Insuring Resources Commentary:
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Showing posts with label episodes of care. Show all posts
Showing posts with label episodes of care. Show all posts
Wednesday, February 17, 2010
Wednesday, January 20, 2010
Health care reform divide grows deeper
Insuring Resources Commentary
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
Wednesday, August 19, 2009
Episodes of Care Based Healthcare Reimbursement Explained
I've talked a lot about changing healthcare reimbursement from basic fee-for-service to reimbursing based on outcomes called "episodes of care". Here's a non-technical, consumer friendly overview of it from the Robert Wood Johnson Foundation.
Using Episode Payment to Fix Our Fragmented Health Care System
Can Episode-of-Care Based Payments Be the Bridge That Finally Brings Accountability to America's Fragmented Health Care System?
A critical part of restructuring the health care delivery system is the need to develop an effective payment formula that rewards professionals for delivering high-quality, coordinated and efficient care.
Many argue that the current fee-for-service and per-patient (capitation)-style payment models have led to a fragmented U.S. health care system beset by poor performance and dysfunction. Rather than encouraging value-driven health care, these reimbursement models reward volume-driven care—where providers are paid for “doing things” (often too many or not enough), rather than working together to deliver quality services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.
In a Perspectives article published online in the New England Journal of Medicine, authors François de Brantes, Meredith Rosenthal and Michael Painter discuss how episode-based payments—and specifically the RWJF-funded PROMETHEUS Payment® model—might be the bridge that brings integration and accountability to America’s fragmented health care system.
A revolutionary payment model currently being piloted in communities across the country, PROMETHEUS Payment offers a potential blueprint for a new health care payment system. It effectively promotes and rewards high-quality, efficient, patient-centered care; provides common performance incentives for all parties; and creates an environment where doing the right things for patients also allows providers and insurers to do well financially.
LINK to the extended article: http://www.rwjf.org/qualityequality/product.jsp?id=47429
Using Episode Payment to Fix Our Fragmented Health Care System
Can Episode-of-Care Based Payments Be the Bridge That Finally Brings Accountability to America's Fragmented Health Care System?
A critical part of restructuring the health care delivery system is the need to develop an effective payment formula that rewards professionals for delivering high-quality, coordinated and efficient care.
Many argue that the current fee-for-service and per-patient (capitation)-style payment models have led to a fragmented U.S. health care system beset by poor performance and dysfunction. Rather than encouraging value-driven health care, these reimbursement models reward volume-driven care—where providers are paid for “doing things” (often too many or not enough), rather than working together to deliver quality services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.
In a Perspectives article published online in the New England Journal of Medicine, authors François de Brantes, Meredith Rosenthal and Michael Painter discuss how episode-based payments—and specifically the RWJF-funded PROMETHEUS Payment® model—might be the bridge that brings integration and accountability to America’s fragmented health care system.
A revolutionary payment model currently being piloted in communities across the country, PROMETHEUS Payment offers a potential blueprint for a new health care payment system. It effectively promotes and rewards high-quality, efficient, patient-centered care; provides common performance incentives for all parties; and creates an environment where doing the right things for patients also allows providers and insurers to do well financially.
LINK to the extended article: http://www.rwjf.org/qualityequality/product.jsp?id=47429
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