HCPF is Committed to Colorado's Medicaid Accountable Care Organization

The Department of Health Care Policy and Financing released a position statement last month related to the Accountable Care Collaborative (Colorado's version of an Accountable Care Organization for Medicaid clients, rather than Medicare). You can read the statement here, but to summarize, the Department states they remain committed to the ACC as the predominant program that will lead Colorado Medicaid into the future of better health care. The primary goals of the ACC Program are to improve the health of Medicaid clients and reduce costs.

Tricia McGinnis of the Commonwealth Fund wrote a blog post about the emergence of Medicaid Accountable Care Organizations in states and the opportunity these programs have to better serve the most vulnerable low-income populations. Read the blog post here.

Learn More About the CO-OP Intended to Improve Coverage in Rural Areas

The Colorado Health Insurance Cooperative, Inc. (CO-OP) was notified last month by the U.S. Department of Health and Human Services that its loan application for $69 million to start and operate a statewide nonprofit health insurance CO-OP was approved. The CO-OP is a Consumer Operated and Oriented Plan, a new kind of nonprofit health insurance company intended to overcome some of the access issues commonly experienced in rural areas by offering affordable, high quality health plans to both rural and urban Coloradans.

The Colorado Health Insurance Cooperative (CO-OP) is sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation. Many consumer groups, healthcare provider organizations, another nonprofit health plan, the Colorado Medical Society and the National Federation of Independent Business supported the CO-OP’s loan application process.

Colorado Public Radio reporter Ryan Warner discusses health insurance cooperatives and the efforts to build a member owned CO-OP in Colorado. You can listen to Ryan's interview here to learn more about what this means for Coloradans.

Aging Baby Boomers Face Home Healthcare Challenge

Home health aides can help keep people in their homes who might otherwise need to live in a long term care facility. The U.S. Labor Department projects that home health and personal care aides will be among the fastest-growing jobs over the next decade, adding 1.3 million positions and increasing at a rate higher than any other occupation. However, filling those new home care positions over the next decade will be a challenge to say the least. Read more from Minnesota Public Radio.

Will Anyone See the New Medicaid Patients?

About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country. A new study in Health Affairs, detailed in Kaiser Health News, says that in Colorado, slightly less than the national average of doctors agree to take on new patients who are on low-paying Medicaid. The Colorado rate is about 66 percent, just under the national average of 69 percent.

Comments from a Rural Healthcare Leader

Watch a video interview with Todd Linden, President and CEO of Grinnell Regional Medical Center, a 49- bed, private non-profit hospital in Grinnell, Iowa. In the interview. Mr. Linden discusses the differences between running a rural versus an urban medical facility, how technology is affecting rural healthcare, and his hopes for the future of the field.

Should You Celebrate Safety Net Clinic Week? The Answer is Probably Yes!

Is My Clinic A Safety Net Clinic? The answer may not be obvious. If you have ever wondered if your clinic is a safety net clinic, the following survey may help you answer that question.

 

First, does your clinic provide preventive and primary health care services or chronic disease management?

Yes / No

 

If you answered yes to the question above, please read each statement below and determine if the statement is true.  

• My clinic is a federally certified Rural Health Clinic (RHC).
• My clinic is located in a health professional shortage or medically underserved area.
• My clinic offers free or discounted services on a sliding fee scale or as a flat fee.
• My clinic sees uninsured patients regardless of their ability to pay.
• My clinic accepts Medicaid, Child Health Plan (CHP), and/or Tri-Care.
• My clinic participates in the Colorado Indigent Care Program (CICP).
• My clinic does not accept reimbursements from third-party payers.
• My clinic utilizes volunteer clinicians.
• My clinic is eligible for FTCA medical malpractice liability protection.
• My clinic receives Primary Care Fund dollars.
• My clinic receives grants, contributions and/or donations.
• My clinic is part of a Family or Internal Medicine Residency Program.
• My clinic provides translation services for non-English speaking patients.
• My clinic receives Section 330 funding (under the Public Health Services Act).
• My clinic provides Indian Health Services.
• My clinic receives funding under Title X.

If your clinic provides health care services and the answer to one or more of the options above is yes, then congratulations, your clinic is a safety net clinic! Therefore, the Colorado Rural Health Center and ClinicNET encourage you to consider celebrating Safety Net Clinic Week August 20th through 24th, 2012. SNCW is a week dedicated to raising awareness of all the various types of clinics with a commitment to serving patients who might otherwise have difficulty getting medical care.

 

Why is it important to celebrate Safety Net Clinic Week? Because while safety net clinics have some similarities, they also look very different from one another and it is important to know where, why and how health care is currently being delivered. When it comes time for the federal, state, or even local government to make decisions regarding provider reimbursements, tobacco tax funds, Medicare or Medicaid payments, public coverage program eligibility, electronic health records (EHR) incentives, or other important policy choices, the people making those decisions need to understand how they affect safety net clinics like yours.

The COHBE Board will Submit Grant Application, and Other Updates on the Exchange

The Chair and Vice-Chair of the Legislative Implementation Review Committee gave approval Thursday for the Exchange to submit a second Level One Establishment Grant application to the federal government for activities related to the Exchange. Previously approved by the Colorado Health Benefit Exchange (COHBE) Board, this grant application seeks funds to pay for planning activities, acquisition of technology systems and development of customer service operations necessary to implement Senate Bill 11-200 for the period between October 2012 and July 2013. The application will be submitted prior to the August 15 deadline.

 

Read the other updates on the development of Colorado's Health Benefit Exchange, from the Exchange's Director of Outreach and Communications, below.

• Patty Fontneau blogs about the next grant application. 
• The COHBE Board will meet on Monday, August 13, 8:30 am. Information is available here. 
• The Individual Experience Advisory Group will meet on Tuesday, August 14, 2:30 pm. Information is available here. 
• The SHOP Advisory Group will meet on Thursday, August 16, 10 am. Information is available here.

How Will You Celebrate Safety Net Clinic Week?

Safety Net Clinic Week Project Coordinator Charlotte Kaye, is available to help you get the most out of the third annual Safety Net Clinic Week, August 20-24, 2012! Are you interested in hosting public officials, candidates for office or business leaders for a site-visit? How about hosting an open house? Do you already have an event or activity planned that week that could be highlighted by Safety Net Clinic Week? Seize this opportunity to celebrate your clinic and the important role you fill in the healthcare safety net with help from the Colorado Rural Health Center and ClinicNET. Please contact Charlotte Kaye for assistance and ideas! She can be reached at charlotte.kaye@clinicnet.org or at 720-863-7805.

To get a sense of Safety Net Clinic Week, click here for a look at past years’ activities!

The Safety Net Clinic Week “toolkit” can be found here. It includes fact sheets, flyers, logo and templates for press releases, letters to the editor, invitations for site-visits, and governmental proclamations.

CIVHC and CHI Release New Report on Payment Models

The Center for Improving Value in Health Care (CIVHC) and the Colorado Health Institute (CHI) released a new report that examines strategies to reform the health care payment system, how the new models are being used in Colorado and their potential impact on improving quality and controlling costs.

The report, titled "New Approaches to Paying for Health Care: Implications for Quality Improvement and Cost Containment in Colorado," documents the role that the traditional fee-for-service payment model plays in rising health care costs and the potential that different payment approaches hold for changing that dynamic.

The report is designed to help policy makers, industry leaders and other stakeholders make informed decisions as they contemplate alternative health care payment approaches.

Court of Appeals Ruled on Physician Supervision Lawsuit

The Colorado Court of Appeals ruled last week in favor of Gov. John Hickenlooper in a lawsuit filed by the Colorado Medical Society and the Colorado Society of Anesthesiologists. The two groups were trying to overturn a Denver District Court’s dismissal of their lawsuit over delivery of anesthesia to Medicare patients.

At the heart of the lawsuit was whether or not to allow certified registered nurse anesthetists (CRNAs) to administer anesthesia without a physician’s supervision. Read more here.

The New “Doughnut Hole” Describes Coverage Gap Created in States Rejecting the Medicaid Expansion

The Supreme Court’s recent ruling on the Affordable Care Act gave governors new flexibility to reject the law’s Medicaid expansion.

States that reject the Medicaid expansion may create a coverage gap being called the new “doughnut hole." Those that fall into the hole will be people who don’t qualify for their state’s current Medicaid eligibility categories nor are eligible for subsidized private insurance in the marketplaces called exchanges. In Colorado, the majority of those folks would be adults without dependent children between 10 and 133% of the federal poverty level (FPL) and adults with dependent children between 100 and 133% FPL. Read the Washington Post‘s article here.

Could Value-based Purchasing Program Hurt Safety Net Hospitals? iVantage Report Suggests Rural May Be Different

A study published in the Archives of Internal Medicine suggests CMS's Hospital Value-based Purchasing program could mean trouble for safety net hospitals, because safety net hospitals tend to get poorer marks from patients than do other hospitals. These patient satisfaction scores will be used to dole out bonuses and penalties beginning in October.

However, according to the iVantage report, "Rural Relevance Under Healthcare Reform," rural hospital performance on HCAHPS patient experience survey measures is better than urban hospitals. The iVantage report was released in April, and updated last month. You can read the updated report here.

IOM Reports Higher Payments Are Not the Cure for Doctor Shortage

An Institute of Medicine (IOM) report released Tuesday concluded that while there are wide discrepancies in access to and quality of care across geographic areas, the variations were unlikely to be influenced by changes in Medicare reimbursement rates to providers. In light of this, the IOM committee recommended Medicare should not try to address the shortages of doctors and healthcare providers by raising reimbursements to entice practitioners to practice in underserved areas. You can read the report here.

Instead of altering payments, the committee recommended that Medicare pay for services such as telemedicine that improve access to medical care in underserved regions. It also encouraged states to change scope of practice laws so that nurse practitioners can provide more care.
Soon the IOM will release a separate report looking into why Medicare spends more on patients in some areas of the country than others without always giving better care.

CHI Presents on the 5 Biggest Questions for Colorado After the Supreme Court's Ruling on the ACA

Do you want to know more about the implications of the Supreme Court's recent ruling on the Affordable Care Act? The Colorado Health Institute (CHI) analyzed the five biggest questions looming for Colorado in the wake of the Supreme Court's decision that the health reform law is constitutional. Download CHI president and CEO Michele Lueck's June 28th presentation, listen to the recorded webinar, and read the report to learn more.

The Center for Rural Affairs Publishes Latest Healthcare Report

The Center for Rural Affairs recently published their latest healthcare report, The Affordable Care Act: Real Help for Real People, which highlights provisions in the law that are helpful for rural people across the country. You can read the short version here.

New Federal Waiver in Oregon Offers Incentives to Get More Doctors in Rural Areas

A new federal waiver for Oregon includes a provision aimed at luring doctors to small towns. The state won final approval Monday from the Obama administration for plans to move ahead with big changes in healthcare. The new agreement also funds a program to help physicians pay off their student loans if they agree to set up shop in rural or other underserved areas. Read more here.

States Should Check with Hospitals Regarding Medicaid Expansion

Hospitals might experience the largest impacts of any type of provider if states decline the opportunity to expand Medicaid eligibility under the Affordable Care Act, so states are being urged to check with hospitals before making the decision to reject the Medicaid expansion. Read more here.

ACO Executives Would Have Continued Regardless of Decision

Accountable Care Organization (ACO) executives say they would have continued building the ACOs, regardless of the Supreme Court's decision. An ACO is a type of payment and delivery reform model that ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Executives believe the rise of healthcare spending creates a demand for greater efficiency, more collaboration, and new incentives that reward hospitals and doctors that keep people healthy. Click here to read more.

Nominations for Dual Eligibles Advisory Subcommittee

To support greater collaboration between the Demonstration to Integrate Care for Dual Eligible Individuals (the Demonstration) and other healthcare initiatives, the Department of Health Care Policy and Financing (HCPF) will assemble a group of dual eligible individuals (eligible for Medicaid and Medicare), family members, advocates, and other stakeholders with additional expertise to interact with existing advisory bodies.

HCPF invites you to nominate an individual to be a member of the Dual Eligibles Advisory Subcommittee. The subcommittee will make recommendations related to the Demonstration and other issues affecting fully dual eligible individuals. The subcommittee’s chair and the Dual Eligibles Project Manager will attend other advisory committee meetings.

For information about the subcommittee’s purpose, composition, and responsibilities, please see the frequently asked questions in the Subcommittee packet (link here). If you would like to nominate an individual to the Dual Eligibles Advisory Subcommittee, please submit an application no later than Friday, July 27 (the packet includes nomination instructions on page three). For additional information about the Demonstration to Integrate Care for Dual Eligible Individuals, please see the Demonstration’s web page on HCPF's website.

CRHC Responds to Supreme Court Decision

As most of you know (probably ad nauseam at this point), the Supreme Court of the United States delivered their ruling today on the constitutionality of the Affordable Care Act (ACA).

Q. So what happened this morning?

A. Ultimately, the ACA was upheld. Likely the most controversial component, the requirement that every American buy insurance, was upheld. But there was a twist; the Supreme Court said it does not violate the commerce clause because the mandate doesn’t regulate existing commercial activity. Instead, it compels individuals to become active in commerce by purchasing a product. Therefore, Americans can choose not to buy health insurance, but will instead pay a tax. The expansion of the Medicaid program up to 133% of the Federal Poverty Level (FPL) was also among the top controversies in the law. The Supreme Court ruled that states will have a choice about whether or not to participate in the expansion. So if states choose not to participate, they will not be penalized by losing their current Medicaid dollars (as written in the ACA). If states opt for the expansion, they will get money to participate, but they must comply with the conditions attached to the new expansion funds.

Q. What position did CRHC take on the ACA?

A. The Colorado Rural Health Center did not take a position on the Affordable Care Act. Our policy agenda is directed by our membership, and the membership did not come to consensus on all provisions of the ACA. However, membership supported the rural provisions which contribute to CRHC’s vision to ensure that all rural Coloradans have access to comprehensive, affordable, high quality healthcare.

Q. What happens with the rural provisions in the law?

A. Given the decisions made this morning, it means that all rural provisions included in the ACA were upheld in entirety. As a reminder, some of the rural provisions included additional funding for the National Health Service Corps program, residency allocation, and creation of Rural Physician Training grants, as well as establishment and funding for the Centers for Medicare and Medicaid Services (CMS) Innovation Center, Primary Care Incentive payments, “Extenders,” and modification of the low volume hospital adjustment. So the workforce modifications, innovation dollars and payment modifications will be administered as outlined in the law.

Q. Does this mean it’s all over?

A. Not at all. There will be additional legal challenges concerning implementation and regarding Medicaid participation, and the political mudslinging has already begun!

CRHC will continue providing training and technical assistance to Critical Access Hospitals and Rural Health Clinics, offering workshops and conferences, administering grant programs, offering the Colorado Provider Recruitment Program and advocating on behalf of rural facilities and communities. We will be in Washington, D.C. at the end of July to fight against the cuts that will disproportionality impact rural and to provide Congress with a real picture of rural health in Colorado.

And we will work with rural communities and facilities on creative solutions that will continue to improve patient health, improve community health, and contain cost, all the while ensuring hospitals and clinics in rural areas remain viable practices that ensure access to their communities.