For the past six months insurance regulators in California have been working through negotiations with Anthem, a BC insurer whose initial premium rate hikes became a cause célèbre for healthcare consumers in that state and the Obama administration, alike. The previously proposed 39% increases created a firestorm in healthcare policy circles and provided Obama and HHS a temporary PR headache as a solution to lower premium increases was sought. The end result after scrutiny of state ledgers is a “smaller” increase —  of approx. 14 percent. | MP3 LINK

The retooled GAMC health plan initiated due to the budget crisis in this state earlier this year appears to be at a crossroads of sorts — and it involves payments to the participating safety-net hospitals.

The discussions began because Hennepin County Medical Center (HCMC) in Minneapolis has had a smaller percentage of potential patients enroll than the other three participating hospitals and, as a result, is getting paid more than twice the amount per patient.

The capitated-type payments to the hospitals which have the resources to participate in the GAMC overhaul was introduced as a way to complement patient enrollment caps to each of those participating hospitals. However, it appears that there is a breakdown in access-to-care and cost-per-patient parity, with HCMC getting the lions’ share of patients outside of the scope of its available general assistance medical funds. | LINK

CMS has informed state Medicaid directors the terms of qualification for federal matching funds for administrative costs toward information technological infrastructures. Specifically, states must comply with the following stipulations: administration of Medicaid incentive payments to Medicaid eligible professionals and eligible hospitals; oversight of the Medicaid electronic health record (EHR) Incentive Program; and the pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of health care quality and the electronic exchange of health information.

Besides the latter bullet point above, the entrance of individual states into EHR IT initiatives carries with it a commitment to Medicaid funds in this era of reform. Some states are already on board, like California — whose governor couldn’t be more excited to get the ball rolling.

“What we are launching today is a new era for healthcare,” Schwarzenegger said. “Through a simple broadband link, this state-of-the-art system will save lives by instantly connecting people from across the state, including under-served and rural areas, with the best and brightest doctors. The California Telehealth Network marks the beginning of a new digital highway that will fundamentally change the future of how healthcare is provided.”

Others, like Minnesota, are leaving some state government agencies — and patients they serve — in a lurch.

Millions of dollars in health care funds seemingly destined for Minnesota after last week’s emergency session of Congress have yet to clear a final hurdle: the signature of Gov. Tim Pawlenty, an outspoken critic of the new federal spending.

UPDATE: In an unsurprising PR move, leading Dem candidate for Pawlenty’s job come November — former one-term U.S. Senator Mark Dayton — wants Pawlenty to just accept fed funds. | LINK

The underlying tenet of heatlhcare reform in this country is access. Achieving that access is a means to an end that separates reform’s political ideology essentially down partisan lines. The ongoing Medicaid saga and its “role” via the states is thorn in the current administration’s side as reform gets underway. With some jurisdictions embracing federal matching funds upfront to finance care in the near term, others are downright hostile to enter in to a commitment when individual states’ financial outlooks are so shaky.

A new study highlights the reality facing states whose budgets are so tenuous (in this case, California), the conflicting scenario between guaranteed healthcare access and the depletion of funds to finance it generally leads to one conclusion: no matter what state governments do to cut spending in one healthcare sector, costs seem to go up in another — sometimes at a far greater rate.

Increasing numbers of Americans, especially adults on Medicaid, are using hospital emergency rooms for their health care, say researchers from the University of California, San Francisco. [..]

The findings suggest that access to primary care is a key problem, Tang [the researcher/author] said. “Whether it’s primary care physicians are not accepting new patients with Medicaid or that there aren’t enough primary care physicians, we need to dig a little bit deeper,” she said.

More spending the answer? Seems really audacious at this point to even ask that question, let alone think it. | LINK

Critics of President Obama’s rosy outlook on Medicare reform as part of the Affordable Care Act are pointing to the entitlement’s chief actuary as proof that his sudden realization of Medicare’s fiscal virtues under reform are peppered with politics. As recently as last weekend, Obama praised the almost half a trillion in savings over the next decade to the federal budget as not only the most fiscally responsible action the government has implemented as part of reform, but also as part and parcel of the overall commitment to the nation’s seniors with respect to the affordable access to healthcare.

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Two thousand ten just may go down as the year that Medicare is finally getting the recognition it deserves. Well, perhaps in a half-perverse way, anyway. The government entitlement program, which has just celebrated 45 years as the godfather of all payers in healthcare, continues to gain ink in an otherwise unrelated news cycle. President Obama appears to be taking credit for saving the program’s solvency singlehandedly, as his vision of healthcare reform would be far less vital without a provision to forming a leaner, meaner CMS.

In his weekly address to the American people, Obama reiterated his commitment to a program that is more “secure” than ever, a “commitment to America’s seniors” — never wavering from that core point. Obama will likely continue that same tenor as he campaigns for (some of the more vulnerable) Democrats in this year’s midterms, highlighting Medicare’s fiscal leanness with such tenacity, that to acknowledge that the country is still mired in a recession flirting with across-the-board double digit unemployment and ever-spiraling jobless claims is completely tangential.

At this stage, it is not clear how this gambit of Obama’s will play out in November, especially when wide swaths of the general population demographic — not just seniors — need the reassurance he continues to express on health reform as generalizable and essential to economic recovery in this country. All the while, the GOP will continue to hold up Obama’s enthusiasm for government’s role in Medicare as reason that 16% of this country’s GDP is one of the prime causes of the current economic disarray.

BC/BS Michigan is asking that state’s insurance regulators to vary the premium amounts on its Medigap supplemental offerings to seniors. It will ask state regulators to allow deeper discounts to low-income seniors while reducing the discounts on premiums for wealthier seniors. Medigap plans are standard insurance supplements to Medicare coverage offered only to beneficiaries with both Part A and B coverage.

Plans offered usually are the same; only the premiums can differ. All Michigan Blue Cross customers for the most popular of its Medigap policies now get a 39 percent discount off monthly premiums. The discount is distributed evenly to all Medigap policyholders, so that everyone pays just over $100.

It appears that with this move, the Michigan insurance marketplace is one of the first arenas in which states will negotiate with payers in the wake of expected cuts under Medicare Advantage offerings to fund reform over the next decade. | LINK

The Obama administration can take solace in some favorable news to become official later this week, as the annual Medicare and Social Security trustees report detailing the entitlement programs’ fiscal health becomes public. The report says that the budget will realize approximately $8B in savings at the dawn of reform, with a trajectory of almost a half a trillion in overall savings by the end of the 2010s.

Although not considered a particularly incendiary demographic with respect to Obama’s reform goals, the nation’s senior citizens have expressed concern over the solvency of Medicare over the next decade. It is safe to assume that the administration will use this news as a talking point to assuage those fears — in addition to running ads like this as a surrogate method.

Critics of the Obama admin’s plan to trim Medicare and Medicaid costs are quick to point out the presumed diversion of those implied savings into subsidies for the uninsured over the next decade — a move, they say, does nothing to retain solvency into the 2020s or save on healthcare costs in the long term. | LINK to report [PDF]

Health care coordination seems to the mechanism by which many healthcare pundits on either side of the the debate agree on how significant waste in spending can be cut. North Carolina’s Medicaid program is utilizing the medical home model as an example of that type of care coordination.

Moving beyond Medicaid FFS and traditional managed care partnerships, the delivery of care in this context identifies the appropriate patient populations based upon services meeting certain primary care needs. Physicians are paid higher reimbursements and a specialized “care-coordination” fee as incentive to continue participation. Community care networks made up of primary care teams in multiple locations serving Medicaid enrollees are headed by physicians and serve as the de facto health plan for those patients.

This model is another example of putting state healthcare spending to practical use, empowering physicians who manage it not only to have a stake in its success but also to remain intimately involved in quality healthcare delivery at the state level. | LINK

On Monday, Medicare (and Medicaid) turn 45. And to celebrate, the government will be touting its annual open enrollment. Well, okay, the feds will also be throwing in a plug for government’s role in health reform and what benefits are in store for those who were spring chickens when Medicare became law. Who better to message than the avuncular Andy Griffith?

Clearly targeted at those seniors who still think “death panels” are an essential creation of the Obama plan for reform, the ad — which begins airing in some markets today — will mostly focus on the benefits for seniors inherent in standalone or the program’s supplemental plans under reform. There will be no mention, however, of the major way the new reform law will maintain Medicare solvency well into the next couple of decades: trimming the fat from Medicare Advantage payouts from plans which originally saw benefit under the George W. Bush administration’s 2003 Medicare Modernization Act. | LINK

Republicans and Dems are waiting to see just exactly how public opinion continues to be shaped on the issue of healthcare reform in this country in the run-up to the 2010 mid terms. If the results of a new tracking poll [PDF] are any indication, there is comfort for the latter party.

The July Health Tracking Poll indicates overall public support for the health reform law is steady from June, while unfavorable views of the law have trended downward.  Half the public (50%) now expresses a favorable view of the law, while 35 percent say they have an unfavorable opinion (down from 41% in June).

The results don’t exactly show that misconceptions do exist, however.

[L]arge shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates “death panels.”

Results are over at the Kaiser (kff.org) website, a link from this blog in the Blogroll.

During the preamble to the passage of the Patient Protection and Affordable Care Act, much was made of the disharmony among the political left and right, giving fodder to explosive townhalls — many of which became inescapable albatrosses around the necks of President Obama and other Democrat proponents of the now famously defunct “public option” in its purest form. In the healthcare debate’s final days, an increasing number of physicians joined in the fray to make their voices heard. Generally (if you don’t count the political institutionalism of the AMA) many physicians saw pending legislation as a positive step toward increasing healthcare access for patients who, at the very least, needed coverage.

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The fact that President Obama is naming Don Berwick, MD, CMS head via recess appointment shows his commitment to quality in healthcare delivery. It’s welcome news given that his drive for cost and access were the other cornerstones of recently passed reform legislation. Via the WH blog:

There’s no question that Don Berwick is the right choice to be our next CMS administrator: he’s the founder of the Institute for Healthcare Improvement and has spent decades as a practicing physician and a Harvard professor. He’s dedicated his career to finding ways to make our health care system work better for patients and cost less for taxpayers.

The choice of Berwick to fill this post is the perfect fit for an administration in search of the holy grail in healthcare delivery: quality. | LINK