10 July 2012

Midwest Edition
Calendar
July 10

States Taking Their Own ACA Tack

Some May Opt Out of Medicaid And Exchanges
total expansion, or close to 13.8 million people. Bruce Siegel, chief executiev ofcer of the National Association of Public Hospitals and Health Systems, believes as many as 30 states are at risk for not expanding coverage. Its in part because of the economy they dont know what state budgets will look like going forward and the second reason is the political messaging going around it, he said. Some governors are going to view expanding it as a political nonstarter. It will be an interesting landscape that will play out for years. Many states, like Illinois and Missouri, have been cutting Medicaid rolls in recent years due to budget woes. In Missouri, Governor Jay Nixon, a conservative Democrat, has said he is unsure about expansion. The states Republican General Assembly has historically vetoed such measures (leaving it with one of the lowest income qualifying levels in the nation for adult coverage, at 19% of the poverty level, or just over $4,000 for a family of four). There is dismally low coverage of Medicaid in Missouri, said David Dillon, vice president of media relations for the Missouri
Continued on Next Page

Although the U.S. Supreme Courts upheld much of the Affordable Care Act as constitutional late last month, states are pouncing on the sliver found unconstitutional. In a 5-4 decision, Chief Justice John Roberts crossed political lines and wrote the opinion that the federal government can 9#3=J!;-.-!E1.!A1.-!K6E1.D,<316 mandate that individual purchase health insurance and pay a tax if they choose not to. This, theoretically, will expand coverage to approximately 16 million Americans in 2014. But the court did not uphold the other mandate regarding the Medicaid program. July 18 One of the provisions of the ACA required states to expand their Medicaid coverage of adults up to 133% of the federal poverty level :/3,6!;-,#<5!9,.-!8-,4-./!://1=3,<316>! ($15,000 a year for an individual and $30,657 ?,6!@.,6=3/=1!A,..31<<!A,.B"3/>!:/3,6C for a family of four in 2012) beginning in :D-.3=,6!5-,#<5=,.-!#-,4-./!E.1D!,.1"64! 2014. States either had to expand their <5-!=1"6<.$!D--<!<1!43/="//!.-#-2,6<!<1F3=/>! programs to cover another 16 million adults or GH&C%II they lose all of their Medicaid funding. That 9#3=J!;-.-!E1.!A1.-!K6E1.D,<316 rule was thrown out by the court. As a result, governors in many states have said they will not expand their programs, including Scott Walker of Wisconsin.
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September 9-11

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There were 26 states that took part in the Supreme Courts lawsuit including Indiana, Iowa, Colorado, Kansas, Michigan and Wisconsin; and a handful of others have said they may not comply (including Missouri). Siegel said these states account for 60% of the

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NEWS
ACA (Continued from Page One)
Hospital Association. Raising the federal poverty level up to 133% would mean a lot of access for adults in rural areas, in particular. One of the bargains in the ACA was that the funds hospitals would get through Medicaid expansion would make up for some of the loss of disproportionate share hospital funds as a result of its passage. According to Siegel, some states will lose about 40% of DSH funding by 2019. The loss of funding will be acute, Siegel said. We are very worried that the safety net will not be viable if we dont have that coverage. Dillon said his association estimates that Missouri hospitals provide about $1 billion a year in free care. There was hope that the Medicaid expansion and the mandate would reduce those numbers.

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In Brief
Ohio Officials Break Off Talks With Aetna Over Medicaid Bidding
The Kasich Administration has decided to cut off continued negotiations with Aetna after a subsidiary of the insurance giant lost a lucrative Medicaid managed care contract when its bid was rescored by state officials. Aetnas bid lost points after state officials claimed it had inflated its experience running Medicaid managed care operations in other states. Aetnas attorneys had suggested an out-of-court settlement, but it was rejected after it was learned its legal team incuded Mary Jo Hudson, the former director of the Ohio Department of Insurance under Gov. John Kasichs predecessor, Ted Strickland, a Democrat. Kasich is a Republican. instead of owning up to their mistake, Aetna hired former Strickland staffers to help them attack the administrations integrity something we take very, very seriously, Scott Millburn, Kasichs communications director, told the Columbus Dispatch. Aetna claimed that state officials changed the bidding process midstream and broke its own rules by communicating with another bidder. It has filed a formal protest.

Something is better than nothing, even if it is Medicaid, which doesnt fully cover the cost of care, he said. The politics of this issue are very complicated, but it is likely that hospitals, safety net providers and healthcare advocates will be leading the charge for expansion. Hospitals have a particular interest in the matter since they help fund part of the states Medicaid matching funds through a provider tax. There is no timeline for when states have to decide at this point and there are a lot of questions that remain unanswered. State ofcials will likely not make decisions until late 2012. I think we are going to see some real hardnose positions and then see others backtracking or negotiating, Siegel said. A lot of it will be about electoral politics. TAMMY WORTH

Some Reactions To ACA Ruling

The decision means that hospitals now have much-needed clarity to continue on their path toward transformation. But transforming the delivery of health care will take much more than the strike of a gavel or stroke of a pen. It calls for the entire health care community to continue to work together, along with patients and purchasers, to implement better coordinated, high-quality care. Now that the Supreme Court has made its decision, hospitals will continue their efforts to improve the law for patients, families and communities. Richard Umbdenstock, President, This ruling will ensure that more Americans will have health insurance and access to timely care while reducing the burden of uncompensated care that we and other hospitals face. We are committed to continuing to deliver high-quality care while containing costs, and welcome the chance to do so for increasing numbers of people. ! University of Michigan Health System "This is a sad day for job providers and families who support healthcare policies based upon free market solutions and strenuously oppose the government interference in purchasing and benefit design decisions contained in Obamacare.! Jim Holcomb, Senior Vice President, Michigan Chamber of Commerce Only with a new president and a new Senate can Americans eliminate this horrific healthcare law and start fresh with true health care reform, rooted in moral principles and sound economics. Brian Burch, CatholicVote.org, Chicago The AMA remains committed to working on behalf of America's physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation's healthcare system. Jeremy A. Lazarus, M.D., President, American Medical Association

American Hospital Association

Mercer Survey Says Some Businesses Remain On Fence Regarding ACA

Continued on Page 3

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UnitedHealth Expands EHR Access

Initiative Makes Patient Records Easily Printable
UnitedHealthcare has begun to greatly expand the portability of the personal health records of its enrollees. Uniteds blue button initiative, which began rolling out during the spring, allows enrollees to easily print all their medical records, including claims data. The les are converted to a text or PDF format with the push of a single button. United enrollees in Nevada were the rst to receive the printer-friendly format. The Minneapolis-area insurer projects 12 million of its enrollees will have blue button access by the end of the year, with all 26 million receiving it by mid-2013. This technology encourages people to update their personal health records as well as print them, so they can take their records with them and discuss their health and treatments with their doctors, said Karl Ulfers, Uniteds vice president of consumer solutions. Access to easily printable blue button medical records was launched by the Veterans Affairs Department in 2010. The U.S. Department of Health and Human Services has been trying to encourage their use in the private sector in the intervening years. With Blue Button the government created a framework that offers patients private and secure access to their data, and is a model for the private sector, said Roger Baker, the V.A.s chief information ofcer. He predicted that as many as 75 million Americans will have access to easily printable medical records by the end of 2012.

In Brief
A new survey by Mercer of more than 4,000 firms immediately after the U.S. Supreme Court upheld the Affordable Care Act determined that a large number are still taking a wait-and-see attitude regarding how they will react. Although 40% of those firms surveyed said they now plan to implement a strategy to respond to the ACA, another 16% said they would wait until the outcome of the Presidential and Congressional elections in November. Meanwhile, 28% of respondents said that responding to the ACA will present a significant challenge to their operations. Employers with large parttime populations, such as retailers and healthcare organizations, are faced with the difficult choice of either increasing the number of employees eligible for coverage, or changing their workforce strategy so that employees work fewer hours, said David Rahill, president of Mercers health and benefits division. With the average cost of health coverage now exceeding $10,000 per employee, a big jump in enrollment is not economically feasible for many employers.

Big Health Disparities In Motor City

Elder Population Need Lopsided Amount of Care
Residents of Detroit over the age of 50 require far more healthcare services and die sooner than other residents of Michigan, according to a new study. The Detroit Area Agency on Aging and researchers from the Wayne State University School of Medicine examined healthcare data between 2007 and 2009. They concluded that inhabitants of the Motor City between the ages of 50 and 59 have a mortality rate 31% higher than the statewide average comparable to the mortality rate of Michigans residents between the ages of 60 and 74. Altogether, Detroiters in that age group have a mortality rate of 1,321 per 100,000, compared to the statewide rate of 571 per 100,000. Moreover, older Detroiters require 30% more hospital services than other Michigan residents. Among those between the ages of 60 and 74, its 43% higher. Ofcials blamed the trend on the citys endemic poverty rate, particularly among younger residents. Because of the lack of availability of healthcare coverage, younger residents are developing chronic illnesses that are not treated at an early stage, said DAA Chief Executive Ofcer Paul Bridgewater. If found early enough, these illnesses could have been treated and prevented from advancing to a chronic stage and having a negative effect on overall health and causing premature death. Ofcials said the implementation of the Affordable Care Act is expected to help address the inequalities.

Cardinal Expands Hospital Pharmacy Consulting Program

Ohio-based Cardinal Health has expanded its consulting services to include design and improvement of hospital-based outpatient pharmacies. Among the services the rm is now offering includes outpatient pharmacy design and management, as well as performance assessments for existing pharmacies. Cardinal ofcials say the services will improve patient care, help hospitals expand their revenue streams and more easily qualify for federal drug pricing programs that offer pharmaceuticals for underinsured and insured patients.

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OPINION

Page 4

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Person-Centered Cares Three Rs

Some Suggestions For Remaking The Current System
Turning disorganized fee-for-service into an cannot be overstated. organized system of care is often presented as a These factors are often intertwined, and different kind of engineering challenge. But at a time interventions can involve more than one. when more than three-quarters of all healthcare Nonetheless, each remains a separate aspect costs are linked to chronic disease, the human deserving of separate attention. element is essential. Rethinking personRules. The person-centered requirements related centered care is central to improving quality to Medicare accountable care organizations provide while containing cost. a framework for action even for those not in the Based on the medical literature, new federal program. ACO rules address person-centered care at requirements and the work of organizations the boardroom level with governance requirements that are leaders in this area, I believe providers for consumer involvement, and they extend to the and payers can follow a roadmap based on exam-room level with rules addressing the three Rs to turn the aspiration to interaction between the ACO, the individual provide person-centered care into clinician and patients. By reality. They are: redenition, rules So, for instance, the Centers for Medicare & Michael Medicaid Services requires ACOs to and role models. Millenson communicate clinical knowledge about Redenition. The term patientcentered originated post-World War evidence-based practices directly to patients. II as an assertion that doctors should treat their Another rule promotes shared decision making, patients as people with physical and including a requirement for tools allowing patients to psychological needs, not just as a bundle of assess the merits of treatment options in light of their symptoms. The terms meaning continues to own values and convictions. Beneciaries must evolve. also be given clear instructions on accessing their The 2001 Institute of Medicine report that medical records. declared patient-centeredness one of six core Role models. As formidable as implementing goals of U.S. healthcare broadly dened it person-centered care can appear, the good news is within an ethical context of autonomy. Patientthat a variety of organizations have started to blaze centeredness meant care that is respectful of the trail. and responsive to individual patient Innovative use of health information technology preferences, needs, and values and ensuring in tandem with innovative rethinking of roles and that patient values guide all clinical decisions. responsibilities have shown that person-centeredness That denition remains, although it has can be integrated into each individuals experience expanded to include family and caregivers as of care, each site of care and the way a health care part of patient decisions. system is organized. Examples include patient and However, the term consumer has a family councils at Bostons Dana-Farber Cancer separate meaning, even though it is often used Institute, patient-family advisors who are part of interchangeably. For one thing, the ethical improvement programs at University Health Systems context of this economic term is different. For of Eastern Carolina and the innovative health another, the concept of service providers and coaching program at Mercy Clinics in Des Moines. consumers in a health care marketplace relates New habits of information sharing, relationship to transparency of quality and cost information building and shared decision-making inevitably feel intended to create patients-as-better-shoppers. strange at rst. Moreover, individuals must begin to Finally, there is a clinical concept related to the understand that person-centered care cannot patient as a unique source of information. justify demands for treatments of dubious clinical Research shows that incorporating patients value. self-perceptions of health status into treatment decisions can lead to more effective Michael Millenson is president of Health interventions. Patients self-reported symptoms Quality Advisors in Highland Park, Ill. He is a and treatment decisions (e.g., using a mobile member of the Payers & Providers editorial phone app to track blood sugar) are an board. increasingly important clinical input. And the American Heart Association earlier this year formally called on clinicians to incorporate Op-ed submissions of up to 600 words are welcomed. Please e-mail proposals to shared decision making in treating advanced editor@payersandproviders.com heart failure, declaring that its importance

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MARKETPLACE/EMPLOYMENT

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AVP - Accountable Care Organization

Patients and families from across the region and around the world come to Cincinnati Children s Hospital Medical Center because we are dedicated to improving child health. We serve the medical needs of infants, children and adolescents with family-centered care, innovative research and outstanding teaching programs. Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S.News and World Report's 2011- 2012 Best Children's Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Working for the largest national pediatric healthcare system, the Assistant Vice President will lead and manage its newly created Accountable Care Organization (ACO) with anticipated annual revenues up to $500 million. Major responsibilities include Network Delivery, Network Management, Credentialing, Data Analysis and Reporting, People Management and Payor Contracting and Relations. Specifically responsible for provider enrollment with payors, network provider contracting and provider relations issues, ACO credentialing program, processes related to administering payor contracts, medical management functions including care management, care coordination, utilization and disease management programs, quality improvement programs across ACO provider network, data analysis and reporting. Assist in payor contract negotiations. To be successful, our ideal candidate will possess a Bachelor s degree along with ten years experience managing network management, care management, medical management, and/or care coordination activities in hospital-owned or physician-owned health plan, PHO, or payor environment. Master s degree in business or health administration preferred. The incumbent must possess resiliency and perseverance in both starting up new business enterprises and in scaling up business enterprises after start-up phase. Demonstrated leadership and management skills required along with experience in formulating credible, effective, long-range strategies to attain overarching organizational objectives; anticipating future trends, as well as potential threats or opportunities; and accurately predicting how strategies will play out. Network management experience in Medicaid managed care plan desirable. Experience starting up new business enterprises preferred. Cincinnati Children's Hospital Medical Center offers a comprehensive employee benefits program that is equal to or better than the majority of the other health care institutions in the city. The benefits program is constantly reviewed to identify better ways to deliver world-class benefits. Visit our career site at www.cincinnatichildrens.org to submit your resume and application. Job ID# 58097. Cincinnati Children s is an Affirmative Action/Equal Opportunity Employer.

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