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Ill. governor refuses to expand medical-marijuana list

September 13, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

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Illinois Gov. Bruce Rauner’s administration has issued a broad rejection  of expanding the list of diseases that can be treated with medical marijuana in the Land of Lincoln, refusing to add osteoarthritis, migraine, post-traumatic stress disorder and eight other health problems, the Associated Press reported.

“Separately, the governor vetoed a bill that would have added PTSD via a legislative route,” the AP reported.

“The moves were a stern rebuke of recommendations from an expert advisory board appointed by Rauner’s predecessor, Democrat Pat Quinn.”

“Adding conditions would have expanded the potential base of patients. So far, only 3,000 Illinois patients have been approved to use marijuana for conditions listed in the original law, such as cancer, HIV and multiple sclerosis.”

As healthcare costs surge, expect more pushback against using public money to pay for such controversial treatments as marijuana and Viagra. Illinois has  been facing  a huge budget deficit and spiraling pension costs. It’s no wonder that he doesn’t want to dramatically expand the legal use (and thus cost) of marijuana as a med that Illinois’s Medicaid program would pay for.

Something’s gotta give!

Big mental-health-reform bill is filed

September 13, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , ,

Senators Bill Cassidy (R.-La.) and Chris Murphy (D.-Conn.) have proposed a bipartisan mental-health reform bill with an eight-point agenda intended to shore up the U.S.  mental-health system (1.usa.gov/1NazR8y). Among other measures, the bill proposes to designate an Assistant Secretary for Mental Health and Substance Use in the U.S. Department of Health and Human Services, require audits on mental- and physical-health-parity law implementation, and establish new grants for early mental-health intervention.

Of course, given the close connections among behavioral health, mental heath and “physical health” (as if the brain isn’t an organ!) such a bill, if it becomes law, could have a huge impact across the healthcare system.

Senator Murphy’s office sent us this summary of the bill:

The Cassidy-Murphy Mental Health Reform Act will do the following:

Integrate Physical and Mental Health

  • Encourages states to break down walls between physical and mental health care systems by requiring states to identify barriers to integration. States would be eligible for grants of up to $2 million for five years, prioritizing those states that have already taken action. States taking part are eligible with additional federal funds to treat low-income individuals who have chronic conditions or serious and persistent mental illness. 

Designate an Assistant Secretary for Mental Health and Substance Use

  • Elevates the issue of mental health by establishing an Assistant Secretary for Mental Health and Substance Use Disorder within the U.S. Department of Health and Human Services who will be responsible for overseeing grants and promoting best practices in early diagnosis, treatment, and rehabilitation. The Assistant Secretary will work with other federal agencies and key stakeholders to coordinate mental health services across the federal system and help them to identify and implement effective and promising models of care.

Establish New Grant Programs for Early Intervention

  • Establishes a grant program focused on intensive early intervention for children as young as 3 years of age who demonstrate significant risk factors recognized as related to mental illness in adolescence and adulthood. A second grant program supports pediatrician consultation with mental health teams, which has seen great success in states like Massachusetts and Connecticut.

Establish Interagency Serious Mental Illness Coordinating Committee

  • Establishes a Serious Mental Illness (SMI) Coordination Committee under the Assistant Secretary to ensure documentation and promotion of research and treatment related to SMI and evaluate efficiency of government programs for individuals.

Establish New National Mental Health Policy Laboratory

  • New entity will fund innovation grants that identify new and effective models of care and demonstration grants to bring effective models to scale for adults and children.

Reauthorize Successful Research & Grant Programs

  • Reauthorizes key programs like the Community Mental Health Block Grants and state-based data collection. The bill also increases funding for critical biomedical research on mental health.

Strengthen Transparency and Enforcement of Mental Health Parity

  • Requires the U.S. Department of Labor, the U.S. Department of Health and Human Services, and the U.S. Department of the Treasury to conduct audits on Mental Health Parity implementation and issue guidance on how determinations are made regarding comparability mental health services and physical health services.

Improve Mental Health Services within Medicare/Medicaid

  • Makes critical reforms to allow for patients to use mental health services and primary care services at the same location, on the same day. Repeals the current Medicaid exclusion on inpatient care for individuals between the ages of 22 and 64 if the CMS actuary certifies that it would not lead to a net increase of federal spending.

 

Trying to close gap between rich and safety-net hospitals

September 8, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

hightide

“A High Tide at Atlantic City,” by  William Trost Richards.

NJSpotlight reports on a new initiative to help safety-net providers in the Garden State.

“{L}arge and wealthy hospital systems have been investing in technology and dedicated staff to meet the goals of the Affordable Care Act and better coordinate patient care among different healthcare and social-service providers. But for hospitals that serve largely low-income residents, it can be difficult to pay for the programs to attain this level of coordination .

“A training program called the New Jersey Innovation Catalyst Initiative and funded by the Nicholson Foundation aims to close the gap between wealthier providers and those that serve as a safety net for patients who are uninsured or receive Medicaid.

“The initiative will bring experts from the San Francisco-based Center for Care Innovations (CCI) to help New Jersey hospitals, clinics and trade associations improve the healthcare they provide patients by using technology — often programs that are free or low-cost.”

Medicaid’s emergence as a state-by-state lab for healthcare reform

September 6, 2015by Robert Whitcomb in Uncategorized tagged

 

“It is one of the happy incidents of the federal system, that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”

–Supreme Court Justice Louis D. Brandeis, writing in 1932.

Across America state Medicaid programs and their contracting managed-care plans  are incubators for innovative solutions addressing healthcare cost, quality and access issues. As a Modern Healthcare report notes, “The innovations include integration of primary care and behavioral health, telemedicine, accountable care, patient-centered medical homes and coordination of medical services with long-term-care services and supports.”

“Several states, including California, New Jersey, New York and Texas, also have delivery system reform incentive payment (DSRIP) programs, which are federally approved waiver programs in which federal Medicaid funding is used to create financial incentives for providers to pursue delivery-system reforms. Those reforms involve infrastructure development, system redesign and clinical-outcome and population-focused improvements.”

 

Beyond Medicaid expansion

September 4, 2015by Robert Whitcomb in Uncategorized tagged

 

New research  focusing on Oregon and an  Ohio county shows how just expanding Medicaid coverage isn’t enough to improve the health of populations. The system for providing the care itself must be reformed from the bottom up to improve medical outcomes while controlling costs.

 

Changing pediatric care through clinical integration

September 1, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Robert Meyer, chief executive of Phoenix Children’s Hospital, discusses how clinical integration is changing pediatric care.

He says: “Twenty-four months ago, Phoenix Children’s Hospital launched a bold initiative to create a first-of-its-kind pediatric clinically integrated organization, or PCIO — a value-based approach to improving care and controlling costs.”

“The clinically integrated organization is different from the ACO  {Accountable Care Organization} in that an ACO is limited to a product offering from a contractual perspective, i.e., Medicare. Clinically integrated organizations can operate in multiple platforms, including Medicare, Medicaid and commercial products. This model’s flexibility allowed us to provide the best possible care specifically focused on children.”

“As we built the infrastructure of our clinically integrated organization, we recognized that 92 percent of all care interactions occur outside the hospital, requiring a proactive approach to patient care. Our PCIO, the Phoenix Children’s Care Network, is a collaborative and integrated system of care encompassing general pediatricians, pediatric specialists and sites of service, including Phoenix Children’s Hospital and the hospital-owned urgent care and surgery centers. The PCCN is governed by physicians, the majority of whom are independent.”

 

Post-Katrina primary-care revolution in the Big Easy

August 28, 2015by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

 

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Bourbon Street.

Here’s a look at how post-Katrina New Orleans has transformed primary and behavioral health there as seen by Susan Todd, executive director of 504HealthNet, a nonprofit alliance of nearly two dozen healthcare organizations in the greater New Orleans area.

There are numerous lessons in New Orleans’s experience for other localities seeking to improve care of underserved populations, for example through Federally Qualified Health Centers, with which Cambridge Management Group has worked.

Before the storm, low-income and uninsured residents largely received care through the very troubled state-run public hospital system, particularly the flagship Charity Hospital, downtown. The system had overcrowded clinics, long wait times, frequent budget shortfalls, and a location inconvenient to many patients.

But since then,  Ms. Todd says, a  robust network of neighborhood-based primary-care and behavioral-health medical homes has arisen. “With the help of investments from foundations and the state and federal governments through grants and the Greater New Orleans Community Health Connection, a Medicaid demonstration waiver program, local organizations have greatly expanded their primary-care and behavioral health capacity, particularly in poor neighborhoods.”
“The majority of these health centers have same-day or next-day appointments, and all of them are dedicated to serving everyone who walks through the door. Also, our city recently celebrated the opening of University Medical Center, a $1.1 billion facility operated by local not-for-profit LCMC Health under a public-private partnership with the state,”  Ms. Todd wrote. 

Philly health insurer grows by partnering

August 24, 2015by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

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Independence Hall, Philadelphia.

Read how Independence Blue Cross, Greater Philadelphia’s biggest health insurer,  is growing by partnering, not merging, with other organizations.

“We believe that we are of a size that if we continue to go it alone, we will be very successful, but we are very open to exploring strategic alliances, collaborations, and who knows what that means in terms of consolidations down the road,” Daniel J. Hilferty, chief executive of Independence, told The Philadelphia Inquirer.

“They have enough revenue and enough interrelationships that they are what I would consider a much more secure group,” said Peter L. Gualtieri, director of business development in the Philadelphia office of Savoy Associates, a health-insurance agency in Florham Park, N.J., told the paper.

Independence has customers in 24 states, largely through its control of Philadelphia-based AmeriHealth Caritas,  the nation’s seventh-largest manager of Medicaid health benefits.

“They are finding these efficiencies without having to merge,” said Mark Cherry, principal analyst for Florida and Pennsylvania at Decision Resources Group, a health-care data firm.

He told the paper that a major rationale for insurance mergers —  leverage over hospitals — is no longer quite as powerful. “Insurers are working more closely with health systems and saying, ‘let’s manage population health together.’ ”

 

 

 

 

 

 

Competing systems cooperate on population health

August 14, 2015by Robert Whitcomb in Uncategorized tagged

 

A  joint venture by two  usually competing Minnesota health systems, HealthPartners and Allina, to improve population health — especially primary care — may have some lessons for the rest of the country about  regional  healthcare cooperation.

“Coordinating care through four HealthPartners clinics along with Allina’s Mercy Hospital and five clinics, the providers  have sought to improve mental-health care access, reduce unnecessary hospital readmissions, increase student health screenings, and improve adherence to prescription medications among chronically ill patients, ” The Minneapolis Star-Tribune reported.

“In a report to be released later this month, the alliance will show that costs for its privately insured patients increased less over the last two years than costs for Twin Cities patients overall. Among low-income patients with Medicaid coverage, spending was even lower than expected. A 2 percent decline in spending on these patients from 2013 to 2014 saved $7 million in public funding.

“The experiment also seems to be helping patients. Adding mental health practitioners in clinics and expanding day treatment at Mercy, for example, led to a 7 percent decline in hospitalizations for people in psychiatric crises.”

“Next up for the alliance is reducing waste and improving pain medicine in the region, which has seen a rash of deaths from prescription painkiller overdoses.”

Survey touts clinical, financial merits of Medicaid

August 11, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

An opinion piece on the Commonwealth Fund’s Web site concludes:

“The results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, suggest that people with Medicaid coverage have better access to healthcare services, including proven preventive care, and fewer medically related financial burdens compared with those who lack insurance. Our findings also suggest that, compared to those with private coverage, Medicaid enrollees have nearly equivalent levels of access to care on many important dimensions. Medicaid coverage also appears to offer better financial protection than private insurance against the cost of illness. This last observation may reflect the steady increase in recent years in many private plans’ deductibles and copayments.”

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