National Health Care Reform

Last week, Center for Medicare and Medicaid Innovation (CMMI) announced the first group of organizations for Health Care Innovation awards. As readers may already know, CMMI was established by the Affordable Care Act (ACA) to test innovative payment and delivery models that have the potential to reduce costs while preserving or enhancing the quality of care. The awards recently announced are part of CMMI’s Health Care Innovation Challenge, which is granting up to $1 billion to applicants who can implement the most compelling new ideas to deliver better health care and to improve care and lower costs to people enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), particularly for those with the highest health care needs. Awards range from approximately $1 million to $30 million for a three-year period and focus on key CMS priorities areas:

• • Workforce Development and Deployment
• • Speed to Implementation
• • Model Sustainability

This is exciting stuff. There isn’t one magic bullet to solve the problems of low-quality, uncoordinated care and escalating health care costs. The CMMI grants will provide much-needed investments in promising approaches across the country to see if they can be brought to scale and expanded.

This a particularly wonderful opportunity for grantees like Cooper University Hospital, in Camden, New Jersey, which was already testing an innovative model of care and now can expand the model even further. Using its new CMMI grant, Cooper will continue to work with Camden Churches Organized for People (CCOP), a faith-based community organization affiliated with the PICO National Network, and Camden Coalition of Healthcare Providers (CCHP), which is led by Dr. Jeffrey Brenner. For the last few years, CCOP and CCHP have been working together to help low-income Camden residents improve their access to health care and reduce avoidable emergency room visits. Now, both will be working with Cooper to reach out to even more Camden residents and “super-utilizers“ to improve their health. CCOP’s role will be to work with Cooper to identify and train 14 health care workers to serve as part of multidisciplinary care teams.

Cooper’s decision to work in partnership with consumer advocates is a clear acknowledgement that their participation is one of the keys to success. The Innovation Challenge presents a unique opportunity for advocates and community-based organizations to work with hospitals, providers and payers to develop a truly patient-centered delivery system.

The next announcement of CMMI grantees is slated for early June 2012. We hope CMMI – and their grantees – will take their cues from Camden and prioritize grants that build in consumer involvement from the start.

Readers can find detailed project descriptions of all grantees on the CMS Innovation Center website.

– Leena Sharma, State Advocacy Manager, Integrated Care Advocacy Project

Nearly 15 months ago, Massachusetts Governor Deval Patrick filed legislation to address the sky rocketing health care costs in the state by shifting away from the state’s largely fee-for-service way of paying for health care services. After initial hearings on this issue last summer, the state legislature remained quiet; until last week, when the House and Senate finally unveiled their versions of the legislation. The legislation addresses many of the elements that advocates, including the Massachusetts Campaign for Better Care (CBC), fought for this past year.

Highlights of the House bill (for more details see this article):

• • Creates a new oversight agency, the Division of Health Care Cost and Quality, which will be run by a governing board with consumer representation (one out of nine members)
• • Requires consumer representation (75 percent) on Accountable Care Organization (ACO) boards
• • Establishes a Wellness and Prevention Trust Fund aimed at promoting wellness at the community level in partnership with clinical providers within certain geographic areas
• • Creates protections that ensure consumers receive needed services and imposes penalties for inappropriate denials of services or treatment
• • Requires any alternative payment methodology to include a risk adjustment based on health status i.e. functional status, socioeconomic, or cultural factors.

Highlights of the Senate bill (for more details see this article) :

• • Creates and funds a Wellness and Prevention Trust Fund through a surcharge on health plans
• • Improves care coordination and access to preventative services
• • Requires the Department of Public Health to develop model checklists of care that may be used by hospitals to prevent medical errors and infections.
• • Requires ACOs to promote patient-centered care by involving patients in shared decision making, in planning their care transitions across settings of care (e.g. moving from the hospital to a rehabilitation center) and establishing ways to evaluate patient satisfaction with access to and quality of care.
• • Requires ACOs to include patient and consumer representation on governing boards

While both versions of the bill are strong and take a comprehensive approach to transforming the state’s payment and delivery systems, there are still areas that need strengthening, most notably: the financing mechanism for the Wellness and Prevention Trust Fund; meaningful compliance with the Americans with Disabilities Act (ADA); shared savings, especially in the Senate version of the bill; and payment policies to discourage potentially preventable errors.

The Massachusetts CBC is working with Senators to amend the legislation. The bill’s passage and implementation over the next several years will not only mark a big change for consumers in how they receive care but also put Massachusetts in the vanguard of states tackling health care costs. So for a bill that took more than a year to be released (and that will probably pass in a matter of weeks), it’s a strong start, and yes, it was worth the wait.

– Leena Sharma, State Advocacy Manager, Integrated Care Advocacy Project

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Global "Heat Map" Shows NC's Role in World Economy CARY, N.C. - North Carolina now has a global heat map, which has nothing to do with the temperature. Rather, it shows the state's business climate and global influence. ...(Read More)