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Senate bargainers say deal reached on children’s health

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http://abcnews.go.com/Health/wireStory/senate-bargainers-deal-reached-childrens-health-49809048

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Senate Republican and Democratic bargainers reached agreement late Tuesday to extend financing for the children’s health insurance program for five years, a pact that if approved would avert an end-of-month cash crunch for the popular program.

In a concession to Republicans, the agreement would phase out extra federal funds that have gone to states for the program since the additional money was mandated as part of President Barack Obama’s 2010 health care law.

Money for the federal-state program is due to expire at the end of September. The program provides health coverage to around 8 million low-income children and pregnant women.

It was initially unclear how the agreement would fare in the Senate and the House.

But the two negotiators — Senate Finance Committee Chairman Orrin Hatch, R-Utah, and that panel’s top Democrat, Ron Wyden of Oregon — work closely with party leaders. In addition, having embarrassingly failed in this year’s attempt to repeal Obama’s health care statute, Republicans and President Donald Trump are eager for an accomplishment and would be unlikely to stymie the continuation of such a widely supported initiative.

It was also unclear if the pact would move quickly and by itself through Congress, or become a vehicle for other, less widely backed legislation.

In a written statement, Hatch said “Congress needs to act quickly” to extend the program.

Without providing detail, Hatch said the agreement would give states “increased flexibility” to run the program. He also said lawmakers will “continue to advance this agreement in a way that does not add to the deficit,” suggesting that a compromise on how to pay for the extra funds may have not yet been found.

Wyden called the agreement “a great deal for America’s kids.”

The federal government pays around $7 billion annually for the program. States by law pay a small share — until recently, an amount ranging from 15 percent to 35 percent of costs.

But under Obama’s law, states each received an additional 23 percent share from Washington. Many Republicans, particularly conservatives, have chafed at that added amount.

Under the agreement, the full 23 percent share would continue for two more years. It would phase down to 11.5 percent in 2020 and the extra money would disappear completely the following year. The details were provided by a Senate aide who spoke on condition of anonymity because full details weren’t released.

After Rallies and a Resolution, These Patients Will Stay in San Francisco

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https://ww2.kqed.org/stateofhealth/2017/09/12/after-rallies-and-a-resolution-these-patients-will-stay-in-san-francisco/

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After months of protests from families, city supervisors and public health officials, California Pacific Medical Center (CPMC) announced that it will continue to care for 28 patients with complex medical needs, instead of transferring them to other facilities outside the city.

In June, the patients and their families received letters from CPMC saying that the skilled nursing unit where they lived  at St. Luke’s Hospital, known as a “subacute” unit, was closing permanently. The hospital as a whole is closing because it doesn’t meet earthquake codes, but CPMC officials are replacing it with a new building on the same site in the Mission district. But they did not plan to include any subacute beds in the new hospital, nor would they create a subacute unit  in another new hospital under construction near Japantown.

But in an unexpected reversal,  CPMC CEO Dr. Warren Browner said Monday the hospital system will continue to care for the 28 patients who would have been affected. Spokesman Dean Fryer said the medical center changed course after hearing concerns about the potential impact of the transition on patients and their families. CPMC officials also changed their minds after facing challenges securing beds for patients elsewhere in the Bay Area.

Subacute nursing units treat patients with complex medical needs, such as those on ventilators, for months or even years. The patients don’t need as much care as a regular “acute” hospital patient, but do need a level of skilled nursing care that is difficult to provide at home.

The subacute unit at St. Luke’s is the last one in San Francisco based at a hospital. Regionally and nationally, hospitals have been shuttering these units. The patients demand a high level of care, but reimbursements for the treatment  — typically through Medicaid — are low compared to private insurance.

Families were concerned that the move from St. Luke’s to another facility would be difficult for patients, who are in medically fragile states, and would also impose a burden on them because of the cost and difficulty of traveling farther away for visits.

When word circulated on Monday that the patients would stay in San Francisco, family members rejoiced. Leneta Anderson’s husband has lived in St. Luke’s subacute unit for 18 months. She visits him nearly every day at dinner time.

“I could cry right now. I am just thrilled, thrilled that my husband and the other patients don’t have to leave,” Anderson said over the phone on Monday. “It’s a victory.”

The new plan is for patients to move to another CPMC facility in August 2018 —  either the new Van Ness hospital, the new Mission Bernal hospital, which will replace St. Luke’s, or CPMC Davies.

Family members, subacute nurses, and city supervisors said Tuesday that their next goal is to increase access by advocating for the creation of more skilled nursing beds in San Francisco.

Uninsured Rate In U.S. Falls To A Record Low Of 8.8%

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Uninsured Rate In U.S. Falls To A Record Low Of 8.8%

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015.

Both the overall number of uninsured and the percentage are record lows.

The uninsured rate has fallen in all 50 states and the District of Columbia since 2013, although the rate has been lower among the 31 states that expanded Medicaid under the health law. California’s rate was 7.3 percent in 2016, less than half of its 17.2 percent rate in 2013.

“California has shown that the Affordable Care Act is working to expand health coverage and provide new patient protections,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “While many thought our nation’s rising uninsured rate was unsolvable, the advancement in California shows that if policymakers and the public are united in trying to make reform work, we can do big things.”

The latest figures from the Census Bureau effectively close the book on President Barack Obama’s record on lowering the number of uninsured. He made that a linchpin of his 2008 campaign, and his administration’s effort to overhaul the nation’s health system through the ACA focused on expanding coverage.

When Obama took office in 2009, during the worst economic recession since the Great Depression, more than 50 million Americans were uninsured, or nearly 17 percent of the population.

The number of uninsured has fallen from 42 million in 2013 — before the ACA in 2014 allowed states to expand Medicaid, the federal-state program that provides coverage to low-income people, and provided federal subsidies to help lower- and middle-income Americans buy coverage on the insurance marketplaces. The decline also reflected the improving economy, which has put more Americans in jobs that offer health coverage.

The dramatic drop in the uninsured over the past few years played a major role in the congressional debate over the summer about whether to replace the 2010 health law. Advocates pleaded with the Republican-controlled Congress not to take steps to reverse the gains in coverage.

The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

Among the states, the lowest uninsured rate last year was 2.5 percent in Massachusetts and the highest was 16.6 percent in Texas, the Census Bureau said. States that expanded Medicaid had an average uninsured rate of 6.5 percent compared with an 11.7 percent average among states that did not expand, the Census Bureau reported.

More than half of Americans — 55.7 percent — get health insurance through their jobs. But government coverage is becoming more common. Medicaid now covers more than 19 percent of the population and Medicare nearly 17 percent.

MESA: An Innovative New Value-Based Health Insurance Plan

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https://altarum.org/about/news-and-events/MESA

https://altarum.org/our-work/MESA

Click to access ALTARUM_MESA_BLUEPRINT_BRIEF.FINAL__0.pdf

Click to access ALTARUM_MESA_BLUEPRINT_BROCHURE_FINAL_0.pdf

MESA Will Improve Quality and Lower Costs for Those Who Use Health Care the Most;
Pilot Sites Will Test Model

To provide consumers with an affordable alternative to high deductible health plans (HDHPs), Altarum has created an innovative new model for those who use health care the most. The Medical Episode Spending Allowance (MESA) plan, developed with support from the Robert Wood Johnson Foundation, is especially well suited for those with chronic or serious health conditions, and takes value-based insurance design to a whole new level, improving quality of care while lowering costs.

“Employers and consumers are looking for alternatives to increasingly unaffordable health coverage, and finding a solution that works is essential,”  said François de Brantes, vice president and director of Altarum’s Center for Payment Innovation. “That’s what our MESA Blueprint is all about. By turning the high deductible health plan on its head, the MESA plan significantly reduces the potential for people with on-going illnesses from foregoing needed care.”

How Does MESA Work?
MESA’s incentives are finely calibrated to encourage consumers to seek out high value care and for providers to deliver it. The plan is based on a reference pricing model, so consumers can choose service providers that offer high quality care at a lower price.

Members pay out-of-pocket only when the cost of care extends above the specified allowance for a given episode of care. Plan members who select network providers that have accepted financial risk—for example through a bundled payment—could potentially avoid out-of-pocket expenses entirely. MESA also arms consumers with tools to research procedures, identify providers in their area, and view providers’ costs and quality ratings, so they can select the best care.

“As Americans are being asked to pay more for their health care, health insurance innovations, such as the Medical Episode Spending Allowance (MESA), that align consumer and provider incentives on quality and cost measures are an essential step forward,” said A. Mark Fendrick, MD, director of the University of Michigan Center for Value-Based insurance Design. “Strategies that reduce the patients’ out of pocket cost burden for clinically indicated services provided by from high performing clinicians are a necessary and important strategies to achieve the Triple Aim.”

“The Kentuckiana Health Collaborative, a coalition of employers, payers, providers, and consumers of health care, supports alignment of incentives to reduce barriers to high-quality, high-value care. We strongly encourage efforts to drive adoption of rational, creative alternative payment models and commend Altarum’s efforts to innovate with MESA,” said Stephanie Clouser, Kentuckiana Health Collaborative data scientist.

A New Path Forward
Each MESA benefit is finely tuned to incentivize the physician/patient relationship towards mutual cooperation and motivation to do the right thing, at the right time, in the right place—in a fully transparent marketplace. Information on the benefit model is available in the MESA blueprint, which provides employers and payers with a practical understanding of the framework, including compliance with legal and regulatory statues and actuarial equivalence to existing group health plans.

“MESA provides a comprehensive plan that marries payment reform with benefits reform, provider engagement with consumer engagement, and physician accountability for costs of care with patient accountability for managing their health and costs of care,” said Emmy Ganos, program officer at the Robert Wood Johnson Foundation. “Many of the concepts aren’t new—they are tried and tested—but their combination is, quite simply, a better solution.”

That solution will be tested in selected pilot sites throughout the United States in years to come. The criteria for sites to become pilots include willing employers and providers, current engagement in and familiarity with alternative payment models, and a commitment to price and quality transparency.  Those interested in becoming pilot sites should contact Altarum at press@altarum.org.

From Payment Reform to Benefit Reform
Over the past ten years, the Center for Payment Innovation’s PROMETHEUS Payment® model has revolutionized the way we pay for medical care. PROMETHEUS packages payment around a comprehensive episode of medical care that covers all patient services related to a single illness or condition. The model has been used as a basis for most of the public and private sector bundled payment models that are implemented in the United States today. One of its offshoots is the PROMETHEUS Analytics® software, which can help power the MESA model and now revolutionize health benefits.

 

Home Visiting Programs Are Vital for Maternal and Infant Health

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https://www.americanprogress.org/issues/early-childhood/reports/2017/09/12/438414/home-visiting-programs-vital-maternal-infant-health/

A woman shows the footprints of her daughter, reaching into photo, in Texas, September 2015.

When 19-year-old Rosa went into labor three months early, she had to be taken 60 miles to the nearest hospital, according to a 2013 video interview with the organization Save the Children. Her baby, Sirena, was born premature and needed immediate and constant medical attention. Days after giving birth, Rosa was discharged to the home she shared with seven other family members in her small, economically challenged California community. Sirena stayed in the hospital’s intensive care unit to continue receiving treatment, miles away from her mother.

Even in the best circumstances, parents’ joy at greeting a new baby is tempered by stress and worry during a child’s first months. But mothers like Rosa face many additional stressors, including preterm birth, inadequate housing, economic uncertainty, and being young themselves. Fortunately, Rosa did not have to navigate these challenges alone. Diana, a dedicated home visitor—someone specially trained to provide support to new or expectant parents—immediately arranged Rosa’s transportation to and from the hospital to visit Sirena. This helped Rosa and her daughter bond during a crucial period and soothed Rosa’s heartache over their separation. Once Sirena was healthy enough to go home with her mother, Diana continued to visit them regularly, bringing books and educational tools to help Rosa support her baby’s development.1

Home visitors like Diana are support professionals, such as nurses or social workers, who are well-versed in child development, parenting, and family functioning. Local agencies—such as tribal organizations and departments of health, human services, or education—match home visitors with new or expectant parents interested in receiving services.2Home visiting is a voluntary, home-based service-delivery strategy that provides services to parents and children that help the whole family.3 Parents often learn about home visiting through their children’s pediatricians, social workers, and other support professionals. Although home visiting can benefit any family, it can be especially helpful for families who need additional support during stressful periods of economic insecurity or health concerns. Decades of research prove that home visiting can promote healthy child development and academic success, improve health outcomes, and support families’ economic security in both the short and long terms.4

This issue brief explores how home visiting programs—specifically, evidence-based programs funded by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program—address three key maternal risk factors that directly influence maternal and child health and disproportionately affect mothers who participate in home visiting: postpartum depression, domestic violence, and tobacco use. Each of these risk factors negatively affects a mother’s physical and emotional health, which in turn can produce worse outcomes for children, including low birth weight, prematurity, and even death. Although families face many more challenges, these health indicators highlight the diverse ways home visiting can benefit mothers and children. The brief also demonstrates how home visiting programs contribute to women’s economic security and, therefore, to the economy as a whole. Finally, it examines continued challenges to funding these programs, as well as potential solutions.

Click to access MaternalHealth-brief.pdf