Health Policy

The ambulance crew gave the hospital staff at Corpus Christi Medical Center a fast rundown. Dennis Fegan, 48, had passed out at his home about 30 minutes earlier. Luckily, his parents were visiting, and they called for an ambulance after he fell from a dining chair to the floor. Then Fegan woke up, just as suddenly as he had collapsed. Three minutes later, he passed out again for less than a minute; then he came to. By the time the medics arrived, Fegan's parents had watched their son lose and regain consciousness at least eight times.

There are two questions that critics of ACOs need to answer. First, what's the quality of care and how do outcomes stack up at an ACO versus the rest of our disorganized, dysfunctional health care system? Right now, organized group practices like the Mayo Clinic and Kaiser Permanente appear to be winning that fight, and Carilion is taking the first steps towards becoming a high value system. 

California was quick out of the blocks and has gotten off to a very fast start in creating the state’s insurance exchange.  The legislation that establishes the California Health Benefit Exchange is actually two bills, a Senate bill that sets the government structure, and an Assembly bill that outlines the activities of the exchange and establishes the regulations that apply to plans offering products both inside and outside of the exchange.  The expectation is that these bills will be passed before the end of the legislative session which is to say by August 31^st. (We should be clear that this creates the basic structure for the exchange; it won't be fully up and running as a health insurance marketplace until 2014 when the federal health reform legislation goes into effect.)

Generally, the design of the exchange is informed both by California’s own experience with its small business insurance exchange, Pac Advantage, as well as by the experience of Massachusetts.  Jon Kingsdale, the former executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts, was contracted to consult with the legislative staff and consultants who are crafting the bill.

Here is my latest contribution to the Altarum Institute's Health Policy Forum, another in my series of "what works" posts. This one is about an innovative Medicaid Managed Care plan in Oregon.

Care Oregon, the state’s main Medicaid managed care plan, had two choices a few years ago, after many commercial partners in the Oregon Health Plan decided to get out of the money-draining business.

It could go broke. Or it could change its world.

It opted for the latter. Today, the Portland-based nonprofit CareOregon is a bit savvier about the business end of its mission. And it’s still trying to change its world.

Joe Paduda hosts the latest edition of the Health Wonk Review over at Managed Care Matters and doesn't waste any time -- he jumps right on in. (Unfortunately, though, not into a pool.) He jumps right into the details of health reform implementation and reminds us that the real work is in the details, the definitions, the requirements and in the operating guidelines. He runs through the fundamentals and then delves a bit deeper, highlighting our colleague Joanne Kenen's recent piece in Slate on ER and the role of palliative care. Check it out!

What if those “death panels” were actually good for your health?

The death panels, of course, don’t exist; they were the product of overheated political imaginations amid an overheated debate about health care reform. But palliative care does exist — and despite the distortions of last summer’s debate, it doesn’t mean “pulling the plug on Grandma.” (Or Grandpa for that matter, although he seems to have been neglected in the national brouhaha about death panels.)

The New England Journal of Medicine has a very important study and editorial (and kudos to them for putting both out on the web open to all, not just subscribers) on how palliative care prolonged the life of dying lung cancer patients -- and gave them a better quality of life. In fact, the patients with palliative care lived an average of 2.7 months longer than a similar group of patients who received standard cancer care at the same hospital. And two months is about how much state-of-the-art chemo can add to life. Here's the start of an online magazine piece, Palliative Care May Trump Heroic Measures in Life Expectancy, I did for Miller-McCune (a smart, relatively new magazine based in California that you should check out if you don't know it):

What if those “death panels” were actually good for your health?

This continues our series of posts on the various constitutional challenges to the individual mandate, by Tony Cardona, an attorney who is doing some work with New America's health policy program. Read his post about the Commerce Clause here.

The President stares out the windows of the Oval Office into a cold January. He can do nothing but wait; it’s now up to the courts. Overwhelmed by a divided Congress and high unemployment, the President looks on as the agenda he muscled through Congress with political savvy is debated and challenged.  Meanwhile, the economy washes slowly and tepidly forward, seemingly on the verge of receding back into the deep, dark water. The law suits begin to surface and the President’s agenda is attacked with concern at best and contempt at worst. Ultimately, it is brought before the Nine. These represent the final judgment not only for the law, but also, possibly, for the President. Everybody waits, not knowing whether Congress has exceeded its powers. Justice Roberts sits in his chamber and drafts his opinion, joined by six other justices. His decision rejects the new Act, declares it invasive of State sovereignty, and finds that Congress has no Constitutional authority to impose such a mandate on the populace. The law is a failure. The President sits down, wondering whether his moment has passed.

Re-posted with clarification about employer-sponsored coverage.

Yes, it is that time of the year, Back To School. Along with the endless flyers announcing sales on packets of pens and pencils is a great deal of confusion around provisions in the health reform law that allow parents to keep their adult children on their health insurance plan, or dependent coverage as it is better known in the policy world.

Here is what I hope is a simple way to think about this for all of the parents and dependents out there, along with some unanswered questions that still need to be sorted out:

This is the fourth and final post in our series explaining Accountable Care Organizations, or ACOs. Today we focus on their role in the new health reform law. Earlier this week we've looked at exactly what makes an ACO, and who can form them. See Part I here, Part II  here, and Part III  here.

Health Care Reform

Accountable care organizations, as envisioned under the new health reform law, will begin as a series of pilot programs in Medicare and Medicaid. If the pilots succeed, similar models can be spread into the private sector. (Some private sector ACOs are already evolving on a parallel track.) The new reform law also gives providers and HHS freedom to come up with innovative new models. The reform law calls for several demonstration projects involving ACOs or a similar concept: the Medicare Shared Savings Program (section 3022), a Pediatric accountable care organization demonstration project (section 2706), and a physician gainsharing demonstration (section 3027).