iLoveBenefits: Industry News Blog

The health of a community is much more than health care

Everyone’s destiny is health care. We have poured billions into the clinical side of health care. We have made huge progress in what we can do to improve outcomes for people. The issue of disparate impact in health care is a vexing one. We are beginning to observe that Socio-Economic Status is a huge predictor of health and health care. We need to do more than simply pour money into health care. We need to pay attention to health and the contributors to health including education, jobs, nutrition, safety and many other factors. Here is a story that is beginning to identify these issues. We need to do more at the community level. We need to build consensus among the many stakeholders in the community — all of whom play vital role in the health of a community.

Report: Physicians should address patient social issues to improve outcomesPhysicians should address social issues, such as housing and access to healthy food, as part of efforts to improve quality outcomes and reduce costs, according to a Manatt Health Solutions report commissioned by The Commonwealth Fund. One option for funding social support services may come through patient-centered medical homes, the report said. Medscape (free registration) (6/13)

CMS report: Reforms will save Medicare nearly $8 billion through next year

Editor’s note: This article doesn’t exactly explain the source of the $8 billion. It does demonstrate that a very substantial part of the savings will come from provider’s pockets. While it calls out specifically $205 billion from providers. It also talks to $15 billion of  improved quality and streamlining which it could be reasoned are additional dollars not going to providers.


By Matthew DoBias

Posted: August 2, 2010 – 10:45 am ET


Provisions of the Patient Protection and Affordable Care Act that limit payments for hospital readmissions, overhaul Medicare Advantage payments and steel against waste and fraud are projected to savThe report focuses primarily on the scores of measures aimed at changing how healthcare is delivered and paid for, which made up the spine of the massive legislative package passed earlier this year.

Programs meant to help reduce the number of hospital readmissions and reshape how hospitals and doctors are reimbursed and those that target fraud and abuse are expected to reduce Medicare spending by tens of billions of dollars.

The CMS estimates that over 10 years the savings will be $145 billion in the Medicare Advantage program and $205 billion in how the agency reimburses providers.

But the report also takes into account a number of changes that affect the actual delivery of care as well. For instance, measures meant to improve quality and streamline care are expected to save more than $15 billion, according to the CMS.

The report comes after congressional Republicans have stepped up their calls for HHS and the CMS to document more clearly the cost and spending structure of the new law.

Which people is people is health care reform focusing on?

Editor’s note: Is there so much focus on the uninsured and the underinsured that what results from a new health care construct is that those currently insured have significantly less than they do now? Will they pay more and receive less — shifting value away from the currently insured? Consider this as you read the following.  

Heath Reform that Puts People First

The health system has to work for the people it is designed to serve, say the authors of a new Commonwealth Fund report that describes the difference comprehensive, integrated health reform would make in the lives of the 116 million working-age adults who are uninsured or underinsured, have medical bill or debt problems, or experience difficulties obtaining needed care. At an event in Washington, D.C., The Commonwealth Fund and Consumers Union will present findings from the report, and three Americans who are currently coping with inadequate health insurance, unaffordable health care costs, and medical debt will be telling their personal stories. 

The report, Front and Center: Ensuring That Health Reform Puts People First, by Karen Davis, Ph.D., Kristof Stremikis, M.P.P., Cathy Schoen, M.S., Sara R. Collins Ph.D., Michelle M. Doty, Ph.D., Sheila D. Rustgi, and Jennifer L. Nicholson, M.P.H., uses the “Path” health reform framework developed by the Commonwealth Fund Commission on a High Performance Health System to detail how such reform will affect different groups of Americans, including the uninsured and underinsured, people working in small businesses, and people who buy their insurance in the individual market. 

Overall, researchers found that the inclusion of a national health insurance exchange giving patients the option of a public health insurance plan would control premium costs, eliminate wasteful administrative spending, and provide insurance stability to consumers regardless of their income, employment status, or pre-existing health conditions. These reforms will also enable the delivery of safe, accessible, patient-centered care. 

“We have a historic opportunity this year to move the nation toward a truly high-performing health care system,” says Commonwealth Fund president Karen Davis. “As the debate about how best to proceed continues, and we hear from stakeholders on all sides, it is imperative that we keep the most important voice—the voice of the patient—front and center.”

The 'Devil is in the Details'

Editor’s note: As we progress through the discussions and debates around health care reform, it will be critical to understand who will influence not only the policy, but the details. As they often say, “The devil is in the details”.

‘Meaningful use’ definition will shape health IT agenda, Blumenthal says

The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.

In his first public remarks since taking over as national coordinator, Blumenthal emphasized the importance of deciding what health IT functions constitute meaningful use of the technology. Once that definition is set, providers must use the specified applications to qualify for health IT funding under the economic stimulus law.

“The definition will inform everything that we do that is related to health IT,” including product certification, funding and technical support, Blumenthal said today during a meeting of the National Committee on Vital and Health Statistics, an advisory panel to the Health and Human Services Department.

“This is a complex job, but in some ways, the overall goals are simple,” he added. Health IT is important for improving efficiency but more so for its ability to improve the quality of health care, he said.

“This is the beginning of a very important process,” Blumenthal said. “Our ears are open.”

Physician and industry representatives at the meeting said health IT interoperability, advanced clinical decision-making, and the ability to report standard quality measures were core functions and capabilities for electronic health records.

Under the American Recovery and Reinvestment Act, beginning in 2011, increases in Medicare and Medicaid payments to providers would be based on their use of health IT to improve quality and patient outcomes.

The law outlines an aggressive schedule for the Office of the National Coordinator for Health IT to form a policy-making committee that would develop its health IT strategy. But the office cannot finish creating the committee without having an HHS secretary in place, Blumenthal said. Under the law, the secretary would select several members of the committee.

The Senate was expected to vote today on whether to confirm Kansas Gov. Kathleen Sebelius to become secretary. Assuming she is approved, Blumenthal said he didn’t know “what issues she was going to pick up first.”

Buyer Directed Behavior

In order for our health care system to mature and deliver value it is imperative that the value is defined by the consumer. 

In order for this to happen the system must be responsive to buyer directed behavior. A useful definition of buyer directed behavior would be:

The moment at which a person approaches a point of care and is provided the information, financial incentives and tools needed to best manage the moment.

November 29, 2008 | Categories: Definition | Tags: | Comments (0)