The initial impact of the new healthcare reform law won’t begin until late September/early October. But how much do Americans really know about the legislation’s benefits and changes? President Obama has embarked on some PR jaunts to remind the public of the virtues of reform, but is the White House’s awareness campaign really enough to get the word out that reform is actually imminent? Apparently not.

Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it’s so complex, consumer advocates worry that people won’t take advantage of its benefits, so they have embarked on a nationwide education campaign. [..]

“People are still afraid that there are death panels . . . or that Medicare is going to go away,” says Cheryl Matheis of AARP, the nation’s largest seniors organization. “We have an obligation to get the information out there…”

It’s the new reality. Focus groups, polls, lobbies. To bad reform won’t cover the cost of these mechanisms of information dissemination. | 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.

President Obama had yet to deal with sinking approval ratings; had yet to encounter such outrage over Arizona’s lukewarm SB1070 law; and had yet to consider how his actions over the previous 18 months of his presidency may impact midterms. Nope. This time last year, the most powerful 48 year-old in the world had to contend with the initial inklings of voter discontent with the looming vote on reform. Late summer 2009 — in the span of the healthcare debate/debacle — represented the germination of alternative voices to his heretofore mostly respected push for guaranteed access to heatlhcare.

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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

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.

What do you get when old-fashioned community activism meets 21st century social media tech? Perhaps the best politics-is-local example of reforming healthcare access so far after its passage on a national scale. Howard County, Md. – approx pop. 250 000 — is partnering with a tech firm with one simple goal in mind: to guarantee access to healthcare for its uninsured.

Its mechanism looks to be a harbinger for reform-based enterprises such as local healthcare exchanges/cooperatives (whether subsidized or not) within which members pay a monthly fee for basic services. These services may run the gamut of primary care — as acute hospitalizations, preventive medical treatments and screenings, and emergency medical access would be covered.

Perhaps even more important, the utilization of concierge providers as healthcare “coaches” as both an empowerment mechanism and compliance tool, ensures continued healthcare access, sound preventive care, and decreased future healthcare costs. Will it serve as a model for state-based healthcare exchanges under reform? Looks like it’s on its way. | LINK

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 U.S. Preventive Services Task Force, an independent, non-partisan body made up of primary care physicians involved in developing preventive medical guidelines based upon evidence-based medicine, has always reveled in its staunch self-governance. That could change ever so slightly in the new age of health reform.

The academic research-oriented group will continue to make recommendations on best-preventive practices and supply ratings (“A”, “B”, etc.); but this time, under reform, insurers will be required to cover services that receive such a rating. The Obama administration hopes that this increase in access (which will require a small premium increase by insurers in the near term) will reap savings in the future — as costs for preventive testing, screening for certain chronic diseases, vaccinations, and well-child visits would be covered (without health plan co-pays and deductibles) if so rated by the USPSTF.

Besides having to consider methodology involved in formulating its ultimate recommendations, the group will also have to contend with the specter of political agenda setting if lobbying groups and disease advocacy organizations have their way under this bit of legislation — scheduled to go into effect in September. | LINK

Some headlines prior to the Independence Day holiday. Normal posting resumes here at Doctor Pundit on July 6. Have a happy and safe holiday weekend!

• Veterans Admin admits to the debacle surrounding dirty dental instruments placing hundreds of patients at risk of HIV transmission. [LINK]
• Minnesota nursing strike may be averted, but time will tell if threat to strike was more of a bluff. Hospitals and nurses pledged to work within the constraints of internal governance. [LINK]
• How’s healthcare reform going? Just fine, according to some. [LINK]
• How influential will states’ insurance commissions be when regulating insurers’ medical loss ratios in the age of reform?
  

  The medical-loss ratio measures how much of premiums insurers pay out for medical care versus administrative costs. The new law requires that insurers use at least 80% of the premiums from individuals and small businesses to pay for medical care and profit-taking, and 85% of premiums from larger employers. Health insurers are waiting for regulators to clarify how companies must account for the numbers—whether they can average the MLRs of their subsidiaries, for instance.

  [LINK]

• Study: Genes key to longevity. [LINK]

Former HHS Secretary from the Clinton Administration, Donna Shalala told a standing room only crowd at the AHIP convention in Las Vegas over the weekend that the recently passed healthcare reform bill’s ultimate utility will depend more on the influence of insurers and not of the government.

“The American people voted not for a government takeover of healthcare, but they committed themselves to the employer-based system and private delivery,” she told the insurance industry crowd during a session titled, “A Way Forward: Next Steps for America’s Health Care System.”

While “a great deal of money” will be spent on public insurance programs, including Medicaid and Medicare, the “basic core” of reform will involve private insurers, she said.

Kudos to Shalala for being honest in this assessment. Although many insurers have begun taking steps to work within the framework of changes that will begin within the next two to four years, the reality is that private insurers will always have a stake in healthcare delivery. The development of exchanges, private-public contracts, and other mechanisms will be the result of the necessity to create innovation to maintain a robust healthcare marketplace. | LINK

It continues to be a rather interesting and fun exercise watching how Massachusetts handles being the example of state-sanctioned guaranteed healthcare coverage. Over the past couple of months the escalating heat brought on by some of the state’s major insurers to test the state government’s reach on the regulation of premiums crescendoed recently, with a judicial ruling that expressed that the state was able to cap premium rate increases coverage for small businesses. Although the insurer in this case (Neighborhood Health Plan) agreed to only a 7.7 percent increase (down from an original 11 percent increase), other insurers are still pursuing the courts via the appeal process.

In a statement, Governor Deval Patrick applauded the settlement. “I appreciate the willingness of Neighborhood Health Plan to work with us to provide immediate relief from skyrocketing premiums,’’ he said, “and hope they will be an example to other health plans as well.’’

Time will tell; but for now, the first test over challenges to the state government’s insurance commission to regulate rates by its insurers guaranteeing small group and individual coverage seems to be in favor of the state. For Neighborhood Health, I wonder if they consider this episode one of “leading by example”. | LINK

Is the President waging an apparent one-man war as he still continues to gauge support for his nascent reform overhaul? As recently as a couple of days ago — as part of his weekly address — he renewed attacks on Insurance, noting that “For too long, we have been held hostage to an insurance industry that jacks up premiums and drops coverage as they please. But those days are finally coming to an end.”

Naturally, this message was directed to WellPoint, the California insurer which came under fire during the latter stages of the reform bill fight in Congress; it was accused of raising premiums to astronomical levels, establishing a fighting target and kicking off a newfound confidence in the President in getting his plan passed into law.

WellPoint’s CEO specifically responded to Obama and essentially told him to stop the attacks.

WellPoint Chief Executive Angela Braly fired back. In a letter Sunday addressed directly to Obama, she noted that policy changes were underway nationwide, and she called on him to stop his attacks on the industry. It will take cooperation between the industry and government to implement the new healthcare reform law, she said.

WellPoint also backed down and pledged its own internal investigations when recently accused of rescinding coverage to previously covered policyholders obtaining breast cancer treatments. HHS Secretary Sebelius and, now, Senator Diane Feinstein (D-CA), are urging for more discussions with the CEO and others to address this issue. Of course, this all begs the question — as insurance companies are supposed to be working with the President before the law requires them to specifically do so — can’t they all just get along? | LINK