Massachusetts is famously ahead of other states when it comes to health insurance coverage. Ninety-eight percent of Bay State residents have insurance.
But the state is also way ahead in another area: health care costs. The cost of care is the highest per capita in the country and, consequently, the world, according to Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.
Insurers, providers and government regulators have been working, with some success, to curb the rate of health care costs in Massachusetts. Continue reading
As many of you know, Gary Cohen, the head of the Center for Consumer Information and Insurance Oversight (the HHS office that is spearheading the exchanges) was a last-minute no-show at our Health Journalism 2013 panel on state implementation of the Affordable Care Act.
Whether it was budgetary (CCIIO is setting up WAY more federal exchanges than it anticipated and hasn’t pried more money out of Congress, as you can imagine) or whether somebody decided it wasn’t really such a good idea for Cohen to face a whole room of inquisitive journalists for whom CCIIO might not yet have answers was a subject of much speculation in Boston.
However, even if Cohen didn’t join us, his team did send us a timeline. (Before you get confused looking at it, QHP stands for “qualified health plans” – health plans that live up to the new rules for participation in exchanges). Here it is. You can use it to help track what’s ready, what’s lagging, what’s going through dry runs before being opened to consumers in your state.
(Click on the image to enlarge it.)
The “Rich Hospital, Poor Hospital” panel at Health Journalism 2013 broke down the hospital industry into a discussion about the business of running a medical facility in terms of customers, revenue streams and federal oversight.
“Hospitals are big businesses, nonprofits or not,” said moderator Phil Galewitz, senior correspondent for Kaiser Health News.
The panel featured Karen Garloch, a medical writer who spoke about the series she collaborated on with a team of reporters for The Charlotte (N.C.) Observer and The News & Observer in Raleigh, N.C., called “Prognosis: Profits;” Margot Sanger-Katz of the National Journal; Kate Walsh, chief executive officer of Boston Medical Center; and Alan Sager, a Boston University School of Public Health professor of health policy and management. Continue reading
About one in five Medicare patients hospitalized for heart attacks, heart failure or pneumonia will be back in the hospital within 30 days.
With the U.S. Center for Medicare & Medicaid Services now penalizing hospitals for high readmission rates, it has become an economic as well as a quality of care issue for many hospitals, which are looking at why their patients are coming back and how they can reduce their number.
It’s a challenging problem and the best models for reducing readmissions may still be in development, said Dr. Susannah Bernheim, acting director of quality measurement for the Centers for Outcomes Research and Evaluation at Yale School of Medicine.
Even at the best hospitals, 27 percent of patients had medication errors on their discharge list, more than half of all discharge summaries were not sent to physicians responsible for following the patient after hospitalization and 71 percent of patients did not know the medicine they were taking, or the frequency they were supposed to take it, panelists said.
“We are not getting it right,” Bernheim said. Continue reading
With less than 10 months until uninsured consumers can buy health coverage via online marketplaces known as exchanges, journalists should expect a tumultuous and at times messy process until Jan. 1, 2014, health experts told journalists at AHCJ’s Health Journalism 2013 in Boston.
The online exchanges, or marketplaces as the Obama administration increasingly likes to call them, are where consumers will purchase health insurance backed by a federal subsidy based on their income. The exchanges will either be run by the states, the federal government or a joint effort between the two.
Cheryl Smith, a director at consulting firm Leavitt Partners, told journalists on the panel that states are asking themselves three questions: Can they meet their deadlines to create the exchanges? Can the U.S. Department of Health and Human Services meet its deadlines to approve or, in some cases set up the exchanges? And will all of these exchanges work when it comes time for people to buy insurance?
“The answers are: crapshoot, crapshoot, crapshoot,” Smith said. “We really don’t know.” Continue reading
I wrote about co-ops as an undercovered health reform topic last month and provided some resources about how to cover them, either from a big-picture perspective about their role in the exchanges across the country next year or if you are looking at co-ops in your state or region – if they exist.
Health Affairs and RWJF have published a brief that explains in more detail about how they are set up, and the challenges they face. The brief gives a description of several of the co-ops – here are the top three on the list to give a taste of the variety. (There are more in the brief and the National Alliance of State Health Cooperatives has a full list (PDF).
- Evergreen Health Cooperative, established by Peter Beilenson, a former Baltimore City health commissioner, intends to provide high-quality care to members throughout Maryland with premiums costing 20-30 percent less than those of traditional insurance to help keep people from developing more serious illnesses. It has been awarded $65 million in loans.
- HealthyCT is a nonprofit health plan sponsored by the Connecticut State Medical Society (CSMS) and CSMS-IPA, a statewide independent practice association of providers. HealthyCT will focus on encouraging members to use patient-centered medical homes. It has been awarded $76 million in loans.
- Compass Cooperative Health Network in Arizona is sponsored by local experts in insurance, chronic disease coordination, use of health information technology, and business formation. It will begin on a regional basis within Arizona and then expand statewide over time. It has been awarded $93 million.
You’ve seen lots of stories – and you may well have written some – about how much the cost of insurance is going to rise for younger people in the exchanges next year – the so-called “premium shock” or “price shock.”
This is a fair concern – but be careful that you handle it fairly. Continue reading
Former AHCJ president Trudy Lieberman, in a CJR “Second Opinion” post, recently pointed out a story that was largely untold– and put it in a helpful national and political context for those of you who may still tell it. That’s the “incredible shrinking insurance co-ops.”
The co-ops’ funding was slashed in the New Year’s fiscal cliff deal. With all the other economic and political aspects of the “cliff,” the co-op story was not widely reported, including in some of the states where they may have made a difference.
Why does it matter? Remember the long battle in 2009-10 over the “public option?” The Consumer Operated and Oriented Plans were the alternative – arguably a sort of consolation prize – to the public option. The co-ops were a way to have a nonprofit health plan alternative to the largely private commercial plans expected to dominate the exchanges.
Lieberman quotes John Morrison, Montana’s former insurance commissioner, now president of the National Alliance of State Health Cooperatives, as saying the co-ops were scrapped not so much to save a few billion dollars for the fiscal cliff deal but as “a gift to the insurance companies” that didn’t want to compete with them. They were expected to have been particularly useful in giving small businesses more choice in rural areas dominated by one or two health insurance carriers. Continue reading
A new project is addressing the special concerns of frail elderly hospital patients in an attempt to help prevent lengthy hospital stays and readmissions for elderly folks, Anna Gorman of the Los Angeles Times reports.
Through the “frailty project” at Cedars-Sinai Medical Center, at-risk seniors are identified and, within 24 hours, assessed for “their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.” Continue reading
I clicked on an Economist story on the future of employer-sponsored health insurance to get a sense of what picture it was painting for its largely overseas but U.S.-savvy, business-oriented audience. It turned out to be a very good overview.
I thought it may have been a tad heavy on the “lots of small- to midsize-employers will drop coverage” angle but not excessively so. It would have been nice to note that they’ve been dropping coverage for years, one reason that the health law was enacted. But it is fair to worry about how employers will react and how employees will fare under the Affordable Care Act and the article lays out a lot of related issues clearly. (I didn’t see a byline on the online version – so kudos whoever you are.)
Unlike some articles and commentary I’ve seen in the U.S. press, when this piece noted that premiums may go up, it also noted:
- they’ve been going up long before health reform and
- low-wage and middle-income workers will get subsidized, so the sticker price isn’t the same as what they will actually pay.
It drives me crazy that the subsidies are so often neglected. Continue reading