Employers Assisting in Managing Chronic Care

Friday's Patient Money column in the New York Times highlights NYBGH member Pitney Bowes as one of the number of employers helping their employees better manage their chronic conditions.  The author briefly compares and contrasts various employer-sponsored chronic care management programs, and features Pitney Bowes as one of the companies that manages chronic conditions at their on-site health clinics.

Click here for the complete article.

New York Times Articles Highlight Industry Activity

Two recent, national articles highlight some of the work that business coalitions, like NYBGH, and employers are focusing on.  Reed Abelson, writing for the New York Times, sheds light on some employers' interest in narrowing their physician and/or hospital networks in order to save costs for both the company and their employees.  Andrew Webber, the President of National Business Coalition on Health (NBCH), is quoted in the article, quipping about the choice battle during the managed care wars of the 1990's.

This article can be found by clicking here.

In a second article, Abelson describes some physicians' groups', such as the American Medical Association (AMA), ire over how health insurers rank and rate physicians participating in their networks. In a recent letter to some of the nation's largest insurers, the AMA and 47 other groups, "called on the insurers to make public how they assessed doctors’ performance and to allow the insurers’ methods to be reviewed by independent parties."  America's Health Insurance Plans (AHIP) responded to the letter, defending insurers' practices, asserting that employers and other purchasers have asked their health plans to ardently work towards achieving greater value and improved clinical performance..

Click here to access this blog post.

HIT Meaningful Use Regulations Released

"The widespread use of electronic health records (EHRs) in the United States is inevitable", asserted Dr. David Blumenthal, the national coordinator for health information technology at the US Department of Health & Human Services (HHS), in a recent New England Journal of Medicine article.   

HHS released on Tuesday the final rules for expanding the use of electronic health records by hospitals and physicians. Eligible physicians and hospital facilities can qualify for Medicare and Medicaid incentive payments if they adopt certified EHR technology and subsequently use it to achieve specified patient health outcomes. Two regulations, in fact, were released by HHS.  The first defines the "meaningful use" goals that providers must meet in order to qualify for the bonus payments. The second rule describes the technical capabilities required for certified EHR technology. This marks the finalization of a highly scrutinized proposed rule that was released on January 13, 2010.

The program, created by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, is expected to award up to $27 billion in bonus payments over ten years.  Providers may receive up to $44,000 under Medicare and $63,750 under Medicaid.  Hospital facilities, on the other hand, may be eligible to receive millions of dollars for implementation and meaningful use of EHRs under both aforementioned public health care programs.

Click here for the HHS press release, which links to a fact sheet on and the text of the final rules.

Obama to Use Recess Appointment for Berwick

The White House yesterday announced that President Obama, to the chagrin of many Congressional Republicans, will use a recess appointment to make Don Berwick the administrator of the federal Centers for Medicare and Medicaid Services (CMS). Mr. Berwick is touted as an expert in and advocate of quality improvement in health care and is also a renowned Harvard professor and pediatrician. His appointment will remain valid until the end of the 111th Congress in January, at which time he will be subject to another confirmation, and presumably a hearing.

Click here to read more from Politico.
Kaiser Health News has released a resource guide on Mr. Berwick.  Click here to access it.

Three New Health Reform Model Notices Posted

Earlier this week, the US Department of Labor released three new model notices, each related to provisions included in the new health reform law. Each provision is effective for new plan years that begin on or after September 23, 2010.

The first pertains to the extension of dependent coverage to adult children up to age 26. It can be found at: http://www.dol.gov/ebsa/dependentsmodelnotice.doc

Next is model notice language for the prohibition on lifetime limits on "essential health benefits". This notice can be found at: http://www.dol.gov/ebsa/lifetimelimitsmodelnotice.doc

Lastly, a model notice pertaining to certain patient protections. These include an enrollee's right to designate a primary care physician or a pediatrician from within their network as well as to obtain obstetrical or gynecological services without prior authorization from their health plan. This model notice can be found at: http://www.dol.gov/ebsa/patientprotectionmodelnotice.doc

High Risk Pool Programs & New Health Insurance Website

Today the US Department of Health and Human Services (HHS) announced the creation of a new government-run health insurance website - healthcare.gov - as well as the highly-anticipated high-risk pool program. 

The new website, mandated by the new health reform law, is an information clearinghouse meant to help consumers navigate what can sometimes be a complicated health insurance market.  Only in version 1.0, the site lists the insurers selling products in a given user's particular service area.  In the autumn, the site will be enhanced with the addition of insurance products' prices and benefits information. Users can also log-on to learn more about how the new health reform law may impact them.

Also launched today, a few days past its anticipated launch date, is the new state-based temporary high-risk pool program, now called the Pre-Existing Condition Insurance Plan (PCIP).  This temporary insurance program is designed to bridge the coverage gap for those with pre-existing conditions until state-run insurance exchanges are established in 2014.  Slightly more than half of the states (29 of them) decided to run their own high-risk pool program, with the remaining 21 states allowing the federal government to step-in and administer theirs.  Coverage for those who qualify is expected to kick-in August 1st for those who apply by July 15th.

To read more on these developments, visit the HHS press release, a Wall Street Journal story, or coverage from Kaiser Health News.