MBGH Participating in TN's All Claims Database Development

 MBGH is a member of the Tennessee Health Information Committee which oversees the development of TN's all claims database in terms of information that is collected and information that is publicly reported.

Click here to read a report which summarizes why states are creating these all claims databases. Examples of how information from these databases can be used include:

• Employers can begin to understand the variation in cost and utilization by geographic area within a state;
• The value equation (cost & quality) of new health care services can be assessed;
• The design and implementation of health reforms can be informed by data and data can be tracked to determine impact;
• Compare prevalence of disease across populations;
• Determine payer competitiveness;
• Report on the cost and quality of individual providers. 

TN's all claims database is currently in the data collection process and the first public reports are expected in 2011. MBGH will keep your members informed as information becomes available.

PWC Report Forecasts 2011 Employer Health Benefit Trends

PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to gauge their perspectives on health care costs and benefits program priorities for 2011. Interviews were conducted in the first quarter of 2010. Click here for a copy of the report.

Major findings include:

• Medical costs are projected to increase 9% in 2011.
• More employers will move away from co-payments & toward co-insurance at the point of care.
• Hospitals, getting less from Medicare, will cost-shift to employers/commercial to make it up.
• Providers will merge and consolidate, creating greater leverage in negotiations with health plans.
• Employers plan to add more worksite wellness & health promotion programs.

Why Do Employees Not Take Their Meds?

Interestingly, cost is the not the only reason. Seems convenience is too. This article suggests physician offices should dispense prescription drugs. Evidence also shows that worksite clinics that dispense drugs save employees and employers dollars and increase adherence.

Click here to read the blog post on this issue.

Mercer Reports on How Large Employers Are Reacting to Health Reform

Click here to read results from Mercer's survey of 800 large employers which shows that:

■Early estimates of cost impact range from moderate to severe, with 30% of employers surveyed still in the dark
■Even so, the excise tax on high-cost plans – which doesn’t kick in until 2018 – tops employers’ list of concerns
■Retailers concerned about cost of expanding coverage to more part-timers
■Employers considering several options for offsetting cost of covering adult children
 
Most large employers are waiting unitl their new plan years to implement coverage for <27 year olds. Click here to read an NPR article on this aspect of the survey results.

MBGH Recognizes 5 Memphis-area Hospitals for "Best Odds of Survival"

Click here to read about MBGH's Leapfrog awards to 5 Memphis-area hospitals that have "best odds of survival" in the Memphis Daily News.

Click here to read the press release which talks about other Memphis-area findings from the Leapfrog Hospital Survey, including how Memphis hospitals compare to hospitals nationally on COST of care.

Memphis Employers Using Incentives & Data to Control Health Benefit Costs

Check out MBGH's comments on how Memphis-area employers are controlling health benefit costs through employee incentives and providing data to make informed choices. Click here to read the Memphis Business Journal article.

Work-Site Clinics Gaining Favor Over Retail Clinics

Read this good article that traces the development of retail walk-in clinics at pharmacies such as Walgreens, CVS and Kroger and compares, as well as their aggressive expansion into the world of "work-site " clinics. Both models are a reflection of pharmacies efforts to rebrand themselves as health & wellness companies. Both models are also focused on cutting employee and employer costs. Today, work-site clinics appear to have the most growth potential.

MBGH Presents on Health Reform to Tennessee Personnel Management Assoc.

Click here to check out MBGH's Health Reform presentation to the Tennessee Personnel Management Association on April 15, 2010 for a reminder on why there was such a push for health reform, how we got health reform, how what we got addressed the issues that pushed reform to happen, and some key provisions impacting employers.

Latest on How Employers Are Preparing (Reacting) to Health Reform

As the dust begins to settle on what actually was passed in health reform, employers are reacting and beginning to prepare to deal with what appears to lie ahead. Greatest concern is being voiced over extending dependent coverage to age 26; extending coverage to part-time employees that work 30 hours/week; caps on FSAs; and the elimination of tax deductability for Mediare Part D subsidies for retiree health plans and on lifetime and annual limits, all of which will increase employer costs.

But many say the version that passed is less onerous than previous versions with delays in implementation of controversial issues including the excise tax on "cadillac" plans and the inclusion of some positives in terms of payment & quality demonstrations. Plus, employers "dodged" the strong employer mandate that had been in the House bill.

In addition to all of these changes, and more, employers will take on additional administrative tasks, which, as we all know, end up costing employers significantly in compliance issues.

Read these two article to get a feel for how employers are preparing and reacting as the dust begins to settle.
Click here for "Employers Scamble to Catch Up with Health Reform's Immediate Impact" and here to read "Benefit Managers Eye Impact of Health Reforms".

The VA Saves $3 Billion over 10 Years with HIT Systems

The VA system reports that implementing health information technology has saved them $3billion from 1997-2007 through reductions in duplicated tests and medical errors, as well as operating efficiencies. Technology implemented included computerized patient records, bar coded medications, radiology, laboratory and medication ordering. Imagine the savings we could have in Memphis if all of our systems implemented these same technologies!!! Quality of care also improved during this period. You can track Memphis hosptial progress in implementing computerized provider order entry for medications by reviewing The Leapfrog Hospital Survey results here (see "Prevent Medication Errors"). We have a long way to go in this area. Methodist Healthcare indicates that Methodist North and Le Bonheur are now operational and the remainder of the system should be operational by 2011.

Click here to read an article about the VA experience.

Employers: Focus on These Aspects of Health Reform NOW!!!

Click here to hear Steve Wojcik, vice president of public policy for the National Business Group on Health, offer his take on what employers should have top of mind between now and when the biggie components of the Patient Protection and Affordable Care Act take effect in 2014 and 2018.

MBGH Says: Real Cost Reform is Still to Come

Memphis Business Group on Health's work is highlighted in the April 1, 2010 Memphis Business Quarterly blog. The posting focuses on the need for real cost reform -- saving dollars and improving quality by preventing things that should not happen and improving health and saving dollars by doing things we should be doing to take better care of ourselves.

There is also a link to the Leapfrog Hospital Survey results for Memphis hospitals.

Check the Memphis Business Quarterly blog out regularly for other Memphis business-related postings.

Not Paying for Readmissions Spurs Improvements in Patient Care

It is estimated that 75% of the Medicare admissions readmitted to the hospital within 30 days of discharge were preventable. In total, the cost of readmissions to Medicare is approximately $17.4 billion annually.

Medicare's decision NOT to pay for preventable/avoidable readmissions to hospitals has gotten attention. Significant work is now being done by hospitals to put better discharge and/or transfer processes into place to better coordinate care, ensure patients have support systems at home and get needed followup services. A good example of how aligning payments with desired outcomes serves as the main "carrot or stick" to get action. And, a good example of how poor quality care drives high cost.

Click here to read the article. The clear connection between aligning payment with expected outcomes is in the last paragrah.

Patient Safety Incidents Cost $8.9 Billion Annually

Latest Health Grade's Patient Safety in American Hospitals study finds that there was little progress in reducing patient safety incidents in hospitals for Medicare patients in 2009. They estimate that these patient safety incidents added $8.9billion to the cost of health care in 2009 and that almost 100,000 Medicare patients died as a result of these incidents.Top performing hospitals had 43% fewer incidents than poorly performing hospitals.One more example of how costly poor quality is!!!

Click here to read an article about the report.

Attend University of Memphis Health Law & Public Polcy Symposium, March 26

Click here for brochure and registration

Health Law and Public Policy:
An Introduction to America's Trillion Dollar Business

History will cement this week as the one which saw the passing of the most significant health law legislation in half a century. Join us for an up-to-the-minute discussion with national authorities never before brought together in Memphis, on The Health Care Ecosystem in Transition; Biomedical Research; Health Care and Economic Development; Health Information Management, Electronic Records and E-Discovery; Perspectives on Health Care Reform; and a Leadership Panel Discussion on Health Care and Public Policy. The day's program will close with an outstanding Leadership Panel comprised of the CEOs from St. Jude Children's Research Hospital, Baptist Memorial Health Care Corporation, Methodist LeBonheur Healthcare, and St. Francis Healthcare. You don't want to miss this.

Friday, March 26, 2010

8:30 a.m. – 6:00 p.m.

To be held at the beautiful new downtown location of the

Cecil C. Humphreys School of Law

One North Front Street

Memphis, Tennessee

Memphis Businesses Get Head Start on Health Reform through MBGH

Click here to read the ABC24 Eyewitness News report (aired on March 23 at 5:00) on the role MBGH plays in health reform.

In the interview, Cristie Upshaw Travis said that even though access to health care dominates the talk about health care reform, Travis said there’s more to the issue. “If we don’t pay attention to the cost and quality of services that everybody receives, we will never see an end to increased costs related to health care.”

Unnecessary Angiograms Are Very Costly to Your Health Plan

Recent study released in the New England Journal of Medicine shows that 62% of 400,000 patients that had no known heart disease and were not receiving emergency heart care had no significant heart blockage found in their angiogram results. The study suggests that physicians should do a better job of identifying those patients that need an angiogram, especially for the 20-30% of the patients that have no symptoms.

Medicare pays about $1,400 for an outpatient angiogram and $3,000 for an inpatient angiogram. Private payors typically pay more. So performing angiograms on patients that do not have significant heart blockage is very costly to you as an employer. For these 62% of the patients, payments could be an estimated $446 million (note: estimated by MBGH. Although the test may have not shown any significant blockage, it may still have been appropriate for some of these patients)

So, what can you do about this?

• Encourage your employees to discuss less invasive alternatives, and the risks associted with these as well as angiograms, with their physician.
• Check with your health plan to see what type of decision support tools they are offering your employees and how they let your employees know these tools are available. Also ask them how many employees actually use these tools.
• Consider plan design triggers that require accessing decision support services for non-emergencies through the plan prior to scheduling invasive tests.

Click here to read the Yahoo article which includes a link to the New England Journal of Medicine.

Cost Effective, Quality, Safe Care Must Be Part of the Med's Plan

Merely waiving co-pays and deductibles is not enough to accomplish what The Commercial Appeal's editorial says the Med must do: "The Med has to convince potential paying patients that it's a quality alternative for medical care."

Waiving co-pays and deductibles reduces financial barriers for patients, but in no way ensures that the care they receive is efficient, high quality, and safe. People should have information on the cost and quality of care at the Med to decide if the waived financial requirements are "worth it". But much of the cost and quality information that is available for all the other hospitals in Memphis is not available for the Med because the Med does not publicly report this information through The Leapfrog Group's Annual Hospital Survey (click here to get results for other Memphis hospitals).

Information that is publicly available on the Med's quality of care shows that significant opportunities for improvement exist. For example, recently released statistics on central line infections in ICUs shows that in 2008, the Med's rate of infection was approximately 238% above the average (click here to read Consumer Reports Health article and click here to get State of Tennessee report) . The Med indicates that they have been addressing this issue, but it would be good for us to know what progress they have made in bringing the infection rate down. If the Med reported to The Leapfrog Group survey, we would know how effective their improvement efforts have been and could track their progress.

In addition, the Med's scores on patient experience of care measures from Medicare's survey for the 12-months ending March 2009 show that only 56% of the patients would "definitely recommend" the hospital to others (compared to a national and statewide 68% average).

Finding a financial solution to the Med's situation is essential, but the Med owes us cost-effective, high quality, and safe care. They owe us this under all circumstances, but especially if they are going to offer us financial incentives to use their services. It is not right to ask people to make the decision to come to the Med based only on the fact that they will "save money". The Med should participate, as all other Memphis hospitals do, in the Leapfrog survey so people can decide if the quality of care they are likely to receive is worth saving money because there are no co-pays or deductibles.

Click here to read the latest Commerical Appeal editorial.

Benefit Plan Costs Could Increase if Med waives Co-Pays, Deductibles

The Med's strategy could end up costing Shelby County's benefit plan a lot more money!! Co-pays and deductibles play an important role in encouraging employees to use the appropriate level of care..e.g., a primary care physician vs. an emergency room. If insured employees go to the Med vs. their physician office because there is no co-pay, costs will increase to the plan. Something that needs to be thought about..

Click here to read the CA article.

7 Ways to Cut Benefit Costs Without Cutting Coverage

Although this article is from 2007, these strategies are still something to at least think about!! MBGH still hears a lot about:

Covering preventive services at 100%
Mandating mail order
Moving from the carrot to the stick (or as a speaker referred to it lately, as a "frozen carrot")
Auditing enrolled dependents

Click here to read the Workforce.com article. You will need to register to see the article,but it is free!!