Passport Health Plan Partners with March of Dimes for Healthier Babies



Contact: Leslie Porta

Phone: (502) 473-6680

For Immediate Release                                                                                                                                                          Email:

Passport Health Plan Partners with March of Dimes for Healthier Babies

Presenting Sponsor for 2013 Louisville March for Babies

(LOUISVILLE, Ky. December 20, 2012) — In an average week, 169 Kentucky babies are born preterm, and seven babies die before their first birthday. Prematurity is the leading cause of death for newborns, and Passport Health Plan wants to help change this as the Presenting Sponsor of the 2013 Louisville March for Babies, the largest fundraiser for the March of Dimes in Kentucky.

Passport Health Plan’s mission is to improve the health and quality of life of its members, so they understand the importance of the March of Dimes’ work to prevent preterm births. “Passport Health Plan is dedicated to helping Kentuckians lead healthier lives, so our mission aligns perfectly with the March of Dimes,” said Mark B. Carter, CEO of Passport Health Plan. “The preterm birth rate in Kentucky is 13.4 percent and that is unacceptable. The community has to work together to ensure more babies get a healthy start to life.”

Kentuckiana residents can start a March for Babies team with co-workers, family or friends at The 2013 walk is chaired by David Gray, president of Baptist Hospital East, and will be held on Saturday May 11 on the Big Four Lawn at Waterfront Park.

The March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. 2013 marks the 75th anniversary of the March of Dimes. Last year, more than four million babies were born in the U.S. and the March of Dimes helped each and every one through vaccines, research, education and breakthroughs. For more information, visit or for Spanish.

For more information on the 2013 Louisville March for Babies contact Leslie Porta, Senior Community Director at 502-473-6680 or  You can also find us on Facebook at or on Twitter @marchofdimesky.

Passport Health Plan is a unique public‐private partnership with the Commonwealth of Kentucky and a provider sponsored Medicaid health plan serving members in 16 Kentucky counties for the last 15 years: Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington. Passport Health Plan is sponsored by the University of Louisville Medical School Practice Association, University Medical Center, Inc., Jewish Heritage Fund for Excellence, Norton Healthcare, and the Louisville Primary Care Association, which includes the Louisville Metro Department of Health and Welfare and Louisville’s two federally qualified health centers, Family Health Centers and Park DuValle. For additional information, please visit



States move forward on health insurance exchanges

By Sean LengellThe Washington Times

December 17, 2012, 11:42AM


Eighteen states and the District of Columbia have moved forward with plans to set up their own statewide health-insurance-buying exchanges ahead of a key deadline.

States had until Friday to submit applications to the federal government to establish state-based exchanges. Health and Human Services Secretary Kathleen Sebelius on Monday announced the list of states that met the deadline, which comprised California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont, Utah, Kentucky, New York, Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington.

States also can choose to set up an exchange under a state-federal partnership, with a decision on that option due Feb. 15. If any state is undecided after that, the federal government will run that state’s exchange.

Exchanges, a major component of the federal Affordable Care Act, are design dot be marketplace where individuals and small businesses can shop for the most affordable coverage and where many will get help from the government to pay their premiums.

About half the nation’s states say they’ll take a pass on the setting up their own health care exchanges, ceding the responsibility to the federal government.

Open enrollment for the exchanges is set to begin in October, with coverage to start in January 2014.

“While last week was one milestone, we are not taking an ‘all or nothing’ approach to exchanges,” Mrs. Sebelius said. “Many states are making impressive progress, and we are committed to working with all states as we approach open enrollment in October 2013.”

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Learning From University of Louisville Hospital’s Partnership Search

 Written by Kathleen Roney | December 14, 2012


In November, the University Medical Center, operator of University of Louisville Hospital and the James Graham Brown Cancer Center, announced a joint operating agreement bringing together University Hospital with KentuckyOne Health in Louisville. This joint operating agreement is the result of more than a two-year partner search for University Hospital, which faced a few obstacles along the way.

In 2011, the hospital was part of a proposed three-way merger between Jewish Hospital & St. Mary’s HealthCare in Louisville and Catholic Health Initiatives’ St. Joseph Health System in Lexington, Ky. Catholic Health Initiatives would have overseen the multi-hospital system. Kentucky Gov. Steve Beshear blocked the merger between the public and faith-based organizations, saying such an arrangement would result in the transfer of state assets, in the loss of governance over those state assets and was not in the best interest of the Commonwealth. This left financially challenged University Hospital without a partner. Jewish Hospital & St. Mary’s and St. Joseph Health System pursued the merger without University Hospital to form KentuckyOne.

Following the failed three-way merger, University Hospital re-started its partnership search, this time taking a more formal approach. After a second attempt, University Hospital again chose the same organizations — this time organized as KentuckyOne Health. However, the second time around, the organizations pursued a different structure — a joint operating agreement instead of a merger — that met the stipulations set by Gov. Beshear and Attorney General Conway.

Under the new deal, University Medical Center  will retain ownership of its assets and will operate University Hospital’s Center for Woman and Infants;  KentuckyOne Health will oversee day-to-day operations of the remainder of the hospital. All current policies for women’s health, end-of-life care and its pharmacy will remain unchanged, including a full range of reproductive services. In addition, KentuckyOne has committed to maintaining University Hospital’s current levels of charity care.

Developing a successful joint operating agreement between a public academic health center and a non-profit, religious-affiliated health system had its challenges, but University Hospital navigated the process — twice. Through two periods of negotiation and deal forming, David L. Dunn, MD, PhD, executive vice president for health affairs of University of Louisville, learned a great deal. Here he discusses the partnership search following Gov. Beshear and Attorney General Conway’s ruling and lessons he learned from the experience.

A second transaction process

“[When Gov. Beshear turned down the three-way merger he] indicated to [University of Louisville] that we needed to ‘cast our net more widely.’ I was at the University of Buffalo prior to coming to Louisville and had experience with a request for proposal process. We used that process as a wider net to search for a partner,” says Dr. Dunn.

In February, the hospital issued a request for proposal, hoping to combat financial challenges and make improvements. Proposals were accepted until March. In October, Dr. Dunn was given authority to choose a private partner and the KentuckyOne Health announcement was made in November.

The interesting point is that University Hospital chose KentuckyOne Health as a partner the second time around after a second, broader partnership search. According to Dr. Dunn, the difference was that University of Louisville satisfied the governor and attorney general’s concerns by following a competitive bid process and considering more partners.  KentuckyOne was ultimately chosen because it was, and is, an extremely good fit, says Dr. Dunn.

Here are five recommendations from Dr. Dunn that other hospitals may be able to learn from in pursuing affiliations, partnerships or acquisitions of their own.

1. Conduct a financial analysis on your hospital. Dr. Dunn recommends conducting a complete financial overview of your hospital before pursuing a competitive process for two reasons.

 “If you are a public entity, and need to involve elected state officials, the financial overview may give reason to why you are planning or pursuing a deal. [For] potential partners, a financial overview increases transparency so the partner may see [the hospital] it is considering clearly,” says Dr. Dunn.

 2. Pursue a competitive process with a request for proposals.

Although University Hospital’s competitive process was an outgrowth of Gov. Beshear and Attorney General Conway’s concerns, Dr. Dunn would recommend other hospitals follow a competitive process.

 “I think the RFP process — at least for academic medical centers — could be considered a best practice because it allows [the medical center] to disseminate [its] interest in obtaining a health system partner. Rather than in a random fashion, [the deal forms in] a very considered fashion. You can select a series of entities that target your terms and ask them to come to the table to discuss the deal further,” says Dr. Dunn.

3. Keep the necessary officials informed throughout the process.

University of Louisville and University Hospital executives maintained regular contact  with Gov. Beshear, Attorney General Conway and their staff throughout the second partnership search, and Dr. Dunn believes this played a role in the success of the transaction.

“They provided advice or counsel before we launched the request for proposal. We asked for their input, because we wanted to make sure that the process we were following was acceptable to them,” says Dr. Dunn. “Even the [communication] plan we used was unique because [it was developed directly] from the guidance that Gov. Beshear and Attorney General Conway gave us as to what the problems in our first deal were.”

4. Engage expert consultants.

According to Dr. Dunn, having a legal team that understands transaction law, in particular, healthcare transaction law, made a big difference because they focused on the legality of the deal.

“They helped us work directly with Gov. Beshear and Attorney General Jack Conway to ensure the legal soundness of the deal as well,” says Dr. Dunn. “We also brought in consultants early on to help us with this process in terms of the analysis. When we issued the RFP we had to engage [certified public accountants] to examine the financial sustainability of the medical center and the health science center. We also engaged an investment banking firm to help us assess financial performance of the organizations that responded to the RFP and to compare the financial pro formas of the proposed transactions.”

5. Consider alignment on mission, culture and values early.

According to Dr. Dunn, considering how two or more organizations will align in mission, culture and values is important, and it is a good idea to get an understanding of those issues earlier rather than later. University Hospital discussed those issues with the organizations now part of KentuckyOne Health during the 2011 negotiations, so the discussions were not as in-depth the second time around. Regardless, they should always be discussed.

“We aligned missions by laying out our mission, understanding their mission and making sure there were large amounts of cross-over between our organizations,” says Dr. Dunn. “We also examined how KentuckyOne Health — in terms of its parent companies — comported itself, what its mission was and how it behaved as a corporate citizen.”

In terms of the religious culture and mission, Dr. Dunn says discussions were very clear around each organization having their own culture — whether it was a faith-based culture, a Catholic faith-based culture or an academic culture. “We had a crystal clear understanding that all of us would respect each other’s traditions but not adopt them.”

Despite challenges along the way, the University of Louisville was able to structure a joint operating agreement that satisfied all parties. The above practices helped the organizations find mutually agreeable terms to form a deal that passed state inspection. Although every deal is different and circumstantial, tenets for success can be applied in multiple situations.


Deadline, Bottlenecks Loom For Health Insurance Exchanges

By Sanjay Singh AOL Government

Published: December 12, 2012


With the deadline just days away for states to declare whether they will institute their own health insurance exchanges as outlined in the Patient Protection and Affordable Care Act (PPACA), many states in the U.S. have yet to formally declare their intentions. Their delay is only one factor threatening to slow down progress on an already rough-hewn path to implementation of health exchanges, which are scheduled to be fully operational with policies taking effect in January 2014.

The state exchanges are a marketplace for health insurance products where, in theory, consumers and small businesses can shop for insurance at competitive rates, enroll in plans and find transparent information on premiums, coverage, and benefits. Exchanges are familiar to any consumer who has experienced the ease of buying airline tickets online using aggregator services, such as Expedia. 

However, buying health insurance is not the same as buying an airline ticket from Chicago to New York. The stakes are much higher; the issues, more complex. It is not a matter of two double clicks and you’re done.

The complications associated with health insurance exchanges stem from the stakeholders involved, the variation from state to state in the form exchanges will take and readiness of the IT infrastructure build-out that must conform to government standards and deadlines.

With regard to technology demands, several key unknowns impact not only how consumers will interface with exchanges slated to start selling insurance by January 1, 2014, but also how federal government, state government and insurers will reconcile subsidized insurance payments. Among the outstanding issues are:

The System of Electronic Rate and Form Filing (SERFF), which enables electronic filing of applications for new policies and premiums, has yet to be updated to be able to support requirements of the new healthcare law. The system, developed by the National Association of Insurance Commissioners (NAIC), will help state and federal regulators determine which products can be sold on exchanges.

The federal hub tool that state exchanges will use to verify an insurance applicant’s income, citizenship, Social Security number and other information is still in the developmental stage. State exchanges must be able to integrate with the tool but because interfaces are not ready, states are making assumptions about how their infrastructure will align with the tool.

Cost-sharing and financial reconciliation procedures for subsidized insurance await clarification. A robust system must be in place for insurers, the Center for Medicare & Medicaid Services (CMS) and the federal government to verify subsidy amounts owed by which entity and account for new developments such as the Medicaid threshold being raised to cover adults up to 133 percent of the poverty line as a result of the law.

The outstanding issues are less a technology issue than a bureaucratic one made more daunting by the magnitude of establishing a new and untested healthcare marketplace. Technology vendors involved in building the exchange infrastructure confront changing requirements, variations in customization that differ by state and, as delays continue, compressed timelines for developing, configuring and testing systems.

Exacerbating this situation further is the fact that most states delayed decisions on whether to set up exchanges. Many gambled that the Supreme Court would overturn the health reform law – it upheld the law in June 2012 – and then held out hope for a change in the Administration after the November elections. Only 17 states so far are moving forward with state exchanges, eight remain undecided on plans and four are planning to establish a partnership with the federal government to operate exchanges, according to the Kaiser Family Foundation. Another 21 states, many of them staunchly opposed to the law, are set to default to a federally facilitated exchange.

The final deadline (extended) for states to present their exchange plans is December 14. Stay tuned. 

Sanjay Singh is Chief Executive Officer and co-founder of hCentive, the first organization to build an exchange solution from the ground-up post the Patient Protection and Affordable Care Act of 2010 (PPACA).


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Flu activity level widespread in Kentucky, officials at Department of Public Health say

Wednesday, December 12, 2012 from


Kentucky Department for Public Health officials reported to the Centers for Disease Control and Prevention this week that the flu activity level in the state has increased from regional to widespread. Widespread activity is the highest level of flu activity, which indicates increased flu-like activity or flu outbreaks in at least half of the regions in the state. The activity levels for states are tracked weekly as part of the CDC’s national flu surveillance system.


“With current widespread flu activity being reported in Kentucky, now is a good time to protect yourself and your family by putting a flu shot on your holiday list,” said Stephanie Mayfield, M.D., commissioner of DPH. “As the holidays approach, people will be traveling and families will gather together, increasing the potential for exposure to the flu. We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”

The flu season can begin as early as October and last through May, and usually peaks between January and March. The holiday season is still a good time to get vaccinated against the flu because it takes about two weeks for immunity to develop and offer protection against flu. However, vaccination can be given any time during the flu season, and this year there is a plentiful vaccine supply.

The best way to protect against the flu is to receive a flu vaccination. The CDC’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals 6 months of age and older. People who are especially encouraged to receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:

• Children age 6 months to 19 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;
• Health care workers;
•Caregivers of or people who live with a person at high risk for complications from the flu; and
•Out-of-home caregivers of or people who live with children less than 6 months old.

Kentuckians should receive a new flu vaccination each season for optimal protection. Influenza strains currently circulating most widely in Kentucky appear to be covered by this season’s vaccine, according to officials. Healthy, non-pregnant people age 2-49 years can be vaccinated with either the flu shot or the nasal vaccine spray. An intradermal influenza vaccination, which was new last season, uses a smaller needle and can be given to adults 18 through 64 years of age. Children younger than 9 years old who did not receive a flu vaccination during the last flu season should receive a second dose four or more weeks after their first vaccination.

Infection with the flu virus can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches. Flu is a very contagious disease caused by the flu virus, which spreads from person to person.

Approximately 23,000 deaths due to seasonal flu and its complications occur on average each year in the U.S., according to recently updated estimates from the CDC. However, actual numbers of deaths vary from year to year. For more information on influenza or the availability of flu vaccine, please contact your local health department or visit

In addition to flu vaccine, DPH strongly encourages all adults 65 or older and others in high risk groups to ask their health care provider about the pneumococcal vaccine. This vaccine can help prevent a type of pneumonia, one of the flu’s most serious and potentially deadly complications.

“The pneumococcal vaccine is extremely safe, effective, can be taken at any time of year and is currently available in an adequate supply,” Mayfield said.

Caused by bacteria, pneumococcal disease can result in serious pneumonia, meningitis or blood infections. According to the CDC, pneumococcal disease kills more people in the U.S. each year than all other vaccine-preventable diseases combined. Between 20,000 and 40,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older.

For more flu information, visit or for those in Fayette county, or call 859-288-7529 for the health department’s flu hotline.

From the Kentucky Department for Public Health

You might also be interested in: First case of the flu reported in Lexington as National Influenza Week kicks off and Beshear, first lady urge Kentuckians to get flu vaccine, particularly people at high risk.

America’s Health Rankings show worrisome rates of chronic disease, inactivity


CBS NEWS/ December 11, 2012, 9:57 AM


A new report shows it’s not only what you put into your body that affects your health — it’s where you live.

United Health Foundation unveiled its 22nd annual America’s Health Rankings on Tuesday that provided a national look at health problems — and progress — in all 50 states.

Researchers pulled data from agencies which included the Centers for Disease Control and Prevention, Census Bureau and American Medical Association to come up with the annual list. This year’s health rankings found that Americans are living longer, but according to Dr. Reed Tuckson, chief of medical affairs for United Health Group, many are living sicker.

“What worries us in particular about this year’s report is that some key risk factors that are driving up preventable chronic illness are getting worse,” Dr. Tuckson told

Some states fared better than others in the annual report. Vermont topped America’s Health Rankings for the sixth year in a row while last year’s least healthy state, Louisiana, was joined in a last place tie with Mississippi.

Tuckson said one of the trends from this year’s report that concerns him most is the high rate of Americans who live a sedentary lifestyle outside of work. The report found more than 26 percent of the country is physically inactive. That’s one in four U.S. adults.

Last July, a study in The Lancet equated the international death toll from physical inactivity to that caused by smoking cigarettes. The researchers found that sedentary individuals are significantly more likely to have heart disease, diabetes and breast and colon cancers because they don’t walk as little as 30 minutes per day, five days a week.

Tuckson also noted increases in chronic diseases like hypertension, which now affects 30 percent of Americans, and also large amounts of diabetes, a disease that one in 11 Americans is diagnosed with. Smoking rates are still too high, Tuckson adds.

A growing problem in the U.S. highlighted in the report is children living in poverty. Today, more than 21 percent of U.S. children under 18 live in poverty — an increase of 35 percent over the last decade — which puts them at a disadvantage for access to healthier foods, physical activity and health care, said Tuckson.

Nationwide, obesity continues to be an epidemic affecting about 27.8 percent of the country, or more than 66 million adults.

Even the least obese state in the country, Colorado, had an obesity rate above 20 percent. Besides adding to belt sizes, obesity causes preventable diseases that rack up $66 billion per year in health care costs, and cost the economy between $390 billion and $580 billion lost productivity each year, according to the report.

Some of the biggest gaps in America’s health can be seen by comparing the five highest ranked states to the five lowest ranked. For example, while smoking rates in the five healthiest states — Vermont, Hawaii, New Hampshire, Massachusetts and Minnesota — ranged from 16.8 percent to 19.4 percent of adult residents, smoking rates were between 23.1 percent and 28.6 percent in the five least healthy states of Mississippi, Louisiana, Arkansas, West Virginia and Carolina.

Likewise, 27.2 percent to 36.0 percent of the population in the five lowest ranked states lead sedentary lives, compared to between 21.0 percent and 23.5 percent of the population in the five healthiest states.

The economy may be a factor in these health gaps, the report found. The top five states reported a higher median household income of $51,862 to $65,880, while the five lowest ranked states ranged from $37,881 to $43,939. Rates of childhood poverty were also significantly higher in the five lowest ranked states compared to the five-highest rated states.

But not all is bleak.

The report found decreases in death rates from heart disease and cancer, including a 30 percent drop in heart disease deaths since 1990, which Tuckson says shows our country’s medical care is effective. He also sees hope for improving physical activity in youth, citing an uptick in after-school physical activity and structured play time. That’s not only important for the children, he said, but it gets adults involved and may make them more likely to change their own health behavior.

Exercise and eating healthy, he said, could be fun and make the family feel great.

“The most common misconception people have about living healthy is it’s hard,” said Tuckson.

Click here for a complete look at America’s Health Rankings 2012.

© 2012 CBS Interactive Inc. All Rights Reserved.


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Leveraging Technology to Reduce Readmissions: 3 Things to Know

Produced by Becker’s ASC Review

Written by Sabrina Rodak | December 08, 2012 

Readmissions are becoming a top concern of hospital leaders, not only because readmission rates reflect quality of care and population health, but also because they have significant financial implications for hospitals. Under the Patient Protection and Affordable Care Act, hospitals will lose a portion of their Medicare reimbursement for having higher readmission rates for heart attack, heart failure and pneumonia. An analysis by Kaiser Health News found that in October, more than 2,000 hospitals will lose a total of $280 million in Medicare funds due to high readmissions. 
Hospitals need to employ a variety of strategies to decrease their readmission rates to improve quality and avoid cuts to Medicare funds.

Collaboration is essential for meaningful change 
“Collaboration is really at the core of reducing readmissions,” says Thomas R. Ferry, president and CEO of healthcare patient-management software-as-a-service provider Curaspan Health Group. Patients most at risk for readmissions are typically those who need additional care after hospital discharge. Hospitals need to collaborate with post-acute care providers to ensure patients receive appropriate care and will not need to be readmitted. 

“As hospitals strive to move [patients] outside their four walls, they’re going to send them to long-term acute care, skilled nursing facilities or rehab facilities, and so they have to measure the performance of those organizations,” Mr. Ferry says. “You have to ensure you’re sending a patient to the right level of care and to an organization that can handle that patient and has a track record of managing that patient population.”

Collaborating with post-acute care providers through technology and data sharing can help hospitals track patients’ progress and avoid readmissions. Mr. Ferry explains three steps hospitals should take to develop a working relationship with community providers to achieve the common goal of reducing readmissions. 

1. Ensure the technology is usable and useful. “The tendency of most organizations is to think of the impact [of technology] within their four walls and the users of the technology within their organization,” Mr. Ferry says. “But if you’re thinking about driving collaboration and the relationship with your external partners, you also have to think about a technology platform that’s going to be useful to those organizations as well.”

Technology that can work across multiple systems will enable hospitals to more easily share data with post-acute care providers, which can support a strong relationship between the two groups.

In addition to functional concerns, hospitals should consider the benefits of technology for both their own organizations and the organizations they will partner with. “Make sure the technology has utility and provides benefits to your users so they adopt it and want to incorporate it into their everyday life,” Mr. Ferry says. The technology should be easy to use to increase the likelihood the post-acute care providers will use IT to share data with the hospital. 

2. Collect and analyze data. When hospitals and post-acute care providers implement a shared technology platform, they can collect data on patients discharged from the hospital and their outcomes at the new care provider. For example, hospitals can track data on how many patients are readmitted from each post-acute care provider, and can drill down further to identify readmission rates for different populations of patients — such as cardiac patients — by post-acute care provider. To pinpoint the source of the problem, hospitals can also track the reason for the readmission from each post-acute care provider. A provider may have a high number of cardiac patients readmitted due to medication noncompliance, for example.

By collecting this data, hospitals can evaluate the appropriateness of different post-acute care providers for specific patient populations. “You can start to use that data to drive the right processes in those organizations that are managing your patients,” Mr. Ferry says. “Without that adoption of technology, you don’t have that data and can’t better manage that process for better outcomes.”

3. Meet with post-acute care providers. Once hospitals and post-acute care providers share data and identify trends, they should meet regularly to discuss strategies for improving care. If a hospital notices higher readmissions for patients who went to a certain post-acute care provider, the hospital and post-acute care provider should discuss what the organization’s internal processes are for managing patients. The hospital may identify a problem or an opportunity to improve processes so patients receive better care and avoid needing to be readmitted.

For example, Mr. Ferry says one hospital realized that a certain skilled nursing facility had a disproportionately high rate of congestive heart failure patients who were readmitted to the hospital. The hospital encouraged the nursing facility to start offering a congestive heart failure coordinator to more effectively manage those patients, and there was a subsequent drop in readmissions. 

In addition, the post-acute care provider may realize that it does not have the capability to care for a certain patient population. By communicating this to the hospital, the hospital will learn not to send these patients to that facility and can avoid readmissions.

Mr. Ferry suggests hospitals meet with their post-acute care provider partners quarterly “to continue to cultivate relationships and reinforce proper behavior to best manage patients for the best clinical outcomes.”

These collaborative relationships between hospitals and community-based organizations, supported by technology, can help hospitals discharge patients to the most appropriate setting and avoid high readmission rates. 



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Passport Health serves us well

As a local eye doctor, I see a great number of Passport Health Plan members and have for over a decade.  The federal government recently changed a rule and has allowed other insurance plans to come into Shelby, Henry, Spencer and other counties as alternate providers to Passport.  The state has gone as far as to randomly shuffle the deck and disperse 75 percent of previously covered Passport patients to other insurance plans.  While I have heard that competition is good from one side and how only the government would break an unbroken thing from the other, one thing remains constant:  Passport is a really great plan for its members.

That is why I have urged my patients that currently have Passport to call 855-446-1245 and tell the state Medicaid office that you want to stay with Passport.  If you have friends, clients, patients or family on Passport, I would urge you to do the same.  The opportunity to switch ends on Dec. 15, so it is important to make this call soon.

Some plans will urge you to try their plans, but you don’t have to.  And why would you?  Passport is widely known as one of the country’s best health-care plans in terms of quality, and it has many innovative programs to help members improve their lives and those that they love.  This has all been done while saving the state of Kentucky millions of dollars.

It’s not often you will hear someone from the medical community champion the cause of an insurance company.  However, Passport, in my opinion, has been solidly working for my patients, treats my office fairly and has done so for about 15 years.  I believe in what they do and how they do it.  In fact, I have been a volunteer on the Passport Partnership Council as the vision representative for 14 of those 15 years.

Again, I urge you to call the number above or inform those you know that have Passport to do the same.  Soon.


Dr. Dan Bowersox


Some health exchange plans to mirror FEHBP

Some health exchange plans to mirror FEHBP

The Washington Post-Federal Eye

Posted by Eric Yoder on December 4, 2012 at 6:00 AM

Health-care offerings to be available in multiple states through the Affordable Care Act’s insurance exchange system would parallel those of the Federal Employees Health Benefits Program in many ways, although the two programs would not affect each other directly, under rules to be proposed on Wednesday.

The rules from the Office of Personnel Management would set standards for multi-state plans on the exchanges,which are to be available starting in calendar year 2014.

The law requires that at least two multi-state plans be offered and that they be available in at least 31 states at the outset. The initial enrollment opportunity is to start next October.

OPM was given responsibility for the multi-state plans because of its experience in running the FEHBP, for which nearly all federal employees and retirees are eligible. As with the FEHBP, insurance companies wishing to participate will apply to OPM, and if they meet certain standards, they would negotiate with OPM over the precise terms of coverage and premiums.

The rules aim to maintain a level playing field with other health-care plans to be offered through the exchanges, officials said. A multi-state insurance issuer could follow standards set by each pertinent state or could instead base an offering on one of the three largest nationwide FEHBP plans — two of Blue Cross-Blue Shield and one of the Government Employees Health Association — although they still would have to adhere to certain state requirements.

The rules require that a multi-state plan’s enrollee pool, whose claims rates will determine premiums, must be kept separate from the FEHBP population.

The Affordable Care Act allows FEHBP-eligible persons to get their health-insurance coverage through the exchanges instead. However, there would be a strong disincentive against doing so, since they would lose the employer contribution toward premiums, officials said. The government pays about 70 percent of the total premium cost for either self-only or self-and-family coverage under FEHBP.

The law meanwhile requires members of Congress and their personal staff, both in Washington and in their home states, to leave the FEHBP and get their health insurance through the exchanges when they become available. The rules do not address the status of the employer contribution for them. 

The proposed rules, which will be open for public comment until Jan. 4, also cover technical issues such as contracting procedures, performance monitoring, quality assurance, fraud and abuse prevention, and how enrollees could challenge claims decisions.


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Medicaid Expansion Report Calculates Modest State Costs

John Commins, for HealthLeaders Media , November 27, 2012

States that expand their Medicaid rolls under the Patient Protection and Affordable Care Act would see only modest increases in their share of the costs when compared with the windfall in federal funding that would come with it.

That’s according to a new report released Monday by the Kaiser Family Foundation that also suggests that some states could net budget savings under the expanded Medicaid rolls, as millions of poor and uninsured people gain coverage.

According to the analysis, which was written by the Urban Institute for KFF’s Commission on Medicaid and the Uninsured, if all 50 states expand their programs, state Medicaid spending nationally would increase by $76 billion from 2013 to 2022, an increase of less than 3%. For the same period the federal Medicaid match would increase by $952 billion, or 26%. With the expansion, an additional 21.3 million people could gain Medicaid coverage by 2022 and with other coverage provisions of the PPACA that would cut the uninsured by 48%.

Alan Weil, executive director of the National Academy for State Health Policy, told reporters in a KFF conference call Monday that the funding for the Medicaid expansion has to be put into its proper context.

“We are talking about healthcare and healthcare is expensive,” Weil says. “It’s fairly easy to have a little sticker shock at the potential costs of various policy options in this area. But what this report does very effectively is place the spending burden that states would face if they choose to expand Medicaid in the context of overall spending.”

“Many states will be surprised at the results showing that the cost to them of the coverage expansion in the Affordable Care Act comes largely from things they must do, and that the choice about expanding Medicaid is a very small share of the ultimate cost that states may face,” Weil says. “But that finding is also a reminder of the importance of not just looking at total cost but disaggregating where they come from. Many states, when they talk about potential costs of Medicaid expansion, are actually lumping together all costs and not just looking at the effect of the expansion.”

When the U.S. Supreme Court upheld key provisions of PPACA last June, it also struck down as overly coercive the federal government’s demands that states expand their Medicaid rolls. Resistance to expanding the rolls, particularly among Republican governors, reached a crescendo in July when Texas Gov. Rick Perry sent a letter to Health and Human Services Secretary Kathleen Sebelius. Perry, who was running for president at the time, explained that the Lone Star State stood “proudly with the growing chorus of governors who reject the PPACA power grab. … Neither a state exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better patient protection or in more affordable care.”

President Barack Obama’s reelection may have caused some governors’ to reconsider their options. But many Republicans see the Medicaid expansion as merely throwing good money after bad to fix a dysfunctional program.

“Even President Obama has recognized Medicaid is broken,” says Mike Schrimpf, spokesman for the Republican Governors Association. “For many states, placing more individuals into a broken system would be like adding more passengers to the Titanic. And regardless of whether it’s federal dollars or state dollars, taxpayers are still on the hook.”

Weil concedes that even a 1% increase in Medicaid spending could prove difficult for a lot of states that are still recovering from the recession. “States have not fully recovered, even though the trend lines now are quite positive in the majority of states,” he says. “But it means there is a lot of deferred attention to other priorities like education, infrastructure, and public safety that have been lining up for years. So even though the relative shares are small, the absolute demands on state governments are quite substantial.”

Drew Gonshorowski, a policy analyst in the Center for Data Analysis at The Heritage Foundation, says the report is hobbled by “the uncertainty around how much savings you can expect from your uncompensated care reduction at the state level.”

“The study is assuming right away a 33% reduction in state spending on uncompensated care for the uninsured as a result of the expansion. They claim that is a lowball estimate but there isn’t any research that exists that shows that will be the case, or anywhere near the case,” he says. “So ultimately this study hinges on that being true.”

Gonshorowski says governors and state lawmakers—who unlike Congress have to balance their budgets every year—should be concerned about the long-term effects of the expansion on their budgets.

“Even in some of the more friendly state-specific estimates on the expansion, a lot of states are seeing cost even as early as 2019,” he says. “You have this case where the states see the expansion as a great deal because the federal government is picking up almost all of the bill in the early years. But when the rubber hits the road, they are going to start paying for the expansion in the long run. Then the question is, can the state actually pay for the expansion at that point?”

However, Richard “Buz” Cooper, MD, director of the Center for the Future of the Healthcare Workforce at New York Institute of Technology and a Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, says the assumptions in the report are “reasonable.”

“Costs at the federal level will be larger than I believe are generally being considered: $800 billion plus the costs of insuring those individuals who leave Medicaid (in states with eligibility levels above 138% of poverty) in the exchanges,” Cooper said in an email exchange with HealthLeaders Media.

“I don’t believe that those costs are in the report, and I expect they would be hard to calculate, since I don’t think that we know the premium for policies in the exchanges or the amount of federal subsidy that will be provided. This is not my area of expert knowledge, but the REAL number is Medicaid + subsidies for old Medicaid patients in exchanges + subsidies for others in exchanges. What we know now is that it’s going to be a lot more than $800 billion.”

Weil also acknowledged that governors and state legislators are justifiably concerned that a fickle Congress could go back on its promises to fund the expansion, which would leave states holding the bag.

“These estimates are built around a financing model that is in current statute, and that is the appropriate model to use. But states are very nervous about the possibility of those formulas changing,” he says. “Although it is possible that states can change their mind and adopt the Medicaid expansion at one point, and then if the federal funding becomes more limited they can reverse that position, that is a painful course of action and states really do want to be able to plan ahead. So the sooner we can come to closure on whether or not the financial arrangement in the Accountable Care Act is going to be stable, the easier it will be for states to make decisions in the long run.”

Gonshorowski says that shifting the cost of Medicaid to the federal government really isn’t much of a long-term solution. “All the expansion is going to accomplish is a massive expansion of federal spending and a shift in cost from the states to the federal government,” he says. “Even in this most recent study, you’re looking at $1 trillion in spending—$950 billion of which is federal spending. That is a massive increase in federal spending.”

In the end, however, Weil says the Medicaid expansion isn’t just about the numbers.

“We all know that this is far more than a fiscal exercise, and looking at the cost in the context of the numbers [of people] that would gain coverage is critical,” he says. “We know that being uninsured leads to excess illness burden and premature death. We know that many states for decades have been working using either their own funding or options provided by the federal government to try to reduce the numbers of people who don’t have health insurance. So while figuring out the cost of this policy is very important, there is a human dimension that needs to be part of the discussion far beyond the dollars.”