Posts Tagged ‘Citizens Health Initiative’
Monday, February 22, 2010
Keeping My Child Out of the ER: The Importance of Accessible Data
By Amy Costello, Project Director, New Hampshire Institute for Health Policy and Practice
Last Thursday, after a scary afternoon of trying to manage my daughter’s asthma at home, we ended up in the Emergency Room. Elizabeth is 20 months old. She has had asthma-like symptoms with a cold so I was able to recognize that she was having difficulty breathing. I called our family physician. She was out of the office and the covering physicians were booked for the rest of the day. I made an appointment for Elizabeth for 9:15 the next morning, and crossed my fingers that the breathing would get easier instead of worse. At 6:00 that night, with Daddy out of town and Elizabeth retracting under her ribcage, I packed her, her older sister, and some Sippy cups into the car for a field trip to the Emergency Room (ER).
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Tuesday, February 16, 2010
Using Technology to Engage Patients in Their Health Care
By Denise Purington, BSN RN
Vice President Information Technology and Services, Chief Information Officer, Elliot Health System
With all the talk of health care reform, the use of electronic medical records, and empowering patients to get more involved in health care decisions, it seems appropriate to share what health care providers around the country are doing to get patients more involved. The question I am hearing most often is, “why can I do my banking online, pay my bills online, make an appointment to get the oil changed in my car online, but when it comes to accessing my health care providers, I still must depend on the telephone or a face to face visit?”
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Tuesday, February 2, 2010
Why Payment Reform and What Are We Doing About It?
By Heather Staples, NH Citizens Health Initiative Staff
Part 1: Why Payment Reform
This is the first piece in a two part series about health care payment reform. The second part will be posted Thursday, February 4, 2010 at NH Health Care Town Hall, where you can sign up to receive announcements about our new blog pieces. Also, we invite you to follow the Citizens Health Initiative on Twitter and become a fan on Facebook.
The NH Citizens Health Initiative Payment Reform Pillar has many active stakeholders who represent provider, hospital, insurance carrier, and policy groups. There is strong consensus among these stakeholders that payment reform is the appropriate, overarching vehicle for rehabilitating health care. Before I explain why payment reform needs to be aggressively pursued, both locally and nationally, let me provide a few facts about the state of our health care system:
• The United States spends more than twice as much as any other industrialized nation on health care (OECD Health Data 2008, June 2008 version).
• The quality of health care is 19th out of 19 industrialized nations when you consider death that could have been avoided with appropriate health care treatment (Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008).
• Health spending in NH amounts to more than 18% of GDP and is expected to reach 22% by 2017. (NH Center for Public Policy Studies, 2008)
• NH’s average family health insurance premium, at $12,686 in 2006, is one of the highest average family premiums in the United States, far exceeding the 2006 national average of $11,381 (AHRQ, 2006 Medical Expenditure Panel Survey (MEPS)-Insurance Component)
• Personal per capita spending on health care in New Hampshire was $6,456 in 2007 and is projected to reach $11,043 by 2017 (NH Center for Public Policy Studies, 2008)
If New Hampshire’s health care costs were equivalent to the average of the top 5 “low cost, high quality” states:
• Our Total Health Care Expenditures as a Percent of Gross State Product (GSP) would be 14.6%, rather than 18.1% of GSP (2008). This would mean that NH healthcare expenditures, (currently about $10 billion per year), would shrink by $2 billion.
• Our Total Health Care Expenditures per Person would shrink from $8,235 to $6,909 (2008), a savings of about $1,000 per person.
• Our average premium for health insurance for family coverage would decline from $12,686 to $10,954 (2006), resulting in savings of about $1,500 per family. (NH Center for Public Policy Studies, 2009)
These facts remind us that no matter the outcome of national health reform, NH needs to continue to drive payment reform initiatives to rehabilitate our own system. Why? Because the manner in which we currently pay for health care is exclusively focused on volume (more services), and not on outcomes (whether the service helped, and in fact improved, the patient’s health). Further:
• It fails to appropriately value the complexity of health care that is delivered in the primary care setting;
• It over-values specialty services, emergency room and urgent care use and specialized testing such as CT-scans and MRIs;
• It pays for services whether they are needed or not, yet fails to pay for important conversations between physicians and patients on end of life care, or effectiveness of alternatives to expensive or risky treatments;
• It fails to pay for coordination of care across physicians, hospitals, testing sites and outpatient procedures, resulting in medication errors, duplicate and unnecessary tests and patient confusion and inconvenience.
Changing what we pay for, and how we pay for health care, has the potential to free up providers to:
• Focus more on outcomes and providing the right care at the right time;
• Take the time to collaborate with colleagues and other treating providers on treatment plans and alternatives;
• Plan for care in a formalized, long-term manner, particularly for those patients with multiple diseases, special conditions or needs and several medications;
• Communicate with patients using methods that make sense for the situation and for the needs of the patient;
• Focus on being more efficient in delivering services, to bring down waste, speed up communication, and remove unnecessary steps from processes, in ways that have been successfully accomplished in nearly every other industry.
In his 2010 State of the State Address, Governor Lynch outlined two important NH health reform initiatives. One is the Primary Care Medical Home Project occurring in 9 sites across the state. More information is available on the Citizens Health Initiative Website and in my previous blog on the topic of Medical Homes . The second initiative is a set of Payment Reform/Accountable Care Organization (ACO) pilots that will be launched early this year in collaboration with the major insurance carriers. For more information about ACOs, look for part two of this series, which will post Thursday, February 4, 2010.
Tuesday, January 26, 2010
Understanding the Cost of Health Care in New Hampshire
By Bruce King, CEO & President, New London Hospital
I am pleased to have the opportunity to comment on behalf of the New Hampshire health care provider community on the ongoing dialogue over reforming the health care delivery and financing systems. By way of background I have spent more than 30 years in my career in various roles of health care Administrative and Finance.*
My view of New Hampshire providers and the outlook for the continued delivery of high quality, cost-effective healthc are to its citizens is quite positive. At a global macro assessment, New Hampshire hospitals are performing quite well. Our scores from the Centers for Medicare and Medicaid Services (CMS) are regularly near the highest in the country for Medicare recipients. In addition, hospital leaders, in collaboration with the Foundation for Healthy Communities, have taken the lead on statewide initiatives including hand hygiene, the reduction of central line bloodstream infections, and the adoption of a patient safety checklist.
A review of the New Hampshire health care cost per capita (per the latest Kaiser nationwide study) reveals that we are, in fact, the lowest of all the New England states. Our hospitals have made significant advances in the adoption of electronic medical records and provide substantial economic and employment benefits. We rank as the third highest industry category for jobs provided and the second highest industry in the state for average annual wages. New Hampshire hospitals have a substantial and positive impact on both the state and local economies.
The New Hampshire Hospital Association (NHHA) recently produced a summary compilation of the 2008 financial results for all New Hampshire acute care hospital systems. The total operating margin of all hospitals was only 2.4%, which is well below both national and capital market expectation and averages. Included in this number was the fact that NH hospitals wrote off $357 million in charity care and bad debt, or roughly 5.2% of our total revenue stream.
Why then do we hear about the “cost” of New Hampshire healthcare premiums so frequently? There are multiple factors, which should be more thoroughly explored and understood when assessing New Hampshire premium performance. These include the impact of 1) cost-shift, 2) for-profit health plans, and 3) pharmaceutical cost.
A major contributor to the employer portion of the cost of health care premiums is the so-called “cost shift” impact. This occurs due to the significant underpayment of providers by the state Medicaid program when compared with the actual costs of services provided to patients. The Center for Public Policy Studies report in September 2008 estimates that the impact of this “cost shift” is greater than $400M of subsidy annually, or roughly 17% of the total employer premium cost.
Another area worth noting is the amount of money that leaves the State and our health care system annually and goes to Wall Street, due to the existence of for-profit health plans operating in New Hampshire. Insurance plans such as Anthem and Cigna require significant operating profit margins and fund a large portion of this from the premium dollars charged to employers.
Lastly, it is important to understand and calculate the impact of pharmaceutical drug costs and profits on the cost of providing health care. For many employers, the actual cost of a prescription drug benefit now exceeds the cost of actual inpatient care in regards to percentage of premium.
Efforts to redesign payments will require greater integration of hospitals, doctors, and other providers, and will result in the assumption of greater risk for those providers, as well as increased accountability for the outcome of the care provided. These new payment models will lead to the creation of new healthcare delivery systems—systems comprised of hospitals, doctors, and other providers along the full continuum of care, from primary and preventive services, to acute, post acute, and rehabilitative services.
Hospitals support efforts to work collaboratively with payers, providers and others, to build and pilot new payment and delivery system models. It’s why I have been such an active participant over the past year in the Citizens Health Initiative payment reform group. As we work to reform healthcare nationally and locally, we must find ways to work together to build lasting solutions to the challenges we face. Our patients, their families, and the communities we serve are counting on us.
* Bruce King worked for 3 years in the Massachusetts Mental Health system, 3 years in a Boston teaching hospital, 5+ years in Boston with a big 8 accounting firm (KPMG), 17 years at DHMC in Finance and Network Development, and the last 6 years as President and CEO of New London Hospital. He is also currently serving as the Chair of the NH Hospital Association board (NHHA), Treasurer of the State of NH high risk pool, and an active participant in the Citizens Health Initiative payment reform group.