Provider Shortage Worsening, Demand Growing

Health and Human Services spokeswoman Erin Shields Britt says continuing to build the primary care workforce will take time, but she notes President Obama's budget working its way through Congress has several new ways to expand the primary care workforce, which includes nurse practitioners and pediatricians. The Affordable Care Act (ACA), she says, significantly increases the number of primary care providers in rural and underserved areas and increases Medicare and Medicaid payment for services delivered by primary care practitioners.

An article in USA Today this week outlines some of the challenges that continue to get in the way of training and placing providers. The challenges include the rising cost of medical school, more lucrative specialty care and scope of practice laws. Read the article here.

Final Surge Pushes ACA Enrollment in Colorado

Enrollment for private health insurance coverage for this year ended Monday with a surge that led to 118,628 Coloradans signing up on the state exchange (Connect for Health Colorado). Some 12,000 people signed up during the last week of open enrollment.

Enrollments under the Affordable Care Act are expected to continue to climb over the next few weeks in Colorado. Those who started their applications prior to the deadline, but were unable to complete them, will be given more time.

Connect for Health Colorado reported yesterday (Tuesday) that between Oct. 1st and March 31st, more than 277,000 Coloradans obtained either commercial or public health insurance under the Affordable Care Act. Medicaid gained 158,521 enrollees. The federal program expanded under the law in Colorado to cover lower-income single adults as well as disabled people, mothers, pregnant women and children.

Read the article in the Denver Post here.

Rural Providers Come Together to Test Out ACO

Nine rural communities have joined forces to qualify the National Rural ACO (NRACO) for the Medicare Shared Savings Program. The NRACO includes a diverse cross-section of healthcare providers across the country, including Rural and Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, and independent physician practices.

Accountable Care Organizations (ACOs) are required to have at least 5,000 Medicare beneficiaries and meet rigorous program requirements. This patient base can make it extremely difficult for rural areas to form ACOs. The number of beneficiaries attributed to each NRACO member community ranged from 252 to 3,507, well shy of the 5,000 beneficiaries required to participate. CMS estimates an average start-up cost and first-year operating expense of $1.7 million for an ACO, which is unaffordable for small rural community health systems. By themselves, none of the NRACO's member communities could have qualified or afforded to become Accountable Care Organizations.

According to the NRACO's founder, Lynn Barr, the organization was formed to overcome these barriers and make the program accessible to small community health systems: "Rural communities can join the NRACO at a fraction of the cost of setting up their own program, and reap the benefits for their communities and patients."

"Rural health systems provide about 70% of all care to their community. This program will help them coordinate the care provided outside their community and act as advocates for their patients," according to NRACO Board Chair, Timothy Putnam, CEO of Margaret Mary Community Hospital. "Forming the NRACO allowed us to do what is right for our patients and fulfill the mission of serving the health needs of our community, while at the same time blazing a trail for other rural communities to follow."

The vision of the NRACO is to be the national leader of the transformation of rural healthcare systems from fee-based to value-based care by creating an affordable, replicable framework that results in the best possible health for rural communities, at the lowest possible cost, and strengthens and preserves the rural health safety net.

You can read more about NRACO here or by signing up for a free subscription to Modern Healthcare here.

Connect for Health Colorado and Colorado Medicaid Update

Read the latest enrollment number from Colorado Medicaid and Connect for Health Colorado below. You can read the press release in your browser by clicking here.

For immediate release:

January 17, 2014

CONNECT FOR HEALTH COLORADO AND COLORADO MEDICAID UPDATE

DENVER, CO – Between October 1, 2013, and January 15, 2014, more than 165,000 Coloradans have signed up or been approved for 2014 health coverage, according to data released today from Connect for Health Colorado and the Colorado Department of Health Care Policy and Financing.

After an extremely busy December, the first two weeks of January continues to see steady interest from Colorado shoppers and enrollment activity. January 15 was the deadline for Coloradans to sign up for private health insurance that takes effect February 1. The next deadline is February 15 to have private health insurance start on March 1. Open enrollment continues until March 31. Enrollment for Medicaid is year-round.

“We are encouraged to see steady interest from Coloradans during the second half of our open enrollment period and we are focused on reaching as many Coloradans as possible to help them shop for health insurance and apply for new tax credits to reduce costs,” said Patty Fontneau, CEO of Connect for Health Colorado.

“Together with our partners at Connect for Health Colorado, we are reaching and enrolling the uninsured,” said Susan Birch, Executive Director of the Colorado Department of Health Care Policy and Financing. “The numbers released today further demonstrate Colorado as a leader in the nation. We are among a handful of States with technology in place to allow for real time eligibility determinations for Medicaid. The technology, along with our strong network of county and community partners, has allowed us to enroll individuals into new coverage faster than many other states many of which have much larger populations to reach.”

Coloradans signed up for health insurance:
165,137 (Total) 101,730 (Medicaid) 63,407 (private health insurance)

Individual and family customer accounts:
86,235 (from PEAK) 155,854 (private health insurance)

Daily website visitors (average daily from January 1st - 15th):
4,546 (Medicaid) 7,982 (private health insurance)

** More metrics information about Medicaid is available here and more metrics information about Connect for Health Colorado is available here.

Through state laws, Connect for Health Colorado was established as a non-profit entity with a Colorado mission. In addition, Colorado is expanding eligibility for Medicaid. Private health insurance purchased through Connect for Health Colorado’s competitive marketplace and the expanded eligibility for Medicaid both take effect in 2014. Enhanced federal funding that is available starting January 1, 2014 will support the Medicaid expansion.

Connect for Health Colorado has been open since October 1, 2013 and operates with separate technology and customer service operations from the federal marketplace, healthcare.gov. Connect for Health Colorado is open to individuals, families and small businesses. Individuals and families can choose from up to 150 private health insurance plans from ten carriers and small employers can create small group plans from up to 92 health insurance plans provided by six carriers. The Customer Service Center is open from 7 am to 8 pm Mondays through Saturdays at 1-855-PLANS-4-YOU (855-752-6749). More information is available at www.ConnectforHealthCO.com.

Colorado Medicaid and the Child Health Plan Plus (CHP+) are public insurance programs for low income Coloradans. The Department of Health Care Policy and Financing administers these programs. Coloradans have multiple ways to apply for coverage, Colorado.gov/PEAK is the online application for public assistance programs including medical assistance. For more information visit Colorado.gov/hcpf or visitColorado.gov/health. The Medicaid Call Center (800-221-3943 for general questions and 800-359-1991 to check application status) are available 8 a.m. to 6 p.m. Monday through Friday. The call center is closed on state holidays.

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Contact information:
Ben Davis, ben@onsightpa.com, 303-552-6790 (Connect for Health Colorado)
Rachel Reiter, Rachel.Reiter@state.co.us, 303-866-3921 (Colorado Medicaid)

Copyright © 2014 OnSight Public Affairs, All rights reserved.

$45 Million Set Aside to Strengthen Nursing

The federal government announced late last year it would deliver $55.5 million in fiscal 2013 to programs designed to strengthen, diversify, and grow the healthcare workforce.

The bulk of the funds, 82 percent ($45.4 million), are targeted at the largest segment of the healthcare workforce - nurses. Many of the grants support the Future of Nursing: Campaign for Action’s call for a more highly educated and more diverse nursing workforce and for more interprofessional collaboration among nurses and other healthcare professionals, according to Winifred Quinn, PhD, co-director of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. Read the full article here.

Colorado Network of Health Alliances, A Statewide Learning Network Convened by CCMU

In dozens of communities across Colorado, formal health alliances are using collective impact approaches to tackle the major social issues of healthcare. Some of the alliances have been around for decades and others are just now exploring formalization, but all of them are working on a common agenda, using collaborative leadership strategies, to improve the local healthcare system and ensure access to care for all community members.

Since 2012, the Colorado Coalition for the Medically Underserved (CCMU) has convened these alliances in a statewide learning network called the Colorado Network of Health Alliances. Last week, CCMU published a year-in-review document, Progress & Possibilities, detailing the first year of the network, including current membership (21 alliances) and highlights of the work being done by these groups. They also identified three strategies for local healthcare change that are common across the members of the Colorado Network of Health Alliances:

1. Developing Healthcare Leadership for Change – Health alliances are on the front lines of identifying and developing champions for healthcare change in communities across Colorado. These organizations have the unique ability to bring diverse and high-powered leaders and stakeholders together to work toward common goals.
2. Increasing Access to the Healthcare System – Health alliances are working hard to catalyze new healthcare access points, to maximize enrollment in new health insurance coverage options, and planning to care for the needs of Coloradans who will remain uninsured after the Affordable Care Act is implemented.
3. Improving and Strengthening the Healthcare System – Through formal alliances, health and community leaders across the state are constantly searching for ways to coordinate services, limit duplication, and pool resources.

Read the full report here.

Financial Challenges Top Concern for Community Hospital Leaders

For the tenth straight year, "financial challenges" have been listed as the number one concern of healthcare executives, according to an annual survey from the American College of Healthcare Executives. The second concern was healthcare reform implementation, followed by government mandates and patient safety and quality (both which ranked third). Read the article in HealthLeaders Media.

The Challenges of Adopting Health IT for Rural Hospitals

Michael Archlueta, Director of IT for Mt. San Rafael Hospital in Trinidad was recently quoted in Becker's Hospital Review. When discussing the challenges of rural health IT adoption, Mr. Archlueta said, "At times, I've faced difficulty in regards to having limited resources made available to me. "The challenge has been the tremendous work-load that I’m juggling and expectations that I’m continuously striving but successfully overcoming all obstacles." 

Mt. San Rafael Hospital is not alone. Across the country, other small rural hospitals face hurdles when it comes to funding, personnel and other resources needed to implement EHRs and other forms of health IT. Read the article here.

Obamacare May Cut Bad Debt Says Southwest Memorial Hospital

As more people in Montezuma County sign up for insurance under the federal healthcare law, Southwest Memorial Hospital in Cortez may take on far less bad debt. Southwest Health System said patients were unable to pay about $4.6 million in medical bills during the 12 months leading up to October 2012.

In preparation for Obamacare, the hospital became certified in the fall to sign people up for Medicaid and other forms of insurance. According to Kent Helwig, CEO of Southwest Memorial Hospital, the hope is that people will seek out preventive care and make fewer trips to the emergency room when they have insurance. Read the rest of the article in the Cortez Journal here.

Newly Insured Begin Seeking Care: An Update on Colorado's Enrollment

According to Modern Healthcare, health systems are reporting a flood of phone calls as newly insured patients start seeking care. Approximately 2.1 Americans have signed up for insurance through an exchange, and another 3.9 million qualified for Medicaid, according to Health and Human Services. The roll-out has been uneven across the country, depending largely on the investment each state has made in setting up and promoting its own insurance exchange or whether it defaulted to the federal marketplace. Read the rest of the article here. 

Colorado's exchange, Connect for Health Colorado (C4HCO) achieved a total of 52,783 Coloradans signing up for health insurance on Colorado's marketplace between October 1, 2013 to December 31, 2013. Most of these enrollees began receiving health insurance benefits on January 1st of this year. October and November had a slow but steady pace of enrollees, then December saw a boom in enrollments. For example, on December 23, 2013, the final day of enrollment for coverage starting on January 1st, 5,354 people enrolled in just one day. Open enrollment continues through March 31st of this year. 

On the public insurance side, 86,432 Coloradans have successfully enrolled in Medicaid since October 1, 2013. “The enrollments in Medicaid and Connect for Health Colorado show that Coloradans are becoming more aware of the importance of having health insurance coverage,” said Susan Birch, Executive Director of the Colorado Department of Health Care Policy and Financing. “Whether Coloradans have health insurance coverage through private insurance or through Medicaid, health coverage is the first step to better health.

Report Says Experience of CHIP Hints at Impact of Medicaid Expansion on Providers

Enrollment in public health insurance coverage will expand significantly beginning in 2014. At this time there is only a limited understanding of what happens when an influx of newly insured patients encounters a relatively fixed supply of providers. Will they choose to work longer hours to accommodate the increase in demand? The experience of the Children’s Health Insurance Program (CHIP) offers a preview of how providers might respond to the expansion.

According to a report in the Medicare & Medicaid Research Review, researchers from the Government Accountability Office and the Washington-based Center for Studying Health System Change found that the creation of the Children's Health Insurance Program in 1997 did not create a deluge of patients that the nation's pediatricians couldn't handle. Read more here.

Clarification Regarding the Colorado Health Insurance Cooperative

In a blog post dated March 15th, I erroneously reported that Colorado received a loan to create a CO-OP, and I would like to correct that information.  The Colorado Health Insurance Cooperative (CO-OP) was established in 2012 through a $69 million loan awarded by the Department of Health and Human Services (DHHS) under the Affordable Care Act (ACA).  The CO-OP is sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation, and is a consumer governed and operated, nonprofit insurance company that aims to offer affordable, high quality health coverage to individuals and small businesses.  The CO-OP will primarily be made available through the Colorado Health Benefit Exchange and independent insurance brokers in 2013.

Improving Quality and Patient Safety for Vulnerable Populations

Dr. Bruce Siegel is the President and CEO of the National Association of Public Hospitals and Health Systems (NAPH), and is a contributor to the Learning Health System Commentary Series of the Institute of Medicine (IOM) Roundtable on Value & Science- Driven Health Care.  Authored commentaries in the IOM Series draw on the experience and expertise of field leaders to highlight health and healthcare innovations they feel have the potential, if engaged at scale, to foster transformative progress toward the continuously improving and learning health system envisioned by the IOM.  Statements are personal, and are not those of the IOM or the National Academies.

In this commentary, Dr. Siegel describes NAPH’s current efforts to improve the disproportionate burden of hospitalization and poor health outcomes for the nation’s safety-net patients. Read his discussion on several concepts central to continuously improving care, including the importance of integrated, coordinated patient care across various care delivery settings here.

Opinion Piece: The ACA is Pushing Physicians to Become Hospital Employees

It is estimated that by next year, about 50% of U.S. doctors will be working for a hospital or hospital-owned health system. A recent survey by the Medical Group Management Association, shows a nearly 75% increase in the number of active doctors employed by hospitals or hospital systems since 2000, reflecting a trend that accelerated around the time that the Affordable Care Act (ACA) was enacted.  Read Scott Gottlieb's recent opinion piece in the Wall Street Journal about hospital-acquired medical practices.

Will Medicare Cost Slow Down Close the US Budget Gap?

New evidence that the slowdown in healthcare costs over the past five years is happening not only because of a weak economy comes from the Economic Report of the President report, recently released by the President’s Council of Economic Advisers.  The report found that if the slowdown were to continue in the future, Medicare spending would basically remain flat as a share of the economy. Read more here about the Economic Report of the President as it examines changes in healthcare spending and unemployment rates across states.

Nurse Practitioners Say How They're Paid Affects Care They Can Provide

According to a study from Kaiser Health News published last week by the National Institute for Health Care Reform, researchers found that while scope of practice laws did not appear to restrict the primary care services nurse practitioners can provide to patients, they do affect how the advanced nurses are paid. Read more here.

Nurse Practitioners Push To Help Care For Health Law's Newly Insured

More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?

"With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients. David Hebert is at the issue’s center. Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, is the first CEO of the American Association of Nurse Practitioners (AANP) -- a new group with 42,000 members recently formed from the merger of the American College of Nurse Practitioners and the American Academy of Nurse Practitioners."

KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.

Click here to read edited excerpts of that discussion:

AHA Rural Chair Says Reimbursement Top Challenge

Alvin Hoover, CEO of King's Daughters Medical Center in Brookhaven, MS, chairs the American Hospital Association's Section for Small or Rural Hospitals. Read his interview in "Health Leaders" about the reimbursement challenges facing rural hospitals in the reform landscape. Hoover says the overarching challenge is going to be to helping the legislators understand that massive cuts to reimbursement to try to lower the deficit can't all be on the backs of hospitals.  Read the interview here. 

Infographic on Healthcare Access in Rural Colorado Released

Joe Sammen, Community Partnership Coordinator for the Colorado Coalition for the Medically Underserved (CCMU), blogged this week about policy options to improve access for rural Coloradans. His opinion piece accompanied CCMU's lastest brief in their infographic series, a series that explores health from the perspectives of different populations. Developed using health survey data, the series demonstrates Coloradans’ varying experiences of health and healthcare. Read Joe's opinion piece here on rural healthcare reform and opportunities for coverage, and view CCMU's rural health infographic with data on access and coverage for rural Coloradans here.

Roughly 12,000 Jobs to be Added Statewide with Expansion of Medicaid

A proposal to expand Medicaid to cover 160,000 more Coloradans will add roughly 12,000 jobs statewide, according to a rough estimate by economic development leader Tom Clark.  Legislators will be debating whether to accept the federal offer this session, which as part of the Affordable Care Act, offers states the option to expand Medicaid to persons living below 133% of the federal poverty level. Gov. Hickenlooper recently gave the expansion his support and estimated it would bring $12.28 billion in federal funds back to Colorado taxpayers over 10 years. Read more here.