TN's Marsha Blackburn breaks down how public programs that do not pay providers adequately results in cost shifting to employers and others in the private sector & describes how a "public option" could crowd out private options.
Click here to watch the video. You can watch more highlights of her presentation at this site as well.
Wednesday, September 30, 2009
Saturday, September 26, 2009
How Do You Cover HIV Screening for High Risk Beneficiaries?
Review how your coverage compares with CMS (Medicare) proposed coverage for HIV Screening.
On September 9, 2009 CMS proposed to cover annual HIV screening for certain Medicare populations, including any beneficiary who requested the service, all pregnant women, and individuals who have engaged in certain high-risk behaviors. This is the first time CMS has used new authority granted under MIPPA to cover new preventive services using the national coverage determination (NCD) process. Before MIPPA, CMS could not cover new preventive services without Congressional action. The new policy stipulates that CMS must cover preventive services that are reasonable and necessary for prevention or early detection of an illness, Grade A or B-recommended by the U.S. Preventive Services Task Force (USPSTF), and appropriate for Medicare beneficiaries. MIPPA also granted CMS the authority to use cost-effectiveness analysis to determine coverage for a preventive service. HIV screening received a Grade A recommendation from the USPSTF, and CMS concluded that recurrent HIV screening is economically favorable for populations with higher incidence of HIV. Comments are due October 9. A final coverage decision will be made by December 8.
Go to CMS HIV for details.
On September 9, 2009 CMS proposed to cover annual HIV screening for certain Medicare populations, including any beneficiary who requested the service, all pregnant women, and individuals who have engaged in certain high-risk behaviors. This is the first time CMS has used new authority granted under MIPPA to cover new preventive services using the national coverage determination (NCD) process. Before MIPPA, CMS could not cover new preventive services without Congressional action. The new policy stipulates that CMS must cover preventive services that are reasonable and necessary for prevention or early detection of an illness, Grade A or B-recommended by the U.S. Preventive Services Task Force (USPSTF), and appropriate for Medicare beneficiaries. MIPPA also granted CMS the authority to use cost-effectiveness analysis to determine coverage for a preventive service. HIV screening received a Grade A recommendation from the USPSTF, and CMS concluded that recurrent HIV screening is economically favorable for populations with higher incidence of HIV. Comments are due October 9. A final coverage decision will be made by December 8.
Go to CMS HIV for details.
CDC Guidance for Small Employers re: H1N1
CDC's Lisa Koonin, featured in this video, recently participated in MBGH's national webinar on employer preparedness for H1 N1.
Tuesday, September 22, 2009
MBGH Releases 2009 eValue8 Report
MBGH released our 2009 eValue8 report at our Annual Conference, "Do It Yourself: Health Benefit Tools for Employers", on August 26, 2009. This year BlueCross BlueShield of Tennessee and CIGNA participated. Next year we will once again report on all 5 major commercial health plans in Tennessee.
This report shows that both BCBST and CIGNA made improvements in identifying and tracking members for program participation and in notifying members of needed or missed services, otherwise called gaps in care. However, there is still significant room for improvement in all of these aspects.
Although there was improvement in some aspects, it was surprising that both plans were at or below the 25th percentile on key HEDIS measures for childhood immunization, well care visits for ages 3-6, adolescent visits, and behavioral health. MBGH will be working with these plans over the next year to identify interventions to improve these HEDIS scores.
Share your thoughts on this eValue8 report and health plan performance in TN by posting comments to this blog. You can see the entire report by clicking on the link below.
2009eValue8
This report shows that both BCBST and CIGNA made improvements in identifying and tracking members for program participation and in notifying members of needed or missed services, otherwise called gaps in care. However, there is still significant room for improvement in all of these aspects.
Although there was improvement in some aspects, it was surprising that both plans were at or below the 25th percentile on key HEDIS measures for childhood immunization, well care visits for ages 3-6, adolescent visits, and behavioral health. MBGH will be working with these plans over the next year to identify interventions to improve these HEDIS scores.
Share your thoughts on this eValue8 report and health plan performance in TN by posting comments to this blog. You can see the entire report by clicking on the link below.
2009eValue8
Sunday, September 20, 2009
Fred Smith's Comments on Health Reform
Memphis' own, Fred Smith, addressed health reform on Fox News Sunday today. Basically, he stated that there has to be reform. Those that cover their employees, such as FedEx (and all other MBGH members), are paying for the un-insured since the health care delivery system does not deny medical care. He proposed that we should have mandated coverage for "major medical" or "catastrophic care", which was the type of insurance many of us had in past. He commented that at one point, there was not "first dollar coverage".
Fred Smith was joined by Steve Odland, CEO & President of Office Depot and former CEO and President of Memphis-based AutoZone, and John Chambers, Chairman & CEO of CISCO Systems.
Fred Smith was joined by Steve Odland, CEO & President of Office Depot and former CEO and President of Memphis-based AutoZone, and John Chambers, Chairman & CEO of CISCO Systems.
Wednesday, September 16, 2009
MBGH Hosted Successful Employer Preparedness Webinar re: H1N1
MBGH just finished hosting a national webinar on Employer Preparedness for H1N1. The webinar was coordinated through the National Business Coalition on Health and over 140 coalitions and employers from across the U.S. particiapted. Presenters included Lisa Koonin, Senior Advisor for the Influenza Coordination Unit of the Centers for Disease Control and Prevention and Liz McKee of Baker Donelson and Salomon Mizrahi of Frist Horizon, both MBGH members. A summary of the webinar and links to presentations and webinar recording will be posted soon, so check back. If you have any questions, contact Cristie Travis at ctravis@memphisbusinessgroup.org .
Wednesday, September 9, 2009
A Call I Can Finally Answer
A friend of mine called last week to ask for suggestions for a cardiologist and a cardiac surgeon. Her husband’s father had been admitted to the ICU and they determined that he needed a cardiac cath and possibly surgery. She reached out to me because she knows that Memphis Business Group on Health has been collecting information on the quality and efficiency of cardiac care in Memphis since 1997. She also knew that we had worked with physicians, including cardiologists, to help them evaluate the quality of care they gave their patients and to see if they met national standards. She knew that my father had practiced medicine in Memphis for 45 years and had referred me through the years to the physicians he knew would give me good care.
In the past, all I would have had to share with her was this “insider” information. Information that was not generally available to everyone in Memphis, but information I had because of my job and because of my family. One of the well-kept secrets in health care is that insiders know who the good doctors are but that information has only been available to those "in the know".
Well, today I am excited that we are beginning to “democratize” healthcare!!! No longer do you have to be an insider to get some credible information on our local physicians. I was able to refer her to www.healthymemphis.org and tell her to scroll down and click on “Patient Experience Survey” to go to the Consumer Checkbook survey results for over 400 Memphis-area physicians, including cardiologists. These results are based on perceptions of care gathered from thousands of Memphis-area residents about their physicians. I was also able to refer her to www.NCQA.org where she could click on the link “Recognition Programs” to see the list of cardiologists in Memphis that have voluntarily submitted information for evaluation and have been recognized for the quality of care they provide.
I am glad I can finally answer a call looking for a good physician by referring a friend to credible information. I hope my friend followed-up and used this information as well as information she gathered from her father-in-law’s primary care physician and other friends and family. Having this type of information publicly available to everyone, not just health care industry insiders, is a huge step in helping make quality care available to everyone in our community. But having this information will only help if we begin to use it. So, check the sites out yourself and let me know what you think.
In the past, all I would have had to share with her was this “insider” information. Information that was not generally available to everyone in Memphis, but information I had because of my job and because of my family. One of the well-kept secrets in health care is that insiders know who the good doctors are but that information has only been available to those "in the know".
Well, today I am excited that we are beginning to “democratize” healthcare!!! No longer do you have to be an insider to get some credible information on our local physicians. I was able to refer her to www.healthymemphis.org and tell her to scroll down and click on “Patient Experience Survey” to go to the Consumer Checkbook survey results for over 400 Memphis-area physicians, including cardiologists. These results are based on perceptions of care gathered from thousands of Memphis-area residents about their physicians. I was also able to refer her to www.NCQA.org where she could click on the link “Recognition Programs” to see the list of cardiologists in Memphis that have voluntarily submitted information for evaluation and have been recognized for the quality of care they provide.
I am glad I can finally answer a call looking for a good physician by referring a friend to credible information. I hope my friend followed-up and used this information as well as information she gathered from her father-in-law’s primary care physician and other friends and family. Having this type of information publicly available to everyone, not just health care industry insiders, is a huge step in helping make quality care available to everyone in our community. But having this information will only help if we begin to use it. So, check the sites out yourself and let me know what you think.
Make Your Own Health Reform
In the midst of all of this health reform hubbub, I was struck by the simple message of an article by Rick Johnson for HealthLeaders Media, published July 28, 2009. He states:
"But whatever comes out of the other end of the health reform debate, insurers and employers should not count on the eventually watered down version of health reform - assuming some plan actually becomes law - to help change the direction of healthcare's cost curve. No, it is wiser to exhaust the tangible options at hand. A truly progressive employer is striving today for a mix of employee wellness efforts and contracts with health care organizations - both at home and abroad - that bring down the cost of some of the most pricey and common procedures....One day this health reform movement seems to gain momentum, and then the next day it loses traction..... So work today to bend your organization's cost curve. No one is going to do it for you tomorrow."
When we developed the theme for our recent August 26 conference, "Do It Yourself: Health Benefit Tools for Employers", we didn't know the twists and turns health reform would take. As it turned out, that was a perfect theme as the conference focused on what Memphis-area employers CAN do to bend their own cost curve. Actions around benefit design, vendor management, work site clinics, and activating your employees are all within your realm of control. You don't have to wait on Congress for changes in these areas. You don't have to wait for the health care delivery system to improve quality and become more efficient to take these steps.
Put these strategies that employers can do now together with local efforts to measure and report on provider performance, create systems to help providers improve the quality and efficiency of their care, and engage consumers across the whole community, and we have a recipe for our own local health reform.
Let's learn more together about ways we can bend our own cost curve and reform our own system and not wait for the federal government to make that happen. The more of us that take these types of actions, the faster we will see the difference.
"But whatever comes out of the other end of the health reform debate, insurers and employers should not count on the eventually watered down version of health reform - assuming some plan actually becomes law - to help change the direction of healthcare's cost curve. No, it is wiser to exhaust the tangible options at hand. A truly progressive employer is striving today for a mix of employee wellness efforts and contracts with health care organizations - both at home and abroad - that bring down the cost of some of the most pricey and common procedures....One day this health reform movement seems to gain momentum, and then the next day it loses traction..... So work today to bend your organization's cost curve. No one is going to do it for you tomorrow."
When we developed the theme for our recent August 26 conference, "Do It Yourself: Health Benefit Tools for Employers", we didn't know the twists and turns health reform would take. As it turned out, that was a perfect theme as the conference focused on what Memphis-area employers CAN do to bend their own cost curve. Actions around benefit design, vendor management, work site clinics, and activating your employees are all within your realm of control. You don't have to wait on Congress for changes in these areas. You don't have to wait for the health care delivery system to improve quality and become more efficient to take these steps.
Put these strategies that employers can do now together with local efforts to measure and report on provider performance, create systems to help providers improve the quality and efficiency of their care, and engage consumers across the whole community, and we have a recipe for our own local health reform.
Let's learn more together about ways we can bend our own cost curve and reform our own system and not wait for the federal government to make that happen. The more of us that take these types of actions, the faster we will see the difference.
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