Quality Health Care Trumps Volume

The federal government’s drive to reshape health care in America continues to take shape with the latest shift to value-based payment.

The Centers for Medicare and Medicaid Services (CMS) recently set a time line for having half of all Medicare payments based on the value of the care provided, not simply the volume of services. While CMS is often the leader in setting quality and value metrics, health plans have also set pay-for-performance metrics for their policy holders, and, most recently, the New York State Department of Health has set value metrics for Medicaid under the Delivery System Reform Incentive program.

The Arkansas Innovation

Mention medical innovation, and you might think of the biotech corridor around Boston, or the profusion of companies developing wireless medical technologies in San Diego. But one of the most important hotbeds of new approaches to medicine is … you didn’t guess it: Arkansas.
The state has a vision for changing the way Arkansans pay for health care. It is moving toward ending “fee-for-service” payments, in which each procedure a patient undergoes for a single medical condition is billed separately. Instead, the costs of all the hospitalizations, office visits, tests and treatments will be rolled into one “episode-based” or “bundled” payment. “In three to five years,” John M. Selig, the head of Arkansas’s Department of Human Services, told me, “we aspire to have 90 to 95 percent of all our medical expenditures off fee-for-service.”

Kansas May File Medicaid Waiver Application Soon

TOPEKA, Kans. — The waiver application needed for Gov. Sam Brownback's proposed Medicaid makeover is nearly complete and could be filed with federal officials before the month is up, Brownback administration officials said yesterday.
Still unclear, an administration source said, was whether public hearings on the waiver application would be required in order to satisfy new federal regulations governing so-called Medicaid 1115 waiver applications.

Access to Healthcare More Difficult for Rural Americans

WASHINGTON -- Rural Americans are more likely to suffer from chronic health conditions such as diabetes, heart problems and cancer, and face greater difficulty getting quality healthcare than their urban counterparts, according to a report released Wednesday.

The challenges facing healthcare providers for rural areas could be compounded by recent healthcare legislation, according to the UnitedHealth Center for Health & Reform Modernization.

"This is kind of an opportunity," UnitedHealth chair and report author Simon Stevens told Reuters. "Expanding coverage will mean that more people will have the ability to access care than before, but it's also a wake-up call."

One Small Step for Autism in Health Care Reform

I've been looking to see anyone address health care reform and how it will effect people with developmental disabilities. Haven't been able to find much until this morning, thanks to Kim Stagliano is Managing Editor of Age of Autism.

Thursday night, my husband, three daughters and I attended the health care town hall meeting in Bridgeport, CT, hosted by our Congressman Jim Himes (D.) We couldn't get a sitter, so we decided to bring the kids along rather than miss the event. After all, healthcare for children is of paramount importance.
The evening began with a few words from Congressman Himes about his desire to see all Americans with health care coverage and his honest appraisal of where he felt some of the faults in the system are today.
After two hours, I got my chance to ask a question. "Hi, I'm Kim Stagliano and I live here in Fairfield County. Last year my husband lost his job. We couldn't afford COBRA. We applied for private health insurance. We were turned down because our three daughters, who are seated behind me, have autism. Will you make certain that people with autism are not turned away from health care? Also, we are, I believe, the only nation that allows direct to consumer ads by pharmaceutical companies. They spend billions. Could we tap into that dollar pool to help pay for healthcare? Thank you."
Congressman Himes answered that just last night he'd spent the evening with families who have children on the spectrum and he was shocked to learn about the financial devastation that never seems to end. So "yes" was his answer, he would include autism in health care.