Monthly Archive for June, 2010

ACOs discussed at national forum hosted by Group Health

By Stephen Tarnoff, MD

Recently, over 100 physicians and delivery system leaders from around the Northwest gathered at the Sheraton Hotel in Seattle to attend the Spring meeting of the American Medical Group Association (AMGA). Members represent leading medical groups and health systems in Washington and Oregon. Hosted by Group Health Permanente, the theme of the meeting was “learning from the best” and focused on creating high-performing care organizations. Attendees heard speakers from Group Health, The Everett Clinic, Virginia Mason and Northwest Physician Network describe their respective journeys toward creating accountable care organizations (ACOs). ACOs are new models of care that Congress is actively promoting as the answer to the overly expensive and disorganized system that is presently common in our country.

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Published on June 25, 2010 in Accountable Care Organization and Health Care Reform. 0 Comments Tags: , .

Defining a grandfather

By Diana Birkett Rakow

Last week, HHS published the much-awaited interim final regulations on “grandfathering.”  As you’ll recall from an earlier post, some insurance reforms will apply to both grandfathered and non-grandfathered plans, while some only to non-grandfathered plans.  The  ”interim final rules ” issued this week now clarify which plans can be grandfathered and therefore excluded from certain reforms. 

So now that we have the rules, we’re busy analyzing our options.  Group Health must determine soon how the grandfathering regulations will impact its current  plan offerings within the individual and group markets. Then, within the next few weeks, we must file health reform-related endorsements regarding any proposed  changes to our plans with the state Office of the Insurance Commissioner for review. 

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Published on June 21, 2010 in Health Care Reform. 0 Comments Tags: , .

Group Health receives national attention for efforts to reduce hospital readmissions

By Brenda Bruns, MD

Critics of our new health reform law have pointed out that while it provides for coverage for most Americans and tackles much-needed insurance reforms, little has been done to address how costs will be controlled and quality of care improved.

But much is already happening at healthplans like Group Health to improve the way we provide care, a theme we emphasize on this blog.

By delivering care in an integrated fashion, with incentives built in that recognize the value (efficacy) of the care provided–instead of volume–Group Health and many other organizations are proving that establishing systems to improve health outcomes actually reduce health costs.

America’s Health Insurance Plans just released a report that showcases innovations happening right now that reduce preventable hospital admissions, readmissions, and emergency room use. Group Health is proud to have our Emergency Department and Hospital Inpatient Improvement Program (EDHI) detailed in the report.

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Published on June 14, 2010 in Health Care Reform. 0 Comments Tags: , .

Birnbaum lecturer challenges Group Health to seize improvement opportunities

By Eric Larson, MD, MPH

After last week’s 11th annual Birnbaum Endowed Lecture, I realize why this year’s celebration was so inspiring. Our speaker brought more than ideas. He challenged Group Health researchers, clinicians, and leaders to improve patient care and efficiency dramatically—in ways that are within our grasp.

Brent James, MD, MStat, is executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare. Based in Utah, this health care system resembles Group Health in its commitment to affordable excellence, despite other differences.

His lecture, which can be viewed online and is worth watching, focused on quality improvements that become easier when health systems shift from “craft-based” to “profession-based” practice. Continue reading ‘Birnbaum lecturer challenges Group Health to seize improvement opportunities’

Published on June 11, 2010 in Health Care Reform. 0 Comments Tags: , , .

Quality of our patients' experiences should be the focus of reform

By Scott Armstrong

As you’ve probably noticed, the debates that led to federal health reform are far less public, and the work to implement change is in high gear. 

Most attention is on near-term changes to health insurance—with work being done to extend the age that adult children are covered under their parent’s health plan, end coverage denials for children with pre-existing conditions, and eliminate cost sharing for preventive care.

While these are important improvements, very little is focused yet on how health care services are provided. As we at Group Health already know, that’s where the most important changes will need to take place.

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Published on June 10, 2010 in Accountable Care Organization and Health Care Reform. 1 Comment Tags: .

How will we do that?

By Paul Sherman, MD, MPH

I was honored to be in DC last week representing Group Health at a meeting hosted by Don Berwick, president of the Institute for Healthcare Improvement and nominee to lead the Center for Medicare and Medicaid Services, Elliot Fisher, Chair of the Dartmouth Atlas Project, and Atul Gawande, noted author and contributor to The New Yorker magazine (including the seminal article on McAllen, Texas).

If there’s such a thing as rock stars in our world of affordable excellence, these three are them.

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Published on June 3, 2010 in Accountable Care Organization and Health Care Reform. 0 Comments

Group Health hosts meeting on creating Accountable Care Organizations

By Stephen Tarnoff, MD

This Friday (June 4) Group Health Permanente is pleased to host the American Medical Group Association’s (AMGA) Northwest Region meeting, one of a series of regional meetings being held in 2010 on groundbreaking delivery system reforms.

Group Health Permanente Executive Vice President Marc West and Executive Medical Director, Health Plan Division, Brenda Bruns, MD will share Group Health’s journey to becoming an Accountable Care Organization (ACO) with similar medical groups who are coming together to share best practices.

The program is designed to educate medical group leaders on how to develop, operate, and maintain high-performing ACOs. They focus on physician-led, patient-centered ACOs and bring together actual case studies presented by the medical group leaders with firsthand experience in providing accountable care to their patients.

Group Health is excited to welcome AMGA to Seattle. We have a new landscape since the passage of health care reform, and we’re eager to realize the gains the law aims to provide. We look forward to enthusiastic discussion and information sharing with some of our nation’s largest and most prestigious integrated health care delivery systems about how we can deliver and finance health care more efficiently and effectively for future generations.

For more information, visit the American Medical Group Association.

by Stephen Tarnoff, MD, Associate Medical Director, Group Health Permanente / Group Health Cooperative

Published on June 2, 2010 in Accountable Care Organization and Health Care Reform. 1 Comment Tags: .

Retiree Reinsurance – What is it, and what does it mean for me?

By Diana Birkett Rakow

Some summaries of the health reform bill say “This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.” 

Understandably, many people who are themselves early retirees age 55-64 want to know how this program will work, and when they’ll start seeing the relief.  Re-insurance lowers costs by providing a second or back-up insurance to companies to cover very high-cost care.

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Published on June 1, 2010 in Health Care Reform. 0 Comments Tags: , .