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.
Follow @nalinipande

Turn Population Health Data into Meaningful Disease Management Strategies

Via Health IT Analytics, a FDA/CMS Summit for Payers event supporter. View the complete article here.

How can providers turn population health data into meaningful chronic disease management?

When you hear the words “population health management” chronic disease care almost immediately comes to mind, diseases such as; diabetes, asthma, hypertension, and COPD. They sap billions of dollars from the healthcare system every year, and represent an enormous challenge for providers.  From medication adherence apps to appointment reminders sent through the EHR, providers have a range of tools at their disposal to track, corral, and encourage patients to manage their own care.

How can providers leverage these technologies while employing effective management strategies that provide patient-centered, population-minded care?

Which patient engagement, adherence strategies will work?

A provider can implement all the health IT in the world, but effective chronic disease management will still rely almost entirely on the patient’s willingness to engage with their care strategies, take their medications, and show up at their appointments.  Devising patient engagement strategies that produce measurable results requires an intimate knowledge of the targeted patient population, an understanding of what drives non-adherent behaviors, and a familiarity with technologies that truly appeal to patients.

For example, the patient population that is covered by Medicaid may face much different socioeconomic challenges than a privately insured community that receives support via their employers.

Dr. Margie Rowland, Chief Medical Officer of CareOregon said, "Many of our members are very poor and have literacy issues" She added, “It’s not just about taking the right pills or coming back for appointments, but it’s making sure people actually understand their illness and understand what questions to ask, or getting help with transportation to their provider - it’s not just health literacy.  It’s literacy in general.”

Different communities require differ services. For instance a non-english speaking population may require a translation service, while a rural population could require telehealth services to eliminate long drives.

Healthcare providers should be sure to assess their patient population before committing to any engagement strategy. The pairing of data with community feedback will provide a base for future efforts.

_____________________________________________

At FDA/CMS Summit for Payers, Michael Willis, PhD, Vice President & Business Information Officer at Kaiser Permanente will discuss how information technology shows tremendous potential in helping reduce disparities by improving access and information flow as well as communication between providers and patients. Session information below:

Health Disparities Using Technology to Bridge the Divide

Health disparities continues to be a major issue for our country. As our country’s diversity has grown we have also seen a parallel increase in health disparities. This presentation will focus on the challenges associated with health disparities and how Information Technology can be used as a catalyst for collaboration and education to measurably improve the lives of individuals and their families.


Register for FDA/CMS Summit for Payers now and take $100 off the current rate when you use the code XP1917BLOG.


Register Here!

Dual Eligibles and HIT: Managing Not Just Measuring

By Nalini K Pande, JD

Why is HIT Important to Duals?

There’s an old saying in the health care quality world: “We cannot improve what we don’t measure.”   And, of course, the follow-up to that is: “how can we measure without good data?” Health Information Technology (HIT) is at the heart of one the most exciting aspects of health reform.  HIT systems are designed to collect and display data related to the delivery and care of patients.  

Dual eligibles are covered under both the Medicare and Medicaid programs and are generally the sickest and most costly beneficiaries of the Medicare and Medicaid programs.  Given this, it is essential that HIT systems, including Electronic Health Records (EHRs),  are designed to supply actionable data for the measurement of dual eligibles and ultimately, to improve the care of this unique population and reduce costs.

Where Are We Now?

The future of the nation’s health measurement and  HIT agenda is at a cross-roads.  We are still in the process of changing old systems to move us into the health electronic age.  We are also in the process of developing and endorsing measures specific to the duals population.  As we do so, there are several key issues that we must focus on to improve the care of the dual eligibles population.  One issue that stands out above the rest is how to better manage this unique population, not just measure them.  It is not enough to just collect the data.   Rather, it is what we do with this data and the measurement findings that will ultimately lead to improvements in health outcomes and care delivery for dual eligibles. HIT can capture data that is critical in improving care coordination, care transitions and disease management for dual eligibles.  We must use this information to analyze clinical trends and better engage dual eligibles as well as help providers in clinical decision support.

It’s no surprise that in the world of health apps and iphones, we turn to HIT to revolutionize our health care systems and improve outcomes.  However, HIT alone is not the Holy Grail we seek.   Rather, HIT is only a tool to get us the data we need to measure and improve our patient outcomes, our clinical care, and our delivery systems.  The story cannot end with more measures and data.  Otherwise, we will simply collect a lot of good information without much action.  We must re-tool our delivery systems and health care culture so we can act on the data we capture such as changing patient care plans and engaging patients differently.  Essentially, we must focus on moving from health measurement to health management and outcome improvement.   This will take a stronger focus on analyzing the data, and measurement findings, using predictive modeling, and taking a more proactive rather than reactive approach.  Many Accountable Care Organizations and other health entities have embraced this new approach but it is far from the norm.  Can we afford to shift from measurement to management?  Many fear the cost of HIT alone is too great.   However, with duals costing Medicare and Medicaid $250 billion, can we really afford not to?



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 health information technology, 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.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.

Follow @nalinipande

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

A Post-Election Day Certainty: New Scrutiny for the Affordable Care Act
This week’s elections ensure a new round of political attacks on the Affordable Care Act, but they also create potential opportunities to repair provisions of the law that people on both sides of the partisan divide would like to fix.

Big data: Enabling the Future of Healthcare
Everyone’s talking about the importance of big data in healthcare. Yet, as the data piles up – most of it is isolated in different silos, and health systems are struggling to turn big data from a concept into a reality. Here’s how I see it having a substantial impact on the health of populations, today and in the future.

Electronic Medical Records, Built For Efficiency, Often Backfire
Electronic medical records were supposed to usher in the future of medicine. Prescriptions would be beamed to the pharmacy. A doctor could call up patients' medical histories anywhere, anytime. Nurses and doctors could easily find patients' old lab results or last X-rays to see what how they're doing. The computer system could warn doctors about dangerous drug combinations before it was too late.

Steward’s ACO focuses patient engagement efforts on 4 percent of covered lives
According to Girard, there are two fundamental processes in healthcare, information flows and people flows. The ideal, he said, is for both processes to be happening at the right time in the right place.

Coordinated care and patient engagement
The healthcare breakthrough of the 21st century may not come in the form of a miracle drug from the pharmaceutical industry. Rather, it's more likely to emerge from the ways caregivers interact and motivate patients.


Enjoy the weekend!

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.


Top Stories:

How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

Health Care Catches Data Fever
The United States is arguably in the midst of a health care crisis, but there is hope on the horizon and it involves learning how to make sense of big data. Over at Communications of the ACM, Oak Ridge National Laboratory (ORNL) shares how it is helping the health care industry benefit from patient data using the power of graph computing.

CFOs Feel Powerless When It Comes To Managing Healthcare Costs, Poll Finds
With U.S. enterprises spending more than $620 billion each year on healthcare costs, and nearly half of all Americans receiving their coverage through their employer, it’s no surprise that four out of five chief financial officers (CFOs) across all industries are feeling the pressure. In fact, nearly all CFOs (97%) believe that employers must “step-up” to the plate to help fix the broken healthcare system.

Omidria™ Granted Pass-Through Reimbursement Status from CMS
Omeros Corporation (NASDAQ: OMER) announced today that it has received transitional pass-through status for its lead product Omidria™ (phenylephrine and ketorolac injection) 1%/0.3% from the Center for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.

Health Groups Aim to Grow Pharmacists’ Care Delivery
Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), and the University of North Carolina (UNC) Eshelman School of Pharmacy have collaborated to generate new approaches to care delivery through pharmacists that will lower medical costs and improve health outcomes.

Have a great weekend!

Last Chance to Register for IIR's Specialty Pharmacy Collaboration Summit

 

Hurry! There's still time left to register for
IIR's Specialty Pharmacy Collaboration Summit!
Online registration closes this Sunday, September 14th
Register Now >>

IIR's Specialty Pharmacy Collaboration Summit is in 4 days! Don't miss out on the only event in the industry offering you the opportunity to partner directly with all the key stakeholders in the specialty pharmacy value chain to increase patient adherence, expand distribution and improve bottom line.


Across three days, you will:

• Hear never-before-heard case studies on accountable care impact on payer provider relations from BCBS, Tufts Health Plan, Denver Health Medical Plan, and more!
• Learn how to overcome the four key challenges in the specialty pharmacy ecosystem:
       o Adherence
       o Managing Costs and Determining Value of Specialty Drugs
       o Distribution of Specialty Drugs and Channel Management
       o Sustainability of the Specialty Pharmacy Model
• Improve operations and enhance compliance in the Pre-Conference Workshop with TWO specialty pharmacy accreditations - URAC and CPPA
• Facilitate more face-to-face meetings to foster meaningful engagement and build relationships with the event specific partnering360 networking tool

Download the updated brochure for full agenda and speaker details.

Don't forget! Online registration closes this Sunday, September 14th! Click here to register. Please be sure to use code XP1968BLOG in order to save $100 off you registration.

Rite Aid Receives URAC Accreditation in Specialty Pharmacy

In April, Rite Aid announced that it had been awarded Specialty Pharmacy Accreditation from URAC – an independent nonprofit organization that is well-known for promoting healthcare quality through its accreditation education and measurement programs.

“We are very proud to have received full accreditation as a specialty pharmacy provider from URAC” said Robert Thompson Rite Aid executive vice president of pharmacy. “Every day Rite Aid pharmacists are committed to providing all of our patients especially those receiving specialty pharmacy treatments with the best care possible. This designation from URAC recognizes our efforts and is great achievement for our Specialty Pharmacy team.”

"By applying for and receiving URAC accreditation Rite Aid has demonstrated a commitment to quality healthcare” said URAC President and CEO Kylanne Green. “In today’s healthcare market URAC accreditation provides a mark of distinction and we applaud Rite Aid for meeting strict quality standards and achieving URAC Specialty Pharmacy accreditation.”

At IIR’s Specialty Pharmacy Collaboration Summit, you can navigate the complex accreditation process with URAC and CPPA.

The number of specialty pharmacies is increasing exponentially. Therefore, maintaining a competitive advantage is critical for specialty pharmacies. Payers and manufacturers utilize accreditation as a key tool in determining which specialty pharmacies to partner with.

At IIR's all-new Specialty Pharmacy Collaboration Summit, hear from TWO leading specialty pharmacy accreditation associations as part of the Pre-Conference workshop on Monday, September 15th. URAC and CPPA will guide you through the complex guideline requirements for accreditation and the continuous quality improvement process to ensure patient safety.

Here's why you need to reserve your seat at this two-in-one accreditation workshop:

Payers & Manufacturers
• Equip yourself with information on quality standards
• Learn how to evaluate your partners better improving your bottom line
• Understand the accreditation process
• Make informed decisions on criteria used to assess specialty pharmacies

Specialty Pharmacies
• Understand the specifics of each accreditation and the criteria you will be assessed on
• Learn how to go about the process of receiving this endorsement
• Understand what payers and manufacturers look for when making a decision

Download the updated brochure for the full agenda and speaker details.

Don't miss out! Friday, August 22nd is your last chance to save up to $300! Click here or call 888-670-8200 to register. Be sure to use the code XP1968BLOG to save!

In the specialty pharmacy model, do all stakeholders win?

Welcome to the Specialty Pharmacy Collaboration Summit Podcast Series. Today we are speaking with Nick Calla, VP of Industry Relations, Community Specialty Pharmacy Network (CSPN)

Download the complete podcast & transcript here.

Is the specialty pharmacy model a win/win for all stakeholders? Basically, who wins and who loses as the industry grows?

Nick: That’s a very interesting question and sort of a future thought kind of question. When you think about specialty pharmacy, there are two wins, if you will. I think the patient ends up winning because they will get a higher degree of care in these higher touch models, whether it be through central fill – which is perfectly appropriate for some patients – or the community-based and even higher touch face-to-face model that we are working with and developing. I think the patient is a big winner in that space.

I think the provider is a big winner in this space. Again, the provider is a specialty. I’ll take a very specific example in the oncology community. As more and more products move away from infused therapy and move more into oral therapy, the provider needs an adjunct to the healthcare team in order to keep the patient on therapy and successful in their therapy. Side effect management, etc. Again, that’s where the specialist will win in using a specialty pharmacy as an adjunct to his practice.

I think the managed-care organizations are also quite honestly the winners in this space. The organization that ultimately is paying the bill --- well, the employer is paying the bill. But through the managed-care organization, they are winners as well because again you are getting patients compliant to therapy, staying on therapy and being successful on therapy. Ultimately, the goal is to reduce abandonment of therapy or short duration of therapy before you truly make a difference. Again, a very specific example of that would be in the Hepatitis B space where the duration of therapy is so important in achieving a response that can be sustained over time.

Finally, I want to mention the manufacturing community. Again, I think they win in this environment because they are able to promote their product, they have a higher degree of understanding that the patient that is on their therapy is going to be successful on therapy and compliant on therapy. Obviously, that means that they are marketing and selling the product that they have spent millions of dollars in getting to market in the first place. In my mind, everyone kind of wins in the specialty pharmacy model.

You say “Who loses?” I think the only way you lose in this model is if you don’t create a little bit more diversity in the model so that you don’t have as much fragmentation within the model and that the standard of care is consistent across all the different types of models, whether it is central fill or community based, etc. To keep that standard of care high and you basically maintain or retain the notion that specialty pharmacy was created as a high-touch model focusing in on intense counseling of the patient with the overriding goal of keeping the patient on therapy and managing their side effects.

As long you stay true to those basic tenets and don’t allow specialty pharmacy to turn into a quote/unquote “mail order” type of operation, then I think obviously all of the stakeholders I mentioned win. But, if you don’t maintain those, then I think really all the stakeholders end up losing in the end.

Click here to download the rest of the transcript and podcast.

To hear more from Nick, please join him at IIR's Specialty Pharmacy Collaboration Summit, September 15-17 in Boston. Also, you can save an EXTRA $100 off the current rate, $300 in total savings when registering by 8/22 with the code: XP1968BLOG - Register now.

Is Medicaid Expansion Feasible?

Welcome to the MDRP Podcast Series. Joining us today is Grace-Marie Turner, President, Galen Institute.

Download the complete podcast & transcript here.

Is Medicaid Expansion Feasible?

Grace-Marie: I just think that it’s going to be very difficult to convince those other states that have resisted so far because more and more evidence is coming down to show that expanding Medicaid as a traditional program as it is currently structured is real harmful to people. And it’s really harmful to the most vulnerable citizens who are on Medicaid today. If people have many chronic conditions, many of them have no place else to go. They are basically not insurable in the private marketplace. If they are under 100 or 138% of poverty, Medicaid really is their only option. As a result, you wind up with more people competing for the same limited number of doctors who will see Medicaid patients and making it even more difficult for people on Medicaid today to find a doctor to see them.

I had a father write to me recently who has a daughter who is on Medicaid – many chronic conditions and in a wheelchair. He said: “It takes me sometimes six weeks to get an appointment with her urologist”. He said: “Do they even think about how much more difficult it’s going to be to get an appointment with the urologist if there are a million more people competing for those same appointments?” So, we must fix it so that it allows the safety net to be intact for the most vulnerable people and give those who have the option to get private coverage to do so, so that they are not competing.

And then finally, I think that the states who want to expand the program need to guarantee that providers will be paid enough that they will be able to see a Medicaid patient. In some states like New Mexico that have a very high match rate, Medicaid pays at very close to Medicare rates. In other states, a doctor may be paid $5 or $7 for an office visit – not even enough to begin to cover expenses. Doctors want to take care of these patients, but they can only keep so many and keep the lights on and pay their own bills. So, we’ve got to be able to pay providers more and that’s the kind of leverage that I think that the states would be able to have if they were not so constrained by an avalanche of federal rules and all the “Mother May I?” waiver requests that they have to get to make any changes to their plan.

If they had more flexibility, then they could make sure that patients on the program today could actually find a doctor to see them and also make sure that those who may be in an expansion population have the option of coverage that looks more like the private insurance and the private marketplace so that it’s a track and a platform to private coverage rather than the cliff that Medicaid is today – either in or out. If you make $1 too much money then you’re out of Medicaid or $1 less and you’re in. It needs to be a smoother ramp to private coverage and there are a lot of ideas to do that, including giving people the option of basically taking their Medicaid allotment as a voucher to buy into private coverage. There are a lot of ideas out there to improve this program, but we need to remember that we’re doing it for the most vulnerable citizens who are on the program today, who have no place else to go, competing for a limited number of appointments with a shrinking number of doctors to actually get appointments.

We can do so much better and I think you’re going to see many more governors actually demanding those kinds of changes and that kind of flexibility in exchange for any expansion.




Click here to download the rest of the podcast.

To hear more from Grace-Marie, make sure you join her at MDRP 2014 this September 15-17 in Chicago. As a reader you can save an extra $100 off the current rate when using the code XP1958BLOG. Register now to save!

See you in Chicago.

Announcing IIR’s All New Specialty Pharmacy Collaboration Summit

IIR is proud to introduce the all-new Specialty Pharmacy Collaboration Summit taking place September 15-17, 2014 in Boston, MA.

This collaborative summit is designed to facilitate networking and integration between all key stakeholders in the evolving specialty pharmacy value chain, including the leading pharmaceutical manufacturers, health plans, and specialty pharmacies.

Register now to save $600! Plus take an EXTRA $100 off with the code: XP1968BLOG - That is $700 in total savings! Register today!    

To see how you can expand distribution, increase patient adherence and improve your bottom line, download the brochure.

Develop consistency and clarity around the integration of all specialty pharmacy stakeholders through:

• Never-Before-Heard Case Studies on accountable care Impact on payer provider relations from:
• Aetna
• BCBS
• Tufts Health Plan
• Denver Health Medical Plan
• And more!

• URAC Accreditation Workshop to improve operations and enhance compliance.
• Facilitate more face-to-face meetings to foster meaningful engagement and build relationships across 3 days than in your entire year with partnering360.

Remember, to save an EXTRA $100 off the current rate, use the code: XP1968BLOG when registering.
  _______________________________________

Connect with Potential Partners and Clients

To learn more about how to sponsor or exhibit, please contact Patricia Rose at 508-614-1406 or prose@iirusa.com.

How will the sequester affect you?

So what exactly is the sequester? It was signed by President Obama back in August 2011 to raise the debt limit. Initially, this bill would never be used because Congress would eventually create a plan for the deficit reduction. If no plan was created, an automatic sequestration would go into effect and as of today, the two parties have not been able to come to an agreement.So what happens now?

The military will see $550 billion in cuts, drawing funds away from national security and military operations. On the domestic side, cuts will affect health care, education, law enforcement, disaster relief, unemployment benefits, non-profit organization funds, scientific research and more. The sequester stipulates certain areas of government spending that will see no cuts. No money will be drawn from spending on wars and military personnel. Funding allocated for Medicaid, Social Security, Pell grants, veterans' benefits and some low-income programs will not be affected, either. 

While programs like Medicaid will not be affected, many basic care community centers will. As well as many research based jobs. How will this impact the future of research and development for health care? 

Want to learn more about Government Programs? It's not too late to register for 5th Annual Government Programs Summit, March 11-13. As a reader of this blog you'll receive 10% off when you use XP1851BLOG to join. To view our full program, download our brochure. We look forward to seeing you in Baltimore!

Happy Holidays from Health Care - From Policy to Practice

We're taking some time off from our coverage of the health care industry to celebrate the season with our loved ones. We want to sincerely thank you for your readership, your comments and your participation. We look forward to returning to the world of healthcare policy in 2011!

Here are our top posts from 2010:
MDRP 2010 Conference - AMP after HCR: Implementation is Here – What Issues Still Remain?
MDRP 2010 Conference - Operational and System Answers
MDRP 2010 Conference - Translating the Impact of Healthcare Reform on your Medicaid, Medicare and PHS/340B Processes

We wish you Happy Holidays!

Rate of Growth in Healthcare Spending at its Lowest

This article in Modern Healthcare discusses how healthcare spending in the US is experiencing the slowest rate of growth in nearly 50 years. Spending growth has only grown 4.4% in 2008 to $2.3 trillion, which is almost a historic low.

It is clear that the economic recession has affected healthcare spending as well as making it difficult for people to afford private insurance. Private insurance benefits also grew at it slowest rate since 1967. What are your thoughts on this decrease in numbers?

Funding Recommendations for President Obama's Health Care Reform

More and more people are beginning to disapprove of Obama's health care reform as time goes by. Les Leopold detailed in this recent article in The Huffington Post a couple of things President Barack Obama could do to gain back the trust of the public with his health care reform. Les mentioned that Obama has yet tapped into the wealthy in order to fund the health care reform, even though Wall Street has received a bail out. Here are some things Les believes the president should consider:


1. Increases taxes on those who have adjustable gross incomes of over $1 million a year.
By collecting an extra 10 percent surcharge for health care from these wealthy returns we can collect an extra $140 billion per year.
2. Place a 90 percent windfall tax on Wall Street profits and bonuses.
If executives are able to still collect bonuses from banks that we own, then the majority should be taxed back to us. It is only fair.
3. Install a very small tax on each and every financial transaction on Wall Street.
A fee on Wall Street transactions would generate nearly $50 billion a year.

Do you agree with Les Leopold's recommendations?

Obama Makes his Case on Healthcare at Town Hall

As we wait and see what will happen over the course of the next week when Obama makes several appearances to convince the American public that his proposed plan will benefit them, make sure to check out the live-blogging being done by David Stout of the NY Times. So far President Obama has mentioned that Americans spend roughly $5,000 to $6,000 more on healthcare than people of other advanced countries. Check the NY Times blog to see live updates of his town hall meeting.

Obama to Hold Town-Hall Meetings to Face Growing Concerns from Democrats

This latest article in The Wall Street Journal blog discusses how President Barack Obama will hold three local town-hall meetings in order to convince the American public that his new health insurance plan will benefit them.

Obama will focus on emphasizing how legislation would help solve these three problems: the practice of denying insurance coverage to those with pre-existing illnesses, keep people from losing insurance coverage if they get sick, and protecting Americans that face high out-of-pocket costs. Republicans already favor two of three changes Obama proposes, but we will see how Democrats will view these changes shortly, as they have already voiced their concerns.

An Alternative to Obama's Healthcare Reform

Obama has seem much opposition to his proposed healthcare reform. Here in The Ithaca Journal Bob Yates suggests an alternative to Obama's healthcare reform. Bob suggests that instead of setting up a new plan that would be cheaper than private plans but yield high taxes, we should open up Medicaid and Medicare to everyone and allow people to buy into Medicaid which is on average $8,000 a year.

He also suggests a dollar-for-dollar credit on medical spending on everything. While this seems like a great alternative, is it really feasible?

Government Run Healthcare

According to Thomas DiLorenzo's post in the Ludwig von Mises Institute blog the more money we have spent on government-run healthcare in the past, the less healthcare we have gotten in return. He mentions that since there are no profits, there is no rewarding system that penalizes for bad performance and encourages good performance. Thomas notes that the federal government is actually doing the opposite, giving higher budgets to those hospitals that are failing in performance and reducing budgets for those that are performing well. Here are some examples Thomas including in his post from a NY Times article entitled "Full Hospitals Make Canadians Wait and Look South"

* A 58-year-old grandmother awaited open-heart surgery in a Montreal hospital hallway with 66 other patients as electric doors opened and closed all night long, bringing in drafts from sub-zero weather. She was on a five-year waiting list for her heart surgery.

* In Toronto, 23 of the city's 25 hospitals turned away ambulances in a single day because of a shortage of doctors.

* In Vancouver, ambulances have been "stacked up" for hours while heart attack victims wait in them before being properly taken care of.

* At least 1,000 Canadian doctors and many thousands of Canadian nurses have migrated to the United States to avoid price controls on their salaries.

What's your take on socialized healthcare?

Obama's healthcare reform

President Obama realizes the nation is not sure about his proposed $1 trillion overhaul of the medical system. He believes that this is the only way for economic recovery to be possible. He believes that our economy could worsen if the overhaul is not completed soon, and that many Americans would continue to be hurt financially. Obama urges Congress to vote in early August to solve this problem as soon as possible because he believes that by controlling cost, the deficit of America and its citizens can be controlled. Read the full article at the New York Times here.

Intel and General Electric Plan to Add More Connectivity Options to Intel Health Guide

According to this article in eWeek Intel and General Electric will invest roughly $250 million over the course of the next five years to develop and improve IT technologies in the Intel Health Guide to better aid linking patients to their physicians and caregivers.

The improved system will allow patients to directly connect with their physicians via high-speed broadband and residential phone services. Louis Burns, vice president and general manager of the Intel Digital Health Group mentions, "We believe that deploying technology in the home can help pave the way for a more personalized, cost-effective health care system and we will continue to innovate and develop products that achieve this."

It will be interesting to see how new technology and improvements to the IT infrastructure will pan out over the next couple of years.

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