Posts Tagged ‘health care’

Medicare Cost Transparency

April 9th, 2014

I’ve always believed that transparency improves the efficiency of any system.  Health care costs are no exception- and health care reimbursement costs are probably at the top of the list of systems that could be improved by applying a healthy dose of cost transparency.

Today the federal government took a giant step forward when they released a public data set called the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File”.  It’s a huge database that contains information on utilization, payment, and submitted charges organized by Provider Identifier, Code, and place of service.

Placing this data in the public domain will give researchers around the country access to critical data that can be used to determine where additional system efficiencies can be found and to propose new evidence-based solutions to improve public health outcomes- while making the Medicare and healthcare delivery system more cost effective.

Opening Day: Mercy Maricopa Integrated Care

April 4th, 2014

openingdayThis was a milestone week for our behavioral health program.  Tuesday marked the start of our contract with Mercy Maricopa Integrated Care as the regional behavioral health authority in Maricopa County.  The transition has gone well this week.  Literally 100s of things had to go right in order to have a smooth transition- including Information Technology, eligibility, pharmacy, medical records, claims management, network capacity and a host of other things.  A big thanks go out to the folks at Magellan, MMIC, AHCCCS and our DBHS, IT, and procurement teams for the weeks and weeks of hard work that it took to have a smooth transition for our members.  Well done!

Mercy Maricopa’s core mission is dedicated to providing its members access to care for their behavioral and medical health needs — focusing on the whole person, taking a holistic approach and empowering members to take charge of their health care. A new, secure health information exchange will help physical and behavioral health care providers to share information- leading to better care coordination, improved health outcomes, and reduced costs. Folks interested in learning more about Mercy Maricopa Integrated Care can visit their website, which has a host of resources for members and health care providers.

We’re optimistic that our collective hard work over the last couple of years to develop this new system of care will continue to result in better public health outcomes consistent with our Vision of Health and Wellness for all Arizonans.

What’s the Medical “Standard of Care” in an Emergency?

January 23rd, 2014

Good question.  Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. For example-  hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies, and beds could be in short supply; and alternate care facilities may need to be used. 

You can imagine how difficult it would be to set alternative standards of care in the middle of an emergency- which is why we’ve been working with a statewide Crisis Standards of Care planning group since last January.  Our Public Health Emergency Preparedness team has been working with healthcare, public health, emergency management, and legal experts to develop a plan and a set of standards to guide the delivery of healthcare during the most catastrophic disasters- providing guidance for managing scarce resources (both people and stuff) in an emergency. 

A key resource is a landmark crisis standards of care report developed by the Institute of Medicine- which examines indicators and triggers that guide the implementation of crisis standards of care and provides a toolkit to help stakeholders establish indicators and triggers for their own communities.  The IOM report has toolkits for behavioral health, emergency management, emergency medical services, hospital care and public health.

Obesity Declared a Disease

June 21st, 2013

The American Medical Association voted to recognize obesity as a disease this week.  This is an important change… because the term “disease” in the managed care world means that that prevention and treatment is more medically necessary, justifying reimbursement for necessary interventions. 

If obesity isn’t a disease then I don’t know what is.  Obesity has gone from being a public health nuisance to a public health disaster in the last 20 years.  In Arizona, the percentage of obese adults has nearly doubled in the last 15 years- from about 13% in 1995 to more than 25% in 2010.  It’s overwhelming the country both in health care costs and productivity. We spend about $150B annually on health care costs related to obesity… and it increases the risk of heart disease and type 2 diabetes. Type 2 diabetes leads to devastating health problems including blindness, the loss of limbs and an early death. 

As a public health system, we’ve got to start pulling folks out at the top of the waterfall rather than fishing them out at the bottom. While the change by the AMA is a positive step forward, some doctors might need the nudge of calling this a disease so that they’ll actually put together a treatment and prevention management plan together for their patients. This is where our work becomes even more important.  

Reducing obesity is a Winnable Battle both nationally and in Arizona.  We have lots of resources to help you and your family eat healthier meals and become more active. Check out the Arizona Nutrition Network’s Champions for Change for simple ways to eat better. Find more ideas for healthy eating and active living at, where you can sign up for healthy recipes that are emailed every week.

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.


AZ Healthy Community Design Tools

April 15th, 2013

Improving the health of Arizonans is critical to improving the quality of life as well as reducing health care costs. The most effective strategies are ones that incorporate the principles of population health… which includes health outcomes as well as the determinants that influence those outcomes including the public policy that influences the social and environmental determinants. A city’s General Plan can be a large public health lever to improve those outcomes. 

Designing healthier communities requires a new way of thinking. For example, the way a city zones can affect how easy it is to get physical activity.  The tough part is connecting all of the right people to sit in on the conversation together. The zoning people might not talk to the health people, who may not talk to the transportation folks. But where can community residents start? One place to start is with a recently developed Toolkit put together by ADHS and other members of the Healthy Community Design Collaborative

This toolkit is really designed to help cities, towns and counties strategically think about how to enhance health through changing the built environment, like through adding sidewalks or bike lanes. It’s basically a guide for local residents who want to participate in their community planning process. The Toolkit provides a general overview of the process, explains the purpose of city General Plans, and gives guidance regarding who to talk to in local government- and presents ways to get involved. There’s also a checklist for what policy topics should be addressed in a plan and even some examples of policies for residents to consider for incorporation into their city’s General Plan. It also provides coaching for community residents to build relationships that facilitate implementing policy language. 

Our team recently created the website, which is another tool that provides information on the influence of community design, accessibility and transportation on health. You can even find some recent examples of how communities in Arizona are working to create healthier environments and learn to create a Health Impact Assessment, which can be used to help city projects improve population health. These are just some examples of how we can work to promote healthy and safe community environments – one of our priority areas of our Strategic Map.

The Health Care/Public Health Continuum

March 13th, 2013

In the world of health care- the clinician works with patients individually. They examine various indicators of health for their patient including direct observations and laboratory or other diagnostic tests and implement interventions to help their patient improve their health. Providers also encourage their patients to live healthy lifestyles and take safety precautions- and help patients with preventative care by providing vaccinations and the like. Over time, the health care provider follows the patient and measures how they’re doing with patient centered criteria. 

In the world of public health, the practitioner works with communities… in other words the community is the patient. Public health folks look at outcome indicators to determine the health of the community so they can take action and implement interventions at the wholesale level to improve population health. In other words- public health uses community indicators like infant mortality, communicable disease rates, obesity and diabetes to assess the patient (the community). Of course, public health relies on health care providers in the health care world to carry out public health objectives and interventions. 

So you can see that there is a strong interface between health care and public health- but the distinction is that in health care the patient is the patient while in public health the community is the patient- the interventions are community based, and community indicators are the primary assessment tool. By the way, reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention. Does prevention sound like a good investment?

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.

Did You Get a Health Insurance Refund You Didn’t Expect?

September 13th, 2012

If you did, you can thank the Affordable Care Act.  When you buy health insurance- the percentage of your premium dollars that your insurance company spends on providing you with health care (as opposed to what it spends on administrative, overhead, and marketing) is called a “Medical Loss Ratio”.   The Affordable Care Act limits how much of your premium dollar your insurer can spend on things besides your care.  They’re supposed to give you a rebate on the portion of premium that was over the limit.  The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care (and efforts to improve the quality of care).  Insurers selling to large groups (usually 50 or more employees) need to spend 85% on care and quality improvement. 

The Medical Loss Ratio part of the Affordable Care Act kicked in this year.  So far, about 400,000 Arizona residents with private insurance coverage received a total of almost $28M in refunds from insurance companies.


Platinum, Gold, Silver, and Bronze Health Plans

August 27th, 2012

The Affordable Care Act will establish various tiers of health insurance coverage beginning in 2014.  The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty).  Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum.  

The levels of coverage aren’t defined using specific deductibles, co-pays, and coinsurance- they’ll use something called  “actuarial value”.  For example, a plan with an actuarial value of 70% (referred to as a “silver” plan) means the plan will pay 70% of a standard population’s health care expenses with the enrollee paying 30% through things like deductibles, co-pays, and/or coinsurance.  The higher the actuarial value the less patient cost-sharing the plan will have on average. 

Bronze plans will have more out-of-pocket costs, and platinum plans will have least.  Bronze plans will cover 60% of enrollee costs, silver 70%, gold 80% and platinum 90%.  Young people (under 30) will be able to buy “catastrophic” plans with an even lower actuarial value.  Each plan (even catastrophic) needs to cover the state’s essential benefit package.   Insurers don’t have to offer plans in all four levels, but within the exchange all insurers must offer at least one silver and one gold plan.  You can read a lot more about actuarial value in this HHS bulletin

There are also benchmarks for premium and cost-sharing subsidies that go to lower and middle income people buying their insurance in the exchange.  I’ll cover that next week.