Today on THCB Spotlights, Matthew talks to Jacob Reider. Jacob is the CEO of Alliance for Better Health, one of New York State’s 25 Performing Provider Systems which work to reduce unnecessary or preventable acute care utilization for Medicaid members by improving the health of communities. Alliance for Better Health has a new approach to this—they’ve created an Independent Practice Association (IPA) called Healthy Alliance IPA to pull together community based organizations focused on improving health and addressing the social and behavioral aspects of health. Their approach helps the 29 organizations within the IPA negotiate funding and creates an infrastructure for integrating social determinants of health into health care. Watch the interview to find out how this is going to work in practice.
Meet the First Aledade ACOs
On June 18, we launched Aledade – a company built on our belief that independent primary care physicians are best positioned to lead the next revolution in health care delivery – boosting quality of care and bringing down costs. Over the past six weeks, we traveled across the country meeting doctors, discussing the future of independent primary care practice, and recruiting physician partners for our first wave of Accountable Care Organizations.
Meeting these doctors, from areas and backgrounds as diverse as the populations they serve has been a constant reminder of the reasons we founded this company. One physician, having spent decades serving the same community from the same office, lamented that in the past, he felt more involved – and more informed – about all aspects of his patients’ care. Today, he told us, fragmentation in care delivery had given him less insight into his patients’ health, and less influence in coordinating their treatment.
When we started Aledade, these were the type of doctors we wanted to empower.
Today, I am elated to announce that we have formally submitted applications to the Center for Medicare & Medicaid Services to form ACOs serving physicians in Delaware, Maryland, New York, and Arkansas for 2015. We expect this first wave of Aledade ACOs to serve tens of thousands of Medicare patients beginning January 2015.
The choice of four dissimilar states was intentional. We intend to establish a model that can be replicated across the country, and the diversity in our practices matches the diversity of our country. Each state has strengths to build on. Delaware- ‘the First State’ has been a leader in electronic health record implementation. Maryland and New York’s health reforms set the stage for alignment and collaboration with acute-care facilities. Arkansas’ tradition of independent primary care practice is strong. We’ll also be serving very different patient populations in each state – from practices that serve urban neighborhoods to those that treat folks in small towns and rural communities.
Reports Suggest Exchange Numbers Are Very Low
“Well, Facebook Wasn’t Built In a Day.” – Unnamed Exchange Developer.
More than 4.8 million users visited Healthcare.gov for the grand opening of the federal health insurance marketplace on Tuesday, according to officials.
It didn’t go quite as planners had hoped. In fact, if there was an unofficial word of the day, it was glitch.
Many users of Healthcare.gov reported long delays and difficulty accessing the federal insurance marketplace, experiencing “glitches” ranging from error messages to blank pages. The problems were repeated at state-run exchanges around the country to varying degree, from California to New York.
Pundits like Wonkblog’s Ezra Klein were quick to point out that the political victory the GOP might have gained from the uncertain start was largely lost in the uproar in Washington over the government shutdown, which dominated news reports.
At least one frustrated user chronicled the experience (see related post ‘Descent into Madness: One Man’s Visit to Healthcare.gov, October 1st ). Others took to Twitter to express their outrage or show off their savage or finely-tuned senses of humor.
Users of the federal exchange reported problems including error messages (see above), funky dropdown menu behavior, page freezes, blips, broken links and long page load times — generally either a sign of high volume or inelegantly designed databases.
HHS officials declined to reveal how many people signed up for new insurance plans overall, leading some theorists to speculate that not very many people were able to make it through the process successfully. In point of fact, there were suspiciously few reports of users successfully completing the registration process at all, probably not a very good sign and possibly an indication of a disaster.Continue reading…
What Happens In New York Stays In New York
While sitting in the crowded waiting room of a medical specialist’s office I was forced to listen to the television set directly over my head. Cranked up so that everyone could listen above the din of conversation, Wolf Blitzer introduced a video clip of the President hailing the latest news from New York about health insurance exchanges.
Speaking as if he was still on the campaign trail, the President’s words came through loud and clear over the television: thanks to his health reform, premiums in the New York exchange would be half that of premiums in the individual market. This was a model the entire nation should embrace.
No one heard me mutter under my breath that this was a model for New York and a small handful of other states that previously regulated their individual insurance markets effectively out of existence.
What the President undoubtedly knows, but dared not say, is that New York’s individual insurance market is unlike any other state. In New York, insurers cannot charge higher premiums to high risk enrollees.
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Health 2.0 EDU offers online classes with the world’s top experts in health care and information technology. Tuesday, July 23rd at 3pm/6pm ET join Alteryx ‘s George Mathew as he explains Customer Analytics: Leveraging Data Blending & Predictive Modeling for Member/Patient Satisfaction. Sign up here.
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As a result of this aggressive community rating, high risk individuals are disproportionately represented in New York’s individual policy risk pools. This drives up premiums, which drives away low risks, driving premiums even higher. Insurers in New York are counting on the purchase mandate, combined with purchase subsidies, to lure low risks into the pool.
This is why they have lowered premiums.
A $910 Million Price Tag For California Exchange: A Dark Omen of Things to Come
So far California has received $910 million in federal grants to launch its new health insurance exchange under the Affordable Care Act (“Obamacare”).
The California exchange, “Covered California,” has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years.
The state will also spend $250 million on a two-year marketing campaign. By comparison California Senator Barbara Boxer spent $28 million on her 2010 statewide reelection campaign while her challenger spent another $22 million.
The most recent installment of the $910 million in federal money was a $674 million grant. The exchange’s executive director noted that was less than the $706 million he had asked for. “The feds reduced the 2014 potential payment for outreach and enrollment by about $30 million,” he said. “But we think we have enough resources on hand to do the biggest outreach that I have ever seen.”
