Tag Archives: Affordable Care Act

ACA changes on the way, CMS official says

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

We tend to focus on the Affordable Care Act as a law that simply gives more people health insurance – and it has.

But as we’ve noted before, the health reform law also contains all sorts of programs and provisions that aim to change how health care is delivered: how we pay, what we pay for, and how we shift from a hospital-centric acute care system to one that stresses prevention, wellness and care and management of chronic diseases. Examples can be found across the country.

At a recent AHCJ webinar, Patrick Conway, M.D., deputy administrator of the Center for Medicare and Medicaid Services, gave an overview of some of the changes underway. Conway, whose job includes oversight of the Center for Medicare and Medicaid Innovation, also announced the next big thing in Accountable Care Organizations. More on that below. Continue reading

The other part of health reform: Changing the delivery of care

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

AHCJ webcastReforms to the health care delivery system have been overshadowed by the Affordable Care Act enrollment story but there are stories galore to be found.

The 2010 law takes steps to shift how we deliver health care – to do a better job of managing chronic diseases, to make hospitals safer, to move away from fee-for-service, to get more quality for our health care spending. It’s a big challenge but it doesn’t get as much attention as the coverage aspects of the ACA, partly because it’s not so politically radioactive.

Join Joanne Kenen, AHCJ’s health reform core topic leader, and Patrick Conway, M.D., M.Sc., director of the Center for Medicare and Medicaid Innovation, for a discussion on new ways of delivering care, evaluating what works and some early results. Health care providers around the country are taking part in CMMI initiatives and private sector counterparts.  There will be plenty of time for questions from participants during this members-only webcast.

How close are we to meeting the promise of electronic health records?

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. She is a member of AHCJ's board of directors, serving as liaison to the association’s local chapters and leading the one in Chicago.

Photo: Carla K. JohnsonA panel of experts discusses health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Photo: Carla K. JohnsonA panel of experts discuss health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Yes, technology is transforming health care. No, we haven’t come anywhere close to realizing the vision.

Smooth patient handoffs, data-driven performance improvement and real-time analytics are still mostly dreams, although those ambitions have been talked about for years.

Independent journalist Neil Versel, who specializes in health information technology, moderated a panel on March 3. The AHCJ Chicago chapter event was held at AMA Plaza, the new headquarters of the American Medical Association.

Electronic medical record systems “need to play nicer together so they can use each other’s information as if it was natively generated,” said Arnold “Ned” Wagner Jr., M.D., chief medical information officer of NorthShore University HealthSystem. “Can we talk to each other transparently? Well, partly. The success of communication depends on human behavior and (technology’s) job is to help understand the reality of what motivates people to do things.” Continue reading

SCOTUS: Some things to note as we wait for a decision

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) - The Oyez Project) [Public domain], via Wikimedia Commons

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) – The Oyez Project) [Public domain], via Wikimedia Commons

On March 4 the Supreme Court heard oral arguments in King v. Burwell. A ruling is expected in late June – though it’s possible it could come earlier. The plaintiffs argue that the health insurance subsidies should only be available to people living in states running their own Affordable Care Act health insurance exchanges or marketplaces, not the 34 states using the federal exchange via HealthCare.gov. They cite four words in the text of the law “established by the state” to make this argument. The Administration says it’s clear from reading the full text of the 906 page law that subsidies were to be available in all 50 states, no matter what kind of exchange they have.

So the Supreme Court has heard the King v. Burwell challenge to the Affordable Care Act.

Now what?

Good question.

Much of the coverage suggested that the March 4 oral arguments seemed to favor the administration, particularly because Justice Anthony Kennedy, often the deciding swing vote on the court, asked some questions showing skepticism of the plaintiff’s case.

But all that tells is precisely that – he asked some questions showing skepticism. He won’t necessarily vote that way. He backed scrapping the entire statute back in 2012 and made clear at that time that he detested the law.

Oral arguments are interesting and important – but rarely decisive. If you think you know how the court will rule – well you have a 50-50 chance of being right.

A few things did come out that health journalists should note. Continue reading

Experts weigh in on covering the SCOTUS challenge

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Seth Borenstein, Associated Press/New York UniversityPhil Galewitz, of Kaiser Health News; Tom Goldstein, an attorney and founder of SCOTUSblog; Christine Eibner, a senior economist at Rand Corp.; and Thomas Miller, a fellow at the American Enterprise Institute (left to right) discussed how to cover Burwell vs. King Supreme Court Case during a chapter event at the NYU Washington, D.C., Center on Feb. 18.

Photo: Seth Borenstein, Associated Press/New York UniversityPhil Galewitz, of Kaiser Health News; Tom Goldstein, an attorney and founder of SCOTUSblog; Christine Eibner, a senior economist at Rand Corp.; and Thomas Miller, a fellow at the American Enterprise Institute (left to right) discussed how to cover King v. Burwell at the NYU Washington, D.C., Center on Feb. 18.

The Washington, D.C., chapter of the Association of Health Care Journalists had a session last week about the upcoming King v. Burwell case that will go before the Supreme Court challenging whether the Affordable Care Act subsidies can flow through the federal exchanges.

More than 30 people attended the event at New York University’s D.C. campus, including some students and faculty, and it was mentioned in Politico Pulse. Seth Borenstein, a science writer for The Associated Press and adjunct professor, helped organize and co-host the session. Kaiser Health News reporter Phil Galewitz, who leads the D.C. chapter, and Margot Sanger-Katz, a health writer with The New York Times, spoke to students after the event about how journalists have covered the Affordable Care Act.

A ruling for King would affect people in 34 states. Three other states – Nevada, New Mexico and Oregon – are using HealthCare.gov technology but are running enough of their own exchange to be a sort of hybrid. Briefs for both sides filed in the case agree that it will affect 34 states, not 37.

We’re assembling a tip sheet with more resources on the case, but here are some highlights from the event. Continue reading

Adequacy, transparency of provider networks among things to watch

Heather Johnson

About Heather Johnson

Heather Johnson is an Oakland, Calif.-based journalist, author and editor specializing in legal writing, general interest, health and fitness, entertainment and consumer and professional audio.

Narrow networks

Photo: Niklas Morberg via Flickr

At a recent San Francisco Bay Area chapter event, health journalists received a primer on the narrowing networks of current health plans and the delicate balance between managing health care costs and providing reasonable access.

Panelists Anne Price, director of the Plan Management Division of Covered California; journalist and “Ask Emily” columnist Emily Bazar of California HealthCare Foundation’s Center for Health Reporting; Larry Levitt of Kaiser Family Foundation; and Betsy Imholz of Consumers Union addressed narrow networks’ impact on consumers, insurers, and providers, as well as proposed government regulation. Marilyn Serafini of nonpartisan Alliance for Health Reform, the panel’s cohost, moderated the briefing.

Narrow networks predate the Affordable Care Act to the controlled HMOs of the 1980s and 1990s, Levitt explained. The ACA accelerated the trend as insurers sought new ways to cut costs under a law that capped deductibles, banned pre-existing condition denials and mandated certain preventative care benefits. Continue reading

A sampling of perspectives on Brill’s take on health reform

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

I’m sure a lot of you have Steven Brill’s “America’s Bitter Pill” on your bedside table by now – I’m not going to try to recap it here.

But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform. Continue reading

Reporting on how, why hospital superusers account for bulk of health-care spending

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Tim Darragh

Tim Darragh

Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.

Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and NJ.com.) But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health. Continue reading

Taking a different look at readmission metrics, penalties

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

One of the high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.

Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.

But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading

Second open-enrollment period discussed at Atlanta chapter event

Andy Miller

About Andy Miller

Andy Miller (@gahealthnews) is the editor and publisher of the nonprofit Georgia Health News. The former health care reporter for The Atlanta Journal-Constitution is a member of AHCJ's board of directors and leads the association's Atlanta chapter.

The Atlanta chapter of AHCJ and the Alliance for Health Reform sponsored a Dec. 2 event focused on the second open enrollment period for the Affordable Care Act.

The panel discussed the state of navigator assistance, narrow networks and slower-than-expected enrollment since the insurance exchanges opened Nov. 15. About 25 AHCJ members and invited guests gathered for the event.

Joining me on the panel were Trey Sivley, a division director in the office of Georgia’s Insurance Commissioner; Lisa Stein of Seedco, which runs a navigator program in Georgia and three other states; and Dorian Martindale of Whitefoord, a federally qualified health center in Atlanta.

Continue reading