Friday, April 18, 2014

My thoughts on: Ezekiel Emanuel's New Book : Reinventing American Health Care +

I.  Ezekiel Emanuel: Reinventing American Health Care

Emanuel has published this new book.   He was a key advisor in the White House on the ACA legislation.  I had the pleasure of hearing him provide a summary of his book earlier this week.  Here are six megatrends that he forecasts for the future.

1) Insurance companies will make greater use of management, analytics, and actuarial services and/or integrated delivery systems
2) Doctors and hospitals will focus on keeping chronically ill out of ERs and hospitals and provide more effective mental health care
3) Many hospitals will close and digital systems will become more widespread
4) Employer participation in health insurance will be dramatically reduced.
5) Health care inflation will be significantly reduced
6) Medical education will be dramatically transformed.

I feel there is a much wisdom and potential reality in these points. Here are some of my thoughts that I shared with him afterwards in which he seems to have concurred:

What do you think of Pay for Performance strategies which are now part of the Medicare program? I think they have potential but have not seen clear evidence so far to support.

I think the Hotspotters as discussed by Atul Gawande has great merit and ties in with your thoughts on chronic care. 

I think it would be very useful to incentivize consumers to select insurance plans based on quality of care measures.  General Motors tried such an approach successfully a number of years ago.

There is a great need to integrate post-acute systems and also to integrate long term care systems.  In addition, to integrate care for dual eligibles.The administration is working on the latter but has not shown a great deal of creativity.   

I think the administration needs to do more to sell Medicaid enrollment, particularly those populations that would benefit the most from such.

I also think the administration needs to do a better job of selling the accomplishments so far and counter the Republicans more effectively. 
II. The Alliance for Health Reform held a very useful session yesterday on Prevention.  There are many positive features in ACA regards prevention but there is much more that can be done from a system viewpoint as well as re funding.

III.  Other articles

Here are other items of interest

Maryland to shift $21m to help stabilize insurance premiums

CBPP Releases New Resource on State Marketplace Design and Policies

Are Exchanges More Appealing To Insurers Now?

Tuesday, April 8, 2014

Personal perspective on the ACA startup

Here are a few personal highlights and low lights for the first six months of the ACA enrollment period 

My best moments were organizing volunteers to assist at several enrollment fairs and seeing the excitement and gratitude of  those enrolled.  A second highlight is discovering a website that is the best source of consumer comparison info and getting it endorsed by Commonwealth Fund and other leading experts.  Wish more folks made use of it.  A third highlight was identifying a fraudulent site masking as the state's site. Fourth, working with Prince George's team to train volunteers on ACA.  Fifth, glad to be able to work with the Capital Region Connector and its team of 10 agencies.  They are a good group working very hard. 

Some concerns:  1) Quite frustrated that Maryland's website had so many problems.  Glad that they are switching. Hope that is a good move.   2) Made several suggestions to key officials in Maryland without success.  However, I am only a minor player in the system. 3) Wish there was a more comprehensive effort in the State to work with volunteer organizations, unions, churches, etc to mobilize around enrollment.  4) Would have liked to engage with more elected officials in reaching out to the public.  I held back to some extent because of the problems with the State computer system. 

Wednesday, April 2, 2014

Some Early ACA Returns

Here are some of the early returns and reflections on the just "completed" enrollment period.   I put a qualification as one can still enroll in many states if they attest that they tried unsuccessfully.  Also, if there is a status change you can make a change and Medicaid enrollment is continuous.  While there has been considerable successes, there is much work to be done.  And Maryland has struggled considerably more than much of the country.  I sure hope the Connecticut fix will work.

Here are various news reports, videos, etc which highlight some of the reactions to the end of this first major enrollment period.

 Video: Obama on Health Care Enrollment Numbers

MISSING FROM THE NUMBERS – “Newly Enrolled, but Not Counted by Insurance Exchanges” 

“Kids suffer when their parents lose their health insurance. Maine knows this firsthand” Bangor Daily News (Opinion)

Co-op Health Insurance Plans See Early Success

Politico: Enrollment Caveats Will Keep ACA Counting

The Star Tribune: As Deadline Passes, MNsure Exceeds Sign-Up Goal

Commonwealth Fund:

1) New Study Finds 32 Million Underinsured in 2012  

2) The ACA's Medicaid Expansion: Alternative State Approaches  

 3) Measuring Progress in Care for 'Dual Eligibles'

 Why Some Don’t Pay Their Obamacare Premium: It’s Not What You Think