Texas refuses to launch health insurance exchange
Texas declined to create a health insurance exchange during the legislative session that ended June 30, but the state did advance its own version of accountable care organizations. Read more here
Doctors and Hospitals Working Together to Keep Patients Out of Hospital Beds
This LA Times article follows up on our Golden Gate Association of Health Underwriters meeting last month where we heard from Chris McCrary, Director of Contracts & Network Development, from Hill Physicians Medical Group. He spoke on Creating Affordability in medical care and touched on their participation in one of the first Accountable Care Organizations (ACO) in California. He mentioned that by reaching beyond their organization to the Hospital and Blue Shield of California they were able to realize better patient outcomes by getting patients out of the hospital setting and back home or into rehabilitative care. This was followed later in the month at an Anthem Blue Cross seminar where they discussed their new ACO small group product that is available to members of Individual Practice Association Medical Group of Santa Clara County. Be prepared to see more of these affiliations in the future as the the ACO partnerships expand.To stay fiscally healthy, state’s hospitals want fewer patients
The new federal health care model, ACOs, and Florida business
Last month, the U.S. Centers for Medicare and Medicaid Services approved two new accountable care organizations, or ACOs, in Central Florida. This brings the total to three approved organizations, responsible for coordinating the care of 13,500 Central Florida Medicare patients. Three additional local ACOs are also in the works.
By definition, an ACO is an organization formed between health care providers- usually primary care and specialty doctors- who no longer will accept a simple fee from the government for the services they render. Instead of the simple fee from the government, they accept a bundled payment. If they keep the patients healthier and save money, they get to keep some of that cash.
There are arguments that ACOs are the HMOs of the 1990s, simply re-named. If they function properly, they should save the government money, lower the cost of health care, and ultimately save businesses money on health insurance premiums.
The Federal Government, as the nation’s largest health insurer, is shifting its focus to quality not quantity. As does Medicare, so does commercial health insurance. As an example, this means every doctor and hospital that touches a patient during a procedure would no longer bill the government. It also means, for example, if an initial surgery is screwed up, then the hospital must eat the cost of the second surgery.
Most analysts agree that ACOs will either prove or disprove themselves over the next few years. If ACOs keep patients healthy and out of the hospital, the financial net loser in this scenario is the hospital. Even if forming an ACO increases a hospital’s market share, the net result, even with the money the government pays it, would be a reduction in revenue.
“The family is the Accountable Care Organization.”—
This post also appears on Managed Care Online.
The tension across the U.S. this morning was palpable. E-mails quieted, phones didn’t jingle, 10 a.m. ET came and went, and suddenly, there it was: The Supreme Court Upholds the Affordable Care Act’s individual mandate, which allows the changes to go forward. Later, we heard that the Roberts Court did alter the clause on mandatory expansion of Medicaid by the states who accept Federal dollars. To be clear, the law said that if a state accepts Federal Medicaid dollars, then it was required to accept the ACA dollars and expand Medicaid; that, the Roberts Court said, was not ok, that the Federal system could not mandate behavior at the State level, which, frankly, is alignment with the known position of Justice Roberts.
So, the kids can stay on their parents’ plans till they are 26, the individual mandate means a penalty on those who don’t participate (it moved from a commerce clause—you have to buy— to a tax clause—if you don’t get in, you pay a penalty, a lot like not reporting your income and paying your taxes), no one will be denied insurance after 2014, the donut hole for Medicare-covered drugs closes (a savings that seniors have felt this year), state exchanges move forward. Or, the fight might go into November and beyond with Republicans vowing to cast this law aside.
Some of the pundits are saying the country is weary of this fight. Others are saying it’s not over. I say it just took on a new dimension: the actual issue is jobs, the very essence of the American dream is owning a house (NYT survey June 2011: Which is more important your job or your house? Majority answered “House.”). By closing, even for awhile, the arguments over the ACA, we can rise up to the real problems, of which health care is a prime cause, but jobs and house are the endposts.
This is the sigh, not one of relief, but one of checking off the box that says “ACA” and refocusing on what matters: the economy, the jobs. Most folks understand that taxes are paid through jobs, houses are bought with jobs, health care is delivered mostly through jobs (either at the worksite or through the money earned at the worksite). Most folks don’t want that to change. Most folks understand that the costs of the insurance have been going up, that U.S. businesses are buckling under the weight, and, when insurance is not in place, the whole community pays in taxes for uninsured coverage in the emergency room. Health care derails jobs, productivity, sales, activities, and taxes, which pay for police, firemen, new roads and bridges, and so much more. So, control the health care costs, and we can actually make a dent in this job/house situation by preserving revenues for rebuilding and purchasing, preserving jobs and communities.
Today’s affirmation of the individual mandate is a subtle reminder that we all have an individual responsibility to take care of our assets, including our health. The door has been opened wider for Americans to manage their health as they manage their wealth: we can invest in our health checkbook with better eating habits, better activity habits, better stress management habits. The more we do individually and with our families, the more we will save in health care costs. As we lower our risk profiles (overweight, sedentary, smoking, no prevention screenings, no immunizations, too much alcohol or pain medication, for example), the less CARE costs us and the more HEALTH we achieve.
I’ve mentioned before a book I wrote years ago—Lifetips: 101 Tips for Personal Health Management (that was the name the publishing house assigned to it, I didn’t get to choose)—that included the concept of health-wealth portfolio, managed by the person/CEO-of-my-health, that leads to better health and wealth and performance. It’s time we revisit the concept.
In today’s lexicon, 4 years after I wrote the book, the word to use is “Accountability.” We read about Accountable Care Organizations, but I posit an innovative thought: The Family is the Accountable Care Organization. Every decision we make about what to eat, stepping up our activity, cutting our risky behaviors, getting the right care at the right place at the right time, affects the health and wealth and performance of the family. Diagnosed with an acute sickness or chronic condition? That will cost the whole family, could cut down on vacation time, or, worse, on education savings. Need a new car? Might have to make do with the clunker because the medication you need has a higher co-pay.
You understand, I don’t need to belabor this discussion. What we witnessed today is the revival of our spirits as we experienced the revival of the belief in the American system:
“The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people.” — John Roberts, Chief Justice of the United States Supreme Court (thank you MCOL).
Any doubt we had about partisanship on the Supreme Court has been dissolved. Justice Roberts used the rule of law to search for solutions that upheld the Congressional will, and only in the case of the state Medicaid mandate was the revision made, still leaving the law intact but one clause modified. The headline surprised many, but the Supreme Court did was it was supposed to do: SCOTUS was the Accountable Organization to assure the law of the land was upheld, according to the voted representaties of our government.
Now, the collective sigh must be turned to the jobs and houses. It starts with each of become our own CEO of our self-defined Accountable Care Organization. Our consultants in the medical community, our beneficiaries in the neighborhoods where we live, will thank us.
We can do it. Turn our collective will to the rebuilding of our economy and our communities. Do the best we can at managing our everyday health and watch the wealth begin to flow again. Make small changes, track progress and stay the course, recruit others to join.
Accountability is our action, health is our goal. Choose wisely, my friends. Now, inhale deeply, and sigh audibly: it’s time to make America the healthiest nation in the world.
Fact #124: King is willing to jeopardize health centers in his district
Congressman Steve King has represented Iowa for ten years. He says he shares Iowans’ values, but his record and his statements over the years paint a different picture.
Today’s example: Congressman King is willing to jeopardize the future of health centers in Iowa by completely repealing the health care bill.
The Sioux City Journal reported earlier this week that if the Supreme Court had struck down the health care reform bill, it would have been a major blow to community health centers like the one in Sioux Center:
Joe Heitritter, director of operations at Greater Sioux Community Health Center in Sioux Center, said his facility might have been forced to shut its doors for financial reasons if the justices had ruled the act unconstitutional.
The center received $595,833 this year and will likely get another $650,000 next year.
“If the entire act had been struck down, it would have been devastating to the health center,” he said. “We had already received the money, so it’s hard to know what would have happened – if we would have had to give it back.”
- Sioux City Journal, 7/2/12
Striking down the entire bill would have also jeopardized Accountable Care Organizations, like the one at Trinity Regional Medical Center in Fort Dodge. These organizations are using incentives in health care reform to experiment with innovative ways to keep patients out of hospitals and reward providers for positive outcomes.
While health care providers such as this are breathing a sigh of relief following last week’s ruling, Congressman King continues to call for a full repeal of the bill. In fact, he has even said that no aspect of it should be preserved:
“I don’t want to hear any talk from Republicans about preserving any aspect of it. It just dilutes the argument. It’s all or none. This is it, we’re all in and I’m ready for that fight.” – Congressman Steve King, 6/28/12
If no aspect is preserved, providers like the Greater Sioux Community Health Center could be forced to shut their doors and three would be fewer health care options for Iowans. This isn’t responsible and it shows that Congressman King is willing to put his own agenda ahead of what’s best for the people of his district.