Saturday, January 28, 2012

ACA's Key steps to Cost-savings

Many folks have expressed frustration that the ACA does not do anything to make the health system more efficient.  In fact, here is my take on all the components of the ACA that move us forward in this direction.

1) PCORI: Patient- Centered Outcomes Research Institute. AHRQ has the responsibility to perform comparative effectiveness research to determine which procedures are the most cost-effective.  [pcori is holding a conference in late February to get input on its agenda priorities]
2) IPAB: Independent Payment Advisory Board. This board makes recommendations each year on ways to save the Medicare funds and Congress has to vote up or down.  Has the potential to save considerably.
3) Pay for performance.  This system is implemented for most Medicare delivery systems, such as hospitals, nursing homes, managed care organizations, etc.  Instead of paying for the amount of services, this provision incentivzes these organizations to provide better quality of care.  Has the potential to reduce costs and provide better quality of care.
4) Electronic Health Records.  Expands upon improvements in this area in a number of ways.
5) Insurance proposed rate increases are reviewed to ensure they are justified.  Furthermore, they are reviewed to ensure that there is at least an 80-85% medical loss ratio.  Review conducted at State or Federal level.
6) In 2014, the law establishes Health Insurance Exchanges, health marketplaces, in each State. Those who need insurance can purchase from a marketplace of insurance policies.  By providing competition it ensures that better packages to those who cannot purchase insurance through other ways.  Similar to the current system used by Federal employees.
7) By reducing the uninsured, we will lower hospital emergency room use which will produce savings.
8) By placing premium taxes on those company policies that provide excessive benefits, it will encourage businesses to eliminate costly unnecessary benefits.
9) By encouraging the creation of Accountable Care Organizations that integrate several components of the delivery systems, such as hospitals, nursing homes, home health agencies, and physician practices, this will result in increased coordination of care and reduced costs.  This is similar to creating a managed care organization but less comprehensive.

cms care innovations summit

CMS held a Care Innovations Summit on January 26, 2012.  Cosponsors were West Wireless Health Institute and Health Affairs.

Here is summit website

CQHealthbeat has a good summary of Atul Gawande's talk for those who are paid subscribers.  Write me at for a copy of that section.

Here are my notes on key points

o  Nationally looking at different regions the best results are not most expensive, which is good otherwise would need to ration
 o Using checklist reduces deaths by 47%

Reisman, Aetna: Eliminating drug copays reduced heart attacks, reduced cost, but still limited compliance

Prestwich, USC: Provide physicians, etc with prompting sheet as part of EMR that includes a treatment plan

Kirchhoff, Weight Watchers: In UK, conducted trial with vouchers, 35% of participants had 10% weight loss in one year

Chen, Chenmed: Have all doctors talk with other after seeing a patient

Hoops, Wellpoint: for ESRD provide comprehensive primary care at clinic, include home visits to understand patient's environment, etc.

Some other key points:
o  To reduce hospital readmissions, hospital staff ensures integration of all services, nurse staff consult with primary care physician and patient
o  Many patients do not take all their meds, so need to ensure they do.

Thursday, January 19, 2012

Kaiser Student Essay Contest on ACA

First Prize:  $1500 and an iPad 2
Second Prize:  $750
Undergraduate and graduate students will be judged separately.  In addition to the monetary prizes, the winning essays will be posted on and announced via email to subscribers of the website. The winning students' schools will also be notified.

            DEADLINE: All essays must be submitted online by Monday, March 12, 2012, 5 p.m. EST

Wednesday, January 18, 2012

Outstanding Video: Illustrating the Success of Health Care Reform + Comic Book

This is an outstanding video by Jonathan Gruber. He played a role in the Massachusetts reform law and the ACA.  I like the video a great deal because in 3 minutes it covers most of the major highlights of the bill and a couple of the key myths. I hope that the administration or some group ensures that this video receives lots of visibility.

Here is a blog about Gruber's comic book that is the focus of this effort.  "Health Care Reform: What It Is, Why It's Necessary, How It Works".

The book is for sale through Amazon.

Monday, January 16, 2012

Comprehensive Achievements of ObamaCare!
this is a pretty comprehensive list of the immediate benefits of the law.  There are actually many more.  This is a much longer list than I had even realized.  Missing are other steps being taken to improve the system such as work at AHRQ and CMS. 

Saturday, January 14, 2012

Four new blog entries

In the past 2 days, I have added the following blog entries.
I am particularly pleased to see the report published by the Center for Budget and Policy Priorities that was written by Shawn Bishop and myself. 


Maryland Health Reform Coordinating Council January Meeting

On 1/5/12, the Maryland Health Reform Coordinating Council held a public meeting to review the following reports. These reports are very useful for other states to consider.

Department of Legislative Services
Joint Hearing Room
90 State Circle
Annapolis, MD 21401
1:00 - 3:00 p.m. 


Shawn Bishop and I recently completed a paper entitled as above.  The paper was prepared for the Center for Budget and Policy Priorities and they have distributed the paper to State advocates.  The guide focuses on three types of delivery system reforms that states can elect to adopt in their Medicaid programs under the ACA: 1) new patient care models, 2) new payment approaches, and 3)
the development of new quality measures. The guide provides overview of the reforms available, and discusses ways in which state advocates can work with their partners and state
officials to effectively implement these reforms.

See me for a copy of the report at  Shawn served on the Senate Finance Committee staff during the work on the ACA and is now primarily working with the Marlowe Group as well as doing independent consulting.

NAIC website

here is a paper and a video from NAIC.The value is the organization producing these.

Thanks Obamacare: Play the game

a fun game and educational

Friday, January 13, 2012

Supreme Court Decision Briefs

Great to see that Maryland Attorney General Doug Gansler is a lead in a brief filed by several state attorney generals supporting the Affordable Care Act.  The number of organizations that are filing briefs on both sides of the fence is incredible. Don't know if this has occurred in other supreme court cases, but I don't recall such. Small businesses are on both sides of the fence as are health profession groups, etc. 

Tuesday, January 3, 2012

HHS accomplishments in 2011

this link lists the major accomplishments that HHS performed in 2011, particularly those dealing with Affordable Care Act.  A good summary.