Payers & Providers Midwest Edition – Issue of September 20, 2011

8/4/2019 Payers & Providers Midwest Edition Issue of September 20, 2011

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Michigan Gov. Rick Snyder unveiled acomprehensive program for healthimprovement in his state last week thatunderscores the responsibility of residents to

take better care of themselves.In a 12-page plan released Sept. 14, the

freshman Republicangovernor remindedMichiganders to practicefour key healthy behaviors diet, exercise, doctorsvisits, and dont smoke and linked the absence ofthose behaviors to healthexpenses. Costs fromcoronary heart disease aremore than $5.9 billion ayear in Michigan, he pointed

out, and treatment of heartdisease consumes one out ofevery six dollars spent.

At the same time, thegovernors ofce released adashboard of 20 leadinghealth indicators, showingwhether Michigan wasexperiencing a favorable orunfavorable trend, depending on whether thearrow is pointing up or down.

Childhood immunizations have increasedfrom 90.6% to 93.7% in the state, but obesityamong the adult population also rose from

30.3% to 31.7%. The number of primary-care

physicians per thousand residents is rising, anupward turned arrow, while attempted suicideis also going up, earning a downward arrow.

The governor said he strongly supports

establishing a health insurance exchange thatwill emphasize free market principles and

serve as a competitivemarketplace. He is asking thelegislature to enact enablinglegislation to create the MIHealth Market-place so that thefederal government doesntimpose a one size ts allapproach, as it is allowed to dounder the Affordable Care Actin those states that dont createtheir own exchanges.

Overall we are encouraged

by what we heard, said KevinDowney, spokesman for theMichigan Hospital Association.There were so many specics.The emphasis on personalresponsibility for individualshealth, thats something wetremendously support. Rick Murdock, executive

director of the Michigan Association of HealthPlans, said that if implemented wisely, thegovernors plans could help control costs andincrease access to high quality medical care

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In Brief

Alexian Brothersof Chicago now

Belongs to Ascension

Alexian Brothers Health System willbecome part ofAscension Health, the

largest Roman Catholic healthcaresystem in the country.

Alexian Brothers is a Catholicsystem based in Arlington Heights, Ill.It operates three hospitals in thenorthwest suburbs of Chicago, plustwo mental health centers. It has anumber of afliated primary careofces and immediate care centers.Alexian Brothers also operates nursinghomes and rehabilitation services inMissouri, Tennessee, and Wisconsin.

Ascension, based in St. Louis,employs more than 113,000 people in1,200 locations in 20 states plus theDistrict of Columbia.

The signing of a denitive

agreement to become part ofAscension Health is a signicant stepforward in the evolution of AlexianBrothers Health System, said MarkFrey, executive vice president ofAlexian Brothers.

The two health systems announcedtheir letter of intent in April. Theagreement must now be reviewed bythe Illinois Health Facilities andServices Review Board. Terms of theacquisition have not been madepublic.

Monthly Premiums for

Michigan High-RiskPool to Drop 10%

Michigan will reduce the monthlypremiums in its high-risk pool by 10%after the federal government approveda request to ease the process ofdocumenting a pre-existing condition.

The states Health InsuranceProgram, or HIP, was created afterpassage of the Affordable Care Act last

Continued on Page 3

NEWS

Snyder (Continued from Page One)

plans could help control costs and increaseaccess to high quality medical care forMichigan families.

The association supports the governors callfor an insurance marketplace that does notadd bureaucracy or complexity to themarketplace.

Murdock especially liked Snyders proposalto review the operations and regulationsgoverning Blue Cross and Blue Shield ofMichigan. The statute under which theMichigan Blues operate is 30 years old.Blue Cross belongs to you and me, as acharitable trust established for Michigansresidents, the governor wrote in his message.It is time to take a fresh look at the way BlueCross operates and is regulated.

The existing law gives the companysignicant advantages over other healthinsurers in the state, Murdock said. Thecompany has used those advantages to gainmarket dominance and is now a defendant ina federal anti-trust case concerning its hospitalcontracting practices.

Blue Cross Blue Shield declined tocomment for this article. The company is not amember of the health plan association.

Snyder, 53, was elected last Novemberwith 58% of the vote. He made his career as atax accountant with the former Coopers &Lybrand and later was an executive with

Gateway, the computer manufacturer. Hebecame a venture capitalist in 1997, based inAnn Arbor. This is his rst elective ofce.

When Snyder ran for governor, Downeysaid, he actually had a comprehensivedocument like this that he developed duringhis campaign. He seemed to be in touch withthese topics. He dealt with healthcare fundingand a lot of different issues. Even that wasimpressive. He has lived it out. Peter D. Jacobson, a professor of healthlaw and policy at the University of MichiganSchool of Public Health, was not so sanguine.Its pretty ho-hum, he said. Its notparticularly bold. It does not push boundaries.There is nothing about delivery change,payments change, how were going to dealwith the access issues the state will face.

Jacobson liked the emphasis on preventionand wellness but regretted that the governorcannot do anything but exhort the citizenry totake better care of itself.

One thing is clear: there is no money toallocate toward achievement of these public-health goals.

The governor also wants to take a hard lat professional regulation of medicalpractitioners. Pointing out that the state now

has 25 health profession licensing boards atask forces, up from 17 a few years ago, hewants to make sure that we are notexcessively regulating our healthoccupations.

The looming shortages of skilled healthprofessionals also drew his concern,especially since if the health reform law isallowed to go into effect as passed, the stateexpected shortage of 4,400 to 6,000physicians by 2020 could well quadruple.The provision of insurance to the previouslyuninsured population is expected to causedemand for primary-care services to surge.

Snyder advocated the use of physicianextenders, such as advanced practice nurseand physicians assistants.

With the collapse of the automobileindustry, Michigans economy has been on ropes for the past few years. Theres littleprospect that the state will feel ush again atime soon.

To ease the scal burden, Snyder wouldlike to examine the alter the way dual eligibare cared for. The state has 205,000 residenwho are eligible for both Medicare andMedicaid, who comprise about 12.5% of thMedicaid population and consume $7.5

billion in health spending. They should bemoved from an uncoordinated fee-for-servenvironment into a coordinated managed-cenvironment, Snyder said.

The governor reserved a lot of his attentito the problem of obesity. Michigans adultobesity rate, 31.7%, is now eighth in thenation, and 12.4% of its young people arenow obese.

To ght this trend, the governor hasdirected the schools to improve nutritionavailable to students. He has asked theDepartment of Community Health to recorand report body mass index as part of theMichigan Care Improvement Registry, whictracks childhood immunization records.Determining BMI is an important rst stepmanaging pediatric obesity, the governornoted. The proposed rule would apply onlychildren under 18, but the governor wants texpand the registry to cover all persons in tstate.

A summit to discuss the obesity epidemiwill convene in Lansing, the state capital, oSept. 21.


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NEWS

In Brief

year. It is a bridge for people with pre-existing conditions to obtain federally-subsidized health insurance before2014, when the full provisions of theact come into effect.

People who apply to HIP Michigancan choose among three options,having deductibles of $1,000, $2,000,

or $3,500.When new premium rates become

available Oct. 1, a 45 year old personcould pay $191 monthly for a $3,500deductible; $227 monthly for a$2,500 deductible, or $315 for a$1,000 deductible. A person who is19 would pay $103.

Under the new rules, applicantswill have to have been uninsured forat least six months.

Michigans HIP plan had 565enrollees as of Sept. 1, the majority ofwhom are older than 45. The stateseventually hopes to cover 3,500residents.

RAC Program forMedicaid is FinallyPublished by CMS

The Centers for Medicare andMedicaid Services is stepping up itsenforcement of Medicaid fraud byintroducing a rule that it estimatesshould save $2.1 billion in taxpayersfunds over the next ve years.

We simply cant afford to seeeven one penny of our healthcaredollars wasted and expanding thisprogram will help us reach that goal,said Health and Human Services

Secretary Kathleen Sebelius.The introduction of the rule on

Medicaid Recovery Audit Contractors(RAC) is modeled after a similarinitiative applying to Medicare.

About $900 million should bereturned to the states, according to astatement from HHS.

The rule implements section 6411of the Affordable Care Act. It explainshow states can expect to pay theirshare of the startup costs andmaintenance of the program.It will take effect Jan. 2.

A coalition of businesses in Missouri andKansas announced it has avoided about $11million in direct healthcare costs by givingemployees and dependents access to value-based benets.

Fifteen employers participated in the three-year program that gave insured employees

access to better health information, reducedbarriers to preventive care, and arrangedearlier treatment of chronic conditions.

The project was led by the Mid-AmericaCoalition on Health Care and involvedroughly 400,000 people in the Kansas Citymetropolitan area. The employers altered theirbenet designs to align incentives withbehaviors that reduced health risks, promotedpreventive care, and encouraged better health.They relied on evidence-based practices.

In one year, nine employers, with 56,000employees, reduced spending per employeeby $194 by concentrating on chronic diseases.

About half the employers charged lowerpremiums to workers to completed a healthrisk assessment, getting an annual physical,quitting smoking, or losing 5% of their bodyweight.

All the employers added healthy eatingoptions at the work place and nine out of 10

offered an onsite health club to raise physicaactivity levels among workers.

About six out of 10 employers waivedprescription copays for for people enrolled ichronic disease management programs.Companies participating in the programincluded Sprint, Hallmark Cards, H&R BlocCerner Corp., and American CenturyInvestments.

Several large healthcare employers alsotook part, including St. Lukes Health SystemChildrens Mercy Hospitals & Clinics, BlueCross Blue Shield of Kansas City, andtheAmerican Academy of Family Physicians.

The Missouri state ofcial who signed off on the

contract to hire SynCare LLC to evaluateMedicaid eligibility later ended up working forthe company, the St. Louis Post-Dispatchreported last week.

Christine Larsen, who was chief of theBureau of Program Integrity, was one of fourofcials who looked at the 11 submitted bids toservice homebound disabled people inMissouri. SynCare was chosen because itoffered a price much lower than the otherbidders, state ofcials said.

The states $5.5 million contract with theIndianapolis startup lasted only three monthsbefore state ofcials rescinded the award after a

torrent of complaints from beneciaries who

said the company was not providing thecontracted services.

Centene Corp., based in suburban St. Loand a leading national Medicaid contractor,had made $400,000 in loan guarantees to aCentene employee, Stephanie DeKemper, tonance the purchase of SynCare LLC. Centemakes substantial political donations to manpublic ofcials and candidates, includingMissouri Gov. Jay Nixon, a Democrat.

SynCare was hired by Missouri to determeligibility for 50,000 persons who neededtreatment at home. They were to receiveassistance in bathing, cooking, cleaning, and

Mo. Official Had a Hand in ContractSoon After, She was Working for Vendor She Chose

K.C. Employers Trim Benefit CostsInitiative Covered 56,000 Local Employees

www.healthexecstore.com
https://www.managedcarestore.com/pandp/p&pmidwestceowpsummary.htmhttps://www.managedcarestore.com/pandp/p&pmidwestceowpsummary.htm


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The chief complaint, the history and physical,the differential diagnosis, the proper testing, thetreatment -- from Day 1, these are the pieces ofmedicine that are hammered in to youngdoctors' heads: the best way to treat this or that,the best drug, widget or gizmo, the latestadvance. We learn which approach is betterthan the other, which treatment to apply whenmore conventional approaches can't be taken.Each of these steps are drilled over and overagain in the hopes of crafting a strategy for eachclinical scenario a doctor is likely to encounter.Yet while each of these steps are important in

their own right, they bythemselves wont entirely sustaina doctors satisfaction in theprofession.

Because after the treatmentstrategy or therapy is applied,there's another vital part ofmedical care that is often under-appreciated: the closure.

Closure is the time inmedicine where we either revelin our success or squirm in ourfailure. It's where we must facethe music -- good or bad -- with

our patients. More often thannot, it's the moment that bringsmeaning to our efforts and thehours we work.

Closure can occur at different times fordifferent doctors. For specialists, closure usuallyoccurs in the post-operative or post-procedureperiod. For primary-care doctors, closureoccurs during the follow-up visit after aprolonged hospitalization or difcult illness. Forboth types of doctors, its the chance to see thegood they did or bad they did rst-hand. Its atime to validate their understanding of thepatient's ailment and the caliber of their

treatment plan. Importantly, its not the end ofthe patients ongoing care but the conclusion toa particular chapterof their care. For doctors,its the moment when we grow as professionals.

Yet sadly, these moments of closure arebecoming rarer for both the patient and thedoctor.

With doctors racing to perform more casesin less time and in more locations to offsetdeclining payment rates, it's become harderboth logistically and nancially to justifyexcessive post-operative time with patients aftertheir procedures. The money required to feed

our administrators, collectors, and quality-scocounters demands an ever-growing source offunds.

To that end, specialist physicians have seenpost-operative care clumped together with thepre-procedure and intra-operative care into obig encounter that pays health systems onlyonce. Increasingly, policy makers are shifting risk of caring for patients to providers. Insurerand policy makers like to call this a shift fromprocedural-based payments to outcome-based payments. In theory this sounds nice, its robbing the doctors of the closure time the

need in their profession.For primary-care doctors whnow only see patients in theirofces, the opportunity to see tproduct of a continuous-carestrategy has been surrendered tthe hospitalist, robbing them ofclosure time. And even for thehospitalists who diagnose and adios from the connes of thehospital, the opportunity see thlate consequences of their care non-critical environment has be

lost to production quotas. No

fractious group medical homcare in the world can replacthis loss of closure inicted u

primary-care and shift-working hospitalistphysicians or the patients for whom they care

Our health policy analysts have assured usthese closure visits can be accomplished byancillary care providers. Technically, they arecorrect. But there is no question that the loss othese post-procedure visits by the treatingphysician or operating surgeon robs them of aopportunity to improve. Further, doctors lose chance to educate and re-connect with thepatient. Doctors need this time with their pati

just like patients like this time with their doctomaybe even more. It's what makes it worthwhto get up and do it all again.

OPINION

Doctors Need Closure with PatientsFinal Visit After Procedure Gives Satisfaction, Educati

By Westby Fisher, M.D.

Westby Fisher, M.D., is an internist, cardiolog

and cardiac electrophysiologist who practi

at NorthShore University Health System in

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