Archive for the ‘Affordable Care Act’ category

National Audit: Room for Improvement at Skilled Nursing Facilities

March 6th, 2014

Data collection and analysis is public health’s most valuable  renewable resource- which is why we’ve made data analysis such a high priority.  Yesterday, the Office of the Inspector General for HHS published a document that highlights the fact that disciplined data analyses can identify key factors that result in poor outcomes- giving us the information we need to intervene and improve results. 

Yesterday’s report is entitled Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries, and it examines “adverse events” that occurred in skilled nursing facilities nationwide between 2008 and 2012.  “Adverse events” are basically events related to medication, ongoing resident care, or infections. 

The study found that about 22% (of Medicare beneficiaries) had an “adverse event” while at a skilled nursing facility.  Of course, not all of these were preventable, but the study found that almost 60% of the adverse (and temporary harm) events were preventable. The report attributes much of the preventable harm to substandard treatment, inadequate resident monitoring, or a delay in administering necessary care. 

Part of our core mission as an agency is to protect public health and safety by addressing quality of care issues in our licensed healthcare institutions.  As part of that mission, we license and inspect 147 skilled nursing facilities statewide.  The facilities range in size from as few as 10 to as many as 200 patients. 

Today’s study will be a valuable as a tool for us because it’ll help us focus our inspections and facility surveys on areas where we can have the biggest impact on improving care and outcomes.  Over the coming weeks, our skilled nursing survey team will be diving into the details of the report so we can become more familiar with the areas that we should focus on while we’re in the field- including updating our focused reviews of nursing home practices to identify and reduce adverse events. 

Additionally, the Affordable Care Act requires nursing homes to develop Quality Assurance and Performance Improvement (QAPI) programs to address quality problems and improve facility performance. Our survey teams will be including an assessment of adverse event identification and reduction in our evaluations of Arizona’s skilled nursing facilities QAPI plans with a focus on the elements of care identified in today’s report.

Border Bi-national Public Health

June 18th, 2013

You can think of the border public health advocacy network as a bi-national matrix of public health partners that collaborate to improve conditions along the US-Mexico border.  The network includes national organizations like the U.S.-Mexico Border Health Commission along with state based partnerships like the Arizona-Mexico Commission and the annual Border Governor’s Conference.   

As part of my job as the Director, I’m a member of the U.S.-Mexico Border Health Commission, whose mission is to provide international leadership to optimize health along the U.S.-México border.  The Commission is comprised of the federal secretaries of health, the lead health officers of the ten border states, and prominent community health professionals from both nations. As a member, I help to educate folks (including policy-makers) about the unique challenges at the border through outreach efforts and conduct joint collaborative public health initiatives with public and private partners in the border health community.  The primary goal of the Arizona Delegation is to strengthen and support bi-national public health projects and programs along the Arizona-Sonora border.   

I was fortunate to be able to spend this week in DC at the US Section meeting of the U.S.-Mexico Border Health Commission.  We had the opportunity to talk about the Commission’s role as the Affordable Care Act comes online, including the importance of access to care and what role community health workers will play.  We also talked about setting priorities for the next three years.

Employee Wellness Standards Locked In

June 11th, 2013

The Fed’s issued their final regulations for worksite wellness programs under the Affordable Care Act this week.  The final rules are designed to incentivize workplaces to develop and execute health promotion programs.  The goal is to improve health and wellness among workers and to limit growth of health care costs moving forward. 

The regulations outline standards what they call “health-contingent wellness programs” which basically reward employees who meet a specific standard related to their health.  For example…  worksite wellness programs could provide a reward to folks who don’t smoke (or that decrease their use of tobacco).  Employers can also reward those who achieve a health-related goal like a specified cholesterol level, weight, or body mass index. 

The rules also include what they call “participatory wellness programs”.  These are programs that reimburse for the cost of membership at a gym, that provide a reward to employees for attending health education seminars or that reward employees who complete a health risk assessment.  The final rules will be effective for health “plan years” beginning on or after Jan. 1, 2014.  Here’s the link to the “inside baseball” regulations in the Federal Register.

Smokers Cost Employers $6K More

June 10th, 2013

A new Ohio State University study found smokers cost businesses about $6,000 more than nonsmokers every year.  The researchers used the cost of increased absenteeism, lost productivity, smoke breaks and health care  to reach the $6K/year figure – not surprisingly, smoke breaks account for the biggest share of the cost. 

More and more businesses are creating stronger worksite wellness programs.  Arizona, for example, has a great benefit in place for state employees who smoke. Anyone interested in quitting can receive one of the 7 approved nicotine replacement therapies and behavioral counseling for free. Since our state employee health plan was selected as the benchmark plan for the Exchange under the Affordable Care Act… more and more Arizonans will eventually have the same opportunity for those resources to kick the habit.  Also, many businesses in AZ have been putting a focus on worksite wellness and have linked up with the ASHLine.   A few businesses have taken it so far as to not hire smokers at all. 

Research studies, and corporate wellness initiatives have shown that worksite wellness programs are a good benefit for employees and employers.  Those programs can significantly reduce employer costs and improve employee health. Healthier employees are more likely to stay in their jobs, less likely to be absent, take fewer breaks, and have lower health care costs.

 

“Navigator” Standards Proposed by CMS

April 11th, 2013

The Centers for Medicare & Medicaid Services released a proposed rule this week establishing proposed  “Navigator” standards under the Affordable Care Act.  Navigators are organizations that will be providing information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs.  In other words, Navigators will be providing assistance to consumers shopping for coverage plans in the new Marketplace.

Doctor Shortage – a Public Health Concern

January 30th, 2013

Public Health tracks the number of healthcare workers – physicians, dentists and psychiatrists – to make sure we have enough to take care of the community.  In Arizona we’ve been challenged to recruit and keep those professionals – and we have numerous Health Professional Shortage Areas.  Just to eliminate the current shortages, we’d need an additional 313 primary care physicians, 250 Dentists, and 136 Psychiatrists… and a new study shows that we’ll need even more as AZ aligns Medicaid eligibility with the Affordable Care Act.  The study estimates the country will need about 52,000 more primary care physicians to meet the nation’s health care needs through 2025.  The biggest reason for the increase is the growing population, but the number of people getting older and the insurance change impact the number too. 

Fortunately, we have some creative people working on solutions here in Arizona.  This month our Health Systems Development shop along with the Arizona Alliance of Community Health Centers and the UA’s Center for Rural Health brought together folks from the healthcare industry, academia, Arizona Area Health Education Centers, and clinicians to discuss strategies to address the shortage of healthcare workers in Arizona.  The group showed strong support for the National Rural Recruitment and Retention Network (3RNet) – a tool that helps businesses solve healthcare workforce issues.  The 3RNet Program invites healthcare facilities in Arizona to register and use 3RNet as a recruitment tool.  Agencies that use 3RNet can post and update vacancies and post videos or pictures of their facility or their community to better market and attract candidates.  If you have questions about the program, you can contact Ana Roscetti, Workforce Section Manage, at Ana.Lyn.Roscetti@azdhs.gov or 602-542-1066.

New Affordable Care Act Proposed Rules Released

November 23rd, 2012

The US Dept. of Health & Human Services released 3 new Affordable Care Act proposed regulations this week…  including: 1) A proposed Rule regarding coverage requirements for pre-existing or chronic conditions; 2) A proposed Rule outlining policies and standards for coverage of essential health benefits; and 3) A proposed Rule implementing and expanding employment-based wellness programs to promote health and help control health care costs.

Affordable Care Act Fact Sheets

November 7th, 2012

The Fed’s put out a series of pretty simple and easy to read 1-page fact sheets this week that summarize some of the aspects of the Affordable Care Act.  There are Fact Sheets for Families with Kids; Health Care Providers; Folks with Disabilities; Seniors; Small Business Owners; and Young Adults.  At the bottom of each fact sheet there’s a link to a special ACA website for each of these categories.  You might want to share these with your Stakeholders in these categories.

What’s National Health Service Corps?

October 25th, 2012

The Affordable Care Act provided $1.5B nationally (through September 2015) to the National Health Service Corps to train and recruit more primary care providers via scholarships and loan repayment assistance. It’s a federal program been building healthy communities by connecting primary health care providers to areas of the United States with limited access to care since 1972. 

The Corps basically brings health care to those who need it most because of limited access to care.  Today, there are more than 10,000 providers who commit to serve in underserved communities and serve many of the country’s most vulnerable populations.  In Arizona, the new expansion provides the opportunity for communities to use the Corps for recruitment and retention of primary care providers in medically underserved areas. 

Locally, our Bureau of Health Systems Development collaborates with the Arizona Association of Community Health Centers to provide tools and successful models for recruitment and retention to Chief Medical Officers, Medical Directors, Human Resources Directors, Clinic Administrators, and other staff involved in recruitment and retention.  You can find the full list of events happening in Arizona to celebrate the upcoming  Annual Corps Community Day.

AZ’s Future Essential Health Benefit Package

October 12th, 2012

The future health insurance exchange plans (as well as most other commercially available plans) will need to offer a standardized (state-specific) Essential Benefit Package once the Affordable Care Act kicks in on 1/1/14.  There are 10 key service categories that future plans will need to cover- including behavioral health services.

States were responsible for picking a plan from a set of existing options to serve as their state’s “benchmark” plan by last week.  Arizona picked the State Employee EPO plan as the benchmark plan that most insurance plans will need to cover (at a minimum) on and off the exchange.  Future exchange health plans (as well as most other commercially available plans) will need to be “substantially equal” to the state employee benchmark plan in the scope, limitations and exclusions (e.g. visit limits).   I think the plan is a good choice because it has a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health).

Obviously there’s a lot more to it than that… and folks can get a lot more in-depth info about what an Essential Health Benefit is and what it means in this document- which provides an Arizona specific analysis of the issues and the various services that’ll be covered under the future benchmark plan.