Submitted by clevine on Sun, 08/14/2011 – 2:45pm
“If you don’t understand how to achieve lower costs, listen to the stories of patients – poor care coordination, ineffective care,” said Dr. Donald Berwick, at a Campaign for Better Care event on Wednesday, August 10, in Cincinnati.
Dr. Berwick, administrator for CMMS (Centers for Medicare and Medicaid Services), addressing a roundtable of 100 providers and advocates in Cincinnati, said that quality improvement is the route to lower costs. The event was organized by the Campaign for Better Care, which is working to ensure that health care reform improves care for older adults with chronic conditions. UHCAN Ohio is the lead organization for Ohio Campaign for Better Care. Go to our website for more information.
Dr. Berwick stated: the alternative to quality improvement – cutting care for people on Medicare and Medicaid – will lead us in the wrong direction. He also opposes turning Medicare into a voucher program. Instead, he is promoting better care coordination, especially for the 77% of Medicare patients with chronic health conditions. Those with multiple chronic conditions tend to be the heaviest users of health care, with the worst outcomes, and highest costs. If we can improve care for them, we can achieve real savings.
Dr. Berwick’s associate, Dr. Paul McGann, explained HHS’ Partnership for Patients, a new campaign involving federal and state governments, hospitals, physicians, health plans, and consumers to improve patient safety. We waste billions of dollars each year on preventable hospitalizations and re-hospitalizations for preventable conditions. The goals of P4P are to reducing hospital readmissions by 20 percent and hospital-acquired conditions by 40 percent by 2013.
The Cincinnati patient safety event will available, by videocast, on the UHCAN Ohio website soon.
Submitted by clevine on Wed, 06/08/2011 – 5:45pm
Ohio Budget Shenanigans:
Medicaid Managed Care Plans Try to Protect Themselves from Accountability for Quality; Will the Ohio General Assembly Go Along?
Periodically during the budget process, State House reporters have asked me why the managed care plans seem so happy with the budget. At least a part of the answer is found in language that first appeared in the Ohio FY 2012-2013 budget, as passed by the House of Representatives.
One of the bedrocks of health care reform is that we must change how we pay for health care. The current “fee-for-service” system pays for volume, instead of health outcomes, leading to the troubling estimate that 30-40% of current health spending provides either no value or negative value. Thus, the Kasich administration and consumer advocates agree with national experts that we must start rewarding better patient outcomes and population health – and reduce payments for lower than expected results.
Thus, consumer advocates – and, apparently the administration – were surprised to discover a new provision in the budget bill (HB 153), as passed by the House, that would insulate the Medicaid managed care plans from financial incentives to improve their patients’ health outcomes.
For several years, 1% of the premiums paid by the state to the Medicaid MCOs were at risk for performance benchmarks. In other words, if an MCO did not achieve those quality benchmarks, they didn’t receive that final 1%. 1% is an awfully small amount to have at risk for meeting quality standards. If we truly want to incentivize MCOs to improve patient outcomes, the state may want to put considerably more than 1% of premiums at risk.
However, the new language “clarifies [sic] that the sum of all withholdings for the Managed Care performance program shall equal no greater than 1% of total premiums.” In other words, the Medicaid Managed Care Plans – capably represented by the Ohio Association of Health Plans – have protected themselves from being held financially accountable for making their enrollees healthier or reducing avoidable health expenditures (such as avoidable emergency room visits or hospital admissions). This provision, which appears to have survived in the Senate, completely undercuts the administration’s ability to create incentives for the Medicaid Managed Care Plans to achieve better care at lower costs.
The challenge with efforts to provide better care at lower costs is that one person’s savings is another person’s revenues. As the Kasich administration rightly pointed out in their budget rollout, if we are going to reduce Medicaid spending, we have to look at where the big spending is. With Ohio paying $6 billion or more to the Medicaid MCOs, it’s time to hold them accountable for performance measures – just as we must do with hospitals and other providers. The 1% cap on MCOs’ pay for performance exposure is the wrong medicine for what’s ailing Medicaid.
Submitted by achenault on Wed, 03/16/2016 – 2:12pm
The Ohio Department of Medicaid (ODM) has announced that they will begin eliminating spend-down after July 2016. People who are currently using health care expense spend-down to be eligible for Medicaid will have to meet income eligibility criteria (below 138% of the federal poverty limit, $16,242 per year for a single person; $24,250 per year for a family of four). At the same time, ODM will require only one determination of disability in order to qualify for Supplemental Social Security (SSI) and Medicaid benefits. Overall, this will bring a greater number of people into Medicaid but will also result in some people losing their Medicaid benefits.
If the following conditions apply to you, you may need to purchase insurance in the Health Insurance Marketplace:
People losing their Medicaid benefits that are 65 or older may need to enroll in Medicare.
ODM describes these changes on their website. ODM will be sending information to all people affected in the next few weeks. It is important that you carefully review any information that you get from ODM.
UHCAN Ohio and our partners have encouraged Medicaid to make the transition as easy as possible for all who are impacted. This includes providing transition periods, expanding coverage to a broader range of behavioral health conditions, and effectively informing those impacted and giving them guidance. We are especially concerned about those who will be losing Medicaid coverage.
If you believe your income is above 138% FPL ($16,242 per year for a single person; $24,250 per year for a family of four) and you will lose Medicaid coverage as a result of the change to spend-down, please let us know how you will be impacted.
Send us an e-mail to tell us how this will impact you and if you are willing to be contacted. Knowing how this affects you will help us tell the Ohio Department of Medicaid how to improve the transition.
The changes that will occur after July 2016 are complicated and are very specific to each individual’s circumstances. It will be important that you pay attention to the letter that you get from ODM to know how you are affected and what you have to do. As more detail is available, we will share it with you. Sign up here to receive email alerts about Medicaid spend-down as they develop.
Tomorrow, the Ohio Department of Medicaid will open public comment on their proposal to significantly change Ohio’s Medicaid program based on guidelines passed by the State Legislature in the last state budget. These proposed changes could cause more than 1 million of Ohio’s most vulnerable people including women, parents, people who are homeless, and others, to lose their health coverage by forcing Medicaid enrollees to pay monthly premiums that aren’t affordable and establishing confusing health spending accounts.
Currently, Medicaid helps many Ohioans, like Jackie B. get and keep employment, stabilizes their families, and helps them stay healthy.
Jackie B. is a retail worker and single mom of four children. Her present employer offers health coverage, but at around $ 40.00 per week out of pocket, it’s simply too expensive. Until last year, when Jackie qualified for Medicaid under the expansion, Jackie had to deal with the day-to-day worry of being uninsured. Over the course of 13 years without access to regular health care, Jackie’s medical needs, went largely unaddressed and her only source of care was the hospital emergency room. Now that she has coverage through Medicaid, she gets the care she needs. But, with the changes proposed in the Medicaid waiver, Jackie fears she will not be able to meet the monthly premiums and could lose the care she went so long without. “I can’t go back to life without health coverage”, said Jackie. “I can now get the care I need to lead a full and productive life,” says Jackie.
The proposed changes could also add to the overall cost of our health system by increasing administrative costs, through a new debit card system. It creates a number of new variables that the state must administer and track. Setting up and maintaining administrative systems costs money. Experiences in several states like Arkansas and Oregon have shown that Medicaid program elements like health spending accounts can be costly to administer and premiums can cause a decline in program enrollment.
“This proposal, if approved, will undermine the progress Ohio has made in increasing access to health care, said Steve Wagner, Executive Director of UHCAN Ohio. “This proposal hurts people like servers at restaurants, retail associates, and caregivers. These are people who are barely getting by as it is. Studies show that requiring our lowest income neighbors and friends to pay for health care costs makes them put off getting important preventive care and instead only going to the doctor when the problem is severe. This “sick-care” drives up health care costs in the long term. If the intention of this proposal is to reduce Medicaid spending while growing healthy families, it is misguided,” said Wagner.
UHCAN Ohio is encouraging people who get their health coverage through Medicaid or care about low income families to participate in the 2 open comment periods, at the state and federal level. “The state and federal government needs to hear how these changes would affect peoples’ access to quality health care”, said Ms. Carter. “There are many ways to make your voice heard, like sharing your personal experience at one of the hearings or through a written submission. Organizations can develop their own comments based on the interests of those they serve, sign on to a letter, or participate in the hearings, said Carter. “Ultimately, we’re asking the federal government to reject Ohio’s waiver proposal in order to protect families so they can get the care they need to live healthier lives,” said Carter.
To learn more about how to participate in the state or federal comment periods, please visit, HealthyOhioMedicaidWaiver.
The Ohio Department of Medicaid is finalizing plans to eliminate spend-down and redesign disability determinations. The Governor’s Office of Health Transformation published a white paper that discusses the plans in detail. UHCAN Ohio outlined some of the changes in our March newsletter. Spend-down will be eliminated, and qualifying for Medicaid will mean meeting the income limits. Ohio Department of Medicaid will provide different transitions for people depending on their situation, so it is important to watch for communications from the Ohio Department of Medicaid.
It is important that people who could have met spend-down to qualify for Medicaid (but did not do so) consider whether they could meet spend-down before the end of June. This applies to people who are 65 or older, have a disability, or are blind. Those who could meet the spend-down requirement before June should make sure to apply to Medicaid. Successfully qualifying for Medicaid reimbursement through spend-down, even for just one month, will help to provide you with benefits after July 1, 2016. If you can meet Medicaid spend-down but are not currently enrolled in Medicaid, contact your county Department of Jobs and Family Services or call the Ohio Department of Medicaid consumer hotline at 1-800-324-8680.
For the past 6 months, UHCAN Ohio has been working to organize consumers, advocates, and organizations to oppose the #NotHealthy4Ohio waiver. As a result of this work, approximately 100 advocates, activists, and other organizations filled the hearing room at the Ohio Department of Medicaid in Columbus to provide comments –all opposing – on the Healthy Ohio/#NotHealthy4Ohio Waiver. Of the 12 people who gave testimony, all of the 6 consumers that testified came in response to UHCAN Ohio’s call to action. All 12 people spoke out against the waiver. Click here to watch their testimony.
At the Cincinnati hearing, around 60 advocates attended. Of the 15 people who gave testimony, all of the 9 consumers that testified came in response to UHCAN Ohio’s call to action. Click here to watch their testimony.
On May 2nd, we launched a successful Thunderclap campaign telling Ohio Medicaid that forcing low-income Ohioans to pay for health coverage is #NotHealthy4Ohio. Many colleagues and consumers participated in the online action which reached over 97,000 people online.
We continue to organize people to write comments to Ohio Department of Medicaid before the May 16th deadline. If you have not already submitted comments, you still have time to do so. The open comment period ends on May 16, 2016. Please send the Ohio Department of Medicaid comments on the #NotHealthy4Ohio waiver and copy UHCAN Ohio at info@uhcanohio.org. We will use the comments you send to Medicaid to convince CMS to deny the waiver request.
For examples of comments, to share how you have benefitted from Medicaid coverage, and more, visit our resource center at www.uhcanohio.org/healthyohiomedicaidwaiver.
