Healthy Howard Plan to bring affordable access to health care to all uninsured county residents.

County Executive Ken Ulman and Health Officer Dr. Peter Beilenson have announced the Healthy Howard Plan – a plan to bring affordable access to health care to all uninsured county residents. This announcement comes on the heels of three other innovative partnerships aimed at awareness and increasing enrollment for currently available health programs. “The Healthy Howard Plan brings government, business and citizens together to address the issue of the uninsured in Howard County and moves our county one step closer to becoming the model public health community,” says County Executive Ken Ulman.

While not insurance, the Healthy Howard Plan will offer primary care services, deeply discounted prescription drugs, in- and outpatient hospital care, as well as specialty care services. To qualify, Howard County residents must make 300 percent of poverty level or below, have been uninsured for one year and have legally resided in the County for one year. The enrollment goal for the first year of the program is 2,000 participants.

The innovative approach to the Healthy Howard Plan places emphasis on personal responsibility as well. “We believe that health care is both a right and a responsibility,” says Dr. Peter Beilenson. To that end, plan participants will be assigned health coaches to assist in achieving health and wellness goals.

Another unique aspect of this program is that it does not rely solely on taxpayers and government. “Partnerships with community organizations including Howard County General Hospital, Johns Hopkins Medical Institutions and Chase Brexton Group Practice will help make this program possible.” continues Dr. Beilenson.

For more information call the information hotline at 410-313-HELP (4357). Plan details (pdf).

Is Spending More Always Wasteful? The Appropriateness Of Care And Outcomes Among Colorectal Cancer Patients

Mary Beth Landrum, Ellen R. Meara, Amitabh Chandra, Edward Guadagnoli, and Nancy L. Keating.  Is Spending More Always Wasteful? The Appropriateness Of Care And Outcomes Among Colorectal Cancer Patients
Health Affairs, January/February 2008; 27(1): 159-168.

Increased area-level medical spending is not correlated with improved patient outcomes or quality, thereby supporting the case for spending reductions in high-spending regions. However, all additional spending need not be wasteful. Examining the care of patients with colorectal cancer, we show that high-spending regions are more likely than other regions to use recommended care but are also more likely to use discretionary and nonrecommended care, the latter of which has adverse outcomes for patients. Our results show that instead of cutting spending, policies designed to target services to patients most likely to benefit could increase the value of medical spending.

Cutting Copayments Yields Increased Adherence To Recommended Treatments

Michael E. Chernew, Mayur R. Shah, Arnold Wegh, Stephen N. Rosenberg, Iver A. Juster, Allison B. Rosen, Michael C. Sokol, Kristina Yu-Isenberg and A. Mark Fendrick. Impact Of Decreasing Copayments On Medication Adherence Within A Disease Management Environment. Health Affairs, 27, no. 1 (2008): 103-112. Abstract (html)

This paper estimates the effects of a large employer’s value-based insurance initiative designed to improve adherence to recommended treatment regimens. The intervention reduced copayments for five chronic medication classes in the context of a disease management (DM) program, including heart-protecting ACE inhibitors and angiotensin-receptor blockers; blood-pressure-reducing beta blockers; diabetes medicines including blood sugar-reducing drugs and insulin; cholesterol-reducing statins; and asthma-calming inhaled steroids. Compared to a control employer that used the same DM program, adherence to medications in the value-based intervention increased for four of five medication classes, reducing nonadherence by 7-14 percent. The results demonstrate the potential for copayment reductions for highly valued services to increase medication adherence above the effects of existing DM programs. The authors say their results demonstrate the potential utility of “value-based insurance design,” which connects patients’ cost sharing to the value of health care services.

A Progress Report On State Health Access Reform

John E. McDonough, Michael Miller, and Christine Barber. A Progress Report On State Health Access Reform. Health Affairs Web Exclusive, January 29, 2008.

Enactment of ambitious health reform laws in Massachusetts and Vermont in 2006 helped instigate a wave of state legislative activities to expand coverage to uninsured people. We identify thirty-nine states that have enacted laws in at least one access category since 2006. At least thirteen states have begun processes to enact comprehensive reforms to cover at least half of their uninsured residents. Key activities involve coverage expansions for uninsured children and for uninsured adults; regulatory changes in small-group and individual insurance markets; and individual and employer mandates. The future extent and durability of this wave are uncertain.  Abstract (html)

Paying for quality: Understanding and assessing physician pay-for-performance initiatives

Jon B. Christianson, Sheila Leatherman, and Kim Sutherland. Paying for quality: Understanding and assessing physician pay-for-performance initiatives. Princeton, N.J. Robert Wood Johnson Foundation, Research Synthesis Report No. 13, December 2007.

To date, policy-makers have had little information on the effectiveness of P4P initiatives in shifting physician practice. They are interested in knowing to what extent and under what circumstances P4P will improve the quality of care delivered by physicians. This synthesis report reviews the available evidence on this issue, addressing five questions: 1. What explains the current widespread interest in physician P4P? 2. How are current incentive programs structured and how prevalent are they? 3. What performance measurement issues does physician P4P raise? 4. How do physicians perceive quality incentive programs? 5. What is the research evidence on the impact of P4P? Full report (pdf)

Listening to Consumers: Values-Focused Health Benefits and Education

Listening to Consumers: Values-Focused Health Benefits and Education
By Lois A. Vitt, Institute for Socio-Financial Studies (ISFS), and Ray Werntz, EBRI Fellow
EBRI Issue Brief No. 313. January 2008.

This report on how employers can provide useful information to employees in conjunction with
consumer-directed health plans concludes: “Consumer values can provide essential insights into consumer thinking about health-related behaviors
and financial decision-making. They also can provide a blueprint for health care businesses and policymakers
working to make the U.S. health care system more responsive to consumers. Should health education
initiatives prove ineffective, the “consumer-driven health movement” could well be doomed, especially if it
relies upon fully educated health consumers taking self-initiated actions. The perceived ineffectiveness of
education in 401(k) plans resulted in legislation to add “defaults” to these plans so that they no longer relied
upon positive employee action. In the health arena, the default approach is exactly what the consumer-driven
health model seeks to move away from.”  Full report (pdf)

The Health Care System for Veterans: An Interim Report

Congressional Budget Office. The Health Care System for Veterans: An Interim Report. Washington, DC: CBO, December 2007.

This interim report provides a brief overview of VA’s medical system, summarizes some of the recent evidence on the quality of VA’s medical care and describes the incentives for quality that VA has included in its performance management system. The report also examines ways in which the department’s health IT may affect the quality of care. CBO’s final report, anticipated in early 2008, will address the potential for other government and private health care providers to make use of VA’s experience, along with other issues.

State’s mandate on health coverage has avoided legal challenge so far

David Kibbe.

When former Massachusetts Gov. Mitt Romney and legislative leaders developed a first-in-the-nation law to provide nearly universal health care, it was based on two bold premises:

One, that the state could impose a mandate requiring people to buy health insurance if it was deemed affordable. And second, that businesses with more than 10 employees could be assessed a $295 annual penalty per employee if they did not offer adequate health insurance plans to their workers.

From the time it was signed into law in April 2006, national and local political observers predicted it would be tested in the courts.

So far, no legal challenges have been brought by an individual or a business.”  Full article.

The new insurance frontier

The new insurance frontier
The Wall Street Journal 01/07/08
by Matthew Collier and Lisa Walsh

A Bain & Company analysis of the health-insurance sector shows that total commercial health-insurance enrollment has been flat at around 174 million people since 2001. In response to rising costs, employers have steadily pared back benefits, and the percent of businesses offering health insurance has fallen to 60% last year from 66% in 1999. Since the 2001 recession, the number of contractors, part-timers and small-business employees has grown two to six times faster than the economy overall. In contrast, traditional workers–the full-time company employees that provide the insurance companies’ bread and butter–have declined 0.6%. As a result, profit pools in corporate-funded health plans are shrinking.For insurers, this means that their greatest source of future growth is selling policies to individuals–not corporations.” Mr. Collier and Ms. Walsh are partners with Bain & Co. in San Francisco, and senior members of Bain’s global healthcare practice. Full article.

The Future of Provider Payment

The right set of payment reforms could address many of the systemic problems and lead to net cost reductions of 15-25%.

Over the last several decades, public and private payors have experimented with a variety of payment mechanisms to manage rising premiums and underlying medical costs. Although there were early successes, such as Medicare’s introduction of diagnosis-related group (DRG) payments for inpatient stays, costs have continued to climb at unsustainable rates. The number of uninsured and underinsured individuals, meanwhile, has also continued to rise, turning healthcare into a major political issue. The experts at Booz Allen Hamilton believe that the right set of payment reforms could address many of the systemic problems-including misuse, underuse, and overuse of medical care-and lead to net cost reductions of 15 to 25 percent. Booz Allen has identified four promising models for reforming the payment system but believes that one solution in particular—evidence-based, bundled case rates—offers the most promise.  Booz Allen’s Joyjit Saha Choudhury, Kristine Martin Anderson, and Karl Kellner are the authors of the new report.

The Future of Provider Payment (Full report)