareness about the need for these new programs.
  • – Sign the Partnership pledge, and encourage local hospitals and providers to do the same. To see a list of the hospitals and others that have already pledged in your state, check out the Partnership map and database.
  • – Reach out to your regional HHS director to find out more about local or regional efforts to build the Partnership, and offer to get involved.
  • – Learn more about patient safety.
  • – Reach out to hospitals and other providers in your area about developing a proposal to participate in the Community-Based Care Transitions Program.

– Jessica Curtis, Policy Analyst, Integrated Care Advocacy Project

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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

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

Six months in: The new health law gives us the key to better care

Thursday, September 23rd, 2010

Our fourth post celebrating the six month anniversary of the Affordable Care Act.

Six months ago today, the Affordable Care Act was signed into law. Since then, the new health law has offered some concrete advances, including some that go into effect today and it’s laying the groundwork for even more.

By 2030, it is estimated that 72.1 million people in the United States will be age 65 or older, more than twice the number of older adults in 2000. As our population ages, it is vital that we improve how the system cares for and engages with patients who have multiple chronic conditions so they get care that’s tailored to their individual needs, receive clear information from their doctors, don’t have to repeat tests, and get the supports and services they need to stay in their homes and out of the hospital.

So far, the Affordable Care Act has helped to close the donut hole for Medicare beneficiaries, created new patient protections, made it possible for people to get better information and compare health insurance plans online. But we know much more is needed to provide quality, coordinated care for millions of vulnerable patients and their family caregivers — the people who need help the most. And there is more to come.

Starting next year, preventive services and annual check-ups will be free for Medicare beneficiaries, hospitals will receive more funding to help provide a smoother transition from hospital to home, and primary care providers in Medicare and Medicaid will receive increased payment — to make sure that everyone has access to primary care.

Perhaps most importantly, the ACA offers unprecedented opportunities to improve the poor coordination that plagues our health care system — one of the core issues we and our partners at the Campaign for Better Care are working to address. These include:

– A new Center at CMS designed to promote innovative ways of providing care, such as using team-based primary care
– A new option for states to create medical homes
– Incentives for hospitals to reduce preventable infections and readmissions

These and other ACA reforms give us the tools to create sustainable, effective coordinated care programs that can provide patients and their families with better care and better outcomes. The ACA can bring the improvements we urgently need — but only if it is implemented with patients and their family caregivers as the focal point. Making that happen is the mission of the Campaign for Better Care.

Community Catalyst has been working toward this mission since it helped create the Commonwealth Care Alliance, and we are proud to bring the lessons from CCA and others to the work of the national Campaign and to the six state Campaigns in Maine, Massachusetts, North Carolina, Ohio, Pennsylvania and Wisconsin. In each of these states, advocates are at the table where decisions are being made to implement key ACA delivery system reforms. We applaud this critical work and urge Hub readers to join existing Campaign efforts or to learn how to get involved in their own states.

Happy Half-Birthday, ACA!

– Renée Markus Hodin, Director Integrated Care Advocacy Project

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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

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As Boomers turn 65, better team-based care becomes a must

Wednesday, May 12th, 2010

cbcWhen Older Americans Month was established 47 years ago, only 17 million living Americans had reached their 65th birthdays.

Today, there are nearly 40 million adults age 65 and older. And when the first baby boomers turn age 65 in 2011 they will become eligible for Medicare. With the aging of the baby boom generation – the largest in our history – the U.S. older population is expected to grow to 71.5 million by 2030.   Will health reform translate into the comprehensive and coordinated care that older adults with multiple health problems need and deserve?

The Campaign for Better Care, a national initiative which launched this spring, is aimed at making sure the answer is yes.  Community Catalyst is proud to be a partner in this new campaign, which recognizes that older adults—those with multiple health problems, in particular—need doctors, nurses and other health providers who talk to each other and work together, along with the patient and their family caregivers, as a team.

This is exactly the kind of approach our friends at the Commonwealth Care Alliance use with their members, all of whom are either older adults or people with complex health needs.  At CCA, members are assigned to a team made up of the primary care doctor, a nurse practitioner, a nurse, and a behavioral health practitioner.  Working together with the member and her family, the team develops a care management plan aimed at enhancing the member’s quality of life.  This approach also serves to avoid medical errors, duplicative tests, and wasted time and costs.

The Campaign for Better Care is advocating at the federal and state levels to ensure that new models of delivering care are patient- and family-centered, team-based, and include important services like:

□    geriatric assessment
□    care planning
□    comprehensive care coordination
□    transition management between care settings
□    medication management
□    community support for older adults and their family caregivers

It supports payment strategies that support primary care practice and reward better quality, coordination and communication among health providers, patients and family caregivers.

Community Catalyst whole-heartedly supports that agenda, which puts into action many of the recommendations found in our care coordination (pdf) and payment reform (pdf) issue briefs.

So this May, as we celebrate older Americans, I hope that you’ll consider joining a month-long public education drive to spread the word in your networks about the need for better coordinated, patient- and family-centered care.  To learn more and become be an “ambassador” for better care, visit www.CampaignforBetterCare.org.

–Renee Markus Hodin, project director

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America needs better care!

Tuesday, April 13th, 2010

cbcHealth reform is law. The hard work of fixing our health system begins now. That’s the message of  Campaign for Better Care, a recently-launched effort to improve health care coordination and quality for people across the country. (Here’s the ad (pdf) that ran in Politico.)

The Campaign, a joint effort of the National Partnership for Women & Families, Community Catalyst and the National Health Law Program (NHeLP), is working to ensure that we realize the promise of health reform by improving health care quality, coordination and communication for older patients with multiple health problems and their family caregivers.

A newly released national survey of Americans 50+ tells the story.

  • Something to talk about. Nearly three-quarters have wished that their doctors would talk and share information with each other.
  • People who take the most meds need to hear more about medication interactions from their doctor. Forty percent of people who take five or more medications say their doctors do not talk to them about potential interactions with other drugs or over-the-counter medications when prescribing new medications.
  • Different info from different doctors. More than one third of people who use the health care system most say they’ve received conflicting information from different doctors.
  • Taking the test over—and not because they failed. One in eight (13 percent) has had to redo a test or procedure because the doctor or hospital did not have the earlier results.
  • Do you have any questions? Yes. Three-quarters of those who use the health care system most have left a doctor’s office or hospital confused about what to do at home.

But the real story is told by people like Joann, whose life was turned upside down last summer when her 79-year-old mother fell and broke her hip. Because her mother also suffers from osteoporosis and dementia, Joann stayed overnight in the hospital for two weeks to help her navigate the system.  She was physically and emotionally exhausted in this solo effort to make sure her mother was safe and well-cared for once she returned home from the hospital.

The new health reform bill is full of programs that could help people like Joann and her mother by providing the comprehensive, coordinated, patient-centered care they need.  And, the Campaign is committed to taking the essential next step: ensuring that these programs are designed and implemented with the needs of patients and their family caregivers front and center.  Because if we can make the system work for people with the most challenging health care needs, we can make it work for everyone.

To support the national Campaign, Community Catalyst is also working in six states to build support for these kind of programs:

Maine (Consumers for Affordable Health Care)

Massachusetts (Health Care for All)

Ohio (UHCAN Ohio)

North Carolina (NC Justice Center)

Pennsylvania (Consumer Health Coalition)

Wisconsin (Coalition of WI Aging Groups)

Check out the state campaign websites to learn more about what they’re doing to promote better care in their states.  And be sure to visit the national campaign website www.CampaignforBetterCare.org to learn more about the campaign and how to get involved.

-Renee Markus Hodin, project director

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