Pioneer ACOs: Moving Toward Needed Transformation In Health Care

Debra Ness, President, National Partnership

Cross-posted from Health Affairs Blog

We have commended the Centers for Medicare and Medicaid Services (CMS) on this blog in the past for actions regarding Accountable Care Organizations (ACOs) – but we’ve also noted the need to establish strong enough criteria to ensure that this new model will be implemented in ways that deliver on the promise of better coordinated, more patient-centered care that gives us improved value for our health care dollars. 

That is why we applaud the launch of the Pioneer ACO program by the Center for Medicare and Medicaid Innovation (CMMI).  It exemplifies the kind of innovation and testing we need to forge a path out of the current dysfunctional system.

William Kramer, Executive Director for National Health Policy, PBGH

Certainly, the nation has few higher priorities than to leave behind a health system that often fails to coordinate patient care, bringing poor clinical outcomes, miserable patient experiences, duplication, waste, errors and skyrocketing costs. The financial security of families and the economic viability of our nation depend on replacing the current payment system, which rewards volume of services regardless of whether those services are appropriate or beneficial to patients.

We need a fundamental transformation, and Pioneer ACOs have the potential to significantly change the way providers coordinate, collaborate and share accountability for the patients they serve.   But the true test of whether these ACOs deliver on their promise will lie in both the spirit and specifics of how they are implemented.

The Pioneer ACOs improve upon the Medicare Shared Savings Program announced in October in a number of ways that can more quickly advance the transformation we need:

  • It has stronger financial incentives – e.g., a higher level of shared savings and risk that can move us more quickly away from fee-for-service to population-based payment to strengthen accountability for both quality and cost.
  • Requirements for the meaningful use of electronic health records (EHRs) by the majority of the ACO’s primary care providers will spur more rapid adoption of EHRs which, in turn, should facilitate care coordination across providers and settings, help clinicians improve patient outcomes, and enable patients to engage more actively in their care.
  • It encourages public-private alignment.  We agree with the CMMI that ACOs will be more successful if the participating providers see this as their core business strategy rather than as a siloed experiment limited to a select group of patients.  The requirement for Pioneer ACOs to enter similar contracts with other payers (such as commercial insurers, employer health plans and Medicaid) reinforces this.  It is important, however, that CMS not allow the “good faith effort” exception to be used to avoid this alignment.
  • The emphasis on prospective identification of ACO patients, where feasible, will enhance providers’ ability to track, assess and improve the care they deliver to patients in their ACO panels.

As important as these requirements is the strong emphasis on patient-centered criteria and accountability to a meaningful set of quality metrics that include patient experience of care.  The assessment of patient experience is essential to determining whether ACOs ultimately deliver better care and outcomes from the patient perspective.

Furthermore, the inclusion of both a patient representative and a consumer advocate on the ACO governing board is critical to ensuring that ACOs are dedicated to serving the needs of their communities and putting patients first as they redesign the care delivery process.  We cannot truly achieve a patient-centered system unless we involve patients and consumers in the governance and design process—right from the start.  Patients have a unique perspective that comes from being the only person at the interface of all facets of their care.  They are the best judges of whether the care they get is well coordinated, meets their needs and enables them to maximize their health.

Experienced consumer advocates can be key allies in ensuring that ACOs are serving and improving the health of all segments of a community.  They can also facilitate consumer education and engagement in this new model of care.

It’s too soon to predict the impact of ACOs, and there is also a need to remain vigilant—especially with respect to the potential for Pioneer ACOs to increase the market concentration of existing large health systems and to use their market power to raise prices or engage in anti-competitive conduct.

But there is cause for encouragement.  We think the Pioneer ACOs will be on the right track to realize the promise of better care and better value for our health care dollars.  If that proves to be right, our nation will be much better off.

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The Imperative for Caregivers to Speak Out and Help Shape Policy

Debra Ness, Leader, Campaign for Better Care

Too often, being a family caregiver is like running an obstacle course: carrying medical records from doctor to doctor, carving out time to attend medical appointments and trying to be sure that you fully understand your loved one’s needs, juggling care for a relative while trying to meet your own job and family commitments. It’s hard and often frustrating work, and it’s led thousands of family caregivers to become activists who are using their experiences to shape health reform implementation.

To harness the power of these powerful activists, the National Partnership for Women & Families joined with Community Catalyst, the National Health Law Program and The Leadership Conference on Civil and Human Rights to create the Campaign for Better Care. With generous funding from The Atlantic Philanthropies, the Campaign is working with patients and family caregivers to ensure that health reform has a broad and lasting impact. The goal is to significantly improve the way we deliver health care so the system finally works for the most vulnerable among us – older adults, patients with multiple chronic conditions and their family caregivers.

With support from organizations like the Family Caregiver Alliance and the Campaign for Better Care, patients and family caregivers from across the country are advocating at the federal and state levels more than ever. They are insisting that new models of delivering care be truly patient- and family-centered. They are calling for team-based and multi-disciplinary approaches that include important services that have not been readily available to many: geriatric assessment, care planning, comprehensive care coordination, transition management between care settings, medication management, and community support for older adults and their family caregivers.

At the same time, in Washington, D.C. we are doing the hard but important behind-the-scenes work to ensure that the Affordable Care Act (ACA) is implemented in ways that meet the particular needs of vulnerable older patients, and make quality, affordable, coordinated health care a reality for families.

By sharing their personal experiences, family caregivers play a compelling and essential role in influencing policy and public opinion. They are telling the stories that underscore the problems in our health system today, and how the decisions made in Washington affect people’s lives. In doing so, caregivers are helping to move our nation closer to the day when essential health services are covered, when preventive care and community based support and services are priorities, and when care is truly coordinated. By speaking out about their own unmanageable burdens, caregivers hasten the day when others families will have fewer of these burdens to bear.

The ACA contains the key ingredients to transform our health care system from one that is shaped by the interests of providers and payers to one that is dedicated to the needs of the patients, and to providing the services and supports that they and their families need. This is long overdue. What this law promises is what the nation needs most: doctors who talk to one another, medical records at our fingertips, and a system that is built around addressing the needs of patients and families. Its real promise is a health care system in which caregivers and the people they care for no longer have to fend for themselves in an uncoordinated and fragmented system.

This month, as we mark National Family Caregiver Month, the U.S. Supreme Court announced that it will soon consider whether to let stand key provisions of this landmark health care reform law. There’s a lot at stake – in Congress, the courts, and at the community level as this national conversation continues. That makes it more important than ever that this month –and every month –caregivers speak out about the imperative to make the health care system work for all of us.

What we do – and don’t do – to address the caregiving challenges will families today and in the future, and it will affect our strength, competitiveness and health as a nation for years to come. The time for action is now.

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Cut Medicaid? Thanks, But No Thanks!

Debra Ness, Leader, Campaign for Better Care

Thanksgiving. It’s a time for family, food and giving thanks especially for programs – like Medicaid – that make a difference in the lives of millions of American women and their families.

Women make up the majority of enrollees in Medicaid.  For younger women Medicaid provides essential preventive and primary care.  And for millions of older women,  Medicaid provides coverage for long-term care services –including nursing home coverage – that Medicare does not provide.  If lawmakers arbitrarily cut Medicaid, these cuts could jeopardize nursing home coverage, making it extremely difficult — if not impossible — for states to meet the needs of the growing number of vulnerable older women who need help to pay the impossibly high costs of nursing home and other long-term care. And tougher limits on eligibility or reduced coverage for services means that many older women could face dramatically higher out-of-pocket spending for the health care and nursing home services they need.

Put simply: deep cuts to Medicaid funding will disproportionately harm older women, and could have disastrous consequences for many of the most vulnerable people in our country.

 Please tell Congress: Cutting Medicaid is not the solution!

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Welcome Progress, But the Final Verdict on ACOs Is Yet to Come

Debra Ness, Leader, Campaign for Better Care

Last week, the Centers for Medicare and Medicaid Services (CMS) may have done what once seemed impossible. Its final rule on Accountable Care Organizations (ACOs) seems to have put an end to the rancor and bitter debate on this particular issue, shaping a framework that just about all parties can accept.

By responding thoughtfully to comments on the proposed rule, and balancing competing interests, the agency has given us a welcome respite from the pitched battles that are raging over so many aspects of health reform. But the real measure of success will be whether successful ACOs are soon in place, providing better-coordinated, more patient-centered care for millions of patients and giving us all a way to get better value for our health care dollars.

William Kramer, Executive Director for National Health Policy, PBGH

We believe last week’s announcement will encourage more providers to participate in this program. From the perspective of consumers, we applaud the strong emphasis on patient-centered criteria that should pave the road to better care. And especially as advocates for our oldest, sickest and highest risk patients, we applaud this

effort to incentivize better primary care, increased coordination, and shared accountability across providers. From the perspective of purchasers, we believe that CMS has crafted a foundation to hold providers accountable for quality performance and cost savings, and created a path to move providers away from today’s perverse fee-for-service system.

We are very pleased that this final rule will require ACOs to use beneficiary experience of care and outcome measures to evaluate performance. We believe CMS landed in a better place with respect to the quality measures ACOs must report on. While we appreciated the comprehensiveness of the original list of 65 measures, there were a number of measures that added minimal value. The final list of 33 measures is a stronger set that focuses on highest impact measures and, very importantly, includes measures of patient experience, functional status and clinical outcomes, care coordination and safety. We would, however, have liked pay-for-performance to occur sooner in the program, especially for measures that are already in use. Finally, we are very pleased that this final rule continues to ensure full transparency, notification and choice for beneficiaries. These provisions are all essential to engaging consumers in a positive way and realizing the promise of successful ACOs.

Nobody got everything they wanted in the final rule and we, too, have concerns. We are disappointed that the upfront anti-trust review process is no longer mandatory, but glad there is strong acknowledgement that there must be close monitoring for any signs of cost-increasing market concentration. We are glad to see that the final rule requires CMS to share ACO applications and new types of data that will strengthen the ability of the Federal Trade Commission and Department of Justice to assess and monitor the market impacts.

It is also unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered, rather than expanded to include representation from a diverse range of community stakeholders, including purchasers, labor and community-based groups. It is now incumbent on CMS to closely monitor ACOs to ensure that they reflect the community interests they are intended to serve, and that consumers, beneficiaries and other key stakeholders are engaged in the design, governance and evaluation of their performance. Consumers and purchasers hope and expect that these provisions will be strengthened down the road if needed.

Every leader from every sector has a list like this – things they like, and things they don’t like, in the final rule. But the time for tallying who won and who lost, and by how much, is over. Now it’s time for all parties to come together to create successful ACOs that deliver care that is patient-centered, that improves quality and care coordination, and that lowers costs. The stakes are too high to let anything stand in our way, or to let opponents of reform exploit any remaining differences.

We said before this rule was released that it’s time for a new dynamic where we come together to implement the reforms the nation so urgently needs. ACOs are one of many promising models and initiatives that will be tested by the CMS Innovation Center over time. It is well past time to leave our broken, dysfunctional health care system behind and give the Accountable Care Organization model the test it deserves.

The final rule gives us a chance to do that. That’s all we could ask. CMS has done its part. Now it’s time for the rest of us to do ours. If we do, patients, their families and family caregivers, our economy and our nation will benefit.

Debra L. Ness is Leader of the Campaign for Better Care and President of the National Partnership for Women & Families. William Kramer is the Executive Director for National Health Policy at the Pacific Business Group on Health. Together, they co-chair the Consumer-Purchaser Disclosure Project, a group of leading employer, consumer, and labor organizations working toward a common goal: to ensure that all Americans have access to publicly reported health care performance information.

Cross-posted from the Health Affairs Blog.

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In the Works: New Patient Rights

Christine Bechtel, Leader

“When it comes to health care, information is power. When patients have their lab results, they are more likely to ask the right questions, make better decisions and receive better care.”
~ HHS Secretary Kathleen Sebelius

Patients and families may soon have a great opportunity to have more control over ­ and make improvements in ­ the health care they receive. Under a proposed rule released by the U.S. Department of Health and Human Services today, patients will be able to receive test results reports directly from labs upon request.

This is great news: it will help patients access their information when they want and need to, ensure that their medical records are updated and accurate, and support them in being active and informed decision-makers in their care.

Does this take doctors out of the equation? Absolutely not. Doctors and other providers always have been and will continue to be essential in helping patients understand and interpret their test results. This rule won’t change that.

Here’s what it will change: Right now, many states have laws that prohibit patients and families from getting their test results directly from the labs; they must go through doctors’ offices instead. And unfortunately, there are still millions of patients who do not receive their lab results, leaving them without the information that they need. That, too, will change.

The new rule will allow patients to have a more hands-on role in their health care decisions and be able to seek the medical attention that they need – and that’s a huge step forward for better care.

Learn more in our statement.

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A Team Approach to Care

As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates.

Community Catalyst and Georgetown University Health Policy Institute Center for Children and Families created the States of Innovation blog series to shine a spotlight on states that are trying to find a better way. We will highlight states that are pioneering new approaches to making Medicaid more sustainable without harming – and often by improving – care for the millions of vulnerable seniors, people with disabilities, children and low-income parents that rely on Medicaid.

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Both the Affordable Care Act (ACA) and many state initiatives have sought to encourage new models for health care delivery that simultaneously reduce costs and improve care. Stemming from pioneering work in one of its cities, New Jersey has passed an innovative new law that allows its Medicaid program to replicate a successful trial of team-based care.

Camden, New Jersey is one of the nation’s poorest cities and has one of the highest crime rates in the nation. Homelessness, drug trafficking, high unemployment, and sky rocketing health care costs are a fact of life in this city of just 79,000. Between 2002 and 2008, 978 patients made 3,882 visits to emergency departments in the city – a majority of the visits were for preventable conditions that could be treated by a primary care doctor.

In this dire situation a family practice physician, Dr. Jeffrey Brenner, pioneered a successful approach to reducing hospital readmissions and health care costs of the sickest and most vulnerable populations. A recent episode of PBS’s Frontline highlighted Dr. Brenner and his innovative work and praised his initiative as a new model of care. The work of the Camden Coalition of Healthcare Providers, the practice that Dr. Brenner set up, laid the groundwork for the Garden State to adopt this model, the Medicaid Accountable Care Organization (ACO) Demonstration Project, which was signed into law by Governor Christie earlier this month.

Where it all began
An article by Atul Gwande in The New Yorker features a story about Frank Hendricks, who had multiple health issues, weighed 560 pounds, had a substance abuse problem and lived on welfare. Hendricks spent a majority of his time in the hospital because no one in the health care system was able to effectively manage his care. Dr. Brenner visited him regularly, arranged for a social worker and a nurse practitioner to coordinate his care, and advised him on how to best take care of his health –taking medication on time, healthy eating habits, etc. This team approach to care resulted in a significant improvement in Hendricks’s health.

Hendricks is an example of a “super utilizer” in Camden’s health care system. Through the collection of hospital data, Dr. Brenner found that a core area in the city, where a nursing home and a low-income housing tower are located, accounted for a majority of the hospital visits and millions of dollars in health care costs. Mr. Hendricks’s case and the other super utilizers identified by Dr. Brenner’s work showed that primary and preventive care with a team approach, which takes the whole person into consideration, significantly improves the overall health of the patient. According to Dr. Brenner this team approach has resulted in a 40-50 percent reduction in Camden’s health care costs since he started this work in 2007. The cost saving strategies that Dr. Brenner and his team have used include:

  • – Nurse practitioner-led clinics in high cost buildings
  • – More super utilizer outreach teams
  • – Medical home-based nurse care coordination
  • – More same day appointments (open access scheduling)

What is New Jersey doing?
Despite the great success of Dr. Brenner’s work to improve patient care and bring down overall health care costs, there are a few barriers to replicating this model elsewhere. Many state Medicaid programs do not have a payment system that provides incentives for providers to work together to improve care for patients, and hospitals in many states often lose money if the rate of preventable hospitalizations decreases.

New Jersey passed the Medicaid ACO Demonstration Project to try to remedy those misaligned incentives and help other communities replicate Dr. Brenner’s success. This legislation enables community-based, non-profit coalitions of hospitals and primary care providers to apply for recognition by the state of New Jersey as Medicaid ACOs. Once approved as ACOs, these coalitions would qualify for “shared savings” if they reduce Medicaid costs by providing increased access to primary care and working together to better coordinate patients’ care.

Under the legislation, the state is required to share any savings it accrues as a result of improved care coordination with the participating providers in the ACOs. To protect patients from any adverse incentives that might give ACOs a reason to skimp on care, ACOs must demonstrate improved care for their patients in order to qualify for these shared savings. The state will therefore be measuring – and requiring – quality improvement based on benchmarks which include: patient experience, access to primary and behavioral care, and reduction of unnecessary and inefficient medical costs.

Key lessons for other states
Dr. Brenner’s work shows that by providing more primary care and better coordinated care, we can drive down costs and create better outcomes for patients. The key is offering the right incentives to providers so they can work as team to coordinate care for the patient.

While New Jersey offers us one model to accomplish that, the ACA encourages many innovative approaches to improving care while reducing costs. For example, the ACA established the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center has the resources and flexibility to rapidly test innovative care and payment models and encourage widespread adoption of practices that promote better health and deliver better health care at lower cost.

The ACA also created an option for states to qualify for enhanced federal funding to set up health homes to better coordinate the care of Medicaid beneficiaries with chronic physical or mental illness. If we can make this approach work for the sickest and most vulnerable population – then the health care system can work for everyone.

– Leena Sharma, Field Coordinator at Community Catalyst. This blog post is cross-posted from the Community Catalyst blog.

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Washington Comes to Cincinnati to Discuss Better Care

Cathy Levine, Leader, Ohio Campaign for Better Care

Each day, health care advocates like me struggle to bring the voices of people who have encountered health care problems to the policymakers who make the decisions that affect our care and our lives. Earlier this month, some of those policymakers came to us in Cincinnati to hear what we had to say. It was a useful gathering that included patients, hospital administrators, doctors, nurses, advocates and policymakers – a gathering I hope will be repeated throughout our state and country.

The 100-odd participants had a serious conversation about how important it is to include patients in discussions about improving care.

We were honored to host Dr. Don Berwick, Administrator and Dr. Paul McGann, Deputy Chief Medical Officer, of the Centers for Medicare and Medicaid Services (CMS). (CMS is the federal agency responsible for Medicare, Medicaid and the Children’s Health Insurance Program, which together provide care to nearly one in three Americans). Our roundtable was sponsored by the Ohio Campaign for Better Care and the national Campaign for Better Care and held at Xavier University.

Drs. Berwick and McGann gave an update on the Partnership for Patients: Better Care, Lower Costs initiative, an unprecedented private/public partnership designed to improve the quality, safety and affordability of health care by reducing medical errors, improving care coordination and lowering the number of unnecessary hospital readmissions.

We’ve been working hard in Ohio to ask our hospitals to sign onto the Partnership, and to include patients and families in efforts to improve quality and safety. At the event, we were proud to announce that Christ Hospital was signing the Partnership for Patients pledge. Now all Cincinnati area hospitals are on-board with this new policy, which makes me very proud.

When our local hospitals establish real partnerships with patients, people like Gloria Smith will benefit. A Cincinnati cancer survivor, Gloria shared her powerful personal story with Drs. Berwick and McGann at the event. Despite a long history with cancer, Gloria was left with a damaged, raspy voice because doctors were slow to diagnose her cancer of the larynx, and she had to be her own persistent advocate to get a diagnosis at all.

Dr. Berwick was moved by her experience, and hit the nail on the head when he said: “The only way we can get American health care where it needs to go in our nation is with a shared agenda, mutual understanding, and real solid communication between the people who benefit from care – and ought to – and the people who give care and want to meet their needs.”

Joining me and Dr. Berwick on the panel were committed advocates and providers, each of whom is breaking ground in patient-centered care. They were: Christine Bechtel, a leader from the national Campaign for Better Care; Karen Meyers, Attorney-Advocate-Adjunct and Past Chair of the Family Advisory Council at Christ Hospital; Colleen O’Toole, President of the Greater Cincinnati Health Council; Laura Trice, Medical Director of TriHealth Seniors’ Health: SeniorLink and GEROS Medical Group; Ken Wilson, Director of Program Operations for the Council on Aging of Southwestern Ohio; Norm Wernet, State Director-Field Coordinator, Ohio Alliance for Retired Americans; and Robert Harris, Peer Support Coordinator, The Center for Independent Living Options, Inc.

They and the people they represent demonstrate the great potential for the Campaign for Better Care to succeed in ensuring that a reformed health care system provides the comprehensive, coordinated, patient- and family-centered care that older adults and individuals with multiple health problems need. This event built new relationships between providers and patients and we look forward to working closely with the Greater Cincinnati Health Council and the Health Improvement Collaborative of Greater Cincinnati, the leaders in local efforts to improve health care safety and quality, to increase patient involvement in the work.

We know that billions of precious health care dollars are wasted every year in this country on poor quality care that makes patients sicker instead of better. And we know that, now more than ever, with Medicare and Medicaid on the chopping block, we must spend our health care dollars more wisely. If we improve the quality and coordination of care, and refuse to pay for poor quality care, we can avoid the kind of irresponsible cuts that leave our oldest and sickest patients – patients like Gloria Smith – to fend for themselves.

That’s what we are pressing for here in Ohio. I am very glad that the federal leaders took the time to hear about our work and that the local health care community wants to work with the Ohio Campaign for Better Care to expand the patient and family voice in improving care.

Cathy Levine, JD, is  Executive Director of UHCAN Ohio and leader of the Ohio Campaign for Better Care.

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Saving Money, Saving Lives: Maryland Paves the Way on Payment Reform

cross-posted from the Community Catalyst blog

STATES OF INNOVATION:

As policymakers across the country cut Medicaid to help balance their budgets, many are recycling the same harmful policies they’ve used year-after-year: cutting vulnerable Americans off Medicaid, restricting critical benefits like prescription drugs, and slashing already-low provider reimbursement rates.

The States of Innovation blog series, a joint initiative between Community Catalyst and Georgetown University Center for Children and Families, aims to shine a spotlight on states that are quietly trying to find a better way. We will highlight states that are pioneering new approaches to making Medicaid more sustainable without harming – and often by improving – care for the millions of vulnerable seniors, people with disabilities, children and low-income parents that rely on Medicaid.

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By improving how Medicaid and other health insurers reimburse hospitals, Maryland dramatically lowered its rates of costly, potentially avoidable events (PAEs) such as hospital-acquired infections. Maryland’s initiative is far more exciting than that sentence would lead you to believe, and we’ll tell you why.

What’s Really at Stake

Wonky terms like “potentially avoidable events” – and even wonkier acronyms like “PAEs” – obscure what this is really about: the hundreds of thousands of people each year whose lives are shortened and who endure needless pain or lengthy hospital stays because of preventable medical errors.

Indeed, “PAE” takes on personal meaning to people like Ginny Harvey. In 1996, Ginny broke her ankle stepping off a curb and had surgery at a prominent hospital in Boston. That’s where her story should have ended.

But during her hospital stay she acquired a staph infection, which quickly escalated into a fast-moving bone infection. After enduring 28 surgeries over the course of five years – including painful bone and muscle graphs – Ginny was forced to amputate her leg to save her life. “The staph infection did not ruin my life,” she says, “but it has altered my life forever.” For more on Ginny’s story, click here.

Maryland vs. Medical Errors

Maryland is tackling this type of hospital-acquired infection and other medical errors head on.  Before we talk about how they’re doing it, let’s start with why we selected Maryland for our debut blog in the series – the tremendous results they achieved in just the first year of their initiative:

  • A nearly 20 percent reduction in hospital-acquired infections, like the type that Ginny suffered from.
  • A 12 percent drop in overall hospital-acquired complication rates. This includes infections but also other preventable harmful events like accidental punctures during invasive procedures.
  • Over $60 million in savings. Because the health care needed to treat these types of preventable complications is extremely costly, as Maryland’s complication rates dropped so did its health care costs.

How Did Maryland Do It?

Maryland’s reforms build on a common-sense concept: hospitals should get paid more for providing higher quality care, and less for providing harmful care. This may seem obvious, but under many states’ Medicaid payment methodologies, hospitals are being fully reimbursed for the costs associated with treating harmful conditions that they could have prevented. Those payment systems fail to reward hospitals for investing in prevention of the types of infections that Ginny endured.

The Affordable Care Act will soon require all states to take the first step: stop paying for the costs associated with a handful of medical errors that are virtually always preventable, such as operating on the wrong body-part. But these particularly egregious and extremely rare medical errors represent only a tiny sliver of the potentially preventable hospital-acquired complications that alter families’ lives and drive up our nations’ health care costs every day.

Maryland is the first state to tackle a broader list of 49 adverse events including ones that are usually – but not always – preventable, such as the type of infection that invaded Ginny’s bones. Because these infections are not always preventable, and no hospital could be expected to lower its rate to zero, Maryland did not eliminate payment altogether for the costs associated with them. Instead, it adjusted just a portion of hospital payments based on their rates of these complications; hospitals that do a good job at avoiding these events relative to their peers get a little extra money, and hospitals with a relatively high rate get a little less. This provides hospitals with the incentive to lower their overall rates of complications – saving money and saving lives.

The Real Question: Why Aren’t Other States Doing It?

Remarkably few states are following Maryland’s lead. And while they leave this cost-saving option on the table, Republican Governors are flocking to Capital Hill and insisting that they need to cut vulnerable Americans off of Medicaid to get their budgets under control. For example, Governor Christie is requesting that CMS allow New Jersey to freeze Medicaid enrollment for parents earning more than $439 a month. This proposal would result in 23,000 New Jerseyans being denied health coverage, and would save the state only nine million dollars.

Harmful eligibility cuts like these are unconscionable, particularly when New Jersey – and other states like it – could save even more money through payment reforms like Maryland’s that improve health care quality and better families’ lives.

To learn more about moving payment reform in your state’s Medicaid program, please read Community Catalyst’s policy brief here. Over the summer, Community Catalyst will also be releasing model Medicaid payment reform legislation, as well as a state-by-state report card to help you track which states are following Maryland’s lead.

This blog was based partly on an interview with Robert Murray, Executive Director of Maryland’s Health Services Cost Review Commission.

~ Katherine Howitt, Policy Analyst at Community Catalyst

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Advocates in Atlanta Have a Vision for Better Care

Jesse Connolly, Campaign Director, Campaign for Better Care

Last week, I traveled to Atlanta for a roundtable discussion with patients, health care providers and consumer advocates, organized by our colleagues at the Georgia Campaign for Better Care.  Dr. Don Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), brought a national perspective and a distinguished health care background to the panel.  But another panelist, Yolanda Chancellor, brought something that was, in its way, even more powerful:  a handful of newspaper clippings.

A retired government administrator, Yolanda began clipping death notices from newspapers in 1999 when her grandmother Rosa died of a hospital-acquired infection. In the years that followed, Yolanda has clipped and saved the notices every time she lost another friend or loved one because of poorly-coordinated care, hospital-acquired infections and other adverse medical experiences.  Yolanda told the roundtable’s 100-plus participants that she has collected 15 death notices – so far. When she shared the clippings with Dr. Berwick as they spoke at the event’s conclusion, it was a powerful reminder of the importance of our work to coordinate and improve health care.

As Dr. Berwick told the gathering, “Despite efforts, millions of people get hurt every year in the health care system and the good people – the doctors and nurses – they get trapped in flawed systems.  What we know is that the burden is not inevitable; we know how to eliminate injures of that type.  The way to do that is to improve the systems of care that allow the doctors, the nurses, the pharmacists, and the others to do what they really desperately want to do which is give care safely.  Blame and accusation are not the answers; teamwork, improvement, and optimism – they are.”

To further this work, CMS has launched an initiative that we at the Campaign for Better Care strongly support – the Partnership for Patients: Better Care, Lower Costs. This new public-private partnership is designed to help improve the quality, safety and affordability of health care for all Americans.  It emphasizes bringing patient advocates together with leaders of major hospitals, employers, physicians, nurses and state and federal government officials to make hospital care safer, more reliable and less costly.

The Campaign for Better Care, working with the Partnership for Patients, aims to ensure that patients and their family caregivers receive better-coordinated, high quality care so that what happened to Yolanda never happens to another patient or caregiver.

Joining Yolanda and Dr. Berwick on the panel were six articulate local advocates and providers, and each had a lot to contribute.  They were:

  • Helen Butler, Executive Director, Georgia Coalition for the People’s Agenda;
  • Chaiwon Kim, CEO / President, Center for Pan Asian Community Services;
  • Holly Lang, Hospital Accountability Project Director, Georgia Watch;
  • Ted Johnson, Director, Woodruff Health Sciences Center, Center for Health in Aging, Wesley Woods Center of Emory University; Division Director, Geriatric Medicine & Gerontology; and Professor of Medicine, Emory University School of Medicine;
  • Adrienne Mims, Medical Director, Medicare Quality Improvement, Georgia Medical Care Foundation; and
  • Nancy Morrison, Program Director, Sixty Plus Older Adult Services at Piedmont Hospital.

At the Campaign for Better Care, we know that vulnerable patients with multiple health problems are the ones who suffer the most when health care is not high quality, well-coordinated and patient-centered.   Making sure that patients are included in the discussion about how to improve care, as we did at the Atlanta roundtable, is a step in the right direction.  We intend to keep working to ensure that patients are included in all these discussions and that better care soon becomes reality, rather than a goal.

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Seniors in America Today: “Not a Pretty Picture”

Debra Ness, President

Earlier this week I was privileged to be a part of Volunteers of America’s third annual discussion on aging issues. I was on a panel with Arianna Huffington, Huffington Post co-founder and editor-in-chief; Mike King, National President and CEO of Volunteers of America, Inc.; and Lorraine Cortés-Vázquez, AARP Executive Vice President of Multicultural Markets and Engagement. Our topic: How our nation’s public policies affect older Americans, especially women. Medical journalist and best-selling author Dr. Bob Arnot moderated the discussion, which addressed how to improve the U.S. health care system, how women can best prepare for old age and care for their loved ones, and how we can press for better coordinated care that lessens the burdens on family caregivers.

During the panel, I talked about the work of the Campaign for Better Care to improve care for the oldest and sickest patients, and described the good-news-bad-news reality of women aging in America. The good news is that women are living longer. The bad news is that they are living poorer and sicker. And when you take a hard look – in particular at the lot of older women and their family caregivers – it isn’t a pretty picture. In the workplace, women experience persistent discrimination and lower earnings on average than men. In the workforce, they face employer policies that make it extremely difficult to be both wage-earners and caregivers. In the obstacle course that is the U.S. health care system, they are forced to jump through hoops to secure the care they need.

My fellow panelists each brought valuable, personal perspectives on caring for the aged. Arianna Huffington talked about the cultural issues involved, as well as the distinct joy she derived from caring for her own late mother. Mike King seconded those sentiments, adding that caring for his mother was an honor.

Lorraine Cortés-Vázquez stressed that we need to educate ourselves to better prepare for aging, and create livable communities that offer long term care services. She also raised an issue that doesn’t get nearly as much attention as it should: the fact in that in some underserved communities, doctors’ offices are vanishing, forging an even stronger link between poverty and poor health.

We also discussed the current debate about the federal deficit. I wanted to stand up and cheer when Mike stated a principle that we all should embrace: “We’re not going to balance the budget on the backs of the older Americans who built this country. It’s not fair. We have to stand up and say that.”

Some time after Mike made that statement of conscience about what we must not do, a woman in the audience asked a great question about what we should do. What kind of strategies can we employ, she asked, to advance change in Congress? I told her what I believe: that one way to influence lawmakers and policymakers is through the Campaign for Better Care. We launched this nonpartisan campaign last year to organize Americans across the political spectrum to make their voices heard. By recounting their real-life struggles in the U.S. health care system, members are giving policymakers both the incentive and the information needed to create change. Older women and their caregivers desperately need a health care system that delivers timely, coordinated, appropriate, affordable care. The Campaign is focused on changing our health care system so that the oldest and sickest patient can get this kind of care and live in their communities for as long as possible.

I commend Volunteers of America for organizing such a fantastic discussion. In preparation for this week’s event, Volunteers of America commissioned a nationwide survey to find out how the elderly and their caregivers are faring during these tough economic times. Its white paper on the findings – “Boomer Bust 2011: Still Unprepared and Unaware” – is well worth reading, and passing along. If you weren’t able to attend the panel, an archived webcast of it is available here.

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