Region’s hospitals, insurers keep close eye on impact of federal decision

9:21 PM, Mar. 26, 2012  |  

Written by

Laura Ungar for the Louisville Courier-Journal

It’s been cited as a driving force behind the proposed but thwarted merger involving University Hospital and a Catholic health care system.

It’s inspired new partnerships called “accountable care organizations,” including one being piloted by Norton Healthcare and Humana.

And it’s been hailed as providing extended coverage for more than 35,000 young adults in Kentucky.

The federal health reform law has already started making an impact locally — so area health advocates and officials are tuned in to this week’s Supreme Court proceedings.

“I think the entire health care sector and insurance sector are watching this closely because it has significant implications on both industries,” said Stephen Williams, chief executive officer of Norton. “This is very far-reaching.”

Jodi Mitchell, executive director of Kentucky Voices for Health, a coalition of health advocacy groups, said her organization takes no position on the arguments before the Supreme Court, instead concentrating on educating the public about health reform. But she added: “We expect the law will be upheld.”

One of the most well-known provisions of the Affordable Care Act, as the reform law is called, requires insurers that offer coverage to children on their parents’ plans to make that coverage available until the child is 26.

That portion of the law took effect in September 2010. According to the U.S. Department of Health & Human Services, 35,610 young Kentuckians already have gained coverage through that provision. In Indiana, 38,480 young adults gained coverage.

“This is helpful for college students going to school who can’t afford coverage,” Mitchell said. “And because they’re generally healthy, they’re advantageous on plans where you’re trying to spread out the risk.”

This week’s arguments before the Supreme Court won’t involve that provision, nor several others of the broad-ranging law, but instead will focus on a key and controversial provision — requiring nearly all Americans to have health insurance by 2014.

According to the U.S. Census Bureau, an average of 15.5 percent of Kentuckians — or 663,000 people — lacked health insurance from 2008-2010, as did 12.8 percent of Hoosiers, or 813,000 people. Nationally, 15.8 percent of Americans lacked health insurance during that period.

Health care experts say the reform law eventually would bring the rate of uninsured Americans down by about 60 percent.

Louisville-based Humana Inc., one of the nation’s largest health insurers, said it has long supported universal health coverage for all Americans.

And the company said that other parts of the reform law, such as requiring insurers to cover all applicants regardless of their health condition, cannot work without the “individual mandate” provision. Otherwise, healthy people could pass up insurance while sicker people would get it, raising premiums for all.

Officials at local hospital systems, which provide charity care for many uninsured patients and have unpaid bills from others, have said projections of how many people would gain coverage under the reform law are encouraging.

But they add a caveat — saying it’s unclear if projected gains in patients who would get insurance under health reform would be offset by funding reductions in a state and federal program for hospitals that treat large numbers of low-income people.

Officials at University Hospital, which cares for large numbers of uninsured patients, talked about this uncertainty during the debate involving the proposed merger with Jewish Hospital & St. Mary’s HealthCare and Lexington-based St. Joseph Health System, which is part of Catholic Health Initiatives of Denver. Gov. Steve Beshear ultimately rejected the proposed three-way merger, and Jewish and St. Joseph merged without University to create KentuckyOne Health.

Officials at those health care organizations — as well as others such as Norton and Baptist Hospital East — have said the reform law encourages them to partner with others to become more efficient, improve care and reduce costs.

Norton and UK leaders said the law is one of the main reasons behind their partnership, announced in June. That partnership includes a statewide stroke collaboration and a cancer program that would share resources.

Norton and Humana are also piloting an “accountable care organization” for commercially insured patients, a program that establishes financial incentives for health care providers to improve quality, eliminate waste and control costs. Louisville is one of four national sites in the ACO Pilot Project of The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice. Officials said the program brings a emphasis on wellness and preventive care for patients.

Last October, the U.S. Centers for Medicare & Medicaid Services finalized new rules under the health reform law to help doctors and hospitals better coordinate care for Medicare patients through ACOs. The Medicare program is designed to reward ACOs that lower the growth of health care costs while still providing quality care.

Williams said Norton will still go forward with the ACO and partnerships no matter what happens with the health reform law.

“Even if major parts of it get repealed, I believe what we are doing and what other providers are doing we will continue to do,” he said. With health care expenditures making up 18 percent of the Gross Domestic Product in the United States, “we have to bend the cost curve or we are going to cripple the economy.”

SOURCE:

http://www.courier-journal.com/article/20120326/NEWS01/303260073/Region-s-hospitals-insurers-keep-close-eye-impact-federal-decision-

Some Insurers Paying Patients Who Agree To Get Cheaper Care

By Michelle Andrews

Mar 26, 2012

In recent years, insurers have tried to cajole consumers into using less-expensive health-care providers by promising lower co-payments and other cost-sharing breaks for members who select those doctors and hospitals.

Lately, they’re trying an even more direct approach: cash rewards.

Some Anthem Blue Cross and Blue Shield members in New Hampshire, Connecticut and Indiana can receive $50 to $200 if they get a diagnostic test or elective procedure at a less expensive facility than the one their doctor recommended. The offer covers nearly 40 services, from standard radiology tests such as mammograms and MRIs to such surgical procedures as hip and knee replacements, hernia repair, bariatric surgery and tonsillectomies.

“We identified a subset of highly utilized services with cost variances that we thought would have a big impact,” says Denise McDonough, regional vice president of sales for Anthem BCBS of New Hampshire. “We want to provide information to members to drive health-care costs down.”

It seems to be working. The city of Manchester, N.H., the first employer to pilot Anthem’s Compass SmartShopper program in January 2010, has saved more than $250,000 in health-care costs in two years, even after factoring in the cash rewards paid to the 476 members who have participated.

The differences in costs can be eye-popping. According to Anthem data, in Manchester a hernia repair ranges in price from $4,026 on the low end to $7,498 on the high end. A colonoscopy could cost $1,450 to $2,973.

“It was a huge eye-opener for us,” says Jane Gile, human resources director for the city government.

It, of course, can also save money for employees who haven’t met their plan’s deductible.

Here’s how the SmartShopper program works. At least 24 hours before a member has a scheduled service, he or she calls a toll-free number or logs on to a Web site to get a list of lower-cost local providers.

If a doctor has referred someone to a location that’s not on the list of cheaper providers, the member can request that the doctor change the referral. If the physician is performing the procedure, the member can ask that the doctor do it at a cheaper location.

After the provider submits the claim and Anthem pays it, the insurer compares the records of online and telephone inquiries made by the member to the SmartShopper program. If the member chose to get care at a low-cost provider identified by the program, he gets a check in the mail within 60 days. (The amount is usually about $100, but it varies with the size of the amount saved.) An employee who has not yet met his annual deductible would also save directly on the cost of the treatment.

If the member wants to stick with his doctor’s initial plan and forgo the cash bonus, no problem. The program is entirely voluntary.

Last year, Harvard Pilgrim Health Care launched SaveOn, a similar program that covers a limited number of services in New Hampshire and that recently expanded into Massachusetts.

Physician groups have some concerns. “It appears as though the decision is being made by the health plan, and tiering of providers is being made simply on an economic basis,” says Scott Colby, executive vice president of the New Hampshire Medical Society.  “We have concerns about giving economic incentives without giving weight and credence to quality measures.”

It’s a fair criticism, insurers concede. Listed providers are licensed and credentialed, but quality indicators such as complication rates aren’t factored in. “It’s a first-generation set of data,” says Eric Schultz, president and chief executive of Harvard Pilgrim Health Care. “We all have a long way to go on performance data.”

Likewise, the Compass SmartShopper FAQ page says, “It is up to you to talk to your doctor or research online at anthem.com to determine your quality requirements.”

For simple diagnostic lab and radiology procedures, choosing providers based primarily on cost is probably fine, says Ha Tu, a senior researcher at the Center for Studying Health System Change, a Washington-based think tank. “But when you start talking about surgery, it’s hard to argue that quality doesn’t vary quite a bit, and people shouldn’t be making these decisions purely on cost.”

Physicians are also concerned that programs such as SaveOn and SmartShopper may hinder care coordination among providers at a time when such coordination is considered key to managing patients’ health and controlling health-care costs.

When the SmartShopper program was introduced, some Manchester city employees were skeptical, says Gile. But many have come around.

Gile herself has used the program three times: twice for screening mammograms and once for a colonoscopy. She had a good experience each time. By choosing a lower-cost provider for the tests, she qualified for cash rewards of a few hundred dollars altogether, she says.

SOURCE:

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/Cash-Rewards-For-Cheaper-Care-Michelle-Andrews-032712.aspx

Periodontal Care Linked to Diabetes Management

‘Striking’ Data Links Periodontal Care to Lower Diabetes Costs

John Commins, for HealthLeaders Media , March 27, 2012

An insurance industry study, touted as the largest of its kind, shows that medical costs can be reduced by more than $1,800 a year for each diabetic patient who receives periodontal care.

The study examined medical records from more than 1.6 million people who were covered by both United Concordia Dental and Highmark Inc. and identified about 90,000 Type 2 diabetics.  About 25% of those diabetics elected to receive periodontal treatment in 2007 and the study compared their medical costs over the next three years with the 75% of diabetics in the group who declined the oral care.   

“The data is striking. In 2007 you had fewer than half the inpatient admissions if the patients had periodontal surgery when compared with the patients who did not,” says Marjorie Jeffcoat, DMD, with the University of Pennsylvania, the lead author of the study.

“I also found it striking that this result was carried through for three years,” Jeffcoat told reporters at a Monday teleconference. “If you look at the mean number of visits they paid to a physician, again in 2007 they saw half the number of physician visits and this statistically significant result was carried through again for three years.”

“If we look at mean medical costs we have a reduction in all three years and if you look at it the mean medical savings was $1,814 per patient per year. That is a striking number. This affect is apparent two years after the periodontal treatment,” Jeffcoat says.

The study’s release coincided with United Concordia launch of a diabetes-specific program that provides 100% coverage for surgical procedures, other treatments, and maintenance for patients with gum disease.

“This is the most statistically conclusive study proving the relationship between oral health and medical cost savings. The savings are just the start of what is to come,” United Concordia COO/President F.G. “Chip” Merkel told reporters. “We believe that employers will realize reduced medical costs when their employees with diabetes receive appropriate periodontal care.”

James Bramson, DDS, chief dental officer for United Concordia, noted that about 25.8 million Americans have diabetes, a number that has doubled since 1999. He says the sheer size and scope of Jeffcoat’s study shows “that the results here are not a fluke.”

“We did some modeling to look at the ability to take care of these kinds of patients and the cost of doing that and what kinds of savings you’d have on the medical side,” Bramson says. “In a group of about 200 members, even as small as that, it would only take about 3% of the diabetics to actually return the savings on the medical side equal to what it would cost to provide these additional treatments. Beyond that all the rest is healthcare savings.”

While the study examined diabetics, Bramson says other studies have provided linkage between oral health and coronary artery disease, cerebral vascular disease, and even premature and low-weight infants. “We believe other chronic diseases will show some association, some economic savings medically if those people had periodontal treatment,” he says. “So when we know more about the breadth and depth of the accuracy of that savings across those other diseases our hope here is to broaden the coverage we are now starting with diabetes.”

“The thought is you don’t need to cover everybody in the population,” he says. “The better thing to do is cover those targeted populations where we can show savings and where we know an intervention program of information and assistance will help them get in and get the treatment they need.”

Bramson says dentistry accounts for about 4% healthcare spending in the United States, while hospital care, physician and clinical services, and drugs account for 63% of all spending. “If we can improve the spending in the dental that is going to affect the three other largest segments of the healthcare spending, so we believe you will have some savings well beyond the $1,814,” he says.

The study did not specifically examine the cause-and-effect relationship between periodontal disease and diabetes, but Jeffcoat says earlier studies have explained the linkage.

“Any sort of infection you have, be it pneumonia, a kidney infection, it makes your diabetes worse,” she says. “Periodontal disease is an infection. If we can get that infection under control we tend to get the hemoglobin A1C, the measure of three months of diabetes, under control. It has to do with inflammation and infection and getting it under control.”


John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.

Passport, Leadership host Chamber breakfast

by Brittany Wise – Grayson County News Gazette
03.25.12 – 12:00 pm

Representatives from Passport Health Plan, along with Leadership Grayson County hosted Thursday’s Chamber of Commerce breakfast at the Centre on Main, where a new local Passport board member was announced, along with the 2012 Leadership class and the new Executive Director of the Grayson County Chamber of Commerce.

Passport’s Chief Executive Officer, Mark B. Carter, spoke to the group about the non-profit organization’s service in central Kentucky. The group serves 16 counties, including Grayson, and provides health care for around 5,000 Grayson County residents – about 20 percent of the county’s population.

Carter explained that through the group’s partnerships with hospitals, primary care providers and a large number of specialty physicians, they are able to provide excellent quality healthcare to residents who would otherwise not have healthcare.

Carter boasted of the group’s #13 ranking among similar agencies country-wide, adding that all but two of the top 100 ranked companies were located in either New England or the West Coast, which makes Passport’s excellent slot an even more powerful accomplishment.

It was also announced that local business-owner Steven Elder has joined the Passport Health Plan Board.

Elder said of the group, “Passport Health Plan truly brings the community together. Their committee and board structures allow concerned citizens like myself to bring perspectives to the table and work collaboratively to find innovative solutions that work for everyone.”

Another exciting announcement for the Elder family was the reveal of the new Executive Director of the Grayson County Chamber of Commerce, his wife, Tara Elder.

Tara will be stepping into the shoes of former Director Caryn Lewis, who is leaving the position to work for the Grayson County School System.

Before Caryn’s departure, however, she had the opportunity to announce this year’s Leadership Grayson County class, which includes: April Bowman, with Wilson & Muir; LaShawn Cole-Hack, with Head Start; Tara Elder, with Grayson County Chamber of Commerce; Kindra Ewing-Jones, with Grayson County Extension Office; Valerie Farris, with Elder Wealth management; Alicia Harrell, with City of Leitchfield; Lisa Jones, with Grayson County Public Library; Amanda Joyce; Jessica Kelley, with Carter Harrell State Farm; Ellis Kiper, with Rocky-K Log Homes; Harold Miller, with WRECC; Trish Niles, with Mid-Park, Inc.; Carrie Petrocelli, with Twin Lakes Home Health; Natalie Taul, with Grayson County Extension Office; and Christopher Wilborn, with United Way of Central Kentucky.

SOURCE:

http://www.gcnewsgazette.com/view/full_story/17984858/article-Passport–Leadership-host-Chamber-breakfast?instance=popular

Passport employee’s award to benefit OVEC’s Head Start

By The Staff
Friday, March 23, 2012 at 3:00 am       (Updated: March 23, 3:06 am)

Marcelline Coots, one of the first individuals to be hired at Passport Health Plan in 1997, has been named the 2012 Making A Difference award winner by the Association for Community Affiliated Plans (ACAP), and that’s going to benefit the Ohio Valley Educational Cooperative’s Head Start program.

She was selected from a pool of candidates submitted by the national organization’s 57 affiliated health plans located throughout 27 states. ACAP serves more than 10 million Medicaid and CHIP members across the country.

In her honor, ACAP is presenting a $500 donation to her charity of choice, OVEC, in a ceremony Wednesday at the cooperative’s office on Alpine Drive in Shelbyville.

Coots, whose daughter attends  Christian Academy of Louisville, serves on the advisory council and community board of the OVEC.

She is the main member outreach event planner for Passport Health Plan and has participated in or planned numerous special events.

“Marcelline embodies the mission of Passport Health Plan – to improve the health and quality of life of our members,” Passport Health Plan CEO Mark B. Carter said in a press release announcing her award. “She’s done things like learn to drive a truck for some of Passport’s large outreach events. That’s the kind of commitment that Marcelline has demonstrated every day during the length of her service here, and I’m delighted that she is being recognized in this manner.”

SOURCE:

http://www.sentinelnews.com/content/business-briefcase-march-23-2012