Tag Archives: Healthcare Access

9 healthcare systems join forces with IHI to reduce healthcare inequities

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http://www.fiercehealthcare.com/healthcare/9-healthcare-systems-join-forces-ihi-to-reduce-healthcare-inequities?mkt_tok=eyJpIjoiTUdJMU1UYzBZMlptTlRFNSIsInQiOiIxU3dwUGNwOEpwMmQyQk9NNklmU3NOaTVuY3FcL0t6UjNVeHhNMFdPRmplQktSNWRcL2NhdW50a2d3cmJrelBlWUxobkIyemU3TGpVejE4akRvT3RpekFOZW84bXpnaHFpcXl2ME1USCtCSVVKZ2Jhdldlc0tmRUFWbUY4Z1lLbzRLIn0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Patient-centered care

Henry Ford Health System, Kaiser Permanente Health Plan and Hospitals and Rush University Medical Center are among nine healthcare systems working on a new initiative to reduce inequities in health and healthcare access, treatment and outcomes.

The Institute for Healthcare Improvement (IHI) launched its two-year “Pursuing Equity” initiative on Monday. Its goal is to break new ground by explicitly addressing institutional racism and by identifying ways healthcare organizations can reduce clinical disparities of care as well as improve equity in employee wellness and social determinants of health.

The other systems participating in the project include HealthPartners in Bloomington, Minnesota; Main Line Health in Newton Square, Pennsylvania; Methodist Le Bonheur Healthcare, Memphis, Tennessee; Northwest Colorado Health, Steamboat Springs, Colorado; and Southern Jamaica Plain Health Center, Brigham & Women’s Hospital, Jamaica Plain, Massachusetts.

Each system will build on the work they’ve already done within their institutions, including launching programs to reduce clinical disparities, track equity in process and outcomes data, and improve knowledge and capability.

“We see a future where every healthcare system in the country pursues equity as part of daily work and core skills, ensuring that individuals and communities can attain their full health potential—and we believe Pursuing Equity is an important step in creating a blueprint for other organizations to follow,” said Derek Feeley, IHI president and CEO, in an announcement (PDF). “Pursuing Equity is part of the next phase of IHI’s ongoing commitment to address the unjust, costly, and persistent inequities in health and healthcare across the nation. We are energized and ready to continue this critical work.”

The initiative will be funded by theRx Foundation, Bristol-Myers Squibb Foundation, and the participating health systems.

Traditional Medicare is cheaper

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http://www.academyhealth.org/blog/2017-03/traditional-medicare-cheaper

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OK, you knew that already. But what are the implications for access to care?

t probably won’t come as a surprise to you that traditional Medicare (TM) pays lower health care prices than commercial market insurers. We’ve known this for quite some time. A significant issue, however, is whether lower TM rates lead (or could lead) to reduced access to care for Medicare beneficiaries.

Jacob Wallace and Zirui Song took up the issue in a Health Affairs paper published last year. They examined health care price and utilization of outpatient imaging and outpatient surgical procedures across the 65-year divide — when most people become eligible for Medicare. Their data included just over 200,000 individuals captured in Truven Health Analytics’ 2007–2013 Medicare and Commercial Claims and Encounters database with broad-network, commercial market insurance before age 65 and TM from age 65 onward.

As shown in the chart just below, unadjusted, per beneficiary, quarterly spending trends for outpatient imaging and procedures are about the same before and after Medicare eligibility, but there is a large discontinuity when Medicare eligibility begins. In the last quarter before age 65, spending for a privately insured patient is about $119. At age 65, on Medicare, that drops 25% to about $89. After adjusting for age, quarter, year, and individual fixed effects, the relative change upon Medicare eligibility is even larger: 32%.

 

A Deep Dive Into 4 GOP Talking Points On Health Care

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http://khn.org/news/a-deep-dive-into-4-gop-talking-points-on-health-care/

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Republican leaders have a lengthy list of talking points about the shortcomings of the health law. Shortly before his inauguration last month, President Donald Trump said that it “is a complete and total disaster. It’s imploding as we sit.” And they can point to a host of issues, including premium increases averaging more than 20 percent this year, a drop in the number of insurers competing on the Affordable Care Act marketplaces and rising consumer discontent with high deductibles and limited doctor networks.

Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems. Here is an annotated guide to four of the most common talking points Republicans have been using. 

 

Healthcare Triage: Republican Plans for The Affordable Care Act

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Healthcare Triage: Republican Plans for The Affordable Care Act

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After campaigning for years on a plan of “repeal and replace Obamacare,” Republicans finally have the means within their grasp to make much of that possible. They control the presidency, the House, and the Senate. The filibuster still poses some potential threats to their plans, but it’s also within their means to abolish its widespread use in such a way that they could both repeal the Affordable Care Act and replace it with something of their own design.

What would that be? In contrast to what many say, there are Republican plans out there to consider. They’re the topic of this week’s Healthcare Triage.

Trump’s Vow to Repeal Health Law Revives Talk of High-Risk Pools

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About 27 percent of people under 65 are thought to have some sort of pre-existing condition that will most likely leave them without individual insurance if the law is repealed, according to a recent study. The guarantee of coverage has already become a rallying cry for people who want to keep the law.

The issue “is the third rail” for the Republicans, said Michael Turpin, a longtime health industry executive.

Before the law, a fairly typical life event — like a divorce or the loss of a job — and a relatively minor medical condition could upend a person’s health coverage options. Stories of sick people unable to get coverage when they needed it most were legion.

Mr. Trump insists he wants to keep the pre-existing requirement for insurers, and other top Republicans say people who want coverage should not be turned away. Details about how they will cover people with existing medical conditions have not yet emerged, but many lawmakers have started pushing an idea — known as high-risk pools — that left many people uncovered or with strict limits to their coverage in the past.

The challenge for lawmakers is this: How do you get insurers to cover people who will definitely need costly medical care — and do so without making insurance too expensive for everyone?

When It Comes to Seeing a Doctor in California, the Uninsured Still Fare Worst

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http://www.chcf.org/articles/2017/01/when-seeing-doctor

California Physicians Accepting New Patients by Payer, 2015

With repeal of the Affordable Care Act (ACA) on the horizon, and no replacement plan in sight, millions of Californians are at risk of losing their coverage. Approximately 5 million Californians are currently covered under the ACA. The state’s uninsured rate, which hit a historic low under the ACA, could start to rise again depending on what happens in Washington in the coming weeks and months.

It’s worth remembering the multiple barriers that people without insurance face in our health care system. I am reminded of some key findings from a 2015 survey of California physicians that the University of California, San Francisco, released last fall with support from the California Health Care Foundation.

The survey asked, among other questions, if physicians were accepting new patients who had various types of insurance (private, Medicare, or Medi-Cal) or who were uninsured. The survey also asked physicians if any of their existing patients were uninsured.

As the slides below show, the uninsured face the hardest time getting accepted into a physician’s practice. Only 38% of all California physicians said they accepted new uninsured patients in 2015; only 55% said they had any uninsured patients. The sample of physicians includes emergency department (ED) doctors who are legally required to see all persons who come to an ED, regardless of whether they have insurance.

Medicaid’s Future: What Might ACA Repeal Mean?

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http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal?omnicid=EALERT1152581&mid=henrykotula@yahoo.com

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Abstract

Issue: Republicans in Congress are expected to repeal portions of the Affordable Care Act (ACA) using a fast-track process known as budget reconciliation.

Goals: This issue brief examines how repeal legislation could affect Medicaid, the nations’s health care safety net, which insured 70 million people in 2016.

Findings and Conclusions:Partial-repeal legislation that passed Congress but was vetoed by President Obama in 2016 offers some insight but new legislation could go further. It could repeal the ACA’s Medicaid eligibility expansions for adults and children but also roll back other provisions, such as simplified enrollment and improvements in long-term services and supports for beneficiaries with disabilities. Additionally, the Trump Administration could expand use of demonstration authority to introduce deeper structural changes into Medicaid, such as eligibility restrictions tied to work, required premium contributions and lock-out for nonpayment, annual enrollment periods, and coverage limits and exclusions. Together, these changes would have far-reaching implications for Medicaid’s continued role as the nation’s safety-net insurer.

More than 50 million adults with pre-existing conditions would lose coverage in wake of Obamacare repeal, Kaiser study says

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http://www.healthcarefinancenews.com/news/more-50-million-adults-pre-existing-conditions-would-lose-coverage-wake-obamacare-repeal-kaiser

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Kaiser Family Foundation poll found the 53 percent of people reported that they or someone in their household has a pre-existing condition.

Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA

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Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA

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Before private insurance market rules in the Affordable Care Act (ACA) took effect in 2014, health insurance sold in the individual market in most states was medically underwritten.1  That means insurers evaluated the health status, health history, and other risk factors of applicants to determine whether and under what terms to issue coverage. To what extent people with pre-existing health conditions are protected is likely to be a central issue in the debate over repealing and replacing the ACA.

This brief reviews medical underwriting practices by private insurers in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance if the ACA were repealed or amended and such practices resumed.  We examine data from two large government surveys: The National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), both of which can be used to estimate rates of various health conditions (NHIS at the national level and BRFSS at the state level). We consulted field underwriting manuals used in the individual market prior to passage of the ACA as a reference for commonly declinable conditions.

The top 5 conditions affecting communities, according to new BCBSA tool

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http://www.healthcaredive.com/news/blue-cross-blue-shield-health-index/431194/

Mapping technologies and population health make a beautiful pairing. Using geographical data can assist care delivery strategies as tech tools such as GIS can track and trend health data for a community overtime.

“As the move to accountable care and value-based payments takes hold, providers and health plans are increasingly interested in applying GIS to assess risk based on geography and the populations that live there, reveal where the greatest need is, and prioritize areas for interventions,” Danny Patel, account executive for health and human services at GIS software maker Esri, told Healthcare Dive in May.

While providers can look to reduce unnecessary readmissions using such efforts, plans like Blue Cross Blue Shield Association – which recently released its new BCBS Health Index – can use local health data to understand the health of a county/population. The tool, using blinded claims data from more than 40 million commercially-insured BCBS members, identifies the health conditions with the greatest impact on the commercially insured. The tool includes information on over 200 conditions.

“What the health index gives us is the ability to work with local stakeholders…to talk about where we need to focus broader health resources,” Maureen Sullivan, chief strategy and innovation officer at Blue Cross Blue Shield Association, told Healthcare Dive. She said the tool isn’t a “healthiest place to live” navigator but rather a starting point to understand conditions affecting communities and develop peer networks.