Tuesday, December 2, 2014

The Medicare Trajectory: Take the Healthcare Quiz

By Nalini K Pande, JD

Want to reduce the nation’s spending on healthcare?  How about your own healthcare spending? This quiz could help do just that.  “How” you ask?  It’s quite simple.  When we think about Medicare spending, we don’t often think about kids, young adults or even adults under 65.  But, we should.  The major driver of Medicare costs is spending on chronic disease.  How do we reduce this spending?  We get people like you and me to take care of their health, focus on prevention, and become an active player in the health system before we become Medicare-eligible.  In doing so, you could end up saving money.  And, we also engage those already on Medicare to better manage their care.  Certainly, this is easier said than done.  

Why is America so alienated from their own health care? Could it be that the health system has become so complex that you would have to be a health care expert to figure out what’s going on?  And, who has the time?  This holiday season as you dine with your loved ones and catch up on some good books, you might consider sharing this fun Healthcare Quiz.  This “take” on the 12 days of Christmas will teach you everything you need to know - well, at least 12 important health topics. 

Quiz Directions: Read the Healthcare Quiz and see how many of these terms you know.  Use the red short answer key to see what these terms mean.  You get 1 point for each numbered phrase/term you know for a total of 12 points. Want to earn extra points?  Then, read the “Detailed Answers” section below to learn why these 12 issues are critical to the health policy landscape and earn extra points.

Detailed Answers
(Give yourself an extra point for every detailed answer you know)

12 States Expanding: The Supreme Court has indicated that states can determine whether they will expand Medicaid to cover some of the uninsured under the Affordable Care Act.  Thus far, 28 states and DC have expanded Medicaid.  You get a bonus point if you know whether your state has expanded.  Click the link to see if you are right.

11 Measures Measuring: Health quality measurement is critical to improving the quality of health care services and identifying areas in need of improvement. Measures also inform consumers.  Check out the following consumer health quality sites: for hospitals (Hospital Compare), health plans (HEDIS), and doctors (HealthGrades), as well as an overview of all consumer sites.  Measures can be controversial given operational challenges, and concerns that incorrect inferences have been made from measures. All of this leads many to question how useful some measures are for determining true health quality. Now that I have you completely confused, let’s move on to the Exchanges.

10 Exchanges enrolling:  Also known as Health Insurance Marketplaces, the Exchanges are where both individuals and small businesses can go to shop for health insurance coverage.  Federal subsidies (premium tax credits) are available to consumers if they meet certain incomes requirements. Some states established their own Exchanges. Other states relied on the federal government to do so.  Open enrollment for 2015 coverage started Nov 15 2014 and ends Feb 15, 2015.

9 Duals pending: Dual eligibles are given this name because they are covered under both the Medicare and Medicaid programs.  They are generally the sickest and most costly beneficiaries of the Medicare and Medicaid programs.  Currently, 9 states are in the process of implementing a capitated (managed care) model with goals of improving quality and cutting costs for duals.  What’s pending is the evaluation.  It has yet to be seen how successful these initiatives will be.  Additional states are implementing other models as well.  What’s important is that HHS is focusing on ways to address this vulnerable and high-cost population that maintains strong quality standards while also reducing costs. 

8 Curves a bending: Bending the cost curve in the policy arena really means reducing costs over time.  If someone is acting like a know-it-all about some policy, just throw out the phrase, “but will it bend the cost curve?” and watch them quickly back away.  You get a bonus point if you use this phrase at work or with friends today.

7 COBRAs extending: The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions require group health plans to continue your employer health coverage (18 months) if you have a qualifying event such as being laid off.  However, you will now pay 100% of the premium costs (not just a portion).  If you’re feeling really adventurous, you can also investigate whether the Exchanges give a better deal given their subsidies or check out your local health plan’s website (except in DC and VT) and shop around accordingly.

6 Health apps trending: Health apps are specialized programs/software often used on mobile devices that focus on health, nutrition or exercise programs.  What’s exciting is that a new app focusing on managing chronic conditions is out.  No longer do the healthy get to have all the apps.  Venture capitalists have been challenged to do more in the chronic condition app arena and it will be interesting to see this field develop further.  You get a bonus point if you have a health app on your mobile device and you use it.

5 Bundled payments!!! Bundled payments is a new payment model that transforms multiple claims into a single payment for one “episode” of care based on predetermined lump sum amount. Why is this important?  This new payment model may lead to higher quality and more coordinated care at a lower cost.  It essentially incentivizes providers to coordinate care and prevent costly and avoidable hospital readmissions. The jury is out as to whether this model will be a strong cost-saver. What is most critical is the cost transparency that the new reform represents.

4 EHRs: Electronic Health Records (EHRs) are seen as the wave of the future (and are currently being used in some health systems). EHRs allow doctors and hospitals to access your medical history, lab tests, allergies, immunizations, and radiology images all in one digital format.  EHRs improve quality, efficiency and care coordination across your care while reducing waste such as duplicative tests.  However, adoption has been slow, and transitioning from paper to digital has been challenging. Further, not everyone believes it is improving efficiency given additional burdens and high costs.  Addressing privacy and security issues are critical for successful implementation.  You get a bonus point if you already have access to your health records online (and another bonus point if you actually use it!)

3 Co-pays: A copay is a fixed amount that you pay when you visit the doctor’s office or when you buy prescription drugs. Why is it important?  As you probably have seen recently, your premium (how much you pay monthly for your health insurance), co-insurance (a percentage you pay of your medical bill) and your deductible (how much you must pay before your insurance will kick in) has been increasing over the years.  How can you effectively select a plan that will best meet your budgetary needs?  Hint: The lowest premium plans aren’t always the best.  They can have high deductibles and out-of-pocket maximums that might make a different plan a more financially appropriate choice.

2 ACOs:  An Accountable Care Organization (ACO) is a group of coordinated providers (doctors, hospitals) in which provider reimbursements are linked to improving quality and reducing costs for a  population of patients. Doctors get more money if their patients stay healthy and if they save money.  (This is unlike previous systems, where doctors are incentivized to reduce costs without always focusing on improving quality). ACOs are seen as cutting edge.  Whether they are the “next big thing” has yet to be seen.  Pioneer ACOs have seen some real success.

And a PCP in a Pear Tree! No, this is not the drug, PCP, but rather what we call in the health field, a Primary Care Provider.  Why is your PCP important?  Having a PCP leads to better health outcomes and reduced costs (through lower hospitalizations), including improved prevention and better coordination of care for those with chronic diseases. You get a bonus point if you have a PCP. 

What’s your Number? How many did you get right? 
• You get 1 point for each numbered phrase/term you knew based on the red answer key for a total of 12 points
• You get an extra point for every detailed answer you knew based on the detailed answers section above for a total of 12 additional points.  
• You get additional bonus points as indicated above for a total of 6 bonus points.

28+: Congratulations! You are a Health Guru. We need more experts like you!

21-27: Great job! You are a Health Professor.  Everyone in the office comes to you for help with their health questions.  Keep up the great work!

11-20: Nice work!  You are a Health Enthusiast. You are on your way to becoming an active player in the health system.  Keep learning and sharing what you know with others!

1-10: Hang in there!  You are a Health Rookie. Healthcare is a very complex topic. It's hard to understand health reform, health delivery system changes and payment reform when the existing system is so confusing. Keep learning!

Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  She previously taught a graduate health quality course at Georgetown University as an Adjunct Professor.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.

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