States try to innovate with health exchanges

Kelly Kennedy, USA TODAY

1:01AM EST November 10. 2012 – States should use their creation of health insurance exchanges required by the 2010 health care law to create prevention programs aimed at promoting long-term savings, expert say, but state officials argue that those “wish lists” might have to wait so states can meet their deadlines.

“To do something different, I sure wish we had an extra year,” said Howard “Rocky” King, executive director of Cover Oregon, Oregon’s health insurance exchange. “Our first priority is to come up with something that works.”

That means states such as Oregon hope to build the foundation of their exchangesfirst and then add the extras over the next few years.

“States could play a huge, important role in prevention and care coordination,” said Ken Thorpe, head of Emory University’s health policy department. “But if we’re looking at yesterday’s benefits, we’ll get yesterday’s problems. We need to pull costs out of the system.”

Otherwise, more people will be covered through the 2010 health care law, also known as the Affordable Care Act, but premiums will continue to go up, Thorpe said.

Rather than focusing purely on making insurance available, states could build evidence-based prevention and lifestyle-change options into the plans. Theycould insist that their insurers pay teams of hospitals, primary-care physicians, home health care professionals and hospice providers a set price to care for a consumer, rather than pay by the injection, scan or visit.

Without such changes, Thorpe said, health care costs will keep rising.

So far, Thorpe said, California has done the most to promote innovation in itshealth care exchange.

Health exchanges are state- or federally run websites that allow consumers to choose a health plan, as well as to compare benefits and costs of each plan. Some states will allow all insurers to participate; others have asked insurers to bid to participate; and some states are creating a list of requirements insurers must meet to participate.

Peter Lee, California Health Benefit Exchange’s executive director, said that insurance has “been a game of avoiding sick people” to keep insurers’ costs low. Now insurers must take everyone, and that means keeping chronically ill people stable and trying to prevent people from becoming sick in the first place.

In part, California can push for change because there are so many players: 33 health plans submitted bids to be part of the health exchange.

“The exchange has asked the plans not just for the lowest cost on Day One, but the lowest costs over the long term,” Lee said. “Our board said one of our values is to be a catalyst for change.”

California officials wanted health plans to show how they pay for and reward primary care, provide better care for the chronically ill and build in preventive services, Lee said.

Not every state is moving this direction. C.J. Bawden, spokesman for the SilverState (Nevada) Health Insurance Exchange, said their main goal is to take as little money from the federal government as possible by outsourcing much of the technology of their exchange to Xerox, rather than building from the ground up.

“A lot of states want to build it from the ground up and keep it in-house,” Bawden said. “We came out with a good business plan.”

Everyone with plans that meet federal and state requirements may participate in whatBawden called a “free-market” approach. “We’re trying to facilitate without doing a lot of market disruption,” he said.

Washington, D.C., exchange officials are waiting to hear what the plans will come up with, but they included preventive services, health club memberships and coordinated care included in the plans on their wish list.

Mohammad Akhter, the chairman of the exchange, said Washington’s main innovation wasthat exchange board members are experts in medicine and education and not politicians.

“We expect more innovations because of that,” he said. Negotiating possibilities with insurers is difficult until everyone knows just how manypeople are enrolled in the exchanges, Oregon’s King said.

Oregon officials have asked that each carrier offer several plans, so that they’ll end up with 10 or so carriers with five or six possibilities each for the smallgroup market. That way, someone who knows she probably won’t need a lot of time with the doctor can choose a high-deductible plan.

In the meantime, the state is testing out new care models in their Medicaid and state health programs to see what works to keep costs down, King said. These things include preventive-care programs, as well as making sure doctors arepaid to keep people healthy, rather than through a fee-for- service program.

In Rhode Island, only four carriers exist, but officials still hope to set up different products than were available before. They’ll be negotiating with the insurers over the next month.

Christine Ferguson, Rhode Island’s director of the health benefit exchange, said the plans will be able to do more with a higher concentration of people.

The state hopes to build the exchange, collect data about what works and what doesn’t, and then re-evaluate. For example, do cancer screenings and immunizations affect the number of days people go to work or children go toschool?

“So we’re looking at improvement,” she said. “The exchange is a catalyst to move the debate to reform.”


Statewide Insurance Services Selects COMS Interactive as Preferred Partner

Enhancing Care to Residents by Reducing Avoidable Hospital Re-admissions

By COMS Interactive, LLC

Published: Tuesday, Nov. 13, 2012 – 5:32 am

LOUISVILLE, Ky., Nov. 13, 2012 — /PRNewswire/ — Statewide Insurance Services (SIS), a subsidiary of the Kentucky Association of Health Care Facilities (KAHCF), has signed a Preferred Partner Agreement with COMS Interactive, LLC (COMS).  Given SIS’s objective of helping KAHCF members enhance the quality of resident care by reducing unnecessary re-hospitalizations, the partnership with COMS is a natural extension of the association’s membership services.  The three-year agreement focuses on improving clinical and financial outcomes for each member facility.

The COMS flagship Disease Management software, Daylight IQ™, is used in leading nursing homes, assisted living facilities and home care organizations nationwide.  The Software as a Service (SaaS) product features a series of integrated, disease-based library of clinical protocols that significantly empower the entire care team including physicians, therapists, nurses, and nurse aides, and facilitates enhanced communication between all parties.  The initial Daylight IQ™ training can be completed in less than two hours, immediately improving clinical results and providing positive tangible financial outcomes.

“With almost 60 years representing long-term care providers in Kentucky, it is incumbent upon us to offer products and services to KAHCF members which facilitate the continued improvement of clinical and financial outcomes,” noted Ruby Jo Lubarsky, President, SIS and KAHCF.  “In light of various Centers for Medicare & Medicaid Services (CMS) mandates, it is critical that our member organizations identify ways to reduce unnecessary re-hospitalizations, and the Daylight IQ™ bedside technology will help our member organizations achieve this goal.”

Daylight IQ™ empowers clinical teams with information and technology at the point of care.  This results in caregivers providing better care for residents.  A key component of Daylight IQ™ is the reduction in unnecessary hospital re-admissions by as much as 50%, a related decrease in premature mortality rates, and an increase in successful discharges.

“As the eighth State Association partnering with COMS, we commend SIS and KAHCF management for their thought leadership and strong advocacy for implementing progressive clinical solutions,” noted Edward J. Tromczynski, Chief Executive Officer, COMS Interactive.  “KAHCF plays a key role in supporting member facilities’ clinical excellence, and we look forward to working with the KAHCF team and association membership.”

Industry data shows that the average skilled nursing facility resident has a complicated disease profile, with one primary disease and up to eight secondary diseases or afflictions.  Over 70% of re-hospitalizations are due to the progression of secondary diseases or the onset of a new disease.  By providing early detection of changes in condition, Daylight IQ™ highlights potential problems and offers caregivers the opportunity to respond, preventing further advancement of the illness.

About Statewide Insurance Services, Incand Kentucky Association of Health Care Facilities

Founded in 1954, the Kentucky Association of Health Care Facilities (KAHCF) represents proprietary and nonproprietary nursing facilities and personal care homes across the Commonwealth.  An affiliate of the American Health Care Association, KAHCF provides a wide variety of services to member facilities including legislative and regulatory activities, professional development, statewide recognition programs, publications, media relations, research and advocacy relations.  In order to meet the growing needs of the membership, Statewide Insurance Services (SIS) was incorporated in 1992 as a subsidiary of KAHCF. SIS provides association members with an array of insurance services as well as providing financial support to KAHCF through various Preferred Partners.  For additional information, visit the KAHCF website or by calling #502.425.5000.

About COMS Interactive, LLC

COMS Interactive, LLC deploys processes and systems that stabilize and improve resident health while improving financial outcomes for skilled nursing facilities. The Daylight IQ™ Software as a Service (SaaS) product combines business administration, disease management and long-term healthcare knowledge to empower the nursing team, reduce medical errors, more efficiently address resident healthcare needs and increase facility revenues.  This combination of clinical and technical processes can save millions of dollars a year in preventable hospital re-admissions. Additional information regarding COMS Interactive and Daylight IQ™ is available or by contacting COMS at #330.650.9900.

SOURCE COMS Interactive, LLC

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