Care Continuum Alliance – Fitting Today’s Health Care Landscape

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Oct 13th, 2010 | by

As an Ohio Medicaid care coordination plan, we have been members of an association called the Disease Management Association of America. In fact, our medical director Dr. Gail Croall is a sitting member of the board. This has always been an important association to us because of their historical focus on care coordination for chronic diseases and health issues in all populations. And recently, the organization changed its name and brand image (but certainly not its mission) to the Care Continuum Alliance.

As the landscape of the health industry has evolved, so have the members of CCA. So we’re proud of CCA’s branding evolution as it aligns more closely with all players in the health care industry.

The focus on all parties within the health care industry is to not only promote healthy living and preventive health care, but to deliver on it.

So to Care Continuum Alliance, we applaud you on your name change and branding effort. We agree that this change better fits the landscape of health care in America. And we encourage our readers to learn more about Care Continuum Alliance – their dedication to promoting care coordination and preventive health care delivery continues to be an inspiration to all your members – like CareSource.

So a question to our readers in the industry, what steps have you taken to transform with the new health care landscape?

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Health Care Reform is easy…isn’t it?

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Aug 26th, 2010 | by

Earlier this summer, our company hosted a retreat which included two national speakers– Dr. David M. Cutler and Thomas Dehner, JD. We invited these leading health care experts to meet with us because of their insights into health care reform, and the transformation that is currently taking place in this industry.

A little background on Dr. Cutler – he is a Harvard professor, and he served on the economic council during the Clinton years. More recently, he was senior health care advisor to President Obama. And, he is intimately involved in strategies around financing health care in our country. So his points of view were particularly eye-opening.

As the Massachusetts Medicaid director, Thomas Dehner led efforts related to the Medicaid components of the Massachusetts Health Care Reform Law. Now a principal with Health Management Associates, Inc., his viewpoints on lessons learned and future implications were also very enlightening.

There was a point in the presentation where Dr. Cutler gauged the difficulty for the health care industry to convert. He proclaimed the following:

  • Insurance reform is easy
  • Coverage expansion is more difficult (he called it Medium)
  • Improving the value of care is the most difficult (or Hard)

It was an interesting assessment, and it sparked a lot of conversation.

Insurance Reform is Easy
First off, none of what needs to happen within the health care system is easy to change. But what makes insurance reform “easier” than transforming other aspects of the health care system is because insurance reform relies heavily on policy and laws. The introduction of federal policy allowing parents to keep their children on their health plan until age 26 is a perfect example of how policy can quickly affect immediate change.

Coverage Expansion is Medium
Expanding health coverage to more Americans is certainly a more difficult goal to achieve. Two reasons expansion is harder:

  1. The exchange could create a mass rush to the health care “storefront”. People who have not had access to health care will now be eligible, and that may empower a lot of people to act. How will our system react?
  2. At the same time, it’s also difficult to get people to enroll. Dehner said this is “a close-to-impossible job” despite the federal dollars set aside for outreach. Communication and promotion will be the key to educating the public about the availability to get coverage. But even with substantial outreach, there will be plenty of people that are eligible for public health care programs and subsidies, but just won’t know it or don’t recognize ongoing health coverage as a priority. So finding these people and getting them into the system presents a challenge.

Improving the Value of Care is Hard
This is by far the most difficult area to transform—but not impossible. All players within the health care arena are being pressured to find ways to reduce cost while increasing quality…and that can sometimes appear to be an oxymoron. But we are already seeing solutions that will help move this goal along:

  • Technology
    The more we integrate technology into the health care system – and that includes technology that provides information, not just devices – the better coordinated the system will be, and the better doctors will be at providing the right kind of care at the right time and place.
  • Case Management/Coordination
    What case management and health care coordination does is put prevention and wellness at the center of caring for patients. By integrating case managers more into the system, patients, providers and insurance companies can be held more accountable, helping increase quality of care. Also, case management ensures that patients are using the health care system responsibly, and that lowers cost.
  • Streamlining Administrative Duties
    It’s estimated that highly trained registered nurses spend one-third of their time charting patient status and there are more administrative personnel on staff than nurses. That’s a lot of resources being devoted to what could be considered “lost productivity.” The industry needs to continue pursuing automation and streamlining this aspect of the business-side of health care.

Hard, Harder, Hardest – But Worth the Pursuit
There are many challenges ahead for this industry. But so much progress has already been made in a very short time. As long as the players within the health care industry continue to collaborate, we will reach our goal. And once we’ve reached our destination as an industry, we’ll look back and understand that the pursuit was worth it. Because we’ll all eventually benefit from the transformation of health care.

What do you think are the hardest aspects of health care reform to further implement?

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Medicaid Extension Provides Much Needed Relief

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Aug 12th, 2010 | by

On behalf of the 844,000 Medicaid consumers we serve, we thank you, Congress, for extending $16 billion in enhanced Medicaid funding to assist states who are experiencing the worst budget shortfalls in history. Our government did what’s right and necessary for people who are desperate for help today.

Nearly 3.3 million more people were enrolled in Medicaid in June 2009 when compared to June 2008 (based on Kaiser Commission on Medicaid) and states are financially strapped – three-fifths of them have expressed a critical need for assistance with its Medicaid programs. Plus, many families continue to feel the burden of the Great Recession as demonstrated by the U.S. unemployment rate of 9.7% (June 2010). It is our obligation as a country that believes in providing opportunity for all to take care of those that need help. And that’s what Congress did this week by a vote of 247 to 161.

Again, thank you, Congress for leading our nation out of the Great Recession.

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Medicaid Extension is Vital to the Underserved

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Aug 2nd, 2010 | by

In this tumultuous and uncertain political year, some things are very clear. State budgets are facing serious deficits. For millions of Americans, the Great Recession is not over. We see it firsthand here at CareSource. In fact, as the nation’s second largest Medicaid health plan, we know there are 844,000 CareSource members who are faced with the realities of the economic downturn each day. Subsequently, this has increased the demand for Medicaid and other important services families need to survive. Simply put, Washington must do more to address the devastating impact of these tough economic times.

Every day, we see the consequences of high unemployment in our states. With more people out of work, more families are relying on Medicaid to provide essential medical care. Any delays may force families who are already struggling to maintain basic necessities to forgo the health care coverage they fundamentally deserve and more importantly – the coverage they desperately need.

Yet efforts in Congress to approve a six-month extension of higher federal Medicaid assistance to the states are being blocked. Instead of voting as if the economy is strong, Congress should take the pressure off states by passing this temporary extension now. Otherwise we could see drastic cuts in health care for the most vulnerable, education, and other critical services. These cuts will only delay the day that we will see the economy actually recover.

Janet Grant
External Affairs

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Thank you, Congress, for doing what’s right

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Mar 23rd, 2010 | by

On behalf of the 15 million Americans who will be eligible for Medicaid as a result of health care reform…we thank you.

On behalf of the children that need health care to support every possible opportunity for a successful and productive life…we thank you.

On behalf of Americans who must choose between buying food and getting health care…we thank you.

On behalf of the senior citizens who are wondering how to maintain their health on a modest budget…we thank you.

Despite the contentious year-long debate, Congress has done what’s right for the American people. Making health care a right – not a privilege – is a fundamental element that has been sorely missing from the ideals of our nation…until now!

Was this the best possible outcome? Probably not.

Does the new legislation fix every problem that ails the current health care system? No, not really.

But it is definitely a start. We elected our leadership to do what is best for the American people given the challenges our country is currently facing. Right now, what is best has arrived in the form of a new and improved health care system that will turn away no one; that will take care of our children; and most importantly, that is in reach to all Americans.

CareSource applauds our Congressional leaders for the following provisions included as part of health reform measures:

  • Expansion of Medicaid to everyone (under age 65) below 133% of the Federal Poverty Level by 2014– removing categorical eligibility which currently forces many individuals in poverty to go uninsured.
  • Creation of state-based health exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four.
  • An individual mandate for all to ensure all Americans participate in the insurance risk pool resulting in lower cost coverage options for all. Requires insurers to cover those with pre-existing conditions, removes lifetime limits, prohibits rescission of coverage and mandates prevention services be covered at 100 percent.
  • Equalization of treatment of managed care and fee-for-service under the Medicaid drug rebate program.
  • Closure of the Medicare prescription drug “doughnut hole” by 2020.
  • Reauthorization of the Medicare Advantage Special Needs Plan program.
  • Improved coordination for Medicare and Medicaid dual-eligibles.

Each of these provisions propels our country into a new era in health care for which we should embrace and build upon. There are many that vow to fight the passing of this bill, and that’s to be expected. But we should applaud all of our policymakers for remembering why and how this nation was created…to be a land of opportunity, of freedom, and of equality. Thank you, Congress, for doing what’s right for all people.

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Money Can’t Solve Everything…Some Issues Require a Shift in Behavior

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Mar 8th, 2010 | by

I read an interesting opinion piece today by Rep. Joe Baca (D-California) in the Huffington Post. He brings up an issue that he feels hasn’t been addressed enough in the health care reform debate – “emergency care in many of our nation’s hospitals is in bad shape, and doctors and patients are paying the price.” The article goes on to explain that hospitals are in bad shape because of their requirement to provide emergency care for any and all people whether they have insurance or not. He cites the unfortunate fact that over 70 hospitals in his state have closed down due to financial pressures.

His solution: “adequately reimburse for the mandated emergency services they provide.”

This is certainly a solution, and probably a fair one at that – hospitals should be reimbursed appropriately for the services and care they provide. But part of the reason why the financials of our hospital’s emergency rooms are an issue is due to how they are being used. Too many people use emergency rooms as a primary care facility – seeking medical care for the flu or a sore throat or a minor fever.

This is a behavioral issue, not necessarily a money issue. We as an industry need to do a better job in educating people on how to responsibly engage the health care system. This is particularly important for the underserved population that accepts publicly funded health coverage. As a Medicaid managed care company, we believe this is a significant part of our role since many of our members are faced with poverty and typically access health care when and where it is most convenient. It’s why we assign case managers to our members. It’s why we look closely at ER utilization rates to identify opportunities to reach out to our members and educate them on appropriate usage. It’s why we have a 24-hour nurse line devoted to helping our members determine if their medical condition is a true emergency. It’s why we provide value-added services to our members like transportation to doctor appointments.

But providing these services must be balanced with patient accountability and sufficient access to primary care providers. The entire industry – insurance plans, providers, hospitals, advocacy groups, government – needs to embrace the idea that educating people about proper health care engagement is a critical strategy to lowering costs and increasing quality of care.

We certainly see the prospect of increasing Medicaid eligibility nationwide as a positive step toward helping underserved people access care without sending them to bankruptcy court. But giving people a shiny, new medical card means little without investing in resources which guide people to the appropriate setting – especially those who are more worried about where to get their next meal or how to put off an eviction.

People need to understand the difference between an emergency and non-emergency medical need. People need to understand the potential impact they have on the system when they miss a doctor’s appointment. Or the effect it has on the system when a person decides not to take his/her medication as prescribed.

This needs to become an industry effort. We can keep on throwing money or taking away money from various aspects of the health care system. But when it comes down to it, we need to address the behavioral aspect of users. We need to educate people about how to engage, and we need to find creative ways to do so.

What ideas do you have around how to better educate people about accessing the health care system?

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Reconciliation as a last resort? Yes, it should be.

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Feb 24th, 2010 | by

So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.

This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.

So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.

The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?

Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?
All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.

It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.

A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?

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Honoring the Health Care Presidents

Author : serves as an information source for those who are interested in helping shape a new system of health care delivery.

Feb 11th, 2010 | by

We all hear “Presidents Day” and think “Washington and Lincoln.” Banks and post offices are closed and for some, another well deserved federal holiday. But that’s just habit.
This year, we might do well to remember another group of presidents–those who have done their best to establish a better health care system for the nation. Every president for the past 75 years has been part of the struggle, yet we still have a system that not only bankrupts individual citizens without regard, it decimates state budgets and paralyzes the federal government from making substantive improvements to the nation’s economy.

While Lyndon Johnson gets much of the credit for getting Medicare and Medicaid passed into law, the true hero of Medicare was John F. Kennedy, who worked, negotiated, and hammered out a solution that would help Americans – and actually found a way to get it approved by Congress.

Medicare has worked fairly well for fifty years—but at the time, the same doubts were voiced that we are hearing today—the bill’s imperfections were too great. At a rally in New York to support health care for the elderly, Kennedy confronted the question: “We’ve got great unfinished business in this country,” he said, “and while this bill does not solve our problems in this area, I do not believe it is a valid argument to say ‘This bill isn’t going to do the job.’ It will not, but it will do part of it.”

The comprehensive health care reform we need today is even more critical than when Kennedy spoke those words in 1962. No, it may not be entirely accomplished by the plans now being discussed in Congress. Yes, it’s imperfect, but the cost of doing nothing is unacceptable. Turning our backs now, when we have a solid plan that insures over 90 percent of Americans; that bends the health care cost curve; that brings down premiums and that strengthens Medicare for seniors, is simply irresponsible. This plan is the closest we’ve ever come to true reform.

There’s no need to give up. Let’s call upon Congress to deliver a bill to the President in recognition of President’s Day. Moreover, for all the presidents before him who have fought tirelessly to get Americans a health care system that will move us one step closer to handling this country’s “unfinished business.”

What do you thing has been the most significant achievement in reforming health care up until now, and which President do you think gets the most credit?”

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Momentum Must Not Waver

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Jan 26th, 2010 | by Toni Bigby

There’s really only one thing that worries me about the Massachusetts election. I’m not troubled by the fact that the Democrats lost filibuster-proof control of the Senate. Control shifts back and forth as often as who is going to host the Tonight Show on NBC.

It doesn’t worry me that Senator Elect Scott Brown will try to block any potential of health care reform. We’ve come too far over the past year…really over the past half century…to turn back now.
I’m also not concerned that the Democrats will try to force through a health care reform policy -just to get it done. Forcing through policy doesn’t always go over well to voters in an election year – especially those with long-term memories. However, a recent poll by the Kaiser Foundation indicates the American public, including skeptics, become more supportive of health care reform after being told about many of the major provisions in the bills.

But what is worrisome…troubling…concerning to me is that momentum will waver, and the true ideals of health care reform will be lost. We must be sure the following elements of health care reform stay in place:

  • Increase Medicaid eligibility – whether its 133% or 150% (which I would prefer), we need to make sure reform protects our most vulnerable citizens
  • Protect our children – CHIP programs work…that’s why so many of our policy-makers rose to the occasion to protect in the current bills – Sen. Casey, Sen. Rockefeller, Sen. Reid, etc.
  • Affordable Coverage for All – Don’t let purchasing health insurance be burdensome to the majority – continue with plans to provide government assistance through subsidies to those under 400% of the national poverty level
  • Use of a state based health care exchange to act as a transparent clearinghouse for consumers to purchase coverage
  • Cost containment to bend the unsustainable curve of health care costs
  • Medicare & Medicaid benefit integration and financing for dual eligibles within a managed care model to rebalance the long-term care system to increase use of home and community based support services. Shifting more of this high-need population into coordinated managed care arrangements could produce significant savings while ensuring options for consumers where they desire to reside.

Sure, CareSource is a non-profit health plan that believes there is always room for improvement, but we support health care reform. Give non-profits wider opportunities to control costs, enable insurance companies to accept anyone with pre-existing conditions, include an individual mandate so that we all pay our fair share and, reimburse for positive outcomes, etc.
So to do my part in making sure Congress knows that I don’t want the momentum to subside in Washington, I used this source to send Congress – and my local newspapers – a letter:
This one is for Ohio citizens…but if you live outside of Ohio, you can go to FamiliesUSA to send your own letter to Congress.

Please let Congress know that we cannot afford to take our eye off the goal just because of one election. We must move forward with health care reform. Our country deserves it.

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Does This Make Sense to Anyone?

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Dec 23rd, 2009 | by Toni Bigby

We know. We don’t want to “make the perfect enemy of the bad” and all.

But really, this new thing about the insurance company tax exemption?  We need to take another look.  As of now, non-profit insurance companies that operate in the private marketplace (primarily the Blue Cross/Blue Shield companies) and spend at least 92% of premiums directly on medical costs would be exempted from the new tax on insurers in the Senate bill. (Wall Street Journal’s explanation of this “bright spot” ).
This needs to be extended to companies serving the public through Medicaid, Medicare and CHIP.  Otherwise, millions of state tax dollars currently being used to provide health care to children, seniors and others will instead be sent straight back to Washington, leaving the states to find some way to make up the difference.
We don’t think anyone meant the new tax on insurers to actually be a tax on states, but that’s how it works out in the current iteration of the bill. It doesn’t make sense to us.
By the way, Associated Press offers a pretty comprehensive list of all the compromises in the Senate bill as it stands, here.

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