Archive for the 'Health Care Reform' Category

Governor signs health benefit exchange legislation at Group Health Olympia Medical Center

By Group Health Communications

Today, Group Health proudly hosted Governor Christine Gregoire as she took the next step in empowering her constituents to choose the best, most affordable health care by signing the Health Benefit Exchange Legislation at our Olympia Medical Center.

Group Health supports the legislation because it simplifies the process for purchasing health care for all Washingtonians and provides a rating system to help consumers select the best plan. Furthermore, the legislation will provide more choices in health plans while also making it easier for them to retain their coverage when switching from job to job. Washington state again leads as one of the first states to quickly and appropriately enact Health Benefit Exchange Legislation in advance of the 2014 federal deadline.

“The rising cost of health insurance is a significant concern for residents across the state,” said Gov. Chris Gregoire. “Today my signature on the Health Benefits Exchange bill makes it easier for individuals and small businesses to compare, select, and buy affordable health care coverage. The exchange will help take the guess work out of the health insurance process and will assure that consumers get what they pay for.  I thank Group Health Cooperative for leading the way on these important efforts.”

Group Health Cooperative has been an active partner in helping shape an exchange that is both sensible and appropriate for Washington state. The Governor’s office has asked Group Health’s Olympia Medical Center to host the bill signing this Friday, on the second anniversary of President Obama’s signing of the Affordable Care Act, in recognition of Group Health’s quality of care and service in the state of Washington.

Sponsored by Senator Karen Keiser for the Senate version of the bill and by Representative Eileen Cody in the House, this legislation highlights the need to increase affordable access to health care.

“I think our law will create a healthy, vibrant marketplace for consumers and small businesses to serve as a ‘one stop shop’ for affordable health insurance,” said Senator Keiser. “We plan to be open for enrollment by the fall of 2013!”

“I’m excited to have Washington state take the next step toward health care reform,” Representative Cody said. “As we move closer to access to health care coverage for all, we must now work together to decrease cost and improve quality. With the help of progressive organizations like Group Health, Washington can be a leader in these efforts.”

Group Health members are already experiencing the kind of next-generation care that national, state, and local administrations would like to see available to more people in the country. Practices such as electronic medical records, the medical home, patient-centered care, comparative effectiveness, and shared decision-making are already at work, creating the exceptional care experience Group Health members value.

Published on March 23, 2012 in Affordable Care Act and Health Care Reform. 0 Comments Tags: .

Washington enacts landmark health benefit exchange legislation

By Scott Plack, State Government Relations Director

The legislature has authorized the state’s health benefit exchange to establish an operational health benefit exchange in Washington. Below is a synopsis of the bill, supported by Group Health, which is expected to be signed by the governor any day.

Market Rules

  • The legislation builds upon a bill enacted last year that created a nine member exchange board.
  • Establishes modest market rules to govern how carriers participate in the individual and small group market; prohibits carriers from only offering plans that attract healthy enrollees or from designing benefits that do the same.
  • Carriers offering bronze level coverage outside the exchange must also offer silver and gold coverage. Carriers offering bronze, silver, gold and platinum plans outside the exchange must abide by the actuarial requirements in federal law. 
  • Catastrophic coverage can only be sold inside the exchange. 
  • The OIC must evaluate prescription drug benefits to ensure variation in consumer costs shares are not structured to result in adverse selection. 
  • The exchange must evaluate the market rules by December 1, 2016, and recommend to the legislature whether they should be continued.

Qualified Health Plans

  • The exchange is authorized to certify qualified health plans if they meet the state’s insurance laws, the Affordable Care Act requirements for qualified health plans, and have tribal clinics and urban Indian health clinics in their provider networks.
  • Provider networks that meet a definition of integrated delivery systems are exempted if federal regulations allow ( final rule still under development). 
  • Retainer practices may be offered in the exchange if they meet federal requirements. 
  • The exchange must establish a rating system to help consumers choose among plan offerings.

Financing

  • The exchange must be financially self-sufficient by January 2015 (or it will be suspended), but may seek federal grants and subsidies, assess health carriers and charge enrollees through premiums. 
  • The exchange shall seek input from carriers to develop a funding mechanism that fairly and equally apportions administrative costs of the exchange; changes will be proposed to the 2013 legislature.  
  • Third-party payers may pay for premiums of enrollees and employees in the SHOP exchange and may choose from any plan in the exchange offering the same plan metal level selected by the employer.

Essential Health Benefits

  • The essential health benefit benchmark plan will be the largest small group plan currently offered by a carrier. All ten of the federally required categories of benefits must be include in that plan, or the OIC may add the missing categories. 
  • The OIC must find that a particular plan meets the essential benefit requirements before it may be offered and can take into consideration whether a plan’s benefit design would create a risk of biased selection based on health status. 
  • Beginning annually in December 2012, the OIC must submit to the legislature a list of the state’s mandated benefits (and the cost to the state) that, if enforced, will require the state to finance coverage for enrollees receiving a federal subsidy (as required by law). If the state does not allocate funding for these enrollees, the mandates cannot be enforced for other plans in the market.

Federal Basic Health Option

  • A federal basic health option (FBHO) may be authorized under certain conditions and with legislative approval. The Health Care Authority (HCA) must certify that sufficient federal funding for the program will be available to cover premium and administrative costs, and that health plan rates will be sufficient to ensure enrollee access to a robust provider network by December 1, 2012. 
  • The HCA must consult with stakeholders and perform a Washington-specific feasibility analysis with economic modeling through an independent nationally recognized consultant.
  • Principles for implementation of a FBHO: 12-month continuous eligibility with 12-month continuous enrollment (or a financing mechanism that enables enrollees to stick with one plan for a year); obtaining a balance between affordable premiums, cost shares, and provider payment rates that ensure robust provider networks are in place; and measures to assure program transparency.

Reinsurance, Risk Adjusters and the Future of the WSHIP

  • OIC is directed to adopt regulations to establish reinsurance and risk adjustment programs and must consider the option of a reinsurance program that is an “invisible high-risk pool.” The latter option would cede the full premium and risk associated with certain high-risk or high-cost enrollees and how such a program could be designed to provide effective care management.  
  • Regulations for the reinsurance program must establish a mechanism to collect assessments, include a reinsurance payment formula, and have a mechanism to disburse reinsurance payments. Rules may be adjusted to preserve a healthy market inside and outside of the exchange.  
  • OIC must identify data submissions to support operation of the reinsurance and risk adjustment programs, and must contract with one or more nonprofit entities to administer the programs. 
  • Assessments from the reinsurance program may be increased to cover cost for preoperational and planning activities.  
  • The Washington State High Risk Pool (WSHIP) is authorized to contract with the OIC to administer the state’s risk management functions.  
  • The WSHIP is directed to review and perform an analysis of continued access to WSHIP pool coverage for certain populations that will not benefit from federal reform, to be reported to the legislature by December 1, 2012, with any recommendations for restructuring the program.  
  • WSHIP assessments (and categories of entities assessed) must be examined to make the assessments fair and equitable and the possibility of credits against the federal reinsurance assessments must be explored.

CBS news story

Published on March 8, 2012 in Access to care and Affordable Care Act. 3 Comments Tags: , .

10 reasons why we can’t ignore health care costs

By Eric Larson, MD, MPH

Many of us have heard the mantra our whole careers: To improve health—and the quality of American life—we must stem the rising cost of care. Health care’s percentage of the U.S. gross domestic product has doubled since 1980. At this rate, by 2040, health care will consume one of every three dollars.

With a U.S. debt crisis and a presidential election looming—and with Group Health paying continually rising prices for care purchased outside our own group practice—the cost-containment drumbeat can seem deafening. But here are 10 reasons why rising costs matter now more than ever:

1. Dollars spent on health care could go to education and other needs.
As former White House Advisor Ezekiel Emanuel, MD, PhD, recently wrote, “The more we spend on health care, the less we can spend on other things we value…middle-class salaries, public education, and other state-funded services.” Money spent on any of those things may promote health more than spending the same on medicine. Also, health care-related debts are weakening American businesses’ ability to compete globally.

2. Lower costs will let more Americans gain access to care.
When insurance premiums rise with the cost of care, fewer people can afford coverage. Emanuel predicted that even after the Affordable Care Act starts providing coverage for the uninsured through Medicaid and subsidies in 2014, some people will still find coverage unaffordable. But bending the curve of cost increases should allow more Americans into the system.

3. Lower costs can be compatible with better care.
Group Health proved this true in our patient-centered medical home evaluation. Results included lower costs, higher quality, fewer hospitalizations and emergency visits, and better patient and provider experiences. Ongoing research seeks to identify more innovations that cut costs while maintaining or improving quality.

4. We know where the money is.
Studies show that the greatest potential for health care savings comes from reducing avoidable hospitalization and improving care for chronic conditions. In the Journal of the American Medical Association, Emanuel recently outlined needed changes, including many under development and/or evaluation at Group Health:

  • tracking patients’ health status and physician performance with electronic health records
  • more intensive interactions between patients, caregivers, and clinic staff, including using care coordinators, 24/7 access, interventions to increase medication adherence, and specialized clinical services for patients with recurrent problems from chronic disease
  • providing services not traditionally covered by fee-for-service reimbursement, such as e-mail, wireless monitoring to increase medication adherence, home evaluations to minimize falls, and lifestyle interventions to improve nutrition and exercise

5. We’re uniquely positioned to help solve the problem.
As a learning health care system conducting non-proprietary research within an integrated health plan, we can study the processes and costs of care and coverage for a large population getting care in real-world clinical settings. This lets us continually refine our ability to design, implement, evaluate, and disseminate innovations that may reduce care costs for Group Health members and others across the United States.

6. We’ve got the connections.
Through Group Health Research Institute’s links to other organizations in the HMO Research Network and other consortia—and our collaborations with universities and medical centers nationwide—we can extend the diversity, power, and reach of our research on costs.

7. It’s the future.
The new Center for Medicare and Medicaid Innovation shows increasing interest in funding research to make care more efficient. Also, the establishment of accountable care organizations (ACOs)—as outlined in the Affordable Care Act—provides new incentives for cost-conscious health care.

8. Improvements are possible.
Other developed nations prove it’s possible to provide higher-quality care at lower cost. Among further glimmers of hope: the Centers for Disease Control and Prevention published a study last month showing a dramatic decrease in amputations among people with diabetes over the past decade, presumably because of better disease control. Such improvements should result in lower costs too.

9. We’re poised to address the problem.
At the Group Health Research Advisory Board Annual Meeting on January 25, leaders from Group Health and our collaborating institutions affirmed GHRI’s recently completed strategic plan. They encouraged the Institute to be more ambitious about solving cost control challenges—for both Group Health and the nation. So a small working group of Group Health leaders will meet soon to plan how GHRI will intensify efforts in cost-related research.

10. It’s our job.
GHRI’s mission is “to improve health and health care for everyone through leading-edge research, innovation, and evaluation.” Reducing costs of care is a pillar of this effort.

Published on February 7, 2012 in Affordable Care Act and health care costs. 1 Comment

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. Continue reading ‘The best ways information technology can support health delivery systems’

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. 16 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: , .

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: .