New Report About Narrow Networks Released by McKinsey Center

Roughly half of the products sold on exchanges in 2014 were narrow-network plans, according to a study by the McKinsey Center for US Health System Reform (read the study here). In the largest city in each state, that figure jumped to 60 percent.

The vast majority of exchange customers had a choice between broad- or narrow-network plans, the McKinsey study found. Broad network plans were available to 90 percent of potential customers, while narrow-network plans were an option for 92 percent of that population. Read the rest of the article in Modern Healthcare here (requires a free subscription). 

Creating rules around network adequacy are difficult for rural areas as a balance must be struck to create standards strong enough for meaningful access protections, but flexible enough to be achievable for the Qualified Health Plans. This discussion won't be over any time soon.

New Study From CHA Shows Impact of Medicaid Expansion on Hospital Volumes

A new study from the Colorado Hospital Association (CHA) shows the impact of Medicaid expansion on hospital volumes in the 26 states that chose to expand Medicaid eligibility under an option offered through the Affordable Care Act. The study shows that the Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals. You can listen to the article on Colorado Public Radio here, and read the study from CHA here.

Community Tools Are Available to Combat the Higher Rates of Childhood Obesity In Rural Areas

The Altarum Institute, a nonprofit health-systems research and consulting organization, reported today that children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas. Rural communities have come up with several strategies to battle childhood obesity. 

According to Sarah Lifsey and Karah Mantinan of the Altarum Institute, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces. They also cite research showing that rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to healthcare, lower levels of physical activity and lower-quality food.  Many rural families who lack access to fresh and healthy foods live in “food deserts,” Studies have found poverty and childhood obesity are more likely in rural food deserts.

Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center’s Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina’s Active Living by Design.

Read the article in the Lane Report.

New ACA Communications Webinar Online Now

The Department of Health Care Policy and Financing, Division of Insurance and Connect for Health Colorado have released a new joint communications webinar. The webinar discusses how community partners can assist in reaching the uninsured and begin to educate consumers on how to use their coverage. The webinar also provides an overview of the resources available for consumers, partners and providers about the Affordable Care Act, Medicaid expansion, Connect for Health Colorado and the changes to private health insurance.

The webinar can be found on Colorado.gov/HCPF/ACAResources or by clicking here. Following the webinar, if you have questions you may submit them to ACAImplementation@hcpf.state.co.us.

Will the "Doc Fix" Really Happen? The SGR Explained

After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act by March 31st of this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own "doc fix" proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal.

Kaiser Health News printed these frequently asked questions and answers about the Sustainable Growth Rate (SGR) formula and how Congress may change it. It's one of the best explanations on the SGR I've read. If you have questions, I encourage you to check it out!

ACA Meeting in Denver on April 27th

Affordable Care Act (ACA) meeting scheduled for April 27th. Come learn the myths from the facts about the ACA and get answers to your questions on Saturday, April 27th from 1:00 – 5:00 at Manual Auditorium in Denver. Get more details in the flyer or read the agenda here.

Interim Report Says There is Little Support for Medicare Payments That Vary

An interim report recently issued by the Institute of Medicine concluded Medicare should not adjust payments on a broad regional basis to reward hospitals and doctors that spend less to achieve high-quality care. 

The study was conducted at the request of the secretary of Health and Human Services, Kathleen Sebelius, in response to a push by some members of Congress to revisit how Medicare pays hospitals and doctors. The report’s authors were responding to the argument that Medicare should pay higher levels of reimbursement to areas of the country that deliver measurably good care at low cost and less to regions where costs are high and outcomes are poor. Read more about the study in the New York Times.

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.

Sequester Digest

News outlets around the country are covering the sequester and its impacts.  A collection of news articles relative to sequestration can be found below.  

The Washington Post: Republican Goal To Balance Budget Could Mean Deep Cuts To Health Programs
Anxiety is rising among House Republicans about a strategy of appeasement toward fiscal hard-liners that could require them to embrace not only the sequester but also sharp new cuts to federal health and retirement programs. Letting the sequester hit was just the first step in a pact forged in January between conservative leaders and Speaker John A. Boehner (R-Ohio) to keep the government open and the nation out of default. Now comes step 2: adopting a budget plan that would wipe out deficits entirely by 2023 (Montgomery, 3/4).

Politico: Paul Ryan Floats Change To Medicare Plan
Paul Ryan's budget will show how Republicans can balance a budget that's trillions of dollars out of whack. But the most significant unresolved issue comes down to a minuscule number: one year. Ryan — the House Budget Committee chairman — has privately been floating the idea of allowing his changes to Medicare to kick in for Americans younger than 56. In previous budgets, those 55 and older were exempted from his plan to turn Medicare into a premium-support — or voucher — program (Sherman and Allen, 3/4).

The Hill: GOP Centrists Balk At Ryan Medicare Shift
House Republican centrists are furious that GOP leaders are considering abandoning their pledge not to change Medicare retirement benefits for people 55 years and older. According to several sources, a handful of centrist GOP lawmakers attending a recent Tuesday Group luncheon erupted when Budget Committee Chairman Paul Ryan (R-Wis.) and House Majority Whip Kevin McCarthy (R-Calif.) broke the news (Hooper, 3/5).

The Medicare NewsGroup: Distrust Of Government Is A Hard Hurdle To Jump In Medicare Reform
One reason that changes to the Medicare program will be hard to make is because people distrust the federal government yet cherish what it offers them. This is a hard conundrum to overcome. The latest polling makes this point with great vigor. And the discussions among experts within different parts of the political spectrum illustrate why President Obama and Congress have scant prospect of success in producing any alterations to Medicare. … Skepticism about government is the deepest since the Pew Foundation began polling in 1958, when it found that 73 percent of Americans trusted the government in Washington, D.C., "all the time or most of the time." Today, the level of trust has shrunk to a meager 26 percent, according to the latest polling, conducted last month (Rosenblatt, 3/4).

New Analysis of Colorado Children and Health Insurance

The Colorado Health Institute recently released its annual analysis of the number of eligible children in the state who are not enrolled in the Medicaid or Child Health Plan Plus (CHP+) public insurance programs.

According to the analysis, about 125,000 Colorado children, or 9.7 percent of all children, did not have health insurance in 2011. This was a decrease from the 132,000 uninsured children in 2010.

View the 2011 estimates from the Colorado Health Institute here in three new publications:

• A fact sheet that summarizes the high-level findings and maps county-level estimates. 
• A data supplement that includes detailed tables of county-level data. 
• A methodology document that outlines the assumptions and processes used to create the estimates.

Healthcare as an Economic Stabilizer

Princeton economics professor Uwe Reinhardt provided his perspective this week on the impact of healthcare on the economy.  Reinhardt says the healthcare sector has functioned for some time as the main economic locomotive pulling the economy along, and in the last two decades, it has created more jobs on a net basis than any other sector.  Read more of his perspectives and enjoy an economics lesson here.

Anthem's Telemedicine Program Connects Members with Needed Services

Anthem Blue Cross’ telehealth network recently marked an important milestone. By providing over 50,000 specialty consults, they connected members in some of the state’s most rural underserved areas to needed healthcare services. Read about how they built their model from its original purpose as a vehicle to serve the growing Medi-Cal population, and how the program has grown over time to serve other Anthem members and even other health plans without a network of their own.

 

NE Study Shows Residents in Rural Counties are Less Likely to Have Health Insurance

A new health study says more uninsured people live in rural Nebraska, and experts say the implications for the future affect all of us. This is true for Colorado, as well as across the country. The rural economy is based on small business and self -employment. Small business owners face inherent challenges in providing coverage for themselves and their employees. Lower purchasing power, increased risk of adverse selection and higher marketing and administrative costs all contribute to insurers charging higher premium costs to smaller employers, a common practice in rural parts of the state. Read the article here, or read more about health disparities facing rural Coloradans in the Colorado Coalition for the Medically Underserved's most recent issue in their infographic series about access.

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.

Sign Up for NOSORH'S Series of Free Webinars to Celebrate National Rural Health Week

November 12th through the 16th is National Rural Health Week, and at CRHC, we will be celebrating the power of rural all week. We recognize that while facing unique healthcare needs, rural areas are full of innovation and are wonderful places to live and work. We also know that these communities are fueled by the creative energy of ordinary citizens who are always willing to step forward and take risks in order to provide a wealth of products and resources for the rest of the country. We thank you for all you do to serve your communities.

As part of the week long celebration, the National Organization of State Office of Rural Health (NOSORH) is hosting a series of free webinars highlighting the good work being done to address rural health concerns.

All webinars will be recorded and made available to the public at www.celebratepowerofrural.org.

Schedule/Participating Partners:

Monday, November 12, 3:00 - 4:00 p.m. EST
The Basics of Rural Health

Kristine Sande, Program Director, Rural Assistance Center
Rebecca Davis, Executive Director, National Cooperative of Health Networks
Mike Shimmens, Executive Director, Rural Recruitment and Retention Network (3RNet)
Teryl Eisinger, Director, National Organization of State Offices of Rural Health

Tuesday, November 13, 1:00 - 2:00 p.m. EST

Cultural Awareness While Serving Rural Veterans

Jay H. Shore, MD, MPH, Associate Professor, University of Colorado Denver

Tuesday, November 13, 3:00 - 4:00 p.m. EST

Exploring Rural Health Policy Issues
Bill Finerfrock, Legislative Liaison, NOSORH

Wednesday, November 14, 2:30 - 3:15 p.m. EST

HRSA Rural Health Update
Mary Wakefield, HRSA Administrator

Thursday, November 15, 3:00 - 4:00 p.m. EST
HRSA’s Office of Rural Health Policy - Celebrating 25 Years and the Rural Assistance Center - Celebrating 10 Years

Tom Morris, HRSA Associate Administrator for Rural Health Policy
Kristine Sande, Program Director, Rural Assistance Center

Friday, November 16, 2:00 - 3:00 p.m. EST

Looking Towards the Future of Rural Health Care

Randall Longenecker MD, Project Director, Rural Training Track Technical Assistance Program
Jim DeTienne, Supervisor, Montana EMS and Trauma Systems; President, NASEMSO

For additional information, contact: Stephanie Hansen 208.375.0407 or steph@nosorh.org.
Click on the following link to register for a webinar - https://www.surveymonkey.com/s/NRHD2012

Funding for the Old Age Pension Program Renewed

A bill passed during the 2012 legislative session which restored funding for the Old Age Pension (OAP) program. Treatment for the Oral Health Program of OAP is anticipated to begin January of 2013.

The OAP program was established by legislation in 1977 to provide dental care (dentures and related services) to senior citizens who receive Old Age Pension public assistance. To qualify for the OAP Dental Program, an individual must be 60 years or older, live in Colorado, and receive OAP public assistance from the state of Colorado. Interested seniors should contact their individual county department of social services for eligibility information.

The Oral Health Program manages the dental component of the OAP providing grants to eligible grantees for the provision of dental services to seniors eligible for OAP.

Approved procedures and maximum allowable fees are set in the Code of Colorado Regulations (6 CCR 1015-8). Clients may be asked to pay a co-payment not to exceed 20% of the maximum allowable fee.

Click here to read more (scroll down to Old Age Pension Program).

GAO Reports on Medicaid Expansion

The United States GAO released "Medicaid Expansion: States' Implementation of the Patient Protection and Affordable Care Act." The report addresses the actions states are taking to implement the Medicaid expansion, what actions selected states have taken to prepare for the Medicaid expansion provisions of the Affordable Care Act, what challenges they have encountered, and states’ views on the fiscal implications of the Medicaid expansion on state budget planning.

Colorado’s Health Care Safety Net: 2012 Primer Released by CHI

This week the Colorado Health Institute (CHI) published, “Colorado’s Health Care Safety Net: 2012 Primer.” The primer provides information about the providers in the safety net, who uses it, and where safety net funding comes from, as well as a list of additional resources and more information regarding the safety net. Click here to read the report.

Webinar: Potential Roles for Safety Net Providers in Supporting Continuity Across Medicaid and Health Insurance Exchanges

Next week the National Academy for State Health Policy (NASHP) is hosting a webinar about the challenge states face supporting continuity of care for individuals and families who may churn between Medicaid and commercial coverage purchased through health insurance exchanges.

As the Colorado Health Benefit Exchange Board works to develop a health insurance exchange where Coloradans can successfully go to compare cost and quality across health plans, determine if they are eligible for Medicaid or for premium tax credits, and purchase coverage, one significant concern remains unsolved. What happens when individuals and families experience changes in income that will cause them to churn (shift eligibility for Medicaid and other subsidized coverage)? Disruptions in coverage have the potential to lead to expensive disruptions in care. Learn more about this challenge and what providers may need to undertake to adapt to the new coverage environment by participating in NASHP’s webinar on Tuesday, August 28th. Click here to register.