The best ways information technology can support health delivery systems

By Megan Howell

An important bi-partisan report was released today that includes a set of recommendations for the most effective use of health information technology (IT) dollars to support coordinated, accountable, patient-centered models of care. We were fortunate enough to have our President and CEO, Scott Armstrong, contribute to this work through the Bipartisan Policy Center’s Task Force on Delivery System Reform and Health Information Technology. Over the last six months, the Task Force, headed by Senators Daschle and Frist, has collaborated across industries and party lines to develop a set of recommendations for the most effective use of health IT dollars to support new models of care that improve quality and health, and reduce costs.

The two primary goals of the Task Force were: 1) Identify real-world examples and best practices that facilitate coordinated, accountable, patient-centered care; and, 2) Make recommendations for ensuring that current health information technology efforts support delivery system and payment models shown to improve quality and reduce costs in health care, in ways that best utilize scarce public and private resources.

The report discusses the common attributes of high-performing organizations that align with emerging delivery system reforms and health IT capabilities needed to support them. Group Health is considered to be a high-performing organization by the Task Force, and our successes are captured throughout the report. The report also addresses gaps in health IT capabilities, the barriers to their achievement, and recommendations for accelerating the creation of a health IT foundation that will drive improvements in the quality, safety and cost-effectiveness of care in the U.S.

Health IT plays a critical and foundational role in these new models of care. When well designed and effectively used, health IT saves lives, improves quality, and reduces costs. This report takes a very necessary step in the right direction to help meet the triple aim of improving health, improving the experience of care for patients and families, and reducing the cost of care.

However, much more future work is needed in this field to further drive innovation in health IT, and we hope this report will help encourage policy makers to promote health organizations who are investing and innovating through health IT. Amidst the national and state discussion on furthering health IT capabilities, Group Health continues to forge the way for other organizations in the use and development of health IT for the benefit of our members.

Press release

Report

 

Published on January 27, 2012 in Affordable Care Act and Health Care Reform. 0 Comments Tags: , .

Group Health signs on to support gay marriage bill

By Scott Armstrong

Group Health has joined other local Northwest companies in signing a letter to legislative leaders and Gov. Chris Gregoire in supporting gay marriage legislation (SB 6239) that will be debated during the current legislative session. Other organizations that signed the letter included Vulcan, Nike, RealNetworks, Concur, and Microsoft.

I believe the support for committed couples is part of respecting our staff and our patients. Respect for all people is a core value of Group Health. Inclusion and equality help build a workforce that reflects and can support the diverse needs of the patients we serve.

“We support our people, both our staff and our patients, and we also support human rights as guaranteed to all citizens of this country,” said Michael Soman, MD, Chief Medical Executive Officer, and President of Group Health Physicians. “Close collaboration and respect, with our colleagues and our patients, are critical to creating better health for individuals and communities.”

Group Health’s position builds on its history of supporting corporate and public policies that promote inclusion and equality. Group Health was recently recognized in the Healthcare Equality Index for its leadership in meeting high-quality standards in serving the LGBT community in its 25 statewide medical centers. The standards include some basic services such as visitation rights and patient non-discrimination policies

Published on January 19, 2012 in Health Care Reform. 14 Comments

HHS issues bulletin on Essential Health Benefits

By Megan Howell

Last week, the Department of Health and Human Services (HHS) issued a bulletin (pre-regulation guidance) on the Essential Health Benefits (EHB) package in an effort to give states the information needed to begin constructing the Exchanges as well as the requirements for qualified health plans sold through the Exchanges. The EHB package, which must be offered by insurers in most policies sold to individuals and small businesses both in and out of the Exchange, is arguably one of the most important aspects of the federal health reform law.

States to determine benchmark EHB plan
Under HHS’ intended approach, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the EHB package. This gives states the option to select a plan that would be equal in scope to the services covered by a typical employer plan in their state, with additional flexibility to adjust with the market as innovative plan designs are developed and advancements in care become available. States will base their package on the benefits offered by: one of the three largest state employee health plans (by enrollment); one of the three largest federal employee health plans; the largest HMO plan offered in the state; or one of the three largest small-group plans in the state. The benefits and services included in the selected health plan would then be considered the EHB package for the state.

Consistent with the Affordable Care Act (ACA), states must ensure the EHB package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs. The bulletin addresses only the services and items covered by a health plan, not the cost sharing—such as deductibles, copayments, and coinsurance—that will be required by a qualified health plan. The cost-sharing features and rules will be addressed in future bulletins.

State mandates
The Institute of Medicine (IOM) issued guidance a few months ago that stressed the importance of affordability in an EHB package, along with stressing that only state mandates that are evidence-based should be included in the EHB package. The HHS bulletin has somewhat deviated from the IOM’s guidance, in that it does not specifically address cost and offers a different solution for state mandates. To prevent federal dollars paying for state benefit mandates, the ACA requires states to pay the cost of state mandated benefits (in excess of the EHB package) for individuals enrolled in any plan offered through an Exchange. However, the bulletin provides that as a transition in 2014 and 2015, state mandates included in the benchmark plans would be included in the EHB package for that state, without requiring the state to pay for the cost.

What we are hearing
Patient advocates previously called for a broad national EHB standard that would cover a wide range of treatments, while business groups have said affordability must be a top consideration, even if it means a more limited package. Both segments appear to have concern with the bulletin. It does not address cost as a consideration for the establishment of the EHB package to satisfy the business groups, nor does it address consumer advocate concerns by creating a national standard that will “beef up” plans in states with minimal state mandated coverage. Furthermore, the bulletin continues the uncertainty faced by insurers, consumers and employers over exactly what will be covered in the EHB package.

To add confusion, the issuance of a bulletin by HHS was an unexpected twist, as the issuance of a Proposed Rule and/or Request for Information is the normal protocol for regulations of this kind. It has been speculated that the administration specifically chose to issue a bulletin as it does not have to provide definitive economic estimates of the proposal or determine regulatory impact on small business. Additionally, allowing states to make the decision on the EHB package that works the best for them saves the administration the potential political backlash from not including specific benefits in the package.

Next steps
All eyes are on Washington state as to which option it will choose as its benchmark plan. As a mandate-heavy state, it will be particularly interesting to see how Washington will impose restrictions on the EHB package in an effort to keep coverage affordable in the post-2014 market. Will there be a continued push for additional mandates at the state level, or will the legislature begin to review the current mandates on the books? Either way, HHS has given the state some time to transition current mandates and develop an EHB package that will offer Washingtonians access to affordable adequate coverage.

Essential Health Benefits Bulletin
Fact Sheet on the Informational Bulletin on Essential Health Benefits

Published on December 22, 2011 in Affordable Care Act and Essential Health Benefits. 0 Comments

Holiday greetings from the Chair of the Cooperative

By Rosemary Daszkiewicz, JD, Chair of the Cooperative

This has always been one of my favorite times of year, especially those rare clear cold days when cheeks are rosy and we truly appreciate every second of daylight. Something about the days of diminishing light lend themselves towards introspection and reflection, all the better to plan our intentions for the coming new year. 

Your consumer Board of Trustees has been busy reflecting on 2011 and planning for the future. As part of that reflection process, we’ve considered the Cooperative’s journey from its creation in the great cooperative movement of the post-war years, and coming of age in the turbulent second half of the twentieth century. Our annual membership meetings were lively and exuberant affairs where many important discussions took place.

We’ve been looking at ways to recapture that spirit of engagement in our Group Health as we celebrate the International Year of the Cooperative. Things have changed since 1947, but our members still care deeply about their health and that of their families and communities. Our job for 2012 is to find ways for our members to engage with their Cooperative in ways that work for today’s lifestyles.  As I said at the Annual Meeting, you’ll be hearing more about that in months to come.

In the meantime, with thanks for your continued enthusiasm for Group Health Cooperative, I wish you a holiday season filled with good health.

Published on December 19, 2011 in Health Care Reform. 1 Comment

America can’t control health costs it doesn’t understand

By Eric Larson, MD, MPH

Deliberations over health care’s future continue to be divisive. The U.S. Senate “super committee”—deadlocked over deficits linked largely to health care spending—has thrown in the towel. The Affordable Care Act is headed for the U.S. Supreme Court. Medicare chief Don Berwick has resigned after Congress failed to confirm his appointment. And pundits predict next year’s presidential election will be yet another referendum on health reform. Continue reading ‘America can’t control health costs it doesn’t understand’

Published on December 6, 2011 in Affordable Care Act, health care costs and Health Care Reform. 0 Comments

Region’s ER facility expansion will drive up costs

By Eric Larson, MD, MPH

The Seattle Times shed important light on a disturbing development in the region’s health care market with its November 29 story, “ER building boom is wrong prescription, critics say.” Experienced ethics reporter Carol Ostrom describes how large hospitals have recently built many new, aggressively marketed emergency facilities—many as free-standing facilities in affluent areas of Puget Sound. Continue reading ‘Region’s ER facility expansion will drive up costs’

Published on December 1, 2011 in health care costs and Health Care Reform. 1 Comment

Supercommittee fails to reach an agreement — what now?

By Megan Howell

After many committee meetings and much speculation whether the bipartisan Joint Select Committee on Deficit Reduction (“Supercommittee”) would come to an agreement to cut the United Stated deficit by $1.2 trillion, the deadline has unfortunately past. Despite the fact that the Supercommittee had full authority to essentially cut from any government budget to reach the $1.2 trillion goal, the Democrats and Republicans could not agree on exactly how to reform certain programs for savings nor develop creative ways to raise revenue without increasing taxes for everyone. Our own Senator Patty Murray, a co-chair of the Supercommittee, stated that the group worked up to the wire to strike a deal, but in the end, no recommendation could be agreed upon by both parties. Continue reading ‘Supercommittee fails to reach an agreement — what now?’

Published on November 25, 2011 in Affordable Care Act and Health Care Reform. 0 Comments Tags: , .

The Supreme Court to hear arguments on the Affordable Care Act

By Megan Howell

On Monday, the Supreme Court of the United States decided it would hear the challenge to major provisions of the Patient Protection and Affordable Care Act (ACA) in its upcoming session. Specifically, the Court will hear arguments contained within the suit filed by 26 states and the National Federation of Independent Business that came through the U.S. Court of Appeals for the 11th Circuit. It is important to note this is the only appellate court to find the law to be unconstitutional. Continue reading ‘The Supreme Court to hear arguments on the Affordable Care Act’

Published on November 18, 2011 in Affordable Care Act. 1 Comment Tags: .

School-based health centers make a difference

By Laura Rehrmann, President , Group Health Foundation

 

Today I joined Mayor Mike McGinn at West Seattle High School to encourage the community to vote “Yes” on the Families & Education Levy so the City can continue providing successful “wrap around” services, including student health centers, to Seattle’s public school students.

Some 1,748 students made 11,066 visits to the seven health centers that Group Health operates in the 2010 school year. Group Health receives grant funds from Seattle’s Families and Education Levy and provides in-kind resources to operate the health centers.  Continue reading ‘School-based health centers make a difference’

Published on November 2, 2011 in Health Safety. 1 Comment Tags: , , , .

Performance Matters

By Michael Soman, MD

Only nine Medicare Advantage plans in the country earned 5 stars overall, and Group Health Cooperative’s plan is one of them.

Numbers are the currency of the land—the best way we have to demonstrate accountability and transparency regarding how we take care of people. But over the years our concept of quality has evolved beyond just scores and numbers. Continue reading ‘Performance Matters’

Published on October 27, 2011 in Medicare and Quality Health Care. 0 Comments Tags: .