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Job Post: Home and Community Based Services (HCBS) Policy Director

Nov 1, 2010• 1

Organization: The Service Employees International Union (SEIU)

Location: Washington, D.C.

The Service Employees International Union (SEIU) is seeking a talented and forward-thinking individual for the position of HCBS Policy Manager. This is a senior-level position within SEIU Healthcare, one of the union’s three operating divisions, and will report to the Home Care Director. The HCBS Policy Manager will have lead-level responsibility for the following:

Providing overall leadership to SEIU’s policy work in the area of home and community based services (HCBS)
Cultivating and maintaining relationships with allied organizations, academic policy experts, government policy-makers and other stakeholders in order to achieve program goals and to drive joint work
Conducting research and policy analysis and developing legislative and regulatory proposals
Developing policy white papers & other written documents for both internal and external audiences
Collaborating with our government affairs staff on lobbying and federal legislative priority-setting
Serving as a resource on long-term care issues for other SEIU staff in DC and in our local union affiliates

The focus of the work is on influencing policy-making at the federal level, though intermittent support of state-level efforts is also part of the job.

PPACA Premium Subsidies: The Government Is Here to Help You!

Nov 1, 2010• 2

By ROGER COLLIER

If anyone ever doubted the extent to which Congressional committees could turn good intentions into a bureaucratic nightmare, they need only to look at PPACA’s premium subsidy provisions and their potential impact on insurance exchanges.

PPACA offers premium and enrollee cost-sharing subsidies for lower-income people not eligible for Medicaid or SCHIP as one of the three key components—along with liberalizing Medicaid income restrictions and requiring everyone to have coverage—of reform’s attempt to solve the affordability problem that’s led to fifty million Americans being uninsured.

How will the subsidy process work? It takes up 25 pages of the final reform legislation, so the following is a vastly simplified description. It’s also one that assumes that the final regulations will not deviate significantly from the law itself.

First, anyone wishing to be eligible for a subsidy must submit an application to an exchange. The application must include all information necessary to determine if the applicant is eligible for Medicaid or SCHIP, as well as for the PPACA subsidies. (Massachusetts’ Connector—the prototype exchange—requires a 12-page page form to convey this information.)

Steve Krein talks OrganizedWisdom

Nov 1, 2010• 2

By Matthew Holt

And in the “stuff I should have posted a few weeks back” file, here’s my interview with Steven Krein, CEO of OrganizedWisdom. Steve (with Unity Stoakes) runs one of the more interesting companies in the online health search and content space. OrganizedWisdom uses actual humans to direct people looking for very specific information to the best content–via their core offering the WisdomCard. As you might imagine that’s harder said than done, so following me teasing Steve a little about him not being at the most recent Health 2.0 Conference (the first and hopefully last they’ve missed), I got him to talk about and show the new WisdomCards and the Expert Health Graph. It’s well worth watching and Steve also gets to hint about some forthcoming news about expanding the presence of WisdomCards much deeper into the health care experience.

Losing Patients With Insurers

Oct 29, 2010• 70

By ROB LAMBERTS, MD

We are losing patients. Certain insurance companies are trying to “play hardball” with doctors, unwilling to negotiate with us over their outlandishly low rates. We have lost patience.

So the signs went up in the exam rooms today:

As of the start of the year, we will only accept X, Y, and Z Medicare advantage plans, and we are presently negotiating with A and B insurance companies. Please consider this when enrolling in plans.

It is highly likely we will drop one of the insurance plans altogether, and we are one of the last practices in our town to accept them.

Patients are distraught. Some of them who have seen us for years are now going to have to go elsewhere, while others that just joined our practice because their previous doctors dropped out of the plan will once again have to find a new doctor. Patients aren’t mad about this, just sad. The conversations go like this:

“So you are dropping X insurance?”

“We will if they don’t change. They are paying us significantly less than other plans.”

“That’s crazy. We just left a doctor because of the same thing. Now we have to move on.”

“Yeah, I am very sorry about that. I just want to see patients; I don’t want to do this kind of thing.”

“Well, I don’t blame you. They pay $1000 for an ER visit for an ear infection, and they won’t pay you what you charge?”

Connected Healthcare: Wellness and Emerging Technology

Oct 29, 2010• 1

You are invited to attend Massachusetts Institute of Technology (MIT) Enterprise Forum’s latest Networking/Panel Event, Connected Healthcare: Wellness and Emerging Technology on Wednesday, November 17th.

Technology is changing how people connect with one another, and the interaction between doctors and patients is next. Never-before-seen opportunities are emerging to further process and analyze data to enrich healthcare outcomes. Please join us for an edifying discussion, and a networking hour to include hobnobbing with movers and shakers in the NY tech scene. Details can be found at:

http://www.mitef-nyc.org/mc/community/eventdetails.do?eventId=292906&orgId=mefny&recurringId=0

DATE: Wednesday, November 17th 2010

TIME: 5:30PM (Reception); 6PM (Panel); 7:30PM (Networking)

PLACE: Chadbourne, Parke LLP, 30 Rockefeller Plaza, New York, NY 10112

THCB Recommends …

Oct 29, 2010

So That’s How The Rates Are Set

Oct 29, 2010• 9

By PAUL LEVY

The Wall Street Journal published a very important article this week. Written by Anna Wilde Mathews and Tom McGinty, it is entitled, “Secrets of the System: Physician Panel Prescribes the Fees Paid by Medicare.

Here’s the lede:

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

Engage with Grace

Oct 29, 2010• 4

By Alexandra Drane

This is the full text of Alexandra Drane's talk about Engage with Grace at TEDMED. I'm so proud of Alex for what she's done and her talk was outstanding–Matthew Holt

So when I heard that I was going to be speaking with all of you about end of life, I was a little sad at first…even though end of life is an obsession of mine….because TedMed is such a sexy event, and speaking here is such an honor. I wanted to talk with you about something like vitality – feeling alive, being empowered, taking life into your own hands…but then it hit me… that’s what end of life actually is – that’s what it can be when it’s done well.

But … It’s not usually. 70% of people want to die at home, only 30% do.

Here’s another stat you might not have thought about recently – You only die once. Think about that for one second – You only die once. Not my words – Atul Gawande’s in his incredible essay on end of life – ‘Letting Go’– which I am now declaring as mandatory reading for each and every person attending TedMed.

End of life in the US has somehow failed to become personal. It’s like this thing we put on a shelf and ignore. And getting what you want at end of life has become synonymous with filling out forms and getting waivers and going to some lawyers office where you pay a lot of money and get excited when you get to keep the pen.

But that’s not what it’s about. Not at all. Let me tell you a story.

Once upon a time there was this extraordinary woman named Za – short for Rosaria. Za was first generation Italian, breathtaking to look at, driven to become a pharmacist – the first in her family to go to college – and of course she was also human…She loved to enjoy…spending money she didn’t always have, generous to a fault. She was madly in love with her husband John and her two year old daughter Alessia, the apple of her eye. Deep within Za welled this enormous sense of joy – a deep gratitude for the life she had. As it turned out, deep within her also lived cancer – and not just any cancer – but the terrible and unforgiving brain cancer Glioblastoma – described by one of her surgeons as whip cream in a sponge – virtually impossible to eradicate. The seven month battle Za waged against her illness was a mighty one – she endured two massive brain surgeries, radiation, chemotherapy, all the related humiliations – but the cancer didn’t really care.

Health Insurance and Life Expectancy

Oct 28, 2010• 22

By JOHN GOODMAN, PhD

Did you know that Hispanic Americans live longer than non-Hispanic whites? If that doesn’t knock your socks off, consider this: American Hispanics are three times as likely to be uninsured as non-Hispanic whites.

If you’re still not blown away, maybe you haven’t been following the twists and turns of the health policy debate. As I wrote at my blog the other day, the Centers for Disease Control (CDC) discovery that Hispanics (one-third of whom are uninsured) have a life expectancy that is 2 1/2 years longer than whites (90% of whom have health insurance) makes mincemeat out of the oft-repeated idea that the uninsured get less health care and die earlier than everyone else.

In support of the conventional wisdom, for example, the Physicians for a National Health Care Program (PNHCP) went so far as to claim that a whopping 45,000 people die every year because they are uninsured. That figure, repeated as though it were unquestioned fact by President Obama and most of the health care media, is almost as large as the number of American soldiers killed in the entire Vietnam War!

Families USA went so far as to make the astounding claim that 6 people die every day in Florida because they are uninsured. Eight die every day in California; and 25 die in New York. In Texas, the report implies that more people die every two months from lack of health insurance than the number killed at the battle of the Alamo (counting only losses on our side, that is). Nationwide, says the PNHCP, an uninsured person dies every 12 minutes.

Health 2.0 Developer Challenge Code-a-thon Finalist: Team Transpera Health

Oct 28, 2010

By BIANCA GROGAN

Team Transpera Health, led by Cathy Huang, introduced software that will enable consumers to make healthcare provider and procedure decisions based on costs and quality. The team utilized databases from the CMS Medicare Physician Fee Schedule and CAHPS Hospital Survey as the basis for calculations. Judges at the Code-a-thon noted the concise and consumer-friendly aspects of the application.