CMS BQI Project Expands
With the recent additions of California and Arizona,
the total is now up to six regional healthcare collaboratives that have
joined the Centers for Medicare and Medicaid Services’ (CMS) Better
Quality Information (BQI) project. The California Cooperative Health
Care Reporting Initiative and Arizona State University’s Center for
Health Information and Research are the latest to combine claims data or
clinical information with that of Medicare in an effort to provide
consistent measures of quality for provider services. The Delmarva
Foundation for Medical Care has entered into subcontracts with each
region. As one of CMS’s quality improvement organizations, the Delmarva
Foundation is a national nonprofit that implements quality improvement
projects and CMS-related initiatives with healthcare providers,
organizations and health plans in Delaware, Maryland and Virginia. The
other four collaboratives in the BQI project include Indiana Health
Information Exchange, Massachusetts Health Quality Partners, Minnesota
Community Measurement and Wisconsin Collaborative for Healthcare
Quality. All of the regional collaboratives are part of the Value Driven
Health Care Initiative spearheaded by Secretary of Health and Human
Services Mike Leavitt.
CMS Consolidates Medical Claims System
The Centers for Medicare and Medicaid Services (CMS)
moves a step closer to consolidating data centers with the awarding of
the third task order to Electronic Data Systems Inc. (EDS). The company
will provide application hosting and production support at its data
center for 180 million Medicare claims from twelve states at a cost of
$92 million. The EDS indefinite-delivery, indefinite-quantity contract
vehicle goal is to reduce the CMS data centers, which house computer and
network equipment supporting agency program operations, from 20 to four.
The EDS third task order contract will last for one year with five
1-year options for full fruition of the award. EDS also was awarded an
earlier task order to provide Web hosting services to support all of
CMS’s outward facing Websites, as well as the task order to provide
processing of fee-for-service Medicare claims.
South Carolina-based Companion Data Services (CDS)
also has been awarded a 6-year $200 million task order to provide
electronic data processing and hosting services for about 650 million
claims filed annually by hospitals and physicians in 30 states, the
District of Columbia and Puerto Rico. CDS will be required to process
about 54 percent of the 840 million Medicare claims filed annually by
January 2008. CDS, EDS and IBM are the three companies competing for
task orders under the 10-year, $1.9 billion EDC contracts. CMS will move
software applications and hosting operations for Medicare, Medicaid and
the states’ children’s health insurance program to the new data center
over the next five years.
Massachusetts Introduces Mandatory Health Plans
The Massachusetts Commonwealth Health Insurance
Connector Board recently approved 28 low-cost plans offered by seven
insurers. The move is part of Massachusetts’ effort to extend healthcare
insurance to every resident. Beginning July 1, uninsured residents will
face growing penalties such as losing their personal state income tax deduction. The plans, known as Commonwealth Choice are intended to
cover the state’s nearly 200,000 residents who earn too much for
subsidized coverage. Previously, the state introduced free health
coverage for low income residents and subsidized plans for those earning
up to three times the federal poverty level, or about $29,000 a year for
an individual.
Among the basic plan designs are the "Bronze" level,
which provides lower monthly premiums but higher out-of-pocket expenses
in the form of copayments, deductibles and coinsurance, and a "Gold"
level with higher premiums but fewer out-of-pocket expenses. There are
also low cost plans for young adults, with all of the plans providing
comprehensive coverage options as determined by the Connector Board.
Critics worry about the plan’s affordability for the
working and middle class. Many cite the coinsurance aspect, which they
say requires a patient to pay a percentage of the total healthcare cost
rather than a set copayment. State officials are considering exemptions.
Insurers participating in the plan include Blue Cross and Blue Shield of
Massachusetts and Harvard Pilgrim Care, who will offer statewide
coverage, as well as ConnectiCare, Fallon Community Health Plan, Health
New England, Neighborhood Health Plan and Tufts Health Plan who will
provide regional coverage.