Submitted by achenault on Tue, 01/20/2015 – 3:51pm
As I wrote in the recent UHCAN Ohio newsletter, Ohio received notice, in December, of a $75 million State Innovation Models (SIM) Test grant
The grant is to test new ways of paying for health care that “improve health system performance, increase quality of care, and decrease costs for [all private and public payers] and for all [Ohioans].” In other words, better health care that makes us healthier, at lower costs. But can they deliver on the promises? Or, will the conflicting interests of insurance companies, hospitals, and other stakeholders overshadow the needs of patients/Ohioans? And, is there anything Ohio consumers can do to increase the likelihood that SIM will improve the lives of all Ohioans – especially those who need improvements the most? Here’s the first in a series on the SIM Grant and how to protect consumers’ interests in Ohio’s changing health care landscape.
What Will the SIM Test Grant Do?
Here’s the summary from the CMS website:
Ohio will transform the state’s health care system by rapidly scaling the use of patient-centered medical homes (PCMHs) and episode-based models and by developing cross-cutting infrastructure to support implementation and sustain operations. By the end of the Model Test, Ohio plans to launch 50 episodes of care and implement PCMHs statewide. Reports for the first six episodes of care will be delivered to providers in November 2014. PCMHs will expand geographically, reaching statewide coverage by 2018. In addition, the state is focused on incorporating population health measures into regulatory and payment systems in order to use those measures to align population health priorities across clinical services, public health programs, and community-based initiatives.
Research shows that the PCMH model of enhanced primary care can improve patients’ care and their health, while lowering costs. The research also shows lots of variability in results, largely because the PCMH models tested are all different. And no research I’ve seen shows what elements of PCMH produce better results than others. In other words, the ability of Ohio’s spreading PCMHs to improve health outcomes and lower costs, probably depends on the specific features of each PCMH.
The other thing we know about improving our health is that the best doctors in the world can’t save you if you chain-smoke, don’t eat vegetables, breathe bad air, and have too many stresses in your life. In other words, improving the health of Ohioans involves medical care and our lives – where we live, work, and play.
What Can We Do to Improve the Value of the SIM Grant to Consumers?
Probably several things, if we organize. Consumer advocates can identify specific strategies (such as use of community health workers) that improve outcomes and/or save money and push for those elements to be included in Ohio’s PCMH model. Effective strategies include making sure that the PCMH practice (the office or clinic) include:
A PCMH without these elements may work reasonably well for a patient population that is well educated, affluent, and in reasonably good health. For the rest of Ohioans, no way. Let me know if you have thoughts on this or want to help UHCAN Ohio and Ohio Consumers for Health Coverage make Ohio health transformation work for Ohioans.
In future blogs, we’ll look at: How do we make sure consumers have a powerful voice in Ohio’s SIM Grant? What are other states with SIM Testing Grants doing to make sure that health care system transformation improves lives?
Submitted by achenault on Wed, 01/14/2015 – 4:25pm
News flash: health care costs too much. But we’re also not getting our money’s worth. Health care reform is about spending more wisely to get better care at lower costs.
On December 16, 2014, Governor John Kasich received a nice holiday gift from the federal Centers for Medicare and Medicaid Services (CMS) – notice that Ohio received a four-year, $75 million State Innovation Models (SIM) test grant.
According to the award letter, this grant is to test new ways of paying for health care across all payers – Medicaid, Medicare, or private insurance – that will “improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program beneficiaries – and for all residents of participating states.” That’s a big promise – better care at lower costs for all Ohioans. Boy, do we need that!
Health care in Ohio (as in the rest of the US) is in serious trouble. First, we pay way too much. Health care costs depress wages and keep many people from getting needed care. Worse, for all that money, we don’t always get the care we need. According to a recent scorecard from Health Policy Institute of Ohio, Ohio ranks 47th (close to the bottom) in health care “value,” which considers both quality and spending. We’re near the bottom on infant mortality, adult diabetes, avoidable emergency department visits by Medicare beneficiaries, air quality, and smoking rates, to name a few. For people of color, the numbers are even more dismal. Given Ohio’s health rankings, we need cheaper health care that improves our health. That’s what this SIM grant aims to achieve.
The grant will test new ways of paying for health care – paying for better care at lower costs. Under today’s system, providers often make money on doing more tests and procedures – whether they hurt or help you. The SIM grant will test two new ways of rewarding providers for better and more cost-effective care. Sounds great – but there’s a lot of money on the line, in this test, for the key players. Will the Kasich administration and their private partners (including insurers and providers) make the right changes needed to improve the health and wellbeing of Ohioans? Will consumers really come out ahead? Only if consumers have a strong, ongoing voice in this test.
Last year, Ohio Consumers for Health Coverage issued a brief on the importance of consumer engagement in the SIM process. That paper – which could have been subtitled “Nothing for us without us” – set out detailed recommendations on how to make sure Ohio consumers have an ongoing, meaningful voice in designing and testing the proposed changes. The lengthy plan that went to CMS, despite input from OCHC, does not lay out a plan for meaningful consumer involvement.
The question for consumers is this: are we going to leave it up to insurance companies, large employers, providers and the Kasich administration to make health care better and more affordable for Ohio consumers? It’s time for us to get active.
In the next few months, UHCAN Ohio will be posting blogs, infographics, and other tools to help consumers understand health care and get involved in reform that works for us. Do you want to host a discussion of health reform? Contact us.
Submitted by achenault on Wed, 01/14/2015 – 2:10pm
More and more people are recognizing that oral health is important to overall health. Yet thousands of Ohioans can’t get affordable dental care in their communities—hurting their ability to live, learn, and work. We need new thinking about how our dental care workforce is configured. Fortunately, there is growing recognition that dental therapists are proven providers who can bring care to communities that need it most.
Dental therapists were recognized in December when The New York Times Opinion Pages series “Fixes” published its Big Ideas in Social Change, 2014. In October, Fixes featured an in-depth article on dental therapists and how they are improving access to care.
This is a significant acknowledgement. In addition to the growing number of evidence-based evaluations of the dental therapist, it should be clear that adding dental therapists to the dental team will:
We should take a cue from the medical care system, where Ohio has done a good job of modernizing our laws and removing restrictive regulations so that nurse practitioners, advance practice nurses, and physician assistants can provide needed care to more people. We need to do the same for dental care. In addition, advances in health information technology mean that dental therapists can work in remote areas and maintain contact with their supervising dentists. This is a great opportunity for us to expand and modernize dental care in Ohio. Please join us as we continue working to bring quality dental care to every community.
Submitted by achenault on Wed, 01/14/2015 – 1:56pm
On January 5, 2015, new members of Ohio’s 129th General Assembly were sworn in with their first task on the horizon – the biennial budget. Capital Bureau Chief Mark Kovac provides a great top 10 list of Things to Know About the Start of Ohio’s New General Assembly. The list shares changes in leadership, new members of the General Assembly, and details about possible legislation and budget issues.
One of the big issues to watch is Ohio Medicaid. Starting on January 1, 2014, Medicaid became available to all Ohioans (except some immigrants) and whose income falls below 138% of the Federal Poverty Level (FPL). To date, over 450,000 Ohioans have enrolled in Medicaid coverage thanks to the expanded eligibility.
Gov. Kasich is expected to present his budget on February 2nd, keeping the current income eligibility requirements for Ohio Medicaid intact. Then the next steps are:
Confused yet? You’re in luck!
If you’d like to learn more about Ohio’s budget process, the issues being considered, and how you can make a difference, join One Ohio Now’s webinar on Tuesday, January 27th from 12-12:45pm. Click here for more information and to register.
What’s this Mean for Advocates and Consumers?
We’ve seen the Medicaid Expansion in action for a year, and it has improved the lives and health of many Ohioans. We’ve got to start laying the groundwork now to preempt any attacks on it this budget season. Telling the stories of those who benefited from expanded Medicaid coverage is going to be key.
What Can You Do?
Have you or someone you know benefited from expanded Medicaid coverage? Or are you a trusted community leader? Right now our goal is to get as many Letters to the Editor as possible published across Ohio, specifically outside of the 3 C’s. We can help you write and submit your Letter to the Editor. Click here to view 3 sample templates. Click here to find the contact information for your local paper. Need more help? Email Alyssa at achenault@uhcanohio.org for more information or help writing/sending your letter.
Submitted by achenault on Wed, 01/14/2015 – 1:51pm
Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane. – Reverend Dr. Martin Luther King Jr.
Dr. King recognized that health care is a matter of justice. As we celebrate his birthday next week, consider honoring his legacy by getting yourself enrolled in health coverage and encouraging others to do the same. The deadline for signing up for insurance through the Marketplace is February 15th.
UHCAN Ohio is calling on all Ohioans to continue the work of Dr. King by getting as many Ohioans enrolled in coverage as possible. We’re providing the following materials to local MLK Day events to make it easy to incorporate Dr. King’s message into an event:
Click here to view the toolkit.
If you’re hosting an MLK Day event or know of an event happening in your community, please email achenault@uhcanohio.org to share your event information and request materials to use at your event.
Submitted by achenault on Wed, 01/14/2015 – 1:50pm
As we move through the current Open Enrollment period, many Ohioans are seeking out assistance to help them understand the enrollment process and get covered. In the first month of the current open enrollment period, 89,000 Ohioans signed up for coverage through the Marketplace.
UHCAN Ohio Certified Application Counselors (CACs), who are located in churches and community-based organizations across the state, are seeing another aspect of Open Enrollment as well. In addition to new enrollees, our CAC sites are also seeing an increase in the numbers of people with existing coverage who are now coming back with questions on re-enrollment and how to use their coverage. Marsha Riley, one of our Columbus-based CACs, states that about 40-50% of those she sees are people she helped last year.
“This is very encouraging, because it shows that our system of using trusted messengers located at community based sites to provide enrollment assistance and follow-up is working,” says Nita Carter, UHCAN Ohio’s Director of outreach and enrollment.
The goal of our project that builds enrollment assistance capacity in African American and other underserved communities is to make sure that people not only get covered but use their coverage to get connected to needed care. “Having people with questions about how to use their insurance is exciting. That means they are not just placing that card on a shelf someplace. They are really using it,” says Carter.
With funding from the Robert Wood Johnson Foundation, UHCAN Ohio has partnered with churches and community based organizations as well as Enroll America to open 22 sites in Cleveland, Columbus and Cincinnati. These sites will remain open after the enrollment period ends to provide follow-up, assist with Medicaid enrollments, answer questions, and help people understand how to use their coverage and get the right care at the right time and place.
For more information on the sites, go to enrollmenthelp.
