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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