We have two unrelated topics to touch on this week.
First, just a brief reference to a recent Washington Post story that was a pretty good snapshot of the progress – and lack thereof – at the state level toward setting up exchanges. As writer N.C. Aizenman makes clear, the delays are partly because of politics.
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Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to firstname.lastname@example.org.
Hesitant states may decide to speed up implementation as the 2012 political landscape becomes clearer. The hesitation is partly related to uncertainty about what the courts will do about the mandate (and when.) And it’s partly because it’s tough for even a pro-reform state to set up an exchange.
As we’ve noted before on this blog, HHS has offered a sort of hybrid model for states that may make progress but not be where they need to be. Instead of an all-or-nothing approach (state run or federally run) HHS may manage parts of an exchange, but let states do the rest.
The second item that may translate into a good local health reform story is a new Thomson Reuters Healthcare study (hat tip to Reuters’ Deborah Sherman) that found hospital employees, as Sherman put it, ” spend 10 percent more on healthcare, consume more medical services, and are generally sicker than the rest of the U.S. workforce,” This is sort of the un-health reform – we’re supposed to be moving toward smarter health care utilization and better care coordination and hospitals, one would think, would be ahead of the curve. (That maybe the wrong cliché if we’re supposed to be bending the curve … not just getting out in front of it.) The findings also are a rather surprising contrast to what we’ve been reading about healthy hospital workforces at places like the Cleveland Clinic. The study speculates on several reasons for the high use of resources by hospital workers. Among the possibilities:
- Location, location, location. Hospital workers saw their doctors less often but used the emergency department and the hospital itself more.
- Stressful work environment and irregular hours may add to the chronic disease burden and make it hard to maintain healthy lifestyle habits.
- Higher awareness of illness, leading to more treatment.
Taking care of these worker/patients adds to hospital costs, at a time when they may be squeezed given the economic conditions and the pressures on state and local governments. It would be interesting to check out what’s going on with health care workers in your community. Is utilization high? Is the hospital trying to deal with costs the good old-fashioned way (cost shifting, cutting fees or having workers pay more for their care?) Or are local hospitals trying any of the new ways of delivering more coordinated care and managing chronic diseases in ways that preserve – or improve – quality while holding down costs?