The Health Care Blog – Page 522 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Letting the Data Speak: Estimating County Health Care Costs In Washington State

Nov 6, 2013• 1

By Frank de Libero

Besides state and higher-level health care expenditures, county level HCE are useful, integral really. For example, to promote the Triple Aim (the best care for the whole population at the lowest cost) you need per capita HCE. And knowing those costs at the county level would help a lot. However, county estimates generally don’t exist. They didn’t in Washington State until a client needed cost estimates for our 39 counties. To supply those estimates I used a regression approach resulting in this model:

percaphce = +0.1*percapinc + 247*pctage65 + 0.71*percapmedaid + 10.5*pctrural – 1349

Washington State Context
Before discussing model rationale and county HCE estimation, here’s some context about Washington State and its counties. You might view Washington as a microcosm of the nation. It has mountains, forests, deserts, rivers and lakes, vast rural areas, major cities, diverse populations and industries, and a varied climate. It is distinguished by active volcanoes and a coastal border. There is a wide range of political, social and economic clusters. In 2010 King County, where Seattle is located, median annual household income was about $67 thousand (the U.S. median was roughly $50 thousand) yet there are state counties where one in three children live in poverty. The total population is approximately 7 million with half of those people living in just three of the 39 counties.1 At the other end about a third of the counties have populations of 30 thousand or less.

An Aside about Seattle Weather
You may have been told that it rains all the time in Seattle. I live in Seattle and can tell you that’s a myth. Seattle’s average annual rainfall is less than New York City’s. However, during a good part of the non-summer months Seattle, and Puget Sound generally, is grey and cloudy. I once heard a story about the original settlers who landed in November, 1851, at Alki near present-day Seattle. The story is they were there for months before the weather finally cleared and they saw Mt. Rainier for the first time. I don’t know if that story is historically true, but as a Seattleite it’s believable. Regardless, Seattle is a summer paradise. Seattle summers, like most of Puget Sound, are characterized by pleasant sunny days, cool nights and no mosquitoes.

Background for the County HCE Estimates
Last year Empire Health Foundation of Spokane, Washington, asked me to estimate HCE for the 39 counties in the state. The purpose was for an upcoming meeting of policy types such as county commissioners, members of various health organizations, and other stake holders. A theme would be Donald Berwick’s Triple Aim, so cost estimates were wanted for benchmarks and context. The CMS2 Office of the Actuary had recently developed state HCE.3 If I could build a reasonable regression model on state-level data to predict state HCE, and there were similar variables at the county level, I could use the state model to estimate county HCE. That’s the approach I took. A caveat is my understanding was that acceptance—believability and reasonableness of the estimates to a lay audience—were as important as accuracy.

Quality Measurement 2.0

Nov 6, 2013• 3

By John Halamka, MD

I’ve written several posts about the frustrating aspects of Meaningful Use Stage 2 Certification. The Clinical Quality Measures (CQMs) are certainly one of problem spots, using standards that are not yet mature, and requiring computing of numerators and denominators that are not based on data collected as part of clinical care workflow.

There is a chasm between quality measurement expectations and EHR workflow realities causing pain to all the stakeholders – providers, government, and payers. Quality measures are often based on data that can only be gathered via manual chart abstraction or prompting clinicians for esoteric data elements by interrupting documentation.

How do we fix CQMs?

1. Realign quality measurement entity expectations by limiting calculations (call it the CQM developers palette) to data which are likely to exist in EHRs. Recently, Yale created a consensus document, identifying data elements that are consistently populated and of sufficient reliability to serve in measure computations. This is a good start.

2. Add data elements to the EHRs over time and ensure that structured data input fields use value sets from the Value Set Authority Center (VSAC) at NLM. The National Library of Medicine keeps a Meaningful Use data element catalog that is likely to expand in future stages of Meaningful Use.

World of Health 2.0 – Interview with Matthew Holt, Co-Chairman

Nov 5, 2013

By Harriet Messenger

The following is an interview of Matthew Holt, Co-Chairman of Health 2.0.

Harriet Messenger – How did Health 2.0 begin?

Matthew Holt – My interest in health began in the early 90s when I found myself doing a study on healthcare in Japan. That then led to getting involved in Japanese versus American comparative health care; which, finally led to me getting a job in health care policy at a place called Institute for the Future. They had a huge technology forecasting component but no one was doing health information technology, so I put the two together.

Around that time the internet got going; there was a sort of E-health stock boom in the late Nineties, so I was involved in looking at that. Some years later I began a blog called The Health Care Blog and as part of that I was spending a lot of time looking at the re-emergence of ‘Web 2.0’, which was the re-emergence of information technology on the web, reaching out to the consumers, doctors, entrepreneurs, etc.

At the same time I met Indu Subaiya, who is my co-founder and my co-chairman. We realised that no one was paying attention to these guys, and that’s when we thought about creating a conference that brought all these great minds together. And that is how Health 2.0 started.

HM – And would you say that Health 2.0 is living up to your initial vision?

MH – Yes, but it takes forever to do anything in health care. Health care has the same problems it’s always had: getting data to the decision maker – whether that is patient or the doctor – and getting the right treatment plans in place for the patient. These are the same problems across the world. However, with the advent of new technology, mostly in the last 20 years, there have been big advances and changes in the way that health care is both consumed and delivered.

I’ve never thought Health 2.0 was going to change the world in three years. I believe that this type of technology is a big deal, but it is going to take time. We are now in the middle of that time – it’s starting now.

Health 2.0 Tools for the Elderly at Health 2.0 Europe

Nov 5, 2013• 13

By Maneesh Juneja

In 2 weeks’ time, at Health 2.0 Europe, I am moderating a pre-conference workshop ‘Health 2.0 Tools for the Elderly’. Dr Leslie Kernisan wrote a blog post after attending the recent Health 2.0 Silicon Valley conference, observing that most Health 2.0 solutions are not designed with the elderly in mind.

That’s why I was very impressed when Health 2.0 invited me to curate and moderate the workshop on Nov 17th in London. We have 11 different technology solutions designed specifically for the elderly being demonstrated at the workshop. Having worked in the pharmaceutical industry, I acknowledge that technology is only one out of the array of solutions available to society.

Looking at the forecasts about the aging population, it’s way too easy to view the elderly as a burden, not a resource. Older people with their talents, wisdom and life experience have much to share with younger members of society. Could technology be used to connect those opposite ends of the age spectrum?
Continue reading…

The Latest Mystery: What Is Happening to All Those Paper Applications?

Nov 5, 2013• 11

By ROBERT LASZEWSKI

Enrollments continue to trickle in. Health plans, with the kind of market share that would have to sign-up 100,000 to 200,000 people for the administration to hit its goal of 7 million people, are generally reporting they have enrolled only about 100 – 200 people over the first 35 days via Healthcare.gov.

Does this mean no one wants to sign-up? No. People can argue about whether we will see the administration hit their goal of seven million or we will end up getting two or three million relatively sicker people for all of the problems Obamacare has faced. But, undoubtedly millions of people, including all of those people who just got cancellation notices, do want to see what they can get for what cost and make a decision about signing up. But they can’t because they aren’t able get through the entire Healthcare.gov website.

As I have said before, Healthcare.gov, because of its many problems, is in de facto shutdown because virtually no one is able to really use it.

Why doesn’t the administration just tell people the site is still too frustrating for people to waste their time on until it is fixed? Instead, the administration says it is getting better and people should keep trying to make it through the gauntlet. More, they are telling them to call the 800 number to fill out a paper application.

If it is better, it is still not better enough for more than a very small trickle to make it through each day.

Many states have literally dozens of complex health plan choices on the federal exchange––each insurance company on the various exchanges is likely offering the four different plans. I find it hard to understand how a consumer can get any real sense of the options over the phone much more be able to understand which plans cover which doctors and hospitals. People really need to see the options on their computer or on the computer of a navigator or an insurance agent to understand what is available and how it fits their needs.

And, as ABC and NBC reported yesterday evening, the paper applications ultimately have to go through the Healthcare.gov system anyway. One thing is crystal clear from the health plans meager enrollment to date; the insurance companies are not getting these “thousands” of paper applications. Where are they sitting?

November is the New October

Nov 4, 2013• 7

By Charles Ornstein

Many health care experts and journalists, including me, felt that the month of October would be the key barometer of the success of Healthcare.gov, the online health insurance marketplace that is a cornerstone of the Affordable Care Act.

But as days became weeks, and the problems plaguing the website stubbornly went unfixed, the question now is whether the administration can make the website work well by the end of this month and salvage the president’s signature achievement. If Healthcare.gov, which handles health insurance enrollment for 36 states, is working well at the end of this month, it will leave consumers just two weeks to choose plans if they want them to take effect on Jan. 1, 2014.

In other words, November is the new October.

The din of partisan accusations and counter-accusations is deafening and only getting louder. But in the interest of finding out what’s really happening on the ground, I consulted Kip Piper, who advises large health care organizations on Medicare, Medicaid, and health reform policy, finance and business strategy.

Piper has served as senior advisor to the administrator of the Centers for Medicare and Medicaid Services (CMS), Wisconsin state health administrator, director of the Wisconsin Medicaid program, a senior Medicare budget officer at the White House Office of Management and Budget, among other roles. He is articulate and clear-headed.

While Healthcare.gov Struggles, A Different Story Plays Out On The Private Exchanges

Nov 3, 2013• 29

By LISA SUENNEN

All eyes are on the hullaballoo created by the challenges at Healthcare.gov and several of the states’ public insurance exchanges. Yet all the while, like in a magic show, attention has been diverted from the real action going on elsewhere. Quietly and in a relatively drama-free way, the private health insurance exchanges are busily taking over the world of insurance and, in my opinion, portend a radical set of changes in how our health insurance system operates.

Several years back, a number of companies began building private health insurance exchanges to initially help companies offload the incredible burden of retiree benefits. Companies such as Extend Health (now owned by Towers Watson), Senior Educators (now owned by Aon), and several others provided a way for large employers to get themselves out of the business (and balance sheet liability) of providing group benefits for retirees, instead providing them with money to purchase their own individual health policies through then small, now large companies. The private exchanges went about the business of building websites that work, call centers that buzz and a wide array of insurance product offerings at various prices. Now, several years later, hundreds of thousands and possibly millions of individuals are out there shopping their little hearts out, choosing their own plans, and dealing with the consequences of high deductibles and the like.

These various private exchanges are now poised and ready to begin serving active employees in 2014 as guaranteed issue (the requirement that all can be insured and no one turned away) goes into effect as a result of the Affordable Care Act. And lest you think this is a small marketplace, you are wrong. In 2008 there were about 120 million total employed workers and just over half of these worked for companies of 500 employees and above (39 million worked for companies with 5000 employees or more). In other words, we are talking about nearly half of American adults and that doesn’t even include the dependents they bring along into their insurance plan.

Interestingly, such large US employers as Walgreens and Petco and DineEquity (parent company of Applebee’s Neighborhood Grill & Bar® and IHOP® restaurants) are all-in on the private exchange program, committing to transfer all of their employees from group plans to the exchange to purchase individual plans come January 2014. The exchanges of Towers, Aon, Mercer, Buck Consultants and a plethora of others are alive and well and open for business at exactly the time when employers are trying to figure out how fast they can reasonably get out of the middle of health insurance administration and run for the hills.

Making Hospital Prices Matter

Nov 3, 2013• 4

By PETER UBEL

I recently learned about a company called OpsCost, which has a very user-friendly website designed to help people figure out how much different hospitals charge for a wide range of treatments and procedures. The company makes use of the data that the Medicare program has recently made available to the general public, and then presents those data more elegantly than many other sites I have seen. You can go here to look at the company website, and you will quickly find yourself looking up prices for hospitals in your region. (Disclosure: I have not received any money from any price transparency companies, nor entered into any business relationships.)

For example, I told the website that I wanted to look at hospital prices near Durham, North Carolina, for “Hip & Femur Procedures Except Major Joint Without Complications And Comorbities/Major Complications And Comorbities,” and the program showed me a list of hospitals and prices, with a Google map on the right-hand side showing where each hospital was located. Pretty nifty.

But is it useful?

The ACA May Kill Me

Nov 2, 2013• 51

By G-Mom

Through a bad roll of the genetic dice, I am the unhappy host for several, rare chronic diseases. Any one of these would render me uninsurable, but the combination of them makes me incurable, and very difficult to treat. The deadliest thing that I can encounter is a well-intentioned but uninformed doctor.

I have currently have excellent insurance through my husband’s job that allows me to see my varied team of treating physicians. Two are in other states, and the rest are all heads of their departments, but none share a hospital or healthcare group. If my husband were to lose his job, I would be placed into the “high-risk-pool,” if there were any slots left, or forced onto the exchanges where my physician options would be cut significantly.

I would likely be forced to pay for healthcare coverage that I cannot use, since many doctors have been unwilling to even attempt to treat me, despite my “Cadillac” insurance plan.

I would likely have to pay cash to see my current team of physicians, which would be a tremendous financial burden on my family and likely end in bankruptcy.

I was cautiously optimistic when I heard of the end of the pre-existing condition exclusions for health insurance, but the current law will not help me at all. It does not expand my insurance options, it will definitely NOT be less expensive than what I have now, and if I am forced to see a well intentioned, overworked and uninformed (or even distracted) doctor, it just might kill me.

BTW: I am NOT disabled, and do not take any form of government assistance. I have owned my own business and paid that higher tax bracket for over 20 years.”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. Drop us a note.

I’m Male. A Non-Smoker. And in My Fifties. Can Somebody Please Explain Why I Have to Pay for Maternity Coverage?

Nov 2, 2013• 59

By THCBist

A THCB Reader in Maryland writes:

“I realize many individual health insurance policies are being cancelled because they are not in compliance with the ACA’s new requirements.

Do the new ACA requirements effect all individual plans sold or just those available in the exchanges?

In other words, if I am a self employed, single 50 year old male who does not want maternity, pap smears and mammograms; can I solicit an individual policy outside of the exchanges that meets these needs? For that matter, could I find a policy in the exchanges that meets these needs?”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. Drop us a note.