Blame it on the Heat
Things are getting goofy in DC. Anne Lowrey of Slate explains the latest idea to plunge the clogged toilet that is Congress:
"One option is coin seigniorage—aka, the "really-huge-coin workaround." The United States has a statutory limit on the amount of paper money in circulation, but no such limit on coins. The Treasury secretary has the authority to mint certain coins of any denomination, with no need for the value of the metal to equal the value of the coin. (It gets a bit technical.) But the idea is that Secretary Timothy Geithner could order the Mint to make a, say, $5 trillion coin. It could then use the coin to buy back and extinguish debt from the Fed, pushing the country back under the ceiling. Or it could deposit it, and the Fed could counteract the inflation by selling government debt."
Your weekend mental health break
Over here at the GHG HQ we're a big fan of Jessica Hagy. We hope you enjoy her insightful venn diagrams and especially hope you incorporate them into your next corporate powerpoint presentation.
Medicare Part D Works
According to a recently released study Medicare Part D is successful in assisting seniors in affording maintenance and other drugs that keep them out of hospitals and emergency rooms. This results in an estimated $12 billion in savings per year or about $1200 per senior that was inadequately covered before the program came into effect in 2006. The $12 billion is not enough to cover the $55 billion cost of Part D, but it is an indicator that seniors are enjoying a better quality of life.
As the discussions around how to reduce the cost of entitlement programs continue it will be important for politicians to keep in mind how all parts of the Medicare program affect each other.
Sebelius Weighs in on the Debt Debate
Politico Pro got the "get" with HHS Secretary Kathleen Sebelius yesterday, who said the debt ceiling negotiation is casting a shadow over HHS's day-to-day operations. "I would think it would make people a little leery about contracting with us, not knowing if we're going to pay our bills. That's a pretty precarious place to be," she said.
Interrupting the department's operations could have serious consequences because of the critical nature of the services the department provides, she suggested. "The services that are delivered by people in our department are really essential ... often life and death services at the ground level, so many states rely on the funding that comes out of our office, we're just going to continue to operate and, as I say, hope that the stalemate and the log jam breaks quickly," she said.
Collaboration and Partnership with CMS
Having spent my government career at CMS, it was interesting for me to listen to current CMS officials Steve Larsen (CCIIO) and Cindy Mann (Medicaid) describe the many opportunities for states and other stakeholders to participate in the development of federal policy for Health Exchanges that were authorized by the Affordable Care Act.
The discussion took place at today's meeting on Insurance Exchange Development sponsored by the Bipartisan Policy Center and the Kaiser Family Foundation.
Steve Larsen described the partnership hybrid model where CMS and States could jointly administer State Exchanges with the federal government performing functions that states would effectively outsource to CMS. Cindy Mann described upcoming state collaboratives where states and CMS would sit together and jointly develop guidance for state exchanges.
The clear message is that the federal government does not have all of the solutions and that there is no "one size fits all" . The new CMS Innovation Center also conveys a strong message of public-private partnerships and consistently seeks ideas and solutions from stakeholders to improve the health care system. This is clearly a different era from my early days at CMS when the tradition was to seek input only through a formal regulatory comment process. CMS is now a "Learning Organization" -- just in time to lead the expected huge changes in health care.
What are the amendments anyway?
As I watched the increasing drama of the debt ceiling unfold over the weekend, several commentators discussed the possibility of Obama being able to raise the limit regardless of congress due to the 14th amendment. Interesting article on this yesterday in the NY times.
We hear commentators and politicians quoting the constitution and amendments constantly as they battle for some political point and I realized I'd never taken the time to read or understand any of it — not a quick task as I discovered this weekend, but a geekily interesting one. Take a look at the Wikipedia article for a quick rundown on the list. I propose a 28th amendment where politicians have to read and understand them before they are allowed to run for office.
CenseoHealth & GHG Poll on Prospective Evaluations
Question: What percentage of your membership are you targeting for prospective evaluations?
Answers: Prof. McCallum Report Card:
9% of webinar attendees said 80 - 100% of members A+
7% of webinar attendees said 65 - 79% of members A-
21% of webinar attendees said 50 - 64% of members B+
19% of webinar attendees said 35 - 49% of members B
44% of webinar attendees said less than 35% of members More Attention Needed
It looks like the marketplace is evolving and those who are evaluating 80-100% are the pack leaders.
Congratulations!
They get an A+ because these health plans & medical groups should have:
• Great member information for medical management and physician as they design treatment plans
• High member satisfaction
• High member retention
• Accurate & timely premium impacts to account for medical expense and aid in bid development
• If they are using a comprehensive evaluation instrument, they should be impacting HEDIS & STARS
The next group to focus on is the 44% who are looking at less than 35%. We have a few questions:
• Are you competitive in your marketplace with benefits?
• What's your MLR?
• How is your member retention & satisfaction?
• How is your physician satisfaction?
• How are you doing on HEDIS & STARS?
For this group, our suggestion is to double your targeted population so you can continue to excel. Make sure you have good member stratification so you are targeting the most appropriate and impactful members.
For those in the middle — continue to increase the number of evaluations, refine your tool, stay competitive and compliant, and make certain you integrate the data into other areas of your health plan or medical group.
CenseoHealth & GHG: Retrospective Review Poll Results
Drum roll please…
Question: What percentage of your membership are you targeting for retrospective evaluations?
Answers: Prof. McCallum Report Card:
32% of webinar attendees said 80-100% of members B-
Far too large a net is being cast and possibly too much money spent on charts that are not yielding much clinical or financial impact. Let's focus this and use stronger analytics to reduce this number.
Remember only 60% of HMO & PPO members actually have an HCC.
**Score: B
If you are a dual SNP, this may be a reasonable starting point but even this volume should be reduced as your evaluations increase.
20% of webinar attendees said 65-79% of members B
This is a good foundation but as you increase your prospective evaluation this volume should continue to drop. Retrospective review doesn't impact HEDIS or STARS so pushing more work over to evaluations will have a great result across your health plan with the right evaluation partner.
25% of webinar attendees said 50-64% of members B+
This is an excellent foundation if you are targeted 25-30% in member evaluation for 2010. Continue the good work and reduce this volume next year as you increase the evaluations
8% of webinar attendees said 35-49% of members A
If you are targeting, 30-50% in member evaluations for the same year this should cover the bases. If you aren't, you may be not accurately reporting the health status of your members and missing needed premium to cover the medical expense for next year.
15% of webinar attendees said Less than 35% A+
If you are targeting, 60-100% of your membership for evaluations in the same year, feel safe and confident in this approach. If not, increase your evaluations immediately because you have not capture your membership's health status.
Facts to remember:
• Charts may be difficult to find during RADV
• Retrospective review does not impact HEDIS, STARS, medical management, plans of treatment or medical home strategies or scores
• On average in a HMO, POS, or PPO Medicare Advantage population only 60% of the members have an HCC (don't over review your population)
• It is not cost effective to review charts to find suspect charts; improve your analytics
• Providers work with multiple health plans with both risk adjustment and HEDIS chart review needs. Try to knock on their door as infrequently as possible.
Economic Calamity Update: Scoring Deficit Reduction
Senator Harry Reid's plan reduces the deficit more that Rep. John Boehner's plan, says the CBO.
GHG Announcement!
We're thrilled to announce the launch of CenseoHealth, a new kind of HCC Management company. Stand by for more discussion on these pages with my colleagues Jack McCallum, M.D. and RaeAnn Grossman. If you have any questions or feedback I welcome it at ngoldstein (at) ghgadvisors.com--- or just leave a comment here.