HMT: Medicare update, lack of Medicaid equals deaths, CA sues Kaiser, and more
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Health Management Technology News
January 31, 2014
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In this issue:

Medicare’s delivery system reform initiatives achieve significant savings and quality improvements

More than 7,100 deaths likely from states’ rejection of Medicaid expansion

Majority of physicians feel left out of Obamacare conversation; poll reveals that 84% of practicing physicians haven’t received enough information on the ACA

California AG sues Kaiser over slow data-breach response

Medicare’s delivery system reform initiatives achieve significant savings and quality improvements

Today, the Centers for Medicare & Medicaid Services (CMS) released findings on a number of its initiatives to reform the health care delivery system. These include interim financial results for select Medicare Accountable Care Organization (ACO) initiatives, an in-depth savings analysis for Pioneer ACOs, results from the Physician Group Practice demonstration, and expanded participation in the Bundled Payments for Care Improvement Initiative. Savings from both the Medicare ACOs and Pioneer ACOs exceed $380 million.

These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” HHS Secretary Kathleen Sebelius said. “Today’s findings demonstrate that organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high quality care while reducing expenditure growth.”v

While ACOs are designed to achieve savings over several years, not always on an annual basis, the interim financial results released today for the Medicare Shared Savings Program ACOs show that, in their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first 12 months, 29 generated shared savings totaling more than $126 million – a strong start this early in the program. In addition, these ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. ACOs share with Medicare any savings generated from lowering the growth in health care costs while meeting standards for high quality care. Final performance year-one results will be released later this year.v

While evaluation of the program’s overall impact is ongoing, the interim results are currently within the range originally projected for the program’s first year. A great majority of the program’s overall net impact was projected to phase-in over the program’s ensuing performance years. Moreover, through regular webinars; tools for sharing information and best practices; opportunities for ACOs to connect with one another; and other activities, ACOs are being provided the infrastructure and resources to learn from one another and to then diffuse what’s working and what is not.

“Our experience has shown that ACOs can increase quality while lowering costs. As a result of the programs we’ve initiated, our patients have experienced better access to their primary care physician, higher quality measures, and fewer trips to the hospital,” said Dr. Kenneth W. Wilkins, president of Coastal Carolina Health Care. “We look forward to making continued progress and seeing future results, and we are grateful to CMS whose advance funding made these initiatives possible.”

Read the full eNews Park Forest article here

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More than 7,100 deaths likely from states’ rejection of Medicaid expansion

Harvard and CUNY researchers say death toll from 25-state ‘opt-out’ may be as high as 17,100 annually; hundreds of thousands more will be harmed by depression, untreated diabetes, and skipping mammograms and pap smears.

The decision by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act will result in between 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York.

The study, the first detailed estimate of the health impact of the states’ decision to reject the Medicaid expansion (with state-by-state data as well), is being published today at the Health Affairs Blog.

The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage will remain uninsured. In addition to the thousands of excess deaths associated with that lack of coverage, the rejection of the Medicaid expansion will have the following likely impacts:

* 712,037 more persons diagnosed with depression
* 240,700 more persons suffering catastrophic medical expenses
* 422,533 fewer diabetics receiving medication
* 195,492 fewer women receiving mammograms and
* 443,677 fewer women receiving pap smears

“We calculated the number and characteristics of people who will remain uninsured as a result of their state’s opting out of the Medicaid expansion, and applied these figures to the known effects of insurance expansion from prior studies,” said Samuel Dickman, a third-year medical student at Harvard Medical School and the study’s lead author. “The results were sobering. Political decisions have consequences, some of them lethal.”

Dickman and his colleagues, longtime health researchers at Harvard Medical School and the City University of New York, drew on demographic data from the Census Bureau’s 2013 Current Population Survey and estimates on Medicaid take-up rates from the Congressional Budget Office and elsewhere to characterize those who would remain uninsured in states opting out of Medicaid expansion.

They developed estimates of the health effects of remaining uninsured based on previous studies that used state-level data on Medicaid expansions and death rates, the National Health and Nutrition Examination Survey Mortality Follow-up, and the Oregon Health Insurance Experiment.

In addition to arriving at national estimates, the researchers were able to break the findings down by state.

Read the full ADW article here

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Majority of physicians feel left out of Obamacare conversation; poll reveals that 84% of practicing physicians haven’t received enough information on the ACA

QuantiaMD, the largest social learning network for physicians, developed by Quantia, Inc., conducted a recent poll of its members in order to understand physician perspectives regarding the implementation of the Affordable Care Act. Despite millions of enrollees, individuals and doctors remain confused about the law – a troubling fact as many patients look to their physicians as a primary resource on health care policy.

The poll garnered responses from 1,265 physicians from around the country and opened up a dialog about the ACA. Results of the study included:

  • 84% of physicians said they did not feel like they had enough information on the ACA to serve as a reliable resource to their patients.
  • 81% of physicians don’t feel they have enough information on the ACA to understand its impact on their practice and comply with its requirements.
  • When asked where they get the most reliable information about the ACA, the majority (35%) of physicians responded saying there aren’t any reliable sources of information.
  • 79% said they would use an HHS-produced FAQ with their patients if such a resource were available.

“This poll proves how physicians have been left out of the health care reform process,” said Mike Paskavitz, Editor-in-Chief, Quantia, Inc. “As the patient’s most trusted point of access to the healthcare system, physicians can be a tremendous communication channel for the ACA, and this poll demonstrates that there hasn’t been much, if any, communication directed at them. This poll was a huge eye opener for Quantia and validates the importance of the Affordable Care Act curriculum we have been developing for our members.”

The QuantiaMD faculty is comprised of 1,000 leading experts from US News & World Report Top 20 “Honor Roll” hospitals. A typical physician now spends 20 minutes per session consuming content and interacting with peers on QuantiaMD, making it an ideal platform to communicate and share knowledge. Nationwide, 1 in 3 physicians visits QuantiaMD each quarter. Additionally, more than 50% of members visit QuantiaMD on a mobile device.

Read the full Yahoo finance article here

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California AG sues Kaiser over slow data-breach response

California's attorney general sued Kaiser Foundation Health Plan Inc. in state court last week alleging the company took too long to notify more than 20,000 current and former employees that their personal information had been compromised in a 2011 security breach.

In a Jan. 23 complaint, Attorney General Kamala D. Harris accused the managed health care provider of engaging in unfair competition as defined by California Business and Professions Code Section 17200 through its handling of the loss of an unencrypted hard drive containing Social Security numbers and other personal data that was discovered after the drive was purchased at a public thrift shop in 2011.

While Kaiser secured and completed its initial examination of the compromised hard drive in December 2011, the company failed to notify affected individuals of the breach until March 2012, a delay that Harris alleges violated Kaiser's duty under California law to disclose a security breach and issue a notification “in the most expedient time possible and without unreasonable delay.”

“Kaiser could have notified individuals it had identified as affected by the breach as early as December 2011, but did not commence notice until on or about March 2012,” the complaint said.

Besides allegedly fumbling its notification obligations under California Civil Code Section 1798.82, Kaiser also violated the code's Section 1798.85 by "publicly posting" or displaying the Social Security numbers of more than 20,000 California residents on an unencrypted hard drive that was allowed to land in the hands of the general public, according to the complaint.

Harris is seeking an injunction to permanently enjoin Kaiser from committing any acts of unfair competition, an order for the company to pay $2,500 for each violation of Section 17200, and the recovery of the state's costs for the suit and its investigation of the matter.

A representative for Kaiser Foundation Health Plan, which is one of the three groups of entities that make up integrated managed care consortium Kaiser Permanente, did not immediately respond to a request for comment Wednesday.

Kaiser discovered the breach at the heart of the regulator's complaint in September 2011, when it learned that an external hard drive containing unencrypted personal information of former and current Kaiser employees had been purchased by a member of the public at a thrift store in Santa Cruz, Calif.

Read the full Law 360 article here

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