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Health Law Funds New Effort To Search For Improvement To Health Care

Kaiser Health News - Mon, 08/11/2014 - 9:12am

News outlets report on aspects of the health law designed to foster and test innovation in the nation's health care delivery system.

Kaiser Health News: Washington's $10 Billion Search For Health Care's Next Big Ideas
The Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans. A federal office you've probably never heard of is supposed to fix health care for everybody else (Hancock, 8/11). 

Chicago Tribune: Obamacare Law Funds Studies On Better Health Care
On a recent afternoon, Dr. Evan Lyon of the University of Chicago Hospitals ... set off to see a patient. Katie White, the patient, was not in a clinical setting but in the bedroom of her small South Side home, about 2 miles from the hospital. The 74-year-old greeted Lyon from a hospital bed that filled the small room — the bed to which she has been confined for a little over a year. "Glad you could make it," she said with a touch of attitude. White is participating in a clinical trial designed to test an old-new system of delivering health care: having the same doctor treat patients both in the hospital and elsewhere, including making house calls when necessary. The $6 million study is one of dozens of research projects made possible by the Affordable Care Act (Peres, 8/10).

Chicago Tribune: As Others Get Money, Hospitals Fear Cutbacks In Research Funding
Although the Affordable Care Act is directly funding a new variety of medical research, some experts fear the health overhaul also could cut into the money available to fund studies traditionally carried out at academic medical centers. Such institutions typically make money by treating privately insured patients in a fee-for-service environment where sophisticated, high-tech procedures carry hefty price tags. That money then can be used to cover the costs of publicly insured or uninsured patients as well as research projects. But that environment is changing, with a move toward capitated reimbursement systems or bundled payments. The act encourages doctors and hospitals to form networks that share financial and medical responsibility for providing care to patients, and the networks are rewarded when they provide that care more efficiently (Peres, 8/11).

Meanwhile, on another health law implementation issue -

Bloomberg: Freshway Contraceptive Coverage Bar Allowed By Court
Fresh Unlimited Inc. won't have to provide contraceptive coverage for its employees under the Obama administration’s health-care reform law, in what may be the first exemption granted since a June U.S. Supreme Court ruling. The parent of Freshway Foods today won an appeals court ruling that qualifies it for the same treatment the high court approved in its June 30 Hobby Lobby decision allowing family-run businesses to claim a religious exemption from the requirement to include contraceptives in their health insurance plans. The suit by Francis and Philip Gilardi, who own Sidney, Ohio-based Freshway, is one of about 50 filed by for-profit businesses over religious objections to the Patient Protection and Affordable Care Act of 2010’s birth-control coverage mandate. The Gilardis are Roman Catholic and said that complying with the U.S. Department of Health and Human Services mandate would require them to violate deeply held religious beliefs (Zajac, 8/8).

Categories: Health Care

Political Cartoon: 'Mechanic Panic?'

Kaiser Health News - Mon, 08/11/2014 - 9:12am

Kaiser Health News provides a fresh take on health policy developments with "Mechanic Panic?" by Dave Granlund.

Meanwhile, here's today's haiku:

PUBLIC HEALTH COMMUNICATION

Papers scream our doom.
Ebola not in the states.
Calm Down! You are fine.
-Jacob Eckles

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

 

Categories: Health Care

First Edition: August 11, 2014

Kaiser Health News - Mon, 08/11/2014 - 7:03am

Today's headlines include reports about health exchange developments in Oregon and Massachusetts.

Kaiser Health News: Washington's $10 Billion Search For Health Care's Next Big Ideas
Kaiser Health News staff writer Jay Hancock reports: “The Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans. A federal office you’ve probably never heard of is supposed to fix health care for everybody else” (Hancock, 8/11). Read the story, which also appeared in The Washington Post.

Kaiser Health News: Capsules: If You Have A Stroke, Better It Should Be In Paris
Now on Kaiser Health News’ blog, Frank Browning writes: “I had a stroke last month, oh boy. It’s just that I know it. Here’s what happened: Only after three days of flashing, floating visual squiggles — commonly known as ocular migraines that usually last 20 minutes — do I e-mail my old friend Dr. John Krakauer, who helps run stroke recovery at Johns Hopkins Hospital in Baltimore. After a few questions he told me to get an MRI scan as soon as possible. In the U.S. that could involve the emergency room (with its hours-long wait) or a complicated process of getting the referral — and then finding a radiologist who would take my coverage. Here, it is so much simpler” (Browning, 8/11). Check out what else is on the blog

Los Angeles Times: Oracle Sues Oregon Over Botched Obamacare Exchange
The legal battle over Oregon's dysfunctional health insurance exchange officially began this week when Oracle Corp. sued the state agency operating the exchange, alleging breach of contract and accusing Gov. John Kitzhaber of attempting to systematically "vilify the company in the media." In a 21-page complaint filed Friday in federal court for the District of Oregon, Portland Division, Oracle charges that during the early months of this year, state officials privately continued to request Oracle's help to fix their system while engaging in a campaign of "constant public slander" against the tech company (Reston, 8/9).

The Associated Press: Oracle Sues Oregon Over Health Insurance Exchange
Oracle Corp. has sued the state of Oregon in a fight over the state's health insurance exchange, saying government officials are using the technology company's software despite $23 million in disputed bills. Oracle's breach-of-contract lawsuit against Cover Oregon was filed Friday in federal court in Portland. It alleges that state officials repeatedly promised to pay the company but have not done so (Cooper and Wozniacka, 8/8).

The Wall Street Journal: Massachusetts To Replace Health Exchange With Privately Run System 
Massachusetts will replace its failed online health-insurance exchange with another from a private company rather than shifting to the federally run marketplace, a state health official said Friday. The state has been scrambling to replace the old system after a problem-plagued enrollment period late last year. In June, it cut ties with the system's architect, CGI Group Inc. (Kamp, 8/8).

The New York Times: Uniting To Take Congress, G.O.P. Tries To Become The Party Of ‘Yes’ 
With control of Congress within reach, Republicans are quietly assembling an aggressive 2015 agenda built around a push for a balanced budget and quick passage of measures, like approval of the Keystone XL pipeline and repeal of a medical equipment tax, to show they can govern. ... Republicans say they would lay the procedural groundwork within the budget for more sweeping changes on taxes and in social programs such as Medicare and Medicaid by initiating an arcane budget process known as reconciliation. The procedure can protect legislation from a filibuster and its 60-vote threshold and reduce the need for Democratic support. ... Even as they talk about pragmatic achievable solutions, though, Republicans also say they are likely to take an early symbolic vote on repeal of the health care law, which would face a certain veto by Mr. Obama. After that showdown, Republicans say, they could move on to more realistic proposals and changes in the law (Hulse, 8/9).

The New York Times: Midterms Give Parties Chance For Sweeping Control Of States
Republicans are looking to take over senates in Colorado, Iowa, Oregon, Maine and Nevada, and houses in Kentucky, New Hampshire and West Virginia. Republicans could emerge with complete control of the legislatures in New Hampshire and Kentucky, though both of those states have Democratic governors. They hope these victories will help them push through legislation that has been stymied by Democrats until now, such as pressing the kind of restrictions on labor organizing the party passed in Wisconsin, or rolling back gun laws in Colorado. In Iowa, Republicans are looking to eliminate a tax on manufacturing and enact a ban there on telemedicine abortions, where women in rural areas obtain abortion pills after videoconference consultations with faraway doctors (Nagourney, 8/10). 

The Associated Press: Crist Opponents Question His Political Conversion
Crist’s reputation for being a say-anything-for-a-vote politician isn’t new. …President Barack Obama’s health care overhaul: As a Republican Senate candidate in 2009, Crist said Obama’s plan was “cockamamie” and “nuts” and demanded its repeal; as a 2010 independent Senate candidate, Crist said there were positive things about the law and it should be fixed, not repealed; as a 2014 Democratic gubernatorial candidate, he says it’s “great” (8/10). 

The Associated Press: Medicaid Expansion Talk Key In Fla. Governors Race
Expanding Medicaid to an additional 1 million Floridians under President Barack Obama’s new health law is turning into one of the biggest issues of this year’s gubernatorial race. Former Gov. Charlie Crist brings up the topic on most campaign stops and says one of the first things he’ll do if elected is call a special session to expand Medicaid. His opponent, incumbent Republican Gov. Rick Scott, seems to be waning in his support. Scott says he’s open to taking roughly $51 billion over the next decade from the federal government, but only as long as Florida taxpayers aren’t left with the bill (Kennedy, 8/9).

The New York Times: New V.A. Chief Promises To Mend Practices
In his first public address since taking the helm of the embattled Department of Veterans Affairs, Secretary Robert A. McDonald vowed on Saturday to restore trust in the agency by initiating an independent audit of its scheduling practices and holding poorly performing officials accountable. Speaking to about 4,000 people at the Disabled American Veterans national conference here, Mr. McDonald acknowledged systemic problems that have plagued the agency; attempts to “game the system” to hide problems; and a culture that failed to protect whistle-blowers who pointed them out (Curtis, 8/9).

The Wall Street Journal: New VA Secretary Seeks Independent Review Of Scheduling Practices
The Department of Veterans Affairs will launch an independent review of its scheduling practices beginning in the fall, the VA announced Friday. In one of his first major announcements as VA secretary, Robert McDonald said the Joint Commission, the largest health care accrediting body in the country, will a make a sweeping, independent review of the VA's scheduling practices (Kessling, 8/8).

The Associated Press: VA Chief Makes 1st Hospital Visit Amid Scandal
Veterans Affairs Secretary Robert McDonald visited a VA hospital Friday for the first time since taking over the embattled agency last month, meeting with veterans and health care providers and vowing to restore trust in the organization. Reports that dozens of people died while waiting to see a doctor and that employees covered up long wait times at the Phoenix VA hospital helped touch off a national firestorm over veteran care. The former VA secretary was forced to resign, and President Barack Obama on Thursday signed a $16.3 billion law to overhaul the department (Kashfi, 8/9).

The Texas Tribune/The New York Times: In the Valley, High Hopes For A V.A. Voucher Effort
In the [Rio Grande] Valley, where the closest veterans hospital is more than 250 miles away, veterans have long had to seek specialty care in the private sector by using vouchers. Those vouchers grant the patients access, but the providers must file invoices to get paid. In light of whistle-blower claims that staff members at agency hospitals nationwide fudged records to make it appear that veterans were experiencing shorter waiting times, the system is expanding the voucher program as part of a major overhaul to help address the massive backlog. Doctors and patients in the Valley welcomed the additional resources, but they said the voucher program must be improved to maximize its effectiveness (Rocha, 8/9).

Los Angeles Times: PTSD Continues To Afflict Vietnam Veterans 40 Years After The War
our decades after the Vietnam War, 11% of its veterans still suffer from post-traumatic stress disorder, according to new research suggesting that for some people it is a condition unlikely to ever go away. The findings, presented Friday at a meeting of the American Psychological Assn., provide a rare look at the long-term course of PTSD in veterans. The research updates a landmark study conducted in the 1980s, when researchers found that 15% of Vietnam veterans had the disorder. Despite the passage of many years and the increasing availability of effective treatments for PTSD, the picture remains much the same (Zarembo, 8/8).

The Wall Street Journal: More Workers File Family-Leave Lawsuits
The 1993 law guarantees employees as many as 12 weeks of unpaid leave a year for medical and family reasons, and bars employers from retaliating against workers for taking it. Lawsuits filed under the statute jumped to 877 in 2013 from 291 a year earlier, according to the most-recent figures from the Administrative Office of the U.S. Courts. The number of family-leave cases was dwarfed by the more than 15,000 suits filed last year accusing companies of violating laws that protect against race, sex or disability discrimination. But the FMLA was the only one among those laws to generate a sharp increase in claims. The statute requires a lower threshold of proof than most other employment laws (Palazzolo, 8/8).

The New York Times: Ebola Drug Could Save A Few Lives. But Whose?
A history of controversy about drug testing in Africa is just one of the complexities facing public health authorities as they wrestle with whether and how to bring that drug and possibly other experimental ones to the countries afflicted with Ebola. Who should get such a scarce supply of medicine? Health workers? Children? The newly infected who are not yet as sick? There are virtually no remaining supplies of the drug, called ZMapp, that was used to treat the two Americans, United States officials say. And even a few months from now, according to various estimates, there may be no more than a few hundred doses (Pollack, 8/8).

The New York Times: Fighting Deadly Diseases Without Breaking A Sweat
The diversity of infectious ailments in the city was part of what drew Dr. Phillips to New York. As a young epidemiologist, he dreamed of battling tuberculosis in Eastern Europe. Then he met Dr. Marcelle Layton, a city health official. She persuaded him to instead battle communicable diseases in the city as an epidemic intelligence service officer for the Centers for Disease Control assigned to the health department in 2000. “I get to eastern Brooklyn,” Dr. Phillips said. “It’s just as good.” Over the years, he has learned to expect the unexpected (Swarns, 8/10).

The Texas Tribune/New York Times: A New Test For Texas’ Abortion Restrictions
The latest legal challenge to Texas’ sweeping abortion measures went to trial in a federal courthouse in Austin last week, as federal judges around the country grapple with the question of how far states can go in regulating abortion — a question that seems likely to end up in the United States Supreme Court. The crux of the matter is what the Supreme Court meant when it ruled in 1992 that abortion regulations may not impose an “undue burden” on women seeking an abortion. Some judges have held that as long as a law has a “rational basis” and does not prevent most women from getting an abortion, it does not impose an undue burden. But others have suggested that laws making abortions harder to get must have a good reason for doing so (Edelman, 8/9).

The New York Times: Out-of-State Clinic Is Central In Texas Abortion Law Fight
Of all the clinics and facilities at the center of a federal lawsuit challenging Texas’ sweeping abortion law passed last year, one has stuck out. It is not in Texas, but about a mile across the state line in Santa Teresa, N.M. Its role in the case gets to the heart of the legal questions swirling around the trial here this week. The law will soon force El Paso’s sole abortion clinic to shut its doors, leaving no abortion providers in all of West Texas. Opponents of the law said that would force women to embark on a lengthy drive to the nearest abortion provider in San Antonio. For women in El Paso, for example, it amounts to a nearly eight-hour, 550-mile trip one way (Fernandez, 8/8).

The Washington Post: Admitting-Privileges Laws Have Created High Hurdle For Abortion Providers To Clear
Among the raft of abortion restrictions passed by states in the past few years, one did not initially gain much notice — a requirement that doctors performing abortions obtain admitting privileges at a local hospital. But the measure, which 11 states have passed in some form, has proved an especially high hurdle for abortion providers to clear and a potent tool for antiabortion activists seeking to shut down abortion clinics (Somashekhar, 8/10). 

USA Today: What Ails Appalachia Ails The Nation
Diabetes is slowly ravaging Alisha Blankenbeckler's body — stealing her eyesight, impairing her kidneys and damaging her nerves so severely she can barely walk across a parking lot without help. And she's only 48. "I try to stay upbeat no matter how bad I feel," she says, mostly so she can keep caring for a husband with dangerously high blood pressure. "It's difficult, though. Dying is something I think about every day." The couple's travails are common in this corner of Appalachia, one of the nation's unhealthiest regions, a place plagued by poor health habits and sky-high levels of chronic disease that some experts say may be a harbinger of where the country is headed if we don't rein in epidemics like obesity. This week, U.S. Centers for Disease Control and Prevention Director Tom Frieden made a "house call" to find out more about the underlying causes of the region's ills and how to treat them — and in the process gain traction against the rising burden of chronic disease that ails the nation. … Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty (Ungar, 8/8).

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Categories: Health Care

Washington's $10 Billion Search For Health Care's Next Big Ideas

Kaiser Health News - Mon, 08/11/2014 - 5:01am

The Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans.

A federal office you’ve probably never heard of is supposed to fix health care for everybody else.

The law created the Center for Medicare and Medicaid Innovation to launch experiments in every state, changing the way doctors and hospitals are paid, building networks between caregivers and training them to intervene before chronic illness gets worse.

One example: George Washington University’s $1.9 million award to improve care and cut costs for at-home dialysis patients. Another: CareFirst BlueCross BlueShield’s $24 million grant to reduce unnecessary hospital visits for chronically ill Medicare patients.

The center’s ten-year, $10 billion budget is the largest ever devoted to transforming care. In several states the office is working to overhaul medicine for nearly all residents — not just those with government Medicare and Medicaid coverage.

More On Health Care Innovation

Every few months it awards test grants of $3 million or $10 million each — or sometimes tens of millions — to community groups, clinics, hospitals, insurance companies, nursing homes and states. Its programs touch millions of patients. Hundreds of organizations have gotten money. More than $2 billion has been doled out or committed since 2011.

One of the biggest experiments is the center itself. Skeptics, including Republicans but also those who support the health law, wonder if it’s up to the task.

“While I certainly appreciate innovation in the delivery of health care, the CMMI is just another big government bureaucracy created by Obamacare that costs billions and duplicates other efforts,” Utah Sen. Orrin Hatch, ranking Republican on the Senate Finance Committee, said through a spokesman. Hatch mused at a hearing last year whether the center’s hundreds of tests represent “barely controlled chaos.”

Even policy pros who hope the innovation lab succeeds wonder if its investment will pay off and complain that it is slow to disclose information on spending and results.

“This is absolutely necessary” to try to change how care is bought and delivered, says Christopher Koller, president of the Milbank Memorial Fund, a nonprofit that works to improve medical decision making. “Is this the right way to do it? A whole bunch of experiments? Is the innovation center adequately resourced in an administrative way to do this? The jury is still out on this.”

Dr. Patrick Conway, the top Department of Health and Human Services official who runs the center, calls it an underappreciated and “essential” part of the health law. “It’s incredibly critical,” he says.

The office’s goal is nothing less than health care’s three pots of gold over the rainbow: making medicine less of an ordeal, improving patients’ health and controlling the spiraling costs that burden taxpayers, employers and consumers.

Backers compare it to a venture-capital fund that can finance the next big idea or Lockheed Martin’s “skunk works” for developing advanced jets. Its programs go far beyond the “accountable care organizations” that are perhaps its best-known experiments.

With a staff of 265 and growing, CMMI must not only administer ACOs and other reimbursement tests that reward quality care at lower cost. It also manages hundreds of grants and dozens of contractors hired to monitor and evaluate the programs.

Projects tend to focus on people with expensive diseases such as cancer, diabetes, heart failure and schizophrenia. In one round of grants, awardees were urged to deploy projects “as rapidly as possible” and show results within six months.

The Johns Hopkins University got $19.9 million to improve care for East Baltimore’s chronically sick and mentally ill. An Asian-American community group got $2.7 million to help low-income Californians navigate the medical system. The University of Tennessee got $3 million to help ensure repeat hospital patients in Memphis stay on their medications after discharge. Intermountain Health Care got $9.7 million to test software that forecasts the best ways for caregivers to interact with patients.

Many efforts don’t just involve the elderly Medicare and poor Medicaid patients in HHS’ primary insurance programs. Six states including Maine, Arkansas and Oregon got up to $45 million each to involve commercial insurers and their members as well as government programs in trials to improve health and control costs.

Dozens of states are talking to CMMI about ways of improving care for their entire populations, Conway said.  More grants are on the way.

“There’s a lot going on there,” says Dr. Mark McClellan, who ran HHS Centers for Medicare & Medicaid Services (CMS) under President George W. Bush. “They have far more [innovation] money than Medicare and CMS have ever had before and a far-broader mandate to try out and expand models.”

Even so, devoting $1 billion per year over a decade to innovation is a tiny outlay for a system that spends $1 trillion every year on Medicare and Medicaid, says Conway. Supporters say CMMI promises to eventually save taxpayers far more than its $10 billion price tag.

“That’s like a drop in the bucket — a cynic would say a low level of investment,” said Dr. Ezekiel Emanuel, a former White House adviser who worked to include the innovation center in the health law.

In a health system costing nearly twice as much as those in other countries and where large portions of spending are estimated to be wasted or harmful, policy experts have long recommended such research. The idea is to learn whether investment in coordination of nurses, computers, new payment incentives, home caregivers and other changes saves more in unnecessary and overly expensive care than it costs.

Tests are supposed to take several years. Contractors paid by CMMI monitor the grant recipients and programs to determine whether successful results could be expanded. Under the health law HHS can broaden innovations to government programs without seeking permission from Congress.

Conway points to the center’s partnership for patients, a national initiative to cut costs and reduce in-hospital harm, as an early success. Hospitals in the program share ideas on avoiding catheter and blood-line infections, guarding against patient falls and bedsores and building community networks to reduce expensive readmissions. 

Analysis by CMMI and its contractors shows that partnership for patients has already lowered readmission rates, cut hospital-acquired infections and other injuries “for the first time in history,” and saved 15,000 lives and $4 billion, he said.

Another success, Conway says, is the “pioneer” accountable care organizations, an early effort to induce care providers to improve quality and control cost through financial incentives. The program saved $147 million in its first year, according to HHS, and it’s “highly likely the second year’s results will also be positive,” Conway said.

But information is limited even for programs whose results have been announced. HHS didn’t disclose how it calculated ACO savings or details on how individual health systems performed.

For scores of other efforts there is even less information. Contractors hired to monitor and evaluate projects are prohibited from disclosing data to anyone other than CMMI. The health law requires HHS to disclose evaluation reports on its tests “in a timely fashion,” but so far the innovation center itself is largely silent.

One reason is that it’s early, officials say. There’s no reason to publish results in the first or second year of a three-year study, they say.

“We are not at the point of drawing conclusions at all,” said Lorenzo Moreno, who leads a team at Mathematica Policy Research that is evaluating experiments in primary care financed with CMMI dollars. “We are still very much in the early stages of processing the data.”

Another reason is the political risk of revealing the inevitable investments that aren’t working.

HHS officials concede that some projects will fail. But even those will produce good information on what doesn’t work, said Conway, a medical doctor who once worked for management consultants McKinsey & Co.

“If every single model met the criteria [for quality and cost goals] then we’re not being innovative enough,” he said. “So by definition there should be some models that are pushing the envelope, that may not succeed.”

But the administration is wary of giving Republicans another political weapon like Solyndra, the failed solar-panel manufacturer that cost taxpayers hundreds of millions of dollars.

“You get government agencies very gun-shy about having a program where some of the applicants might fail,” Emanuel said. “Every failure is going to be a front-page story about government malfeasance.”

Even so, independent researchers say they’re frustrated by the information blanket over the most ambitious attempt ever to test new kinds of payment and care management.

“If you don’t know whether something isn’t working, then you can’t make an interim fix,” said Christopher Langston, program director at the John A. Hartford Foundation, a nonprofit that works to improve care for seniors. Langston says he supports CMMI but adds: “It is incumbent upon the government to share publicly the results of work that taxpayer money is funding.”

The innovation center has already stopped funding for some grants that didn’t meet early goals, Conway said.

“We take the direction of Congress — that the goal was to test these models, to expand the successful ones, but also to terminate unsuccessful ones — very seriously,” he said.

But the department would not disclose the identity of recipients who have been cut off. Nor would it identify independent researchers with whom it says it has shared interim data.

There is also concern about the capacity of CMMI to manage its programs and expand the ones that work. Conway, also CMS chief medical officer, took over CMMI last year after its previous director, Dr. Richard Gilfillan, resigned to run a Michigan hospital system.

Conway is an “exceptional” leader, says Robert Kocher, a venture capitalist and another former White House adviser who helped launch the health law. As for the center’s chances of success, he says, “it comes down to people. Has CMMI recruited people who are capable of managing across these areas and who will have insights on what are the most effective approaches? That’s going to be a constant tension.”

Categories: Health Care

<p>headlines </p>

Kaiser Health News - Mon, 08/11/2014 - 12:00am

headlines

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Categories: Health Care

Mass. Pledges New State-Run Insurance Website Will Work

CommonHealth (WBUR) - Fri, 08/08/2014 - 2:07pm

The decision is in: Massachusetts will go with a new state-run health insurance website.

The Patrick administration revealed Friday that it is no longer building out the option of sending residents shopping for coverage to the federal health insurance site, HealthCare.gov.

“We are poised to offer consumers a streamlined, single point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment,” Gov. Deval Patrick wrote in a letter to federal officials, dated Thursday.

About 450,000 residents are expected to use the state’s new site, built with the Virginia-based company hCentive, when it is set to go live Nov. 15. The residents include:

– at least 251,000 residents who’ve tried to enroll for free or subsidized coverage since last October and are in a temporary plan through MassHealth (this coverage expires Dec. 31);

– another 98,000 people who were in Commonwealth Care when the website failed and have remained in those plans (this coverage also expires Dec. 31);

– and residents who purchase private insurance through the Health Connector.

Many of these people are wary of state promises. They waited months after applying for coverage online, not sure if they had health insurance.

“We appreciate that some people experienced some poor issues last time,” said Maydad Cohen, a special assistant to Patrick who is running the website project.

“The hCentive tool … will really allow individuals to use this product and continue to use our call centers … to make this year’s experience a much better one,” she added.

Cohen says tests of the new hCentive site show it is already performing as well as HealthCare.gov. Cohen says it will be ready for consumers to register, shop for plans, determine what, if any, assistance they can get, and enroll — all online. Members will not be able to pay for coverage online, though; they’ll have to put a check in the mail.

Everyone, Cohen stresses, will need to re-enroll beginning in November.

The Health Connector plans an extensive outreach campaign to help people re-enroll and review their insurance options.

The Patrick administration, guided by the Health Connector, opted to build a new state-run site rather than join the federal health insurance exchange so it could maintain control of insurance policies and programs. Massachusetts offers more generous subsidies for low-income residents. And insurers in Massachusetts weren’t sure they could build billing and enrollment systems that worked in conjunction with HealthCare.gov.

Insurers say they’re pleased with the administration’s decision.

“We appreciate the collaborative and transparent process the Administration and Connector have undertaken with us and we commend them for the significant progress that has enabled the Commonwealth to reach today’s decision,” Lori Pellegrini, the president and CEO of the Massachusetts Association of Health Plans, said in a statement Friday.

Patrick says the state will have contingency plans in the event that something goes wrong on the hCentive site. But some critics say it should keep building out the federal option just in case.

That would be an expensive proposition for a project that has already cost $108 million — with nothing the public can use yet. That $108 million has come out of a set-aside $174 million for IT implementation of the federal Affordable Care Act. The Patrick administration expects to ask the Centers for Medicare and Medicaid Services for additional funds — roughly $80 million, but that number is in flux.

“I wish that there had been a more open public discussion about the costs of the program,” said Josh Archambault, a senior fellow at the Pioneer Institute, a think tank. He pointed to many remaining questions, including, “how they are going to pay for [the website], what the federal government is going to pay for, the technology challenges that are ahead and will remain.”

Archambault said the public needs to be wary of “this rosy picture that we seem to be getting. It looks eerily similar to the first time around.”

Patrick says it’s important to stay focused on the goal: expanding coverage for the uninsured. There, he says, Massachusetts continues to be a leader with the lowest rate of residents who do not have coverage in the nation.

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