A handful of health systems like Geisinger have successfully played the role of both provider and payor for the past 30-plus years. As health care reform continues to evolve, more hospitals and health systems are exploring the option of starting their own health plans and insurance divisions.
The Pew Charitable Trusts and the John D. & Catherine T. MacArthur Foundation recently explored state and local health spending data from 2011 that show while total U.S. health care spending grew slowly in 2011, rising about 4 percent, health care spending by states and localities increased 10 percent, and consumed a larger share of revenues.
In a recent interview with Kaiser Permanente CEO George Halvorson, the executive discusses the money- and life-saving care delivery techniques used within the vertically integrated system he operates. Halvorson also discusses his upcoming retirement from Kaiser after holding the CEO position since 2002.
A new technique for quickly analyzing the DNA of newborns is being developed to a pinpoint a disease-causing mutation in a couple of days instead of the more typical weeks or months.
Patients who have access to doctor's notes in their medical records are more likely to understand their health issues, recall what the doctor told them and take their medications as prescribed, according to a recent study published by the Robert Wood Johnson Foundation.
In the wake of more than thirty attempts by Congress to repeal The Affordable Care Act, Secretary of Health and Human Services Kathleen Sebelius published an Op-Ed in The Arizona Republic describing the harmful effects of repeal on the average Arizona family. She went on to explain ACA provisions that have already helped to grow health care coverage across the country. Secretary Sebelius' Op-Ed comes on the heels of a report released by the Department of Health and Human Services regarding the negative effects of a repeal of the ACA on middle class families.
By Arnold Buchman, Senior Advisor to The Margolin Group
July 7, 2012
Thoughtful Conservatives and Liberals agree that the Affordable Care Act, while constitutional, is a flawed attempt to remedy our dysfunctional health care system.
Liberals are disappointed in the Supreme Court basing the act's constitutionality on Congress' taxing powers rather than its commerce powers. The distinction reverses 70 years of precedents and bodes ill for future Congressional attempts to fashion national solutions to national problems.
Conservatives take long-term procedural comfort in this limitation and see a short-term political advantage of characterizing Obamacare as a tax.
Meanwhile, reported polls continue to show that most people are opposed to the Affordable Care Act even though large majorities favor its constituent parts like extending dependent coverage and eliminating pre-existing condition limitations and life-time caps on benefits. This apparent paradox is probably attributable to a general lack of understanding of what the Affordable Care Act is intended to accomplish and how it would do so. That is of little wonder given the Act's 2,000-plus pages as explicated by the 193 pages of last week's Supreme Court opinions to say nothing of two-years worth of speciously glib attacks citing death panels, socialized medicine and the collapse of freedom.
Most people focus on the Act's intention of providing access to health insurance coverage to the 40 million or so currently without it, not knowing that a major portion of the Act is aimed at making the delivery of health care more efficient, effective and economical. For those now paying ever increasing, debilitating premiums, this has translated into the Affordable Care Act being viewed as an expensive, tax-funded entitlement program. To the extent that the Affordable Care Act guarantees health care to Americans, it is an entitlement program. But, it is one that owes its idea of entitlement, in large part, to an earlier piece of legislation, the Emergency Medical Treatment and Active Labor Act of 1986.
This 1986 legislation was enacted to end a hospital procedure known as "wallet biopsy" that was performed on patients coming into a hospital emergency department. If the patient could not prove they had the resources to pay for care, they could be turned away without treatment or even evaluation, no matter how dire his or her condition. With respect to providing access to coverage, the Affordable Care Act, in effect, can be seen as an extension of the earlier Emergency Medical Treatment Act.
Assuming that most Americans would agree with the public policy goal behind the Emergency Medical Treatment Act, they fail to recognize that they were paying for this policy with a heavy, albeit indirect tax. That tax came in the form of increased premiums by shifting the cost of care from non-paying patients to paying (insured) patients in the form of the $40 aspirin, the $750 stitches, etc. This shift is exacerbated when health care providers attempt to make up for the only-partially compensated costs of patients covered by low-paying public programs (Medicare, Medicaid).
The result has been that as premiums spiral out of the reach of middleclass Americans, there is more uncompensated care to be shifted. As long as we have a medical system model based on employment-status eligibility and fee-for-service medicine, the Affordable Care Act will not solve either the health care funding or delivery problems. Solution lies with replacement of employment-status eligibility with universal coverage and fee-for-service medicine with Geisinger Health System and Mayo Clinic type models of salaried professionals and integrated care.
Until then, the constitutional Affordable Care Act, whether denominated a tax or an exercise of commerce clause authority, is a giant first step in the right direction. Hopefully, Congressional efforts will concentrate on improving it rather than repealing it.
In June, the California HealthCare Foundation announced the winners of its “The Picture of Health: A Data Design Challenge.” Applicants were asked to illustrate health care cost data in “a compelling and comprehensive manner.” Challenge winners provided interesting ways of conceptualizing the cost of care.
By Jaimy Lee
Modern Healthcare Magazine
August 18, 2011
The center found that hospitals can improve quality by aligning with physicians but employing physicians is not a guarantee of clinical integration.
“What do you want health care to become?” was the question that opened discussion among a group of national thought leaders assembled on Sept. 8, 2010 in Washington, D.C. The answer to this question became the framework for a daylong discussion led by moderator Susan Dentzer and hosted by The Commonwealth Fund, the Patient-Centered Primary Care Collaborative and the Dartmouth Institute.
Almost eight months in planning, the journey to the September 8 meeting began during a conversation between Paul Grundy, MD, and White House health reform policy staff during a round table discussion on Aug. 10, 2009. The meeting showcased the evidence and outcomes from patient centered models of care that are transforming health care delivery. Those assembled recognized that activity around the patient centered medical home should focus not only on the Joint Principles...