Alycia-Care: Peace of Mind in Knowing Sick Child Won’t be Denied Health Coverage

As Alycia Steinberg of Towson, MD, tells us, when a child is seriously ill, a parent shouldn�t have to worry that an insurer would deny coverage due to the child�s pre-existing condition.

That is why she�s grateful that the Affordable Care Act protects her daughter Avey�s health insurance coverage because it bars insurance companies from denying coverage to children based on pre-existing conditions.� �To have a child with cancer, there is so much to worry about, but the Affordable Care Act means that I don�t have to worry that Avey will be denied treatment because of her pre-existing condition,� Alycia says.

At 2-years-old, Avey was diagnosed last year with leukemia, a terrible shock to her parents. Alycia says the prognosis is good and Avey is �doing amazingly well,� following intensive chemotherapy and some initial developmental setbacks due to the treatment. She now faces two years of maintenance chemo. Her treatment is very expensive.

�My first thought, as I was trying to process the fact that my two-year-old has cancer, [was] how am I going to take care of her?� What does this mean if we have our health benefits through my employer? Can I leave my job? Are we going to be able to maintain our coverage?� Alycia says.

The health care law is a �huge relief� for Alycia because insurers won�t be able to deny Avey coverage because of her pre-existing condition now or in the future when she�s an adult and looking for a job.

�As a mother of a child with cancer I have plenty to give me worry. One thing I don�t have to worry about now, thanks to the Affordable Care Act, is having Avey�s treatment denied,� she says. �The Affordable Care Act has given us tremendous peace of mind to know that Avey will be able to get the treatment that she needs. � It allows me to be a mom who can focus on taking care of my little girl with cancer.�

Diabetes diagnosis motivates reporter to change his life

A mile into my workout at the gym and I start dreaming of cake.

Chocolate cake with buttercream frosting that's chilled but not frozen � cold enough so the cake and frosting are firm and rich and so sweet that you can get lost in the flavor.

And French fries, crinkle-cut and just snatched from the deep fryer, so crispy that they almost snap when you take a bite. With buckets of ketchup on the side and a Blue Moon beer with a slice of orange to wash them down.

I could eat these things.

Then I would die.

Not right away, but sooner than I want to.

Before my children are grown and settled into lives of their own.

Before my grandchildren are born.

Before I have time to enjoy growing old with my beloved.

Eight months ago, a very nice nurse from my doctor's office called with the news that something was wrong with the blood work from a routine physical.

A normal fasting blood sugar level, taken after not eating for eight hours, should be around 80.

My fasting blood sugar was 243, just below the level that requires a trip to the emergency room. My hemoglobin A1C test � which looks at blood sugar over a three-month period � should have been under 7. My score was over 12.

That blood sugar test meant that I � like about 25.3 million other Americans, according to the American Diabetes Association� had diabetes.

Even worse, the high blood sugar had begun affecting my kidneys, putting me at risk for kidney failure in the future.

My body had become a ticking time bomb.

I had known for months that something was wrong. I was ill-tempered and flew off the handle at the slightest frustration. Once, while driving home from the East Coast, I began screaming at my wife in the parking lot of a Dairy Queen after eating a mocha Blizzard. God only knows what my blood sugar was at that point.

My eyes would not focus when I tried to read a book. Sometimes it felt like my blood was literally on fire. Every negative emotion � anger, fear, frustration, anxiety � was amplified.

I was becoming someone that my children were afraid of � someone called Angry Bob, who flew off the handle without any warning.

A complete transformation

A preacher once told me that the New Testament Greek word "metanoia" � which my Bible translates as "repentance" � really refers to a complete transformation or metamorphosis.

He said that it literally means to stop walking in one direction, to turn around, and begin walking the opposite.

Diabetes for me has meant that kind of transformation.

I had lived for years on fast-food cheeseburgers, coffee with extra sugar, fries and pasta � those were my four main food groups, with a side order of garlic bread.

The only exercise I got was walking from my car in the parking lot to my desk at work or from the couch to the fridge.

Today all that has changed.

The fast-food burgers and garlic bread have been banished, replaced by yogurt and bananas, salads made of carrots and baby spinach and romaine lettuce and sometimes goat cheese, fresh asparagus and apples, along with plenty of whole-wheat tuna wraps.

Every day, rain or shine, I walk two or three miles, and at least twice a week I go to the gym and run about a mile and a half.

At the beginning of June, I was down to 212 pounds � 40 less than when I was diagnosed and more than 50 down from my all-time high.

I am becoming, quite literally, a new man. I even started wearing my wedding band on the middle finger of my left hand so it doesn't fall off.

Before that call from the doctor's, I would not have believed that this kind of change was possible.

I felt terrible but was too overwhelmed with the pressures of life � work, raising a family, this never-ending recession � to do anything about it.

Getting diagnosed made the problem simple: Change now or die.

Walking every day

That change started with simple advice from my doctor, who told me to do three things.

Buy some comfortable shoes. Walk 20 minutes, three times a week. Pay attention to what you eat.

Those three small steps took what seemed to be an impossible task and put it into bite-size pieces.

I knew I couldn't change my life overnight. But even I could buy some shoes.

I did deviate a bit from the doctor's plan. Instead of three days a week, I walk every day, usually at lunch.

I mapped out a mile-and-a-half course from my office. Out the front door of The Tennessean, turn left on Broadway, left again on Seventh, up the hill, right on Charlotte, down the hill, left on 12th to the back door of the paper. On ambitious days, I can walk across the Cumberland on the pedestrian bridge and back to the office, for a two-mile route.

Three months in, my wife bought me some new pants and an iPod with a pedometer to keep track of how far I have walked. On June 10, I passed the million-step mark. I hope to log another million by the end of the year.

The hardest change to make was to take medication.

My doctor put me on an oral medication called Metformin. I started at 500 milligrams a day, then went up to 750 for three months. This past month, I went back down to 500 and hope to be medication-free at some point.

For now, if I don't take my medicine, Angry Bob comes back. And I don't want to be that guy anymore.

The great irony is that I feel better knowing I have diabetes than I did before my diagnosis, when I was sick and didn't know how near to death I was.

In the Old Testament book of Numbers, the people of Israel stand outside the Promised Land with their leader Joshua.

He gives them a choice: "This day I call heaven and earth as witnesses against you that I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live and that you may love the LORD your God, listen to His voice, and hold fast to Him."

So today I will choose life.

I will not eat cake.

Instead, I will wipe the sweat from my eyes and continue running as fast as I can into the future.

Contact Bob Smietana at 615-259-8228 or bsmietana@tennessean.com. Follow him on Twitter @bobsmietana.

Could Kaiser Permanente's Low-Cost Health Care Be Even Cheaper?

Enlarge Michel Euler/AP

George Halvorson, chairman and CEO of Kaiser Permanente, speaks during a session at the World Economic Forum in Davos, Switzerland, in 2009.

Michel Euler/AP

George Halvorson, chairman and CEO of Kaiser Permanente, speaks during a session at the World Economic Forum in Davos, Switzerland, in 2009.

Kaiser Permanente rose out of Henry J. Kaiser's utopian, industrialist dream.

During the 1930s and '40s, Kaiser wanted to make sure the workers at his Richmond, Calif., shipyard stayed healthy. Kaiser Permanente then opened its doors to the public in 1945.

That's a key difference from other providers: Kaiser Permanente owned its own hospitals and clinics and directly employed physicians. Other insurers had to negotiate with outside hospitals and doctors demanding ever-higher payments. Without those burdens, Kaiser could offer health coverage that was high-quality and less expensive than conventional insurers.

Today, it's a different story, says Mark Smith, head of the California HealthCare Foundation. The organization is no longer the bargain it used to be, he says, possibly because of what economists call "shadow pricing."

 

"If your competitor takes $4 to make a banana and it only takes you $2 to make a banana, you price your banana at $3.95 and you pocket the rest," Smith says.

It's difficult to discern just how Kaiser fares against other companies since negotiations between health plans and employers are largely confidential. Kaiser says its costs increase by about 5 percent each year. But some of Kaiser's biggest customers say their premiums have jumped much higher, in some cases 20 percent.

That's a charge Kaiser CEO George Halvorson denies. "We're at least 10 percent better everywhere. Sometimes we're 15 to 20 percent less expensive," he says.

Halvorson insists Kaiser's rates are based on how much it spends on patient care, not based on what other insurers are charging. And, he adds, Kaiser offers richer benefits than other plans.

But according to David Lansky, of the Pacific Business Group on Health, Kaiser Permanente has difficulty explaining how it sets its prices.

This may stem in part from the very trait that makes Kaiser Permanente so efficient: The health maintenance organization, unlike other providers, doesn't have a menu of fees.

Bob Kocher, a former health care adviser to President Obama, says Kaiser's model was at the back of policymakers' minds when they wrote what are essentially Kaiser look-alikes into the health overhaul law.

Kaiser hospitals have shown they can deliver top-shelf care for happy-hour prices. Recent Medicare data show all but one of Kaiser's hospitals cost significantly less than the national average. And the company's electronic medical record system is one of the most advanced in the world and has largely eliminated duplicative tests.

But Kocher suspects that as more doctors and hospitals band together into Kaiser Mini-Me's, Kaiser Permanente could face more competition.

Kaiser Permanente, meanwhile, is marching east. It's expanding in the Washington, D.C., area, as well as in Georgia. Some health policy experts assert that the company is setting its premiums, in part, to underwrite this expansion.

Halvorson says Kaiser Permanente spends its surplus to benefit its customers.

"We use our money to invest in our care system; we use our money to invest in our computer systems," he says. "We reinvest money in hospitals and clinics and that's the only use of the money."

Halvorson contends if all Americans got their care at Kaiser-like facilities, the U.S. would save hundreds of billions of dollars in health care costs. Others are less convinced. The cautionary tale of Kaiser Permanente, they say, is that even under the best circumstances, U.S. health care prices may still be untamable.

This story was supported in part by Kaiser Health News, which is not affiliated with Kaiser Permanente.

Kentucky, Healthbridge partnership 'tip of the iceberg' for health data sharing

The Kentucky Health Information Exchange, St. Elizabeth Healthcare and Healthbridge are successfully sharing patient information. The partnership, says Trudi Matthews, director of policy and public relations for HealthBridge, is just the “tip of the iceberg” in terms of connecting healthcare providers and sharing patient information in Kentucky and healthcare markets in bordering states.

Connecting to St. Elizabeth Healthcare, one of the largest healthcare providers in the Greater Cincinnati-Northern Kentucky region with six facilities and 62 physician practices, represents a significant milestone for KHIE towards achieving connectivity throughout the state. St. Elizabeth Healthcare is also one of the first participants of HealthBridge, which was founded in 1997 and is one of the largest and financially sustainable health information exchanges in the U.S.

[See also: HealthBridge data exchange gives boost to e-prescribing, diabetes registry]

St. Elizabeth Healthcare didn’t want to duplicate its HIE activities with KHIE, so now as data flows to HealthBridge, the HIE sends a copy of the feeds – with appropriate filters in place – to KHIE, Matthews said. Authorized healthcare providers can securely access critical patient information in order to make timely, better-informed decisions.

KHIE uses a query model, enabling emergency department physicians, for example, to search and receive a matched summary of care record with health information from Medicaid and healthcare providers such as St. Elizabeth Healthcare. KHIE now has the capability to receive and send patient information from St. Elizabeth Healthcare to other participants of the statewide HIE.

For HealthBridge, this partnership also represents a significant milestone. HealthBridge serves a healthcare market that spans three states – Ohio, Kentucky and Indiana. It is already connected with the Indiana HIE and four other HIEs, including HealthLINC, based in Bloomington, Ind.

[See also: HealthBridge offers HIE advice]

“This is a perfect microcosm for inter-state exchange,” Matthews said, of the partnership. “This effort is going to grow over time.”

The Office of the National Coordinator for Health IT (ONC) funded connectivity among KHIE, HealthBridge and St. Elizabeth Healthcare through its State Health Information Exchange Program and Beacon Community Program. ONC selected the Greater Cincinnati-Northern Kentucky community as one of the 17 ONC-funded Beacon Communities. St. Elizabeth Healthcare is participating in the Greater Cincinnati Beacon Collaboration.

HealthBridge is also connecting with the Nationwide Health Information Network. It has already installed Direct and Connect, as additional means for connectivity with other exchanges. “There’s still a lot of work to do with standards to make it [connectivity] easy, but we’re showing it can be done,” Matthews said.

[See also: Kentucky health data exchange kicks off e-prescribing initiative]

Q&A: Beacon leaders discuss IT's role in care revolution

Flour, sugar, the last pinch of salt… in crafting the perfect confection, there's often some singular component that holds the rest together, and makes the cake stand up, or the frosting stick. 

In the realm of public health, IT is proving to be the vital ingredient behind the revolution of patient care. 

At the recent HIMSS 2012 Virtual Conference, leaders from two Beacon communities spoke with Jason Kunzman, project officer for the Office of the National Coordinator for Health Information Technology. The session was titled, "Beacon Comunities: Leveraging Health IT to Fuel the Quality Revolution."

Chris Chute, MD, a principal investigator for the Southeastern Minnesota (SE MN) Beacon Community and Lacey Hart, SE MN Beacon's program manager, outlined the CDR and HIE technology that's driving enhancements in their community. Keystone Beacon Community HIE Director Jim Younkin and Doreen Salek, case manager at Geisinger Health System, highlighted the technology behind the central-PA health system. 

To conclude the event, Kunzman asked the officials questions that were posed by the audience. In this Q&A session, the Beacon leaders discussed the future of HIEs, the importance of trust models, data normalization in relationship to CDRs and HIEs, and the measures they've taken to meet security requirements as IT plays an increasingly prominent role in public health. 

What will it take to make HIEs national? Will we see that in our lifetime?

Kunzman: I will just say that the office of the national coordinator wants to see substantive and robust exchange really take root in 2012 – for those of you that have seen the proposed ruling for Stage 2 meaningful use, I'm sure you've picked up on the fact that we're driving hard towards interoperability and exchange. ONC has sponsored two sort of open-source solutions toward that end, one being the Direct Project, and the other being the Nation-wide Health Information Network. 

Chute: Clearly it's not a technology challenge or problem. There are a number of technology solutions with respect to push or pull models that are sustainable. What is a major challenge, of course, is the trust model – how do we understand to whom we're sending, and to whom we're requesting? Think of the scenario; without a very well-formed governance model and trust network, I could conceivably set myself up as a spam healthcare organization and solicit health information exchange records - this is the nightmare scenario - on celebrities or politicians from their care providers. And who's to know that I am who I say I am? And who's to know that these requests are legitimate and validated? That's when we get into notions of a trust network and a governance model. Now, this is well-recognized by everybody, and I believe a request for information on a governance model was released fairly recently. It is a major topic of ONC, and the standards and interoperability framework. It's something that is very well recognized. But at the end of the day, we will have to have a trust network that works, and more pertinently, one that the public will have confidence in. 

The two Beacon communities that are on the line right now (SE MN and Keystone) are led by two large delivery networks. Some may walk away from this with the impression 'Well of course they can do this, they're large IDNs; they have the resources and the tools to be able to pull something like this off.' What do you say in response to this 'IDN-or-bust' type of perspective?

Younkin: Well I think that's a good point, and a good question, and you're right; we do get asked that a lot. We've certainly been able to learn from a lot of the work that Geisinger has done in its medical home model in terms of how to create these kinds of initiatives. But what we have done through the Beacon program is we have developed a community–based model that really uses some of the same infrastructure, but it pushes the tools out to community members that are not part of the Geisinger Health System, and in fact in many cases are competitors of Geisinger. We believe through the right kind of governance, and by having a care coordination team that is working on behalf of all of those community members, that this model is entirely possible to be replicated nationwide, regardless of what the organization is that's leading it. And of course this is the predecessor to the accountable care model; we'll be working on setting up an accountable care company to use these tools exactly in that community model, as described. 

Salek: I would just say that, as Jim said, some of our participating providers could even be considered competitors, and all but one of our sites are non-Geisinger physician sites. So we feel that the care model, that Jim had spoken too, didn't have to really change or be tweaked going out to these sites. How we connect with those sites, how the nurses have technology at their sites to document, and how they stay connected between all those facilities, is really not about Geisinger per se, but really about our HIE, and how we also leverage the already-existing EHRs in those practices and how we connect… What we do is bring the common care model and, as Jim said, push out to them some of the ideas, but it's not our Geisinger technical model, because these are non-Geisinger sites. 

In blending the varied environments, what has proven to be the biggest challenge?

Chute: It depends upon the use case. Quite frankly for health information exchange where you're going to present the information to a human being, humans are very adaptable in terms of the consistency and comparability of the data they get. They sort of 'get-it' if they read it. If on the other hand we're tying to do quality metrics, or best practice discovery, then the data-normalization thing starts to become really important. We make very limited efforts to do data normalization in our health information exchange. We make extraordinary efforts to do data normalization in our clinical data repository because that's when we're really posing questions. If the data's not comparable, we can't really ask it questions. 

How does your model take care of complying by Faith Harbor HIPAA requirements when releasing data for healthcare clinical research related activities?

Chute: Simplistically, if it's used for discovery research that is intended to be published, then the usual patient privacy and protection rules of institutional review boards, patient consents, and corresponding types of issues, pertain. In the state of Minnesota we have what's called Minnesota Research Authorization, which is required by Minnesota law before we can inquire a patient record, even if it's an anonymous inquiry. So we're extremely respectful of the protection and constraints on use for research. On a quality-metric perspective, that's considered part of doing business, and our ability to establish whether metrics are being met, or what those metrics actually are, is allowed under Minnesota law, and I believe under HIPAA. Of course then we are not able to publish or disseminate that, because what we achieve under quality by IRB convention and use is not equivalent to what we would disseminate as a shared learning resource and public knowledge. 

BancTec acquires GTESS claims processing business

IRVING, TX – BancTec, which specializes in financial business process outsourcing, transaction automation and document management, has acquired certain assets of Richardson, Texas-based GTESS, a provider of claims pre-adjudication technology and services for the healthcare industry.

GTESS has served a client base including more than 40 healthcare payers nationwide. BancTec officials say the acquisition – financial terms of which were not disclosed – will enable the firm to strengthen and expand its healthcare claims processing services.

“In this era of healthcare consolidation and reform, health plans and related organizations are under increasing pressure to improve efficiency – but too often are held back by complex, manual pre-adjudication processes,” said Maria L. Allen, senior vice president and president of the Americas at BancTec. “With this addition, BancTec will be able to effectively address this pain point as part of an integrated claims processing offering.”

Founded in 1990, GTESS specializes in automation technologies that drive cost and process improvements in the front-end, or pre-adjudication, portion of healthcare claims processing. This includes the automation of costly, labor-intensive pre-adjudication processes such as provider and member matching and paper claim handling, keying and processing. GTESS has enabled clients to achieve their goals for increased automation, speed and lower costs of claims processing.

“BancTec and GTESS have shared a commitment to superior service and client satisfaction that have stood the test of time,” said Mark King, chairman of GTESS.  “Like GTESS, BancTec provides flexible, focused automation and outsourcing solutions that serve the healthcare industry well. This strategic move gives clients the opportunity to significantly reduce annual expenses by lowering the cost per claim and dramatically improving accuracy, consistency and customer response.”

Roundtable forecasts big changes for state HIEs

WASHINGTON – A new report from the HIMSS State Advisory Roundtable argues that state HIEs will need to adapt to changing approaches to reimbursement, evolving their mission and business models from "information exchange" to "coordination facilitation."
 
Convened about this time last year, the HIMSS State Advisory Roundtable comprises experts and advocates from state and federal governments, regional extension centers, health information exchanges and more. It seeks to target health IT issues that transcend state boundaries, helping enable different states advance their health IT programs.

Its inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.

Two of the roundtable's members are former Vermont Gov. Jim Douglas and former Wyoming Gov. Jim Geringer. In a blog post on the Government Health IT website, they wrote that, with many states still finding themselves "far behind where they were economically when the recession started 4.5 years ago," a key way "to address the economic challenges of many state budgets is to encourage our states to invest in health information technology."

But there's no shortage of challenges along that road, especially with regard to funding, infrastructure, sustainability, and, most notably, a healthcare industry that's in the throes of reinventing the very basis of its business model – steering away from fee-for-service and toward value-based care.

Other challenges faced by the states include a surge in Medicaid patients – with some states anticipating a more than 50 percent increase in enrollees – and pitfalls with regard to patient engagement. "Putting data in the hands of patients should be a major component in both enabling transparency and driving responsibility of the individual’s and family’s health," according to the report. "This is a challenge due to the complete lack of transparency between the caregiver, the payer and the patient today."

Health information exchanges are another area of concern – but also hold big potential, the report argues.

"Almost all states have large contracts in place for a more extensive build that is just getting underway now," it points out. "Stage 2 Meaningful Use will drive much more rapid development but that is no guarantee of success of state run HIEs. There has always been a concern about state run HIEs being able to compete with private options that are emerging as the market organizes.?

Indeed, there are big questions about many exchanges' sustainability.

"With few exceptions, such as Rhode Island and Vermont, the state-level HIE business model is almost completely void of private investment, leveraging mostly state and federal funds for development and implementation activities," according to the report. "Most models that have found success to date are based on driving efficiencies to providers in a fee-for-service model."

But as that outdated model fades in favor of value-based care, "the sustainability model for HIEs also must change," the report argues.

"This will likely come in the form of leveraging HIEs for care coordination, telehealth visits and quality and payment analytics. Therefore, the business of state HIEs will likely need to shift from 'facilitator of sharing' to 'data aggregator and analyzer' in order to build a sustainable business plan. The challenge will be to provide a basis for comparison across private providers."

[See also: States lead the way on healthcare IT.]

In their blog post, governors Douglas and Geringer offered other advice:

States should leverage their HIEs and other IT infrastructure in "new and innovative ways," such as closer partnerships between state governmental entities, regional extension centers, Beacon Communities and professional trade associations.Health IT "transcends political lines" and should be a top legislative priority, regardless of which part is in power, to maintain its forward momentum.States should "facilitate, engage and educate patients and consumers with the delivery of their healthcare services and promote overall increase in health literacy."Health IT should be foundational to healthcare reform.As that reform drives the shift from "fee-for-service to pay-for-quality models," state-level HIEs, to remain sustainable, will need to rethink their approach, from “health information exchange” to “healthcare coordination facilitation."Better coordination is needed between and among federal and state health agencies to make sure state-level HIEs are aligned with funding sources to ensure success.

Access the HIMSS State Adivsory Roundtable's report here.

 

Shocker: Doctors Work When They're Sick

iStockphoto.com

Take a sick day, doc.

How do doctors work around so many ill people without getting sick? Well, they don't.

Even if they scrub their hands like crazy, which certainly helps, they succumb to germs every once in a while, just like the rest of us. And also like lots of the rest of us, they'll go to work sick, a survey of medical residents finds.

A little more than half of the 150 residents surveyed at an Illinois medical meeting in 2010 said they'd worked while having flu-like symptoms in the previous year. And about one-quarter said they'd done so at least three times.

Why? They were just being responsible. More than half � 56 percent � said they felt a responsibility to take care of their patients. Fifty-seven percent said they didn't want to make their colleagues cover for them.

 

The results were published in the latest Archives of Internal Medicine. In a note about them, Dr. Deborah Grady wrote:

"Working while sick may demonstrate an admirable sense of responsibility to patients and colleagues, but clinicians also need to worry about the real danger of infecting vulnerable patients as well as colleagues and staff."

Now, don't you sometimes feel the same way when the cougher in the next cube won't take a sick day? We did our own survey in 2010 and found that almost three-quarters of people had gone to work sick in the past year.

The top reason, cited by 25 percent of people, was that they wouldn't get paid for the absence. That was followed by people saying they weren't sick enough to stay home and "work ethic" came in third at 19 percent.

Greenway integrates patient data with Microsoft HealthVault

CARROLLTON, GA – With an eye toward driving patient engagement, Greenway Medical Technologies is piloting a project by which its EHR and practice management technology, PrimeSUITE, will link with Microsoft's personal health record.

Through PrimeSUITE's secure online portal, PrimePATIENT, patients can create and access a HealthVault account to gather, store and manage centralized and sharable health information.

The integration will provide patients with digital health history forms to establish the HealthVault clinical record. Following each patient visit, entire clinical summaries or chosen elements can be sent from PrimeSUITE into HealthVault through standards-based continuity-of-care document (CCD) transport. Patients can merge the discrete data with compatible medical device, home healthcare and mobile application data to create a broader or tailored clinical picture, officials say.

"Mobile, accessible and liquid data are prerequisites for today's care coordination," said Greenway President and CEO Tee Green, who noted that "it's time to recognize patients as consumers of healthcare best practices. They are demanding it, and payers are increasingly linking patient engagement and empowerment into quality reporting and data exchange criteria in meaningful use and accountable care programs. We are committed to providing these innovations, and are proud to announce this collaboration with Microsoft."

Greenway officials say the combined data is sharable with other providers regardless of which EHR system they use if HealthVault integration is also present, or through permissible PrimeSUITE data exchange directly into EHRs and health information exchanges.

"With more than three hundred live applications across the Web and mobile devices, HealthVault can be a truly transformational tool to create more informed and engaged patients, but it only works when people have access to their clinical information," said Sean Nolan, Microsoft HealthVault distinguished engineer. "Greenway has made it easy for their providers to deliver exactly that."

Physicians' EHR success recognized at White House event

WASHINGTON – Eighty-two healthcare providers from across the country will be recognized for their successful implementation of electronic health record (EHR) technology at Tuesday's White House Health IT Town Hall in Washington, DC.

At the town hall, senior White House and HHS officials will discuss progress and barriers on the road toward a national health IT system. The HHS Office of the National Coordinator for Health IT (ONC) is hosting a variety of healthcare professionals to share lessons learned in adopting, implementing, and meaningfully using EHRs.

Among the providers attending the meeting will be Jeff Hummel, MD, medical director for health informatics at Qualis Health and the Washington & Idaho Regional Extension Center (WIREC), and Gregory Reicks, MD, who will be representing Colorado Beacon.

Hummel has been an EHR user and advocate since 1998 and will be discussing leveraging health IT to promote better health in communities, including solutions to health IT barriers such as privacy and security and the challenges of building systems that can “talk to each other.”

One of these challenges is delivering a clinical summary to each patient after a visit, which is a requirement for meeting the first stage of Meaningful Use. Like most of his colleagues, says Hummel, “my effort to give my patients clinical summaries at the end of each visit were usually characterized by good intentions that were usually abandoned by mid morning each day in an attempt to stay on schedule.”

When he was handed an after-visit summary at the end of a visit to his own primary care physician, he was intrigued. “I spent the next year figuring out how to redesign my clinic workflow so that entering and updating the information for the clinical summary was built into the structure of the visit, and reviewing the clinical summary with the patient became the end of the visit ritual that my patients came to expect. Now over 80 percent of my patients receive clinical summaries, and I go home on time.”

Reicks, who has seen health IT transform care delivery at Colorado Beacon, said this is a "tremendous opportunity for someone in the trenches, working with practice transformation every day, to engage with high level staff who are involved in this transformational work at a national, big-picture level," Reicks continued, "I look forward to sharing the direct impact these federal dollars are having on my region and my practices."

In addition to discussing the meaningful use of EHRs, providers will likely share their insight on the important role that health IT programs, such as the Regional Extension Centers (RECs), have played in helping them implement EHRs. More than 132,000 primary care providers, almost half in the country are partnering with RECs to overcome the significant barriers that primary care and rural providers face in EHR adoption.

State data disparity creates IT challenges

Quality, timeliness vary widely across the country

NASHVILLE, TN – It’s difficult for healthcare organizations to make informed, data-driven decisions when the data they receive from state agencies is incomplete or slow to arrive.

“If organizations wait to use the hospital discharge data compiled by state agencies and sent to the Agency for Healthcare Research and Quality (AHRQ), it’s going to be pretty dated by the time they get their hands on it,” said Nancy Foster, the American Hospital Association’s vice president of quality and patient safety.

“That’s why many hospitals rely on ORYX-certified data aggregators – including state hospital associations and the Veterans Health Administration – to collect data from facilities all over the country.”

“Some states do a much better job than others,” said Jason Moore, president of Nashville-based Stratasan. “Florida is one of the best in the nation in providing hospital discharge data that’s timely, comprehensive and reasonably priced. And Virginia will likely be the first state to release first quarter 2012 discharge data. But the quality and timeliness of the data varies widely from state to state.”

Stratasan serves its hospital clients by purchasing raw state data, running quality checks, and putting the reams of information into a usable format.

“Hospitals are looking for information that’s timely and actionable,” added Moore. “I’m not aware of any hospital that makes strategic decisions based on the AHRQ report. It provides more of an overview, not an action plan.”

There are now major federal initiatives that are bypassing the states to disseminate hospital discharge data and much more. The National Hospital Care Survey (NHCS) will soon be integrating data from the National Hospital Discharge Survey and a variety of other sources.

“In 2011, the NCHS recruited a nationally representative sample of 500 hospitals to directly submit UB-04 administrative claims,” said Carol J. DeFrances, CDC’s team leader at the National Center for Health Statistics.

“In 2013, participating hospitals will also be asked to provide healthcare data on a sample of visits to their emergency and outpatient departments, as well as their ambulatory surgery locations.”

As the scope of NCHS widens, state data may one day be seen as “too little, too late.”

“NCHS will soon be collecting Protected Health Information (PHI) to allow linkage of patient data across hospital settings and to other data sources such as the National Death Index (NDI) and the Medicare and Medicaid claims databases,” said DeFrances. “Linkage to the NDI will allow researchers to conduct a wide range of outcome studies, such as 30-day mortality from hospital discharge.”

Some observers say that getting faster, more accurate data will have a greater impact on hospital financial performance than on quality efforts.

“Right now, it’s difficult for IT systems to collect reliable quality data,” said Foster. “Most of the quality measures in place today assume that a clinically savvy person will be the one extracting the information from electronic records. But we haven’t been able to make that marriage work yet. We either have to retool the quality measures or improve the savvy of the machines so they can make some of those judgments.”

 

Calif. Runs With Health Law Without Waiting On Supreme Court

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California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining benefits and guaranteeing coverage to people with pre-existing conditions.

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California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining benefits and guaranteeing coverage to people with pre-existing conditions.

Many states have done nothing to implement the health overhaul law, saying they'll wait to see how the Supreme Court rules.

Not California.

The country's most populous state got out in front first on implementing the law, and it hasn't slowed down in recent weeks as the rest of the country waits to hear from the high court.

"California has been moving ahead 100 percent assuming it will upheld," says Peter Lee, who left his Washington job as a health policy official in the Obama administration to lead California's Health Benefit Exchange. "We [aren't] doing anything in the way of contingency planning because it makes no sense to plan for what seems like an outer bounds of possibility, and rather, we've got a big job to do to get ready to cover what will be millions of Californians in 18 months."

 

Lee has a staff of 36 that is working feverishly to be ready � and he is optimistic about the exchange's future in California even if the court overturns the requirement that most people buy insurance. He argues that the tax subsidies to allow some people to buy insurance will be enough to entice customers to buy their insurance in the online marketplace his agency is setting up.

"The reason the exchange is going to have � we project � over 2 million people in it after a few years, [has] very little to do with the [individual] mandate," Lee says. "We're a place where people can get subsidies for care, and can make informed choices."

Without the requirement that everyone buy insurance, known as the individual mandate, Lee estimates that the exchange would lose a few hundred thousand people; it would still be a viable marketplace for California, however.

But Patrick Johnston, president and CEO of the California Association of Health Plans, says the federal law wouldn't work without the mandate.

"We need to have a group of people that is big enough and has enough people who for the most part are healthy to make sure that the insurance costs will be shared and not high," Johnston said. "States that decided to say 'Everybody gets insurance at the same price but you can buy it whenever you want,' found that prices just went way up and people dropped out."

Still, on the legislative side, California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining standard health benefits and guaranteeing coverage to people with pre-existing conditions.

"I'm going to remain fully committed to figuring out how do we preserve and protect what was the vision of President Obama, to replicate that in California by any means necessary," says Assemblyman Bill Monning, chairman of the state assembly's health committee. "We will figure out how to do it."

Monning and his counterpart state Sen. Ed Hernandez, a Democrat, hesitate to say they'd propose a state health insurance mandate, without knowing the court decision. But Hernandez says he would author a bill that would "start the discussion" about compelling people into the market. Hernandez worries, though, that funding a new state marketplace without federal help would be difficult.

"The state just doesn't have any money," he said. "My biggest fear and concern is if we lose the federal subsidies, I just don't know how we can make it ... work."

Republican Assemblyman Dan Logue is a fierce opponent of the health law. He thinks the Democratic majority in California would succeed in passing a state mandate if the federal one goes down. But if a state mandate were proposed, he would take it to the voters.

"I think once they realize the dynamics and the cost and how it would put California at risk financially with the rest of the country, that it would go down in flames easily," Logue said.

Lee of the health exchange says he isn't losing any sleep over the thought of the mandate being thrown out . "I've seen community groups, I've seen hospitals, I've seen health plans, I've seen the business community, not throwing rocks at our effort but, rather, joining in to make this thing work," he says.

Despite Lee's optimism, a recent survey by the Public Policy Institute of California showed 63 percent of Californians were against the mandate.

This story is part of a project with the Capital Public Radio, NPR and Kaiser Health News.

New app maps patients' health risks

WASHINGTON – IndiGO, an application developed by San Francisco-based Archimedes Inc., uses a patient's EHR and advanced algorithms to generate graphical analyses of that individual's health risks. The app brought its game face to last week's Health Data Initiative (HDI) in Washington, D.C., eventually walking away with a win.

IndiGO was presented with the "Best of Care Applications" award at the HDI event earlier this month for its ability to provide a graphical representation of a patient’s heart attack or stroke risk, chance of developing diabetes and the predicted impact of interventions, such as lifestyle changes and medications that are most effective at reducing these risks.

The algorithms that make this possible incorporate clinical evidence related to diseases, behaviors and interventions. IndiGO and individualized guidelines can be used at the point-of-patient care, involving the patient in the decision-making process and improving collaboration between patient and provider. IndiGO is designed for use within ACOs, medical groups, integrated delivery networks (IDN), independent practice associations (IPA) and patient-centered medical homes (PCMH).

"The 'Best of Care Applications' award for IndiGO represents further recognition of the value of clinical decision support, delivered at the point of patient care," said Josh Adler, vice president of Archimedes and IndiGO business leader. "IndiGO's unique capabilities, in the hands of our physician partners, have been found to drive better patient engagement and increase adherence, leading to improved outcomes and lower costs."

The HDI, now guided by the Health Data Consortium, encourages innovators to utilize health data to develop applications to raise awareness of health and health system performance, and spark community action to improve health. Archimedes was one of 17 companies, chosen by a panel of judges from among more than 200 contending companies, to present during the main stage session at Health Datapalooza.

Would single-payer healthcare be less vulnerable to the court than the ACA?

If the Supreme Court does decide to strike down any or all of the Affordable Health Care Act, the implications will range from the political to the medical to the economic.

For me, such a decision will take its place among the more supremely ironic of unintended consequences: a law designed to avoid greater government intrusion into health care will have been invalidated as an unconstitutional overreach of government power, while a far more intrusive approach would have clearly passed muster.

How could this be possible? Welcome to the wonderful world of constitutional interpretation.

Let�s begin by imagining that Congress and the president decided to adopt a genuinely radical health care plan�the kind in place in most of the industrialized world. They decide on a �single-payer� system, where the government raises revenue with taxes, and pays the doctor, hospital and lab bills for just about everyone.

Put aside the question of whether this is a good idea, or an economically sustainable notion. The question is: would such a law be constitutional?

The answer, unquestionably, is �yes.� In fact, it would be the simplest law in the world to enact. All the Congress would need to do is to take the Medicare law and strike out the words �over 65.� Why is it constitutional? For the same reason Medicare and Social Security are: the taxing power. Its reach is immense. During World War II, the maximum income tax rate was 91 per cent (it was paid by few, thanks to loopholes, but still). The same Congress that could abolish the estate tax could set just about whatever limit it chose; it could impose a 100 percent tax on estates over, say, $5 million. If it decided that a national sales tax was an answer to huge budget deficits, it could impose one at whatever level it chose.

(The remedy, of course, lies with the voters, who would be more than likely to send a powerful message at the next election, which is why the lack of constitutional limits on the taxing power do not lead to confiscatory rates.)

So why is Obama�s health care plan, with a far more modest use of government power, in serious jeopardy? It�s because the key element in the plan�the �mandate� to purchase health insurance or pay a penalty�was not based on the taxing power, but on Congress�s power, under Article I, Section 8, to regulate interstate commerce. And that power, while broad, has its limits…even if those limits are murky.

Up until the late 1930s, those limits were more like shackles. The Supreme Court repeatedly struck down sate and federal laws regulating wages, hours and working conditions on the grounds that the commerce power only touched the distribution of goods, not their manufacture. But once the court changed its mind�after an effort by FDR to �pack� the court with additional justices had failed�there seemed to be no limits at all. Back in 1942, the court said the government could stop a farmer from growing his own wheat for his own use, because of the potential effects on the wider market. But in 1995, for the first time in decades, the court said �no� to a federal law based on the Commerce clause�one banning firearms within school zones�because it could find no reasonable connection between the law and interstate commerce.

In the health care case, the questioning by several justices indicated strong skepticism about the mandate. If the commerce clause can compel a citizen to buy a specific product�in this case, health insurance�what couldn�t it do? Could it, as the now famous question had it, compel citizens to buy broccoli on health grounds? (Well, a defender might have pointed out, the government does compel taxpayers to �pay for� all kinds of things in the form of government subsidies, such as ethanol. It could clearly do the same with a broccoli subsidy.)

As a policy matter, it�s clear that a �mandate� is a much more modest extension of government power than a single-payer system. The citizen would choose which insurance to buy; in fact, under the law, a citizen could choose not to buy any insurance, and pay a penalty instead. The whole premise of a mandate is to spread risk as widely as possible; as Mitt Romney used to note when he was defending the Massachusetts plan he designed, the mandate to prevent �free riders� from benefitting from treatment once they are sick or injured. That�s why the genesis of the idea came from such conservative roots as the Heritage Foundation.

As a constitutional matter, however, the idea of compelling a citizen into a specific economic activity raises alarm bells. It evokes the specter of some bureaucrat inviting himself into your home, while checking the shelves to make sure you�ve purchased multigrain cereal and cage-free eggs. (It�s a specter the administration tried to avoid by arguing that the health-care market is unique, one in which we are all likely participants at some point, voluntarily or otherwise. Unlike life in a Robert Heinlien libertarian �utopia,� hospital ERs do not have the power to say to an uninsured heart attack or auto accident victim: “you chose not to buy insurance? Sorry…have a nice day.�)

So, for its effort to design a health care plan that moved in the direction of less government intrusion, the Obama administration faces the distinct prospect of having its signature domestic program shot down for exceeding the limits of the constitutional power it did choose to use.

I somehow doubt the White House will appreciate the irony.

Consumer Assistance Programs: Making Sure Health Insurance Works for You

Recently, a woman in Maine was facing $34,000 in hospital bills for costs related to a mastectomy and reconstructive surgery that her insurance company was refusing to pay.� Thankfully, Maine�s Consumer Assistance Program identified a law that required the insurance company to pay part of those costs, and they helped her file an appeal that led to the insurance company covering an additional $24,000 of her medical expenses.

Health insurance problems are difficult enough to sort through in the midst of our busy lives, but they can be overwhelming when we or our loved ones are sick.

That�s why the Affordable Care Act includes resources to help states strengthen existing Consumer Assistance Programs or start new ones.� In this case, Maine used grant funds to increase its ability to file appeals on behalf of consumers and to educate consumers about the appeals process.

Today we�re releasing a report that shows the remarkable assistance that Consumer Assistance Programs have given to consumers over a one-year period.

From October 2010 to October 2011, Consumer Assistance Programs funded by grants authorized under the Affordable Care Act:

provided direct assistance to over 200,000 consumershelped overturn insurance company decisions in favor of more than 22,000 consumersobtained more than $18 million in direct savings on behalf of consumers and millions more due to more choices and better benefitsprovided valuable outreach and education to hundreds of thousands more

Put simply � these programs work.

That�s why we�re also announcing today that we�re providing nearly $30 million in grants to existing or new Consumer Assistance Programs.

We want to make sure that these programs have the resources to continue the critical work they do. It�s work that literally saves lives. Beth, a mother in Massachusetts, found this out first hand when her 20 year old son, Joe, was diagnosed with Stage 4 Hodgkin�s Lymphoma.

Joe faced a course of extensive and aggressive treatments � so much that he would have to take medical leave from college and go home to his mother in Massachusetts. But because he had to leave school, Joe was no longer eligible for his student health insurance.� Beth couldn�t afford the premiums if Joe joined her plan. Joe suddenly found himself uninsured and in need of thousands of dollars� worth of treatment�treatment that Beth couldn�t afford to pay out of pocket.

Fortunately, Beth called the Massachusetts Consumer Assistance Program. �Its staff worked with Beth and Joe to find affordable health insurance that met their needs, and helped Joe to enroll.

Beth says that, thanks to this program, Joe was able to receive treatment, and he�s responding well.

If you need help with a health insurance problem or have a question about your coverage or benefits, you can find out where to go in your state for help. Our interactive�Consumer Assistance Program Map, on HealthCare.gov, will show you where you can find the help you need. �For consumers in states that didn�t apply for Consumer Assistance Program grants, the map offers links to a variety of agencies and public programs that may also be able to offer assistance.

We can always use a helping hand in understanding our rights and protections as we find the best health coverage for ourselves, and for our families. �Thanks to the Consumer Assistance Program, that help is just a phone call away.

UnitedHealthcare Pledges To Keep Popular Coverage, Regardless Of Supreme Court

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One of the nation's largest insurers said early Monday it would continue to follow some of the rules in the federal health law that are already in effect, including keeping young adults up to age 26 on their parents' plans and ending lifetime dollar limits, no matter what the Supreme Court decides.

UnitedHealthcare, which covers about 26 million people in plans that could be affected by such regulations, is the first insurer to make public such a promise. The Supreme Court justices are expected to rule sometime this month and could uphold the law, remove parts of it or reject the entire legislation.

 

The insurer said no matter what, it would continue to offer policyholders no-copayment preventive services, such as cancer screenings, and third-party appeals for cases where treatments are denied. United also said it would not cancel policies retroactively, except in cases of fraud.

Related NPR Stories Health Care Decision Hinges On A Crucial Clause June 11, 2012 Health Overhaul Brings Ban On Lifetime Benefit Caps Sept. 14, 2010

Those rules score high on public opinion polls, even among people who say they don't like the overall law.

United stopped short of saying it would continue to accept all children, no matter if they had a pre-existing medical condition. The federal law says insurers cannot reject children up to age 19 simply because they have a medical condition.

While the company "recognizes the value of coverage for children" United said "one company acting alone cannot take that step," adding that it is "committed to working with all other participants in the health care system to sustain that coverage."

No mention was made of other rules in the health law that some insurers find onerous, including a requirement that they issue rebates to customers if they fail to spend at least 80 percent of premiums on medical care.

What happens if all or part of the law is rejected is the subject of near-constant speculation in Washington and beyond. Many experts believe that even if the court rejects the law, some things across the industry may not change immediately. For young adults on their parents' policies, for example, insurers would likely need to continue coverage until the policy's contract term expired.

United did not disclose what retaining the provisions would cost.

"These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue," said Stephen J. Hemsley, president and CEO of UnitedHealth Group said in a statement. "These provisions are compatible with our mission and continue our operating practices."

Tim Jost, a consumer advocate and a law professor at Washington and Lee University, said he hoped other insurers follow suit. One thing the United statement demonstrates, he said, is that "the provisions are not bankrupting the industry."

But, while the rules United mentioned tend to be popular in opinion polls, Jost said, other provisions in the law will do more to cover the uninsured. Those include preventing insurers from rejecting adults with pre-existing medical conditions and the government tax credits aimed at helping low and moderate income Americans purchase coverage, both of which begin in 2014.

"I'm glad to hear United is doing this and I hope other insurers follow suit," said Jost. "But that doesn't solve the problem of the uninsured, which is why we need the rest of the health bill."

To Count As A Young Scientist, Anything Less Than 52 Will Do

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You're not getting older, you're getting better.

I always suspected that the pursuit of science could keep a person young � or at least young at heart.

Now I have evidence. Sort of.

The Foundation for the National Institutes of Health, a charity that helps raise money to support the NIH, today announced the Lurie Prize. A $100,000 check awaits a "promising young scientist in biomedical research" with the right stuff.

The awardee will be selected by a jury of six eminent researchers in recognition of outstanding scientific achievement. Nominations (and you can't nominate yourself) are due Aug. 15.

 

So what's the cutoff age?

"Nominations are to be for an outstanding young biomedical investigator, who shall not have passed his/her 52nd birthday on April 12, 2013."

Fifty-two still qualifies as being a young scientist? Really? I thought there must be a mistake.

I called the foundation, and spokeswoman Kimberly O'Sullivan confirmed that it was correct. "It was a board decision," she said. "Most awardees of this nature seem to be older."

Criteria for some other grants and awards define young a different way, pegging it to how long ago researchers completed their terminal academic degree or medical residency.

Ten years, for instance, closes the window for some NIH grants earmarked for new investigators. And it's true that the average age for researchers getting their first career-making R01 grant from NIH is now north of 42.

Back when I was young, or at least younger, I wrote my journalism master's project on the problems young biomedical researchers were having landing enough grant money to get their careers on track. That was back in the '90s, and most of the youngsters I talked to were 30-somethings. The graybeard in the group was 41 at the time.

But it apparently takes even longer for people to get traction in the world of science these days, and we're living longer, too. So maybe 50 is the new 30, if you're a promising scientist.

Childhood cancer survivors face high breast cancer risk

Children diagnosed with cancer remain at risk from a variety of serious, long-term complications even years after doctors pronounce them cured.

Now, new research shows that girls treated with radiation for pediatric tumors face a later risk of breast cancer that's six to seven times as high as that of other women.

About 24% of women treated with chest radiation for any childhood cancer develop breast cancer by age 50. About 30% of women diagnosed as children with Hodgkin lymphoma � a disease treated with higher doses of chest radiation � develop breast cancer by age 50, according to a study to be presented today in Chicago at the annual meeting of the American Society of Clinical Oncology. An average woman's risk of breast cancer by age 50 is 4%.

In comparison, women who carry a mutation in the gene BRCA1 have a 31% risk of breast cancer by that age, while those with a mutation in the BRCA2 gene have a 10% risk, says study author Chaya Moskowitz of New York's Memorial Sloan-Kettering Cancer Center.

The findings affect not only women who were treated with therapeutic radiation as children, but also the thousands of children and adolescents in treatment today. Nearly 60,000 American women alive today had chest radiation for any pediatric cancer, according to Memorial Sloan-Kettering. About 12,500 children and adolescents are diagnosed with cancer each year.

The research reflects a growing sensitivity that "cure is not enough," says Michael Link, outgoing president of the oncology society. Over the past 50 years, cure rates for young cancer patients have improved from 20% to 80%. But the therapies used to cure children are incredibly toxic.

While doctors have known of the increased breast cancer rates among pediatric survivors for years, Moskowitz says her study is the first to compare their risks with those of BRCA mutation carriers, who are well-known for their high risk of breast cancers. Some women with a strong family history of breast cancer now get genetic testing and, if they carry one of the mutations, undergo mastectomies or ovary-removing surgery to reduce their chance of cancer.

Risk of breast cancer by age 50

� Women treated with chest radiation for any pediatric cancer: 24%
� Women treated with larger dose of chest radiation for Hodgkin lymphoma: 30%
� Women with BRCA1 mutation: 31%
� Women with BRCA2 mutation: 10%
� Women with average risk: 4%

Source: American Society of Clinical Oncology

Jeanne Miller, 37, survived Hodgkin lymphoma at age 16, after undergoing 13 months of chemotherapy and six weeks of radiation. Last August, she was diagnosed with breast cancer. Doctors recommended a double mastectomy.

"We need to know how to take care of survivors and change childhood cancer therapies, so this doesn't happen to the next group of survivors," says Lisa Diller of Boston's Dana-Farber Cancer Institute. "Children treated for Hodgkin lymphoma today are treated with therapies that try to maintain the excellent cure rates but use as little radiation as possible."

Miller says she is grateful that doctors caught the tumor at the earliest stage.

The Children's Oncology Group recommends women treated with higher doses of radiation begin breast cancer screenings at age 25, or eight years after finishing radiation, whichever comes later, using both mammograms and MRI, or magnetic resonance imaging. Typically, medical societies recommend women at normal risk for breast cancer begin getting screening at age 40 or 50.

Moskowitz says doctors may need to re-evaluate those guidelines for pediatric cancer survivors. She found that even women given lower doses of therapeutic radiation had a significant risk of breast cancer. That risk may continue to rise, too, as childhood cancer survivors age. Few survived the disease before the 1970s, so many of the first survivors are just hitting middle age.

Miller's doctor gives her regular checkups, she says, because some of the chemo drugs she took are known to damage the heart. Her doctor, study co-author Kevin Oeffinger, also of Memorial Sloan-Kettering, has promised her that breast cancer won't slow her down. Miller, of Fairfield, Conn., says she's back to exercising and is currently enjoying a weekend at the beach. Oeffinger has told her "that this would be a blip on my life's radar screen," Miller says, "and that I would celebrate my 90th birthday."

7 critical success factors for ACOs

To date, 32 organizations across the country are participating in the Pioneer ACO initiative, hoping to inspire others in their regions to follow suit. As the benefits of adopting this model become clear, more organizations are looking to explore the possibility of becoming anACO. 

Ron Parton, MD, chief medial officer at health IT firm Symphony Corporation, outlines seven critical success factors for ACOs. 

1.Align the payment model with value. The key for organizations to be successful in these types of new payment arrangements, said Parton, is to make sure they have the payment arrangements in place as they change their care delivery models. "There are organizations and integrated systems around the country that have introduced their quality improvement programs before entering into a shared risk arrangements, and [they] have improved quality significantly but have lost revenue because they reduced fee for service business," he said. "So one of the keys is to try to make sure you're matching your payment model with your quality improvement efforts so you don't get ahead of yourself." And once you've created that type of payment model, Parton added – whether it's participating in a Medicare shared risk arrangement, or a local or national insurance company that's creating a pay-for-performance or a shared risk opportunity – it becomes a question of investing in the right type of infrastructure. 

2. Pay attention to leadership and cultural change. According to Parton, one of the most pressing things to understand when changing payment models is that specialty physicians, in particular, may struggle with understand the importance of these new arrangements, since most have depended on fee-for-service to be successful through their careers. "So, it's important to pick leaders who are forward-thinking and who will support the new care payment arrangements," said Parton. These selected individuals can help lead initiatives across the medical staff. "Once you get some of the medical staff bought in, it's important to invest in infrastructure that helps them be successful in the new model," he said. 

[See also: ACOs dominate early discussion at MGMA conference.]

3.Hire experienced health professionals, especially nurses and health coaches. Part of driving cultural change, said Parton, is to hire staff to help make these new initiatives successful. "One of the key factors of all this work is to identify complex patients who have difficulty navigating the system, managing their own illness, taking medications, etc.," he said. "The professionals who have skill sets to change that behavior may be different than what current integrated systems have hired." Identifying nurses who understand how to implement specific techniques and help patient manage their illness can drive the transition more quickly, said Parton, therefore making it essential to have these types of staff members on board. 

4.Take the time to gain buy in from the primary care practitioners and their staff. Naturally, there will be practices that are resistant to change, said Parton, so make sure you touch base with every practice and have a contact and leader in each to help educate and lead their group. "This is extremely important, otherwise, people will give lip service but they won't change their workflow of how they're managing their practice day to day," he said.  He added that a lot of the work doesn't need to be done by physicians, but by associated in their offices, like nurses, medical assistants, nutritionists, etc. "Getting that buy-in across the entire staff of a practice is important," he said. "It's not just the practitioners." Keep in mind the role EHRs will play in the transition, Patron added, especially when it comes to adding more work to learning the new IT system. "Doing this work for an ACO is additional stress," he said. "So helping them understand some techniques, some new tools they can use to improve their work is part of the issue."

[See also: ACO program is asking too much, says expert.]

5.Develop the data model, IT infrastructure, and tools to support reporting and analytics. One key piece for larger organizations, said Parton, is getting all organizations involved in the transition on the same page. "There are multiple organizations involved, and they come together to do the shares risk arrangement," he said. "So they may be on multiple systems and multiple data sources, and one of the challenges upfront is integrating and taking data from all those sources into one common data warehouse." The first step, he added, is to identify who's participating in the ACO and what the differences are in their data infrastructures. The next step is to create interfaces with each separate data source to do mapping. "That's where the data model comes in," he said. "You need to make sure you understand the differences in data from one entity to the next … all that detail is extremely important." The last step, said Parton, is pulling the data and integrating it into a common platform, "so if you invest in that, you have the data to do any of the programs, projects, or measurements, and it makes your life so much easier if you do all that upfront."

6. Invest in a population health and care management system, and integrate with the EHR. A population care management system allows you to take data from all your sources and use it specifically to track and manage subpopulations, said Parton. "You want to target and allow care teams to do follow-up work with care plans, " he said. "The population care management system can be the common care plan platform that allows professionals to track and manage patients across the system... care is coordinated in a way that helps people stay out of the ER and out of the hospital." In turn, the system takes nightly feed of EHR data and makes it available to care teams, allowing them to determine gaps in care by seeing the care across an entire population. "Whether they're following evidence-based guidelines and are looking for patterns of someone not taking medication, or they have multiple doctors managing care and it's uncoordinated, they can look for that pattern," said Parton. "They can target the right patient and give them the care they need."

7.Match the organizational readiness for change. "All the things an ACO needs to do simultaneously, it's a lot of work and a lot of change for an organization," said Parton. "It's important for the organization to continuously monitor how well these initiatives are going on a daily or weekly basis and make sure you're not getting ahead of yourself." Constant communication and listening, Parton continued, in terms of feedback from physicians is key. "At some point, you may find you have to step on the brakes for a bit because you have to wait for your IT team to catch up," he said. "Or, from a payment model perspective, you have the model in place and need to accelerate those results-oriented projects because you need results from the bottom line sooner. It's about stepping on the brake or the gas to make sure things are moving."

Microsoft and GE Healthcare get regulatory approval to form Caradigm

REDMOND, WA – General Electric and Microsoft announced Wednesday they have completed the formation of Caradigm, the 50/50 joint health IT venture first announced this past December.

Officials say Caradigm will draw on both companies' strengths to develop an open intelligence platform and new clinical applications aimed at enabling better population health management.

In addition, GE and Microsoft on Wednesday announced the appointment of Lauren Salata as chief financial officer and Michael Willingham as quality assurance and regulatory affairs executive for Caradigm.

Salata previously served as the chief financial officer and compliance officer of Care Innovations, an Intel and GE company based in Roseville, Calif. Willingham joins Caradigm from Philips Healthcare in Bothell, Wash., where he served as senior director of quality and regulatory affairs.

“The combination of people and technology from GE Healthcare and Microsoft will allow us to drive the dramatic change that is needed in healthcare,” said Simpson. “By forming Caradigm, we can offer innovative healthcare solutions, including an open platform and tools that enable software developers around the world to address the complexities of population health today.”

[See also: Newsmaker Interview: Michael J. Simpson - Caradigm CEO.]

Caradigm will be headquartered in Bellevue, Wash., with offices in Salt Lake City; Andover, Mass.; Chevy Chase, Md.; and other cities around the world.

Employers Less Likely To Drop Coverage Than You Might Think

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Employers are bruised by health costs, but most aren't thinking about dropping coverage just yet.

When it comes to businesses providing health coverage for employees, there's a mad dash for the exits, right?

Maybe not, according to a recent survey of more than 1,300 U.S. employers of varying sizes. Consultants at Oliver Wyman's health practice wondered how employers are weighing the increasing costs of providing health insurance and the potential exit strategy paths available under the federal health law (if it survives the Supreme Court).

Bottom line: only 8 percent of the employers surveyed have plans to drop coverage altogether. But half of the companies surveyed do plan to make big changes to the coverage they offer.

"The most critical points are that they by and large have a very strong desire to take care of their employees," Oliver Wyman's Mindy Kairey tells Shots. Many employers have a strong belief that healthy employees are better employees.

 

And some employers worry that they'd be less able to attract the workers they want without offering health coverage. Companies that employ more highly paid workers are less likely to be thinking about dropping coverage.

So what's changing? Health costs continue to rise, putting pressure on employers to manage insurance expenses. The folks at Oliver Wyman asked about two relatively new approaches that are starting to get some traction.

One is private insurance exchanges, essentially beefed-up menus of coverage options that feature a wider variety of options than you might already be choosing from each year. In some cases, the employer might give you a fixed amount of money to make the decision about which one to pick. About 60 percent of companies would consider this approach if it save them at least 10 percent on health costs, the survey found.

Another option gets a new buzzword: value-based networks. In this approach, providers of health care get paid based on the quality bang for the buck they provide. About half of employers are interested in this option, if it save them at least 10 percent of costs.

As it is, the erosion of employer-based health coverage is well under way, as NPR reported as part of a series on what it's like to be sick in America. "In plain language, it's becoming skimpier and skimpier and less and less comprehensive," Drew Altman, president and CEO of the Kaiser Family Foundation, told us.

Cerner revenues up 18 percent in 4th quarter

KANSAS CITY, MO – The economy may be in crisis, but Cerner Corp. has a rosy outlook. The Kansas City-based healthcare IT company posted a better-than-expected fourth quarter result on Tuesday, with revenues up 18 percent.

Executives credited the company's broad global client base for its success.

"The large size and geographic diversity of our client base and the deep strategic relationships with those clients contributed to our ability to deliver solid results in a difficult environment," said Cerner founder and CEO Neal Patterson.

"We are pleased with our fourth quarter and full-year 2008 results, which reflect good execution in a challenging economic environment," Patterson said. "We delivered solid bookings, revenue and earnings and record levels of cash flow."

"We are cautiously optimistic that we will continue to generate solid results," he said, adding that Cerner is well positioned to take advantage of the Obama administration's focus on healthcare IT as a necessary piece of healthcare reform.

Sean Weil, an analyst with Piper Jaffrey, concurs that Cerner is well positioned for the stimulus package making its way through Congress.

"Cerner is one of a handful of companies that can benefit from both the hospital and physician stimulus incentives," he said in an analysis issued Wednesday.

In addition, Weiland said Cerner's size and scale likely afford it the capital it needs to execute.

Cerner's bookings in the fourth quarter of 2008 were $404.9 million, near the record level of $406.6 million recorded in the fourth quarter of 2007. Fourth quarter revenue increased 18 percent, to $465.7 million, over the same period a year ago.

Net earnings were $71.5 million compared with fourth quarter 2007 net earnings of $41.3 million.

Other fourth-quarter highlights:

Cash collections of $441 million and record operating cash flow of $98 million.Days sales outstanding of 92 days compared to 93 days in the third quarter of 2008 and 90 days during the same quarter last year.Total revenue backlog of $3.5 billion, up 7 percent over the same quarter a year ago. This is composed of $2.9 billion of contract backlog and $0.6 billion of support and maintenance backlog.

Senate negotiations may drop healthcare IT grant funding from $5B to $3B

WASHINGTON – Senate wrangling over the weekend on a proposed $900 billion economic stimulus package has led to a $3 billion cut in proposed healthcare IT discretionary funding.

The Senate had been looking at spending $22 billion to $23 billion for healthcare information technology in the economic recovery package – including $5 billion originally allotted for funding that could include grants for providers to purchase healthcare IT.

Over the weekend, however, $2 billion was cut for healthcare IT federal discretionary funding.

The Senate says it may have the three Republican votes needed to pass its version of the stimulus package, but insiders say negotiations will be fierce before an expected final vote on Tuesday – and chances for passage may lessen the longer a vote is postponed.

Republican Sens. Susan Collins and Olympia J. Snowe of Maine and Arlen Specter of Pennsylvania have indicated they are likely to support the trimmed version of the Senate stimulus package, according to (italics) CQ Daily. (end italics)

Healthcare IT privacy activists are lobbying hard for privacy measures to be included in the package. "Privacy and security protections have to be meaningful and comprehensive or electronic health systems will never be trusted," said Deborah Peel, founder of Patient Privacy Rights.

Once the Senate passes its version of a stimulus package, it must be reconciled with the House version before it can be signed into law.

President Barack Obama hopes to have a bill passed before Feb. 13.

House Rejects Ban On Sex-Selection Abortion

The House on Thursday fell short in an effort to ban abortions based on the sex of the fetus as Republicans and Democrats made an election-year appeal for women's votes.

The legislation would have made it a federal crime to perform or force a woman to undergo a sex-based abortion, a practice most common in some Asian countries where families wanting sons abort female fetuses.

It was a rare social issue to reach the House floor in a year when the economy has dominated the political conversation, and Republicans, besieged by Democratic claims that they are waging a war on women, struck back by trying to depict the vote as a women's rights issue.

"It is violence against women," said Rep. Chris Smith, R-N.J., of abortions of female fetuses. "This is the real war on women."

The White House, most Democrats, abortion rights groups and some Asian-American organizations opposed the bill, saying it could lead to racial profiling of Asian-American women and subject doctors who do not report suspected sex-selection abortions to criminal charges.

"The administration opposes gender discrimination in all forms, but the end result of this legislation would be to subject doctors to criminal prosecution if they fail to determine the motivations behind a very personal and private decision," White House spokeswoman Jamie Smith said in a statement. "The government should not intrude in medical decisions or private family matters in this way."

The bill had little chance of becoming law. The Democratic-controlled Senate would likely have ignored it, and the House brought it up under a procedure requiring a two-thirds majority for passage. The vote was 246-168 30 votes short of that majority. Twenty Democrats voted for it, while seven Republicans opposed it.

The bill's author, Rep. Trent Franks, R-Ariz., said before the vote that regardless of the outcome, the point would be made. "When people vote on this, the world will know where they really stand."

Rep. Steny Hoyer of Maryland, the House's No. 2 Democrat, said he thought the bill was introduced because "somebody decided politically that this was a difficult place to put people in."

The legislation would have made it a federal offense, subject to up to five years in prison, to perform, solicit funds for or coerce a woman into having a sex-selection abortion. Bringing a woman into the country to obtain such an abortion would also be punishable by up to five years in prison. While doctors would not have an affirmative responsibility to ask a woman her motivations for an abortion, health workers could be imprisoned for up to a year for not reporting known or suspected violations of the ban on sex-based abortions.

An earlier version of the bill also made it illegal to abort a fetus based on race.

"We are the only advanced country left in the world that still doesn't restrict sex-selection abortion in any way," said Franks, who has also collided with abortion-rights groups recently over a bill he supports to ban abortions in the District of Columbia after 20 weeks of pregnancy.

Franks and others say there is evidence of sex-selection abortions in the United States among certain ethnic groups from countries where there is a traditional preference for sons. The bill notes that while the United States has no federal law against such abortions, countries such as India and China, where the practice has contributed to lopsided boy-girl ratios, have enacted bans on the practice.

Lawmakers "who recently have embraced contrived political rhetoric asserting that they are resisting a 'war on women' must reflect on whether they now wish to be recorded as being defenders of the escalating war on baby girls," said National Right to Life Committee legislative director Douglas Johnson.

His group, in a letter to lawmakers, said there are credible estimates that 160 million women and girls are missing from the world due to sex selection.
But the Guttmacher Institute, an organization that favors abortion rights, said evidence of sex selection in the United States is limited and inconclusive. It said that while there is census data showing some evidence of son preference among Chinese-, Indian- and Korean-American families when older children are daughters, the overall U.S. sex ratio at birth in 2005 was 105 boys to 100 girls, "squarely within biologically normal parameters."

NARAL Pro-Choice America president Nancy Keenan said that while her group has long opposed reproductive coercion, "the Franks bill exploits the very real problem of sex discrimination and gender inequity while failing to offer any genuine solutions that would eliminate disparities in health care access and information."

Marcia Greenberger, co-president of the National Women's Law Center, said the bill fosters discrimination by "subjecting women from certain racial and ethnic backgrounds to additional scrutiny about their decision to terminate a pregnancy."

"Doctors would be forced to police their patients, read their minds and conceal information from them," said Rep. Jerrold Nadler, D-N.Y.

Republicans also used the bill to continue their ongoing criticism of Planned Parenthood, citing a video taken by the group Live Action purporting to show a Planned Parenthood social worker advising a woman on how to determine if her fetus was female before she terminated the pregnancy.

UPMC deploys Wi-Fi-based RFID

PITTSBURGH – University of Pittsburgh Medical Center has implemented RFID technology to automate temperature monitoring at UPMC St. Margaret Hospital, and it will soon roll out wireless monitoring and asset tracking across most of its U.S. hospitals.

Officials say UPMC will deploy AeroScout’s Healthcare Visibility Solutions, which use advanced radio frequency identification (RFID) technology that will leverage UPMC’s standard Wi-Fi network to avoid the purchase, installation and maintenance of a proprietary RFID network.

After researching real-time location systems (RTLS) for several years, UPMC decided to use a Wi-Fi-based solution to leverage the investment in its Wi-Fi network and the related expertise it had developed, officials say. AeroScout technology can use low frequency and ultrasound for additional use cases such as par level management, and offers integration capabilities to allow other UPMC software providers to utilize location and condition information, for instance, temperature readings, for specific clinical and operational applications.

"After our extensive testing and due diligence, it was clear to us that Wi-Fi-based healthcare visibility solutions were not only the best model for our health system, but also the standard that would prevail industry-wide because of the important advantages they offer over proprietary systems," said James Venturella, CIO, Physician and Hospital Services at UPMC. "By using our existing Wi-Fi infrastructure, the AeroScout solutions are easier to deploy, allowing us to see the associated productivity and patient care benefits more quickly."

The asset management technology enables UPMC staff to track the location of critical medical equipment throughout its facilities, ensuring that it's at the right place at the right time and eliminating the need to manually search for items.

UPMC uses the temperature monitoring solution to automatically and wirelessly monitor the temperature of refrigerators and freezers, helping prevent spoilage of medicines, vaccines and even food. Both applications free up a significant amount of time so that staff can focus on caring for patients, officials say.

Following the success of its current implementation, UPMC plans to extend the technology. It will use AeroScout when it introduces a SmartRoom system at its new UPMC East hospital in Monroeville, which is scheduled to open this summer. Officials say the SmartRoom will use RTLS to identify caregivers as they walk into a patient’s room and provide clinicians with real-time, relevant information at the patient’s bedside.

Senate negotiations may drop healthcare IT grant funding from $5B to $3B

WASHINGTON – Senate wrangling over the weekend on a proposed $900 billion economic stimulus package has led to a $3 billion cut in proposed healthcare IT discretionary funding.

The Senate had been looking at spending $22 billion to $23 billion for healthcare information technology in the economic recovery package – including $5 billion originally allotted for funding that could include grants for providers to purchase healthcare IT.

Over the weekend, however, $2 billion was cut for healthcare IT federal discretionary funding.

The Senate says it may have the three Republican votes needed to pass its version of the stimulus package, but insiders say negotiations will be fierce before an expected final vote on Tuesday – and chances for passage may lessen the longer a vote is postponed.

Republican Sens. Susan Collins and Olympia J. Snowe of Maine and Arlen Specter of Pennsylvania have indicated they are likely to support the trimmed version of the Senate stimulus package, according to (italics) CQ Daily. (end italics)

Healthcare IT privacy activists are lobbying hard for privacy measures to be included in the package. "Privacy and security protections have to be meaningful and comprehensive or electronic health systems will never be trusted," said Deborah Peel, founder of Patient Privacy Rights.

Once the Senate passes its version of a stimulus package, it must be reconciled with the House version before it can be signed into law.

President Barack Obama hopes to have a bill passed before Feb. 13.