Sharing Test Results in the Same Way

: Name: Bob Coli, MD; Location: Plainfield, NH, United States

Thursday, February 21, 2008

Healthy Rhode Island Reform Act of 2008

Lieutenant Governor Elizabeth Roberts

Healthy Rhode Island Reform Act of 2008

Executive Summary

Overview:

The Healthy Rhode Island Reform Act of 2008 will transform the health care system in our state by putting in place a strong new structure for ensuring that all Rhode Islanders will have access to high quality health care at a price they can afford. This package will immediately start moving to insure over 10% of the uninsured with no new state expenditures, and will establish a serious process for cutting costs and increasing value in our health care system. The legislative package creates a strong and sustainable structure that will make it possible to bring every uninsured Rhode Islander into this new system as money becomes available from the savings accrued through the transformation of the health care system, as well as from other sources. Because the plan focuses on BOTH expanding coverage AND containing costs while increasing value it transforms health care for all of us, not just those who are now uninsured. At its most basic, this legislation is about increasing health care value and access for ALL Rhode Islanders, with the overall result being a transformation of our ailing system into a healthy one.

Aligning Payments to Priorities

In our current system health care providers are paid to perform procedures, not to keep patients healthy. This is bad for patients, bad for doctors, and bad for the system. As we transform our health care system in Rhode Island we need to reverse this and compensate doctors for keeping patients healthy through preventive care and chronic disease management.

The broken compensation system was not built overnight, and it cannot be reformed in a day. However inaction is not an option. In order to ensure real change the Healthy Rhode Island Reform Act of 2008 requires that the state's health planning and accountability advisory council establish a Healthy RI Strategic Plan and Healthy RI Chronic Care Management Program. [Healthy Rhode Island Reform Act of 2008 - Part 1]. The state is a major purchaser of health care on behalf of state employees and Medicaid recipients. This presents a unique opportunity to lead the way in reform initiatives with the health insurance that the state provides. The Healthy Rhode Island Reform Act of 2008 - Part II integrates best practices in insurance coverage, designed to enhance healthy outcomes, into the health insurance that the state provides for state workers and Medicaid recipients effective January, 2009. This means that health insurance provided by the state will include cutting edge chronic disease management, an emphasis on primary care and paying physicians to keep their patients healthy thus leading the way for the state and the nation. Part II of the package goes on to require that all health insurance in Rhode Island integrate these cutting edge practices by January 1, 2010. The Healthy Rhode Island Strategic Plan creates a permanent capacity for the state to incorporate new methods to into a state of the art health system - leaving behind our current "sick care" system. Effective chronic disease management for all Rhode Islanders is only a first step in realizing the potential of this reform.

Organizing Care for Quality and Value

Aligning payments to priorities will go a long way toward bending the health care spending curve downward to a level that is sustainable, but the Healthy Rhode Island Reform Act of 2008 goes further by demanding true cost and outcome transparency and accountability in health care.

One way it does this is through the creation of the Health Care Quality and Value Database within the Department of Health [Healthy Rhode Island Reform Act of 2008 - Part III]. This comprehensive database will shine a spotlight on cost and quality information that has never before been accessible to the consumer or to policy-makers. The Health Care Quality and Value Database brings a laser-like focus on both cost and quality. It creates a user-friendly, online interface that will empower individuals and families to take control of their health care expenditures by providing a tool for them to make rational decisions about many of their health care needs. It will also put in place the resources and tools that will allow policy-makers to access the empirical data that is desperately needed if we are to move toward a rational, evidence based health system.

It is also imperative that our state move ahead to implement Health Information Technology including integrated electronic medical records with appropriate privacy protections. Much work has already been done in this area, and an important piece of the package is legislation that establishes safeguards and confidentiality protections for a Rhode Island Health Information Exchange. The legislation will put in place systems to improve the quality, safety and value of health care, keep confidential health information secure and confidential and use the HIE to progress toward meeting public health goals. Rhode Islanders need to be confident that HIT will be used appropriately and confidentially, and all stakeholders need to work together to ensure that we pass legislation that will earn this confidence.

Covering All Rhode Islanders

13% of Rhode Islanders have no health insurance. This proportion has increased since 2001 and the fastest growing part of this group is working Rhode Islanders. Uninsured Rhode Islanders often have little choice but to access the health care system in the most expensive way: by going to the emergency room. They lack access to preventive care and chronic disease management, so their care ends up being more expensive than it has to be - wrong time, wrong place, wrong cost care. Studies have shown that the uninsured have significantly worse health outcomes than those with insurance, and we also know that the cost of care finally provided in an emergency room is being passed along to everyone else through higher taxes and increased insurance premiums. Uncovered health care costs have become the top cause of personal bankruptcy.

Part IV of the Healthy Rhode Island Reform Act of 2008 creates a structure during 2009 and 2010 will reduce the number of uninsured Rhode Islanders. It does this in a number of ways.

The legislation creates a new public/private partnership called the Rhode Island Health Insurance Access Hub (HealthHub RI). By July, 2009 the HealthHub will allow individuals and small business owners to purchase portable, affordable health insurance for themselves, their families, and their employees. HealthHub RI will allow Rhode Islanders to shop online, on the phone, or in person to choose among competing plans for the one that fits them best. Insurance companies will have to compete for business in a transparent environment, and individuals, families, and small business owners will benefit from the bargaining power of the Hub.

HealthHub RI will also play an important role in aligning payments to priorities. The HealthHub board will begin its work in September 2008. It will set standards for a minimum level of coverage acceptable in plans with the HealthHub seal of approval and will allow insurers to make available innovative plans that emphasize preventive care and chronic disease management. The board will also be charged with ensuring that the plans offered will be affordable, flexible, and robust.

To further jump-start the move toward covering all Rhode Islanders, the legislative package includes a bill that calls on individuals and businesses who can afford insurance to take responsibility for coverage. Part V of the Healthy Rhode Island Reform Act requires all Rhode Island residents whose income exceeds 400% FPL ($40,840 for an individual, $82,600 for a family of four) to purchase affordable health coverage through the HealthHub once the Hub opens for business in July, 2009. The Office of the Health Insurance Commissioner estimates that there are close to 15,000 Rhode Islanders (more than 10% of the Rhode Island uninsured) who would be covered by this mandate. Part VI of the legislative package also whittles down the number of uninsured Rhode Islanders by allowing young adults to stay on their parents' family plan through age 25, regardless of student status.

One of the great strengths of our current system is that the majority of Rhode Islanders have access to health insurance through their employers. In order to maintain this strength, Part V not only impacts individuals but also requires employers, (except those with ten or fewer employees) who do not provide health insurance, to pay a health security assessment to the state. This health security assessment goes to the HealthHub for purposes of providing support for insurance for the uninsured. This requirement, combined with the requirement that individuals with sufficient means purchase insurance, will have a combined effect to reduce the number of uninsured Rhode Islanders. Part VII of the legislative package further expands the options for those Rhode Islanders who still need coverage. By opening up the Rhode Island market through reciprocal licensure for health insurers already licensed to do business in Massachusetts and Connecticut more value-priced options will become available to Rhode Island businesses and individuals seeking new approaches to coverage.

This multifaceted approach to insuring every Rhode Islander does not make sense unless it is matched by a commitment our award winning RIte Care program which is a national leader in covering children. The majority of funds used for RIte Care coverage come from the federal government, so every dollar cut by the state removes over two dollars from the health care system. Cutting RIte Care will force children and parents into the emergency rooms. This will cost everyone more in the form of higher premiums and taxes to pay for the resulting uncompensated care. The proposed RIte Care cuts would move Rhode Island’s health care system in the wrong direction, and thus a key element of the Healthy Rhode Island plan is a focus on ensuring that this does not happen.

Although the Healthy Rhode Island Reform Act of 2008 does not call for the expenditure of any new state dollars at this time, most experts say that covering all Rhode Islanders will require additional shared financing down the road. What makes the Healthy Rhode Island Reform Act of 2008 unique is that it calls upon policy makers, state officials and citizens to work together to put in place the infrastructure for change BEFORE new public funds are invested so that we can proceed cautiously and with full information as new investments are considered and debated. It also combines the creation of this infrastructure with a laser-like focus on reducing cost, increasing value and improving health outcomes in the health care system more broadly. The Healthy Rhode Island Strategic Plan and Chronic Care Management program [Part 1], Health Care Quality and Value Database [Part III] and cutting edge innovations in the health plans for public employees and Medicaid recipients [Part II] will all contribute to bending the cost curve for health care in Rhode Island toward affordability. These innovations are supportive of reducing the ultimate cost for covering all Rhode Islanders when Rhode Island is ready to take that final step.

Planning Forward for Success

Comprehensive reform of the health care system is a challenging and complex undertaking that will require an ongoing commitment from citizens and policy makers. The final element, Part VIII, of the Healthy Rhode Island Reform Act of 2008 is designed to guarantee that the momentum for positive change is sustained beyond this legislative session. Part VIII creates a Joint Legislative Task Force to be co-chaired by a Senator, a Representative and the Lieutenant Governor. This core group of elected policy makers will create and sustain momentum for change and will make recommendations for additional reforms.

THE HEALTHY RHODE ISLAND REFORM ACT OF 2008

AT A GLANCE

Bill	Topic	What it does
Part I	Healthy RI Strategic Plan and Chronic Care Management Plan	Recently created statewide health planning group (2007) establishes and implements a plan for chronic care management plan that will apply to all Rhode Islanders by 2010.
Part II	Cutting edge innovations integrated into publicly purchased insurance (Medicaid recipients and public employees)	By January 2009 designation of a primary care physician will be required, chronic care management plan will be part of coverage, and payment reforms in public insurance plans (i.e. pay for performance) will be instituted for Medicaid recipients and public employees.
Part III	Quality and Value “all-payer” database	Expanded authority for existing Department of Health quality measurement group to analyze health outcome and cost data from all sources in Rhode Island. This is a critical building block to bending the cost curve downward.
Part IV	HealthHub RI	Creates the RI equivalent of the Massachusetts “connector.” Board will begin work in 2008, and affordable products will be offered to individuals and small groups by 2009.
Part V	Individual mandate and Employer “pay or play”	Institutes a requirement for individuals at 400% FPL ($40,840 individual, $82,600 family of four) and above to purchase affordable insurance as of July 2009 (coincides with Hub product availability). Also introduces an employer universal health security assessment, with full offset for employers who provide health insurance. The assessment will be approximately $1000 per full time employee per year, with proceeds going support to coverage for the uninsured.
Part VI	Expand coverage to 25 year for dependent children	Removes the requirement that dependent children up to 25 must be students in order to remain on their parents’ insurance.
Part VII	Reciprocal licensure	Enables insurers licensed in MA and CT to offer products in RI without additional licensing.
Part VIII	Joint Legislative Task Force	Creates task force co-chaired by Lt. Governor, a state senator and a state representative to oversee reform efforts from legislative perspective.

Rhode Island HIE Legislation Underway

TODAY'S HITS HEADLINES: 2-13-08

Legislators in the Ocean State have introduced the Rhode Island Health Information Exchange Act of 2008 to facilitate secure patient data exchange as providers prepare to launch an HIE.

The legislation addresses privacy and security issues of an information exchange, which has been under development by the Rhode Island Quality Institute since 2004 through a five-year, $5 million grant from the Agency for Healthcare Research and Quality. The institute partnered with the state to develop the act.

Security measures through the act will ensure patients are aware of the exchange and have given permission to share their data.

The exchange is voluntary for both providers and patients, who will have the right to terminate participation at any time, under the new legislation.

Consumers also will be able to obtain reports of what information is shared and who is accessing it, as well as notices of security breaches. -- by Jean DerGurahian/ HITS staff writer

EHRs & PHRs: iHealthBeat
February 14, 2008

Rhode Island Bill Aims To Facilitate Statewide Health Data Exchange

Rhode Island lawmakers this week introduced legislation aimed at addressing privacy and security issues related to the exchange of patient data as the state prepares to launch a health information exchange, Health IT Strategist reports.

The Rhode Island Health Information Exchange Act of 2008 would ensure that patients are aware of the health information exchange and have given permission to share their data. In addition, the bill would make the exchange voluntary for both providers and patients, and they would have the right to terminate participation at any time. The bill also would give consumers access to what information is shared and who is accessing it, as well as reports of security breaches.

Since 2004, the Rhode Island Quality Institute has been working to develop a statewide health data exchange through a five-year, $5 million grant from the Agency for Healthcare Research and Quality (DerGurahian, Health IT Strategist, 2/13).

Readers are invited to send feedback to: ihb@chcf.org

Saturday, October 06, 2007

Putting Individuals in Control of American Healthcare

American Health Care in Critical Condition

The Case for Putting Individuals, Not Employers or Government, in Control of Health Care

By JOHN STOSSEL and ANDREW SULLIVAN

Sept. 11, 2007 —

Most everyone agrees, America's health-care system is a mess.

Millions of Americans lack health insurance and still our annual health-care costs exceed $2 trillion that's about the size of the entire economy of China. For the country with the world's "best" medical care, a lot of people seem unhappy.

Many hate the insurance industry.

Employers have seen insurance premiums rise 87 percent over the last seven years. General Motors now spends more on its employees' health insurance than on steel. Doctors are fed up, too; the average physician's office spends 14 percent of its income filling out paperwork.

No one seems angrier than the patients who have been denied care. Vicki Readling of North Carolina was diagnosed with breast cancer after she had quit her job and lost her employer's insurance. Readling purchased temporary insurance for herself, but when it expired she was told that because of her pre-existing condition, cancer, she would now have to pay $27,000 a year for a new policy. With an income of $60,000 and twin sons in college, she couldn't afford it.

Watch "Whose Body Is It, Anyway?! Sick in America" Friday on "20/20" at 10 p.m. EDT

Insurance industry spokeswoman Karen Ignani is eager to report that most people aren't like Readling. Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage. Only 3 percent of health insurance claims are denied, she says.

In his hit documentary "Sicko," Michael Moore focuses on tragic stories of people whose insurance claims have been denied. His prognosis? He calls for "the elimination of private profit-making health insurance companies" and suggests turning over all health-care spending to the government to provide "free" health care to everyone. He goes to countries like Canada and Britain and implies that their socialized systems are far better than that of the United States.

'What It Costs When It's Free'

There are many problems with health insurance, but that doesn't mean we should put the government in control. If it's decided that health care should be paid for with tax dollars, then it's up to the government to decide how that money should be spent. There's only so much money to go around, so the inevitable result is rationing.

It's just the law of supply and demand. Lowering prices increases demand. Lowering the price to nothing pushes demand through the roof. Author P.J. O'Rourke said it best: "If you think health care is expensive now, wait until you see what it costs when it's free."

When health care is free, governments deal with all that increased demand by limiting what's available.

The reality of "free" health care is that people wait. In the United Kingdom, one in eight patients waits more than a year for hospital treatment and the British government recently set its goal to keep wait times to less than 18 weeks that's more than four months! In Canada, almost a million citizens are waiting for necessary surgery and more than a million Canadians can't find a regular doctor. In the small town of Norwood, Ontario, a weekly drawing is held in which a townsperson wins the right to access the town's one family doctor.

Governments ratchet down health-care costs in different ways. Doctors went on strike last year in Germany because their government's system pays them less than they thought they deserved and forces them to work thousands of hours of unpaid overtime. In the United Kingdom, one hospital was inspired to save money money by not changing sheets daily. British papers report that instead of washing the linens, nurses were told to just turn the bedsheets over.

Government is less the answer to our health-care crisis than the problem. It was our government that helped to create the absurd system in which two out of three Americans get health insurance through their employer. In a country where four in 10 Americans change their job every year, this system makes little sense; it leaves people like Readling without coverage when they need it most.

The government also makes insurance expensive by mandating the medical services that policies must cover. Required services vary state by state and include massage therapy, pastoral counseling, acupuncture, hair prosthesis and dentures. Such mandates are a reason why an individual policy in New Jersey costs around $4,000 a year while a policy in Iowa costs only a third of that. Yet insurance regulations make it illegal for someone in New Jersey to buy a policy from out of state.

The Way We Pay

Another problem that raises costs, and keeps individuals from controlling their own health care, is the way we pay for medical care. Out of every dollar that the United States spends on health care, only 12 cents comes out of the pocket of patients, according to the Centers for Medicare and Medicaid Services. Most of us have our medical expenses covered by a third party, either an insurance company or the government.

When we pay for health care with someone else's money, it creates nasty incentives. It's good to be covered in case of a medical catastrophe, like a heart attack or cancer, but when patients pay for almost everything from physicals to acupuncture using third-party money, they have no reason to care about cost.

Because the buyers don't care about cost, neither do the health-care providers.

"It's gotten to the point where doctors don't even know how much it costs them to provide this service or that service or how much an office visit should cost. Try asking a doctor how much an office visit costs and watch their face go blank," said Michael Cannon, director of health policy at the Cato Institute.

Our health-care system has become totally removed from the competitive market forces that have improved every other area of the economy. If patients cared about cost, health-care providers would compete to attract patients. They'd do innovative things to keep costs low while increasing quality.

Harvard Business School professor Regina Herzlinger, author of "Who Killed Health Care?", reminds people that "when Henry Ford came around, cars cost more than houses." By competing for profit, Ford revolutionized the auto industry. In eight years, he cut the price of cars in half while improving quality immensely. In nearly every sector of the economy, prices drop over time as technology improves. Not so in health care.

Customer Service, Competition, Control

Can you e-mail or call your doctor to ask quick questions? In the 21st century, when even small children regularly use computers, many doctors and hospitals don't.

"Why would they?" said Dr. David Gratzer, author of "The Cure." E-mail and telephone consultations aren't things most doctors can get paid for. Dr. John Goodman of the National Center for Policy Analysis, said, "The federal government has a list of 7,500 procedures it will pay for, the telephone's not on the list [and] neither is e-mail."

But when patients are in control of their health-care spending, things get better. Lasik surgery isn't covered by most insurance policies, so patients pay for this high-tech procedure out of their own pocket. It's for this reason that laser surgeon Brian Bonanni gives out his cell phone number and e-mail address to all of his patients. He knows that he has to attract patients by making himself available.

Competition has also made Lasik cheaper: While in nearly every other field of medicine, prices have gone up faster than consumer prices in general, the price of Lasik has fallen by as much as 30 percent. The quality of the surgery has also improved. The difference is that people care about prices when they spend their own money, so providers compete to offer services that are faster, better and cheaper.

John Mackey, CEO of the supermarket chain Whole Foods, saw his insurance premiums rise through the roof so he changed the way his employees got health care. He proposed a health insurance plan with a high deductible. To help meet that deductible, the company puts money into a "personal wellness account" for each employee and employees use that money to pay for routine care. The money in the account belongs to the employees and puts them more in control of their health-care spending. Employees pay for the small stuff, like sore throats and sprained ankles, but their health insurance covers them in case of a catastrophe. Accounts like these are typically called HSAs, or Health Savings Accounts.

Mackey saw Whole Foods' health-care costs drop by 13 percent the first year the plan was in place. Some employees objected. They wanted the old "full-coverage" plan back. One wanted "pet bereavement services" covered. Whole Foods then held a vote and "77 percent of team members voted for the health plan that we have today," said Mackey. Today he says most of his employees love the plan because it allows them to spend the money how they want to spend it.

'You and Me'

Whole Foods' health-care costs have been creeping back up lately. Mackey says it's because there are so few people with health plans like his. Only 4.5 million people in America have Health Savings Accounts, according to a 2007 census conducted by America's Health Insurance Plans. That's a tiny fraction of the insurance market, but consumer-directed health plans are a step in the right direction toward placing individuals, not government or insurance companies, in charge of their health-care dollars.

The more people control the money they spend on their own health care, the more people shop around and the more providers compete to attract patients by lowering prices while improving quality. It's putting individuals in control that could turn our health-care sector into the vibrant, competitive marketplace that we see in nearly every other area of our economy.

After all, it's our body and our health. Shouldn't we be in control of how our health-care dollars are spent?

Harvard's Herzlinger said, "Who should decide whether you live or die? Do you want the government to decide? Do you want a health insurer to decide? Who's gonna make that decision? Is it gonna be a government? Is it gonna be an insurer? Or is it gonna be you and me?"

Putting individuals in control of our health rather than our employers or the government is a better way to cure what ails America's health system.

Friday, October 06, 2006

Goal is EHRs; path is state by state

In the nation's ambitious quest to bring information technology to the practice of medicine, state governments are beginning to play a critical role in shepherding new systems into hospitals and doctors' offices, health experts say.

Governors and legislators, for starters, are embarking on a variety of strategies to encourage the use of electronic health records and other innovations."There is a tremendous amount of focus, and it continues to grow," said Sheera Rosenfeld, a senior manager for Avalere Health in Washington, who helped write a report earlier this year on state initiatives.Read more (registration may be required).
New York Times

Most States Developing Roadmaps to Support Healthcare Quality Improvements Through Electronic Health Information Exchange

Policies and practices for improving quality, safety and efficiency through HIT will be focus of National Assembly of State Leaders at eHI's Health Information Technology Summit, Sept. 25-27 in Washington, DC

A new eHI report finds that most states in the US are developing roadmaps to support electronic health information exchange (HIE).

Preliminary results from the 2006 Third Annual Survey of State, Regional, and Community-based Initiatives were released in a new report focused on state-level activity.

The 2006 survey takes the pulse of 165 multi-stakeholder efforts across the country, representing initiatives in nearly every state, Puerto Rico and the District of Columbia.

This year's survey also takes a special look at a new, rapidly emerging phenomenon--the role of state leaders in planning, coordinating and implementing policy and in some cases, practical issues related to the use of HIT in improving health and healthcare.

A copy of the Report is available at:
http://www.ehealthinitiative.org/assets/documents/eHI2006ReportonStateActivities.pdf

Key findings from the report will also be discussed at the HIT Summit, hosted by the eHealth Initiative and Bridges to Excellence, which will include a national assembly of state leaders driving improvements in healthcare through HIT and health information exchange who will gather to share insights, learn from one another and inform the policy agenda for the nation. It will also include an in-depth look at rapidly emerging policy changes related to both quality and HIT, touching on financial, organizational, legal, technical, privacy and confidentiality standards and issues. Click here to Read the press release

Thursday, July 13, 2006

Rhode Island To Contribute $6M Toward RHIO

http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=123024

The Rhode Island General Assembly has approved a state budget, which includes $6 million to help finance the cost of developing a regional health information organization, American Medical News reports. The money is contingent upon funding agreements from other players who will benefit from the health information exchange.

The initial budget submitted earlier this year by Rhode Island Gov. Donald Carcieri (R) asked the state to borrow the full $20 million needed to build the network. However, lawmakers decided the state should not provide all of the funding because "there's a lot of financial benefit accrued to insurers ... and others should pay their proportional share," said Dr. David Gifford, director of the state's Department of Health.

The state determined the $6 million figure by estimating its "fair share" of the network's start-up capital cost at 30%, American Medical News reports. Rhode Island is seeking funding from insurers to help cover the cost of building the network and to provide the $2 million to $4 million in estimated annual operating costs. The RHIO will not launch for at least another year, according to Gifford.

Health insurers in Rhode Island, such as Blue Cross & Blue Shield of Rhode Island and United HealthGroup, have indicated a willingness to discuss contributing to the RHIO but noted that physicians also will benefit from the network, American Medical News reports. The Rhode Island Medical Society supports the measure. "We're not opposed to paying our fair share," said Steve DeToy, director of government public affairs for the group.

Rhode Island is optimistic that discussions with insurers and other players will be successful, according to American Medical News. Rhode Island's small population provides a "natural advantage" because the state can "get all the players in the health care arena to the table to work on the development of this type of network," said Jeff Neal, the governor's press secretary (Chin, American Medical News, 7/17).

Wednesday, June 21, 2006

Rhode Island Funds Statewide EHR Repository

Rhode Island Plans Central Bank of e-Health Records

BY Nancy Ferris
Published on June 15, 2006

Rhode Island's legislature has approved borrowing $20 million to finance the creation of a statewide repository of e-health records, Gov. Donald Carcieri told the Government Health IT Conference today.

Carcieri said his state, like others, is facing rapid escalation of health care costs and is taking steps to hold them down. Medicaid alone now accounts for 24 percent of the state's budget.

"Health care is the No. 1 public policy issue for our nation," he said, and no solutions are at hand. "It falls on the states to do something."

Of all the potential fixes for health care, Carcieri said, health IT holds the most promise in the near term. "Health IT can really squeeze costs out of the system, increase quality and improve outcomes," he said.

The governor said up to $2 billion of the $6 billion spent on health care annually in Rhode Island is wasted because the right information isn't available when needed. For example, he said, 20 percent of the diagnostic tests done on patients are unnecessary.

The compact size of Rhode Island, which has about 1 million residents and only two major health insurers, may make it easier to fix the health care system, Carcieri said.

The health records bank recently approved by the General Assembly will hold digitized patient records and make them available to authorized individuals.

Carcieri said it should be established as a public-private partnership. "There needs to be public oversight" to increase public trust in the data bank, he said.

Although the bond issue authorized by the legislature will pay for establishing the databank, the governor said the method of financing operations hasn't been decided yet. He favors charging a small fee for each transaction, he said, but getting such a system in place will not be easy.

Asked how his state's program meshed with federal health IT activities, Carcieri acknowledged the potential value of a national health information network. But, he said, "If we wait for the federal government to come up with a whole large scheme, there are so many interests" it could take years.

Massachusetts Hospitals Leading the Way on Healthcare Quality

Leading the way on healthcare

By Cleve L. Killingsworth | June 21, 2006

IMPROVING the quality of health care saves lives. That's the lesson behind last week's announcement by the Institute for Healthcare Improvement that more than 120,000 such lives were saved nationally because hospitals followed proven interventions that deliver safer and more effective care.

All 72 Massachusetts acute care hospitals participated in this campaign. Their success -- together with the state's landmark health care reform law that will focus on many of the best practices used by the institute through the Massachusetts Health Care Quality and Cost Council -- puts the state in a unique position to lead the country in delivering top-quality health services.

Don Berwick, president of the Cambridge-based institute, explained that, over the past 18 months, a national effort by 3,000 hospitals across the country prevented the unnecessary deaths of more than 122,300 patients.

The effort supports interventions that make a real difference for patients. In many cases, that just means getting hospitals and front-line health workers to agree to follow practices that have been shown to eliminate error and save lives.

Some policies and procedures that the institute and the participating hospitals have put in place are relatively simple. For example, they are committed to giving patients who are at risk for heart attacks aspirin and beta-blockers. They are making sure that patients on ventilators have their heads raised between 30 to 45 degrees at all times to prevent them from developing pneumonia. They are implementing rapid-response teams at the first sign that a patient's condition is worsening. And they are making sure that doctors and nurses working with patients who are receiving medicines and fluids from central lines clean the patients' skin with a certain type of antiseptic.

While these procedures are not revolutionary in concept, they require significant collaborative effort and commitment. Taken together, these everyday actions can represent a sea change in patient outcomes for hospitals. Because of the size, diversity, and complexity of the health care system -- with all its insurers, providers, caregivers, and facilities -- it is difficult to disseminate best practices that improve patient health. And yet the success that the institute has fostered shows that it can be done.

It is fitting that every acute-care facility in the state is participating in this process. Massachusetts has already shown it can lead the nation in achieving better health care. Passing the legislation that made universal access to health care the standard wasn't easy. It took bringing together political leaders from all sides, business leaders, consumer and patient groups, insurers, hospitals, doctors, and nurses.

And there is more that can and must be done. The state Health Care Quality and Cost Council, established by the landmark legislation, can further improve the delivery of medical care and do so in a way that restrains the growth in spending. The success of the institute's effort shows what can be accomplished when all insurers and hospitals collaboratively choose concrete goals that improve the safety and effectiveness of care.

Massachusetts has the best health care system in the country -- but it can get better. Given the high caliber of the hospitals and medical schools, the commitment of doctors and nurses, and the pioneering spirit of organizations such as the institute and others that are willing to point out where the system is failing and fix it, Massachusetts is in a unique position to fundamentally transform it.

The institute has shown that improving the system will save lives. And so with the wind of reform at our backs, universal health coverage within reach, and progress not only possible but demonstrable, now is the time to commit to making Massachusetts the standard bearer for quality health care for all.

Cleve L. Killingsworth is president and CEO of Blue Cross Blue Shield of Massachusetts.

Massachusetts Health Plan for 500,000 Uninsured to Define Provider Networks

State plan may curb hospital choice

Insurance authority looks at ways to keep premium costs down

By Jeffrey Krasner, Globe Staff | June 8, 2006

At yesterday's first meeting of the state authority charged with crafting affordable health insurance, a state Medicaid official said restricting patient access to a limited network of hospitals could help keep premiums down.

Brian Wheelan , assistant director of Medicaid, spoke before the board of the Commonwealth Health Insurance Connector Authority, which was created under the healthcare reform bill intended to extend coverage to the roughly 500,000 Massachusetts residents without health insurance.

As an example of the differences in hospital costs, he said that Cambridge's Mount Auburn Hospital, a Harvard-affiliated teaching hospital, charges $1,800 to deliver an underweight infant, while Massachusetts General Hospital, also a Harvard-affiliated teaching hospital, charges about $5,300. Brigham and Women's Hospital, another teaching hospital that has a reputation for quality maternity services, charges $3,200, he said.

"Don't let anyone tell you there aren't huge savings in cost while maintaining quality," he said at the meeting held at One Ashburton Place.

Wheelan said defining provider networks, which mandate which hospitals patients can use, could generate enormous savings as the Connector seeks to craft an affordable insurance plan for individuals that features a target premium of $300 a month. Some board members seemed open to that approach.

"If you have to restrict something, I'd rather restrict the breadth of the network rather than cut benefits," said Dolores L. Mitchell , who also serves as executive director of the Group Insurance Commission, which provides insurance for state employees and retirees.

David Torchiana , chief executive of the Massachusetts General Physicians Organization, acknowledged that costs are higher at his hospital, but he warned against restricting access. Residents of Everett, Chelsea, and other areas rely on Mass. General as a community hospital, he said.

Jon M. Kingsdale , the former Tufts Health Plan executive who is executive director of the Connector, said he will rely on insurers to craft low-cost offerings, which might include a restricted network. ``We want to be open to what health plans bring us," he said. ``I suspect if there is substantial value in limited networks, we'd be open to them."

Kingsdale is being offered a three-year contract with a $225,000 annual salary, although final details have not been worked out.

The issue of restricting networks was one of many addressed yesterday . The new authority is chaired by Thomas Trimarco, secretary of health and human services, but will operate largely independently. It will develop a low-cost insurance plan that is intended to be a key part of the state's reform effort. The state will also expand Medicaid, the federal and state program that provides healthcare to low-income residents, and will provide subsidies for residents who earn less than three times the federal poverty rate, about $60,000 a year for a family of four.

The authority's decisions will determine what is covered by the affordable health insurance plan, called Commonwealth Care. But it is also operating under a tight deadline.

"We'd like to be enrolling people in Commonwealth Care by Oct. 1, less than four months away," said Kingsdale.

Along with limited provider networks, the state highlighted other approaches to low-cost insurance, such as eliminating some healthcare mandates. For instance, Massachusetts insurers now must cover assisted reproductive techniques like in vitro fertilization. Wheelan said the Connector should look at suspending some of those benefits for its low-cost product.

He also discussed using tax-advantaged health savings accounts, which enable employees to set aside pretax dollars for out-of-pocket expenses. Such accounts are typically linked to health plans with high deductibles. Wheelan said preventive services like routine checkups could be exempted from the deductibles.

Another approach would be to charge higher premiums for residents who smoke, similar to the way life insurance companies charge higher rates for smokers, he said.

Charles Joffe-Halpern , executive director of Ecu-Healthcare Inc. of North Adams, which provides access to healthcare for Berkshire County residents, said he was wary of so-called consumer-directed healthcare plans, which feature high deductibles and copayments.

"It's a slippery slope when you start to talk about consumer-directed healthcare," he said.

Jeffrey Krasner can be reached at krasner@globe.com.

Consumer-driven Health Plans Membership Continues to Grow

UnitedHealth sees explosion in HSA and HRA enrollments

San Francisco Business Times - June 16, 2006

by Chris Rauber

Minnesota-based UnitedHealth Group said membership in its consumer-driven health plans continues to soar, both in California and nationwide.

Membership nationally has surpassed 1.75 million enrollees, UnitedHealth said June 8. In California, that translates into 118,000 people enrolled in so-called "CDHPs", up more than 74 percent from the prior year, said Cheryl Randolph, a spokeswoman for UnitedHealth's Cypress-based PacifiCare unit. She said the company doesn't break out those numbers by region.

Of those 118,000 enrollees, she said, 25,000 have signed up for a health savings account or HSA and 93,000 for a related health reimbursement account.

Nationally, membership in its HSA and HRA plans jumped 75 percent from June 2005, with more than 750,000 new individuals participating in the last year.

"Consumers are becoming much more comfortable with account-based plan designs," said Mike Tarino, CEO of Definity Health, the UnitedHealth unit that manages these health plans. "More than 13,000 employers have already turned to us to incorporate a consumer-driven design into their benefits strategy, and our CDH membership among large, national employers alone recently topped 1 million."

Still, all is not rosy in the consumer-driven health plan world. Other sources say that nationally, only about 1 in 4 enrollees in such plans actually opens and funds an HSA, although the data is a bit murky. Without a linked HSA or related account, a consumer-driven plan is just a high-deductible insurance offering by another name, critics say. PacifiCare's Randolph cautions that it's just five and a half months into the year, however, "and believe it or not some people simply don't get around to opening the account right away."

The company's data on companies with 100 to 5,000 employees shows that when the employer contributes to the HSA, 89 percent of employees open an account, and 60 percent fund it.

Chris Rauber can be reached at (415) 288-4946 or crauber@bizjournals.com

Monday, June 12, 2006

Encouraging Results of Incentive-based Health Insurance Plans

Wellness pays as health costs shift
Consumer-directed insurance plans use education, rewards to change lifestyles

By Ann Meyer
Special to the Chicago Tribune
Published June 12, 2006

Pedometers, workouts and wellness points are the topics of casual lunchtime conversations at the DuPage Credit Union in Naperville now that the company offers a consumer-directed health insurance plan that rewards employees for healthy behavior, the company said.

"I'm watching team members come together and really motivate one another to be more healthy individuals," said Lori Mecca McGrath, human resources manager.

The wellness focus has been building since October 2004, when the credit union nixed the standard PPO plan it had offered for years in favor of a lesser-known, $1,000-deductible consumer-directed health plan with lower premiums and a health reimbursement arrangement to which the company contributes $600 per employee, she said. If workers don't spend the $600, it is theirs to keep, McGrath said.

Besides encouraging employees to spend wisely, the company's new plan from Destiny Health rewards employees with "Vitality Bucks" for engaging in health-oriented activities such as health screenings, fitness workouts and smoking-cessation programs. Bucks can be exchanged for merchandise.

"It gives you an impetus to pay a little more attention to your health care," McGrath said.

While many businesses are turning to high-deductible health plans to curb double-digit premium increases, experts say the plans must encourage healthier lifestyles for them to be effective long term.

"Without that component of prevention it's more of a short-term savings than long term," said Kenneth Olson, president of Horton Benefit Solutions in Orland Park.

By encouraging workers to control behavior that otherwise can lead to expensive health care, a company also can control its premium increases, Olson said. In the past couple of years, he said, companies are beginning to see a greater spread between premiums of standard PPO plans and those of consumer-directed plans.

"This is very encouraging," he said.

But encouraging workers to change their habits requires a major educational push, and many small businesses simply do not have the resources to deliver it themselves.

The wellness concept makes sense to David Johnson, director of human resources at Beckett Associates, a Bedford Park distributor of trading cards and collectibles that gives its 140 employees a choice of three Blue Cross plans: a PPO, HMO or high-deductible plan tied with a health savings account.

"A healthy workforce is a reliable, dependable workforce," Johnson said. "We're looking for people able to come to work not encumbered by maladies and diseases. You want people to feel well and to be healthy."

While some of the company's workers play basketball or soccer on their lunch breaks, to administer its own full-blown wellness program with something for everyone would be too big a task, Johnson said. So the company is considering adding a program administered by Blue Cross.

Blue Cross offers Blue Care Connection, with an online personal health manager who provides guidance on exercise and nutrition based on members' personal data and goals, said Debbie Halan, senior manager of product management. Members start by taking the Mayo Clinic health risk assessment online.

From their answers the online program provides advice on eating healthier, setting up an exercise program and sticking with it.

Members report their progress daily and are sent reminders to encourage follow-through.

"If you didn't walk your mile today, it's like having a personal trainer there reminding you," Halan said.

Another component provides information about treatment costs and hospital comparisons. Members with questions about a condition or treatment can contact a Blue Cross nurse for additional guidance.

Besides concerns about escalating health-care costs, more companies are embracing wellness programs to keep their workers healthy and productive, said Kirk Pion, director of strategy innovation and delivery at Blue Cross and Blue Shield of Illinois.

"It's a bottom-line savings," Pion said.

Meantime, Humana Inc. offers several consumer-directed health plans and is slated to roll out its Virgin Life Care wellness offering in the Chicago market by 2007, said David Reynolds, vice president of sales for Humana in Illinois. That plan, available in several other markets, rewards members with HealthMiles for exercising, tracking blood pressure, body fat and weight, and achieving health and fitness goals. Reward points can be redeemed at stores like Best Buy, Home Depot and Target

Currently, Humana has 421,000 members in its consumer-directed plans, representing about 13 percent of its total membership. But Reynolds noted that the Chicago market has not been as quick to embrace them as other areas of the country.

"In Chicago, there's a great HMO presence and an industrial economy. There's a history of offering very rich benefits," he said. "We're having to open people's eyes to new possibilities."

But education will gradually change that, Reynolds said.

"What really helps is once people get into these plans and start to see the behavior change, it changes the claims trend," he said.

By encouraging employees to use more preventive health services, they often need fewer after-the-fact interventions like hospital stays, according to Humana's three-year study of 155 companies representing 13,000 consumers.

The study indicates customers using Humana's consumer-directed health plans saw annual claims-cost increases of between 5 percent and 6 percent, compared with double-digit increases in other plans in recent years.

Most savings came from changes in behavior instead of shifting costs, as many consumers used preventive services and avoided the need for hospital stays, the company said.

Meantime, Destiny Health recently reported disappointing financial results for the six months ended Dec. 31, 2005, stemming in part from trouble gaining traction in the Chicago market.

Still, Destiny is considered a leader in the area of incentives, and many other insurers are taking note of its Vitality rewards program, particularly as it contributes to smaller premium increases. Destiny offers discounts on premiums when employer groups achieve certain goals, said Patty Peterson, vice president of marketing.

"Long term, the healthier people get, the better health-care costs will be in check," Peterson said. "It's better for the system and the small employer."

Copyright © 2006, Chicago Tribune