New tech tops health IT purchasing plans

NC teachers, state workers to pay more for health insurance

Teachers and other state employees across North Carolina will see premiums and out-of-pocket costs rise next year if state lawmakers approve a proposal before the State Health Plan’s board of trustees.

That plan would raise premiums by about $40 a month in 2016, while also boosting out-of-pocket costs on two of the state’s three plans.

During the 12-plus years I covered education, I heard plenty of teacher complaints about health insurance, especially after the recession spurred cost-cutting. I avoided delving into the details. But now that I’m writing about high-deductible insurance, I can see why teachers were fuming.

The traditional plan currently has deductibles of $933 for an individual and $2,799 for family coverage, not huge compared to many private-sector plans but still a pinch on a teacher’s salary. After that the plan pays 70 percent of costs – and the employee keeps paying 30 percent until hitting a cap of $4,726 individual or $14,178 family. That’s a higher limit than most companies set on high-deductible plans.

State employees can also pay a higher premium to cut their share to 20 percent and limit out-of-pocket exposure, though at $11,730 for family coverage it’s still a big hit.

This year the state added a “consumer-directed” plan that requires a higher deductible up front ($1,500 individual/$4,500 family) but limits the total out-of-pocket risk and includes a contribution to a health reimbursement account. Charlotte-Mecklenburg Schools, which has more than 15,000 covered employees, saw just over 4 percent choose that option, and that’s higher than statewide participation of 3 percent.

State employees can expect a push this year to persuade them that the new option is, in the words of spokesman Schorr Johnson, “the best valued plan the State Health Plan offers and provides the richest benefit.”

Last year “the Plan did not push or market the (Consumer Driven Health Plan), and given that many of our members were not familiar with how it works and often find it easiest to stay with what they currently have and know, the initial enrollment results are not surprising,” Johnson said.

Under the 2016 proposal, the state’s contributions to employee reimbursement accounts would increase. The plan also includes bigger incentives to take part in healthy lifestyle activities and use preferred providers.

Meanwhile, increases to out-of-pocket costs on the traditional 70-30 plan might nudge employees to try something different. Under the proposal, those who choose the traditional family coverage could end up paying $16,000 out of pocket.

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Funding for Rural Health Care Broadband Program Underused

Resources aimed at expanding broadband connectivity among rural health care providers are underused, according to a blog postpublished in Health Affairs, Government Health IT reports.

Background

The Rural Health Care Program — established under the Telecommunications Act of 1996 — provides subsidies to public and not-for-profit health care providers for:

• Advanced telecommunications and information services for urban and rural providers;


• Internet access to rural providers; and


• Telecommunications services for rural providers.

Details of Blog Post

The Health Affairs blog post was written by:

• Mohit Kaushal, a partner at Aberdare Ventures, an investment group;


• Kavita Patel, a fellow and the managing director of delivery system reform and clinical transformation at the Engelberg Center for Health Care Reform;


• Margaret Darling, chief evaluation and advocacy officer at Nueva Vida;


• Kate Samuels, project manager at the Engelberg Center; and


• Mark McClellan, director of the Engelberg Center and chair of health policy studies at the Brookings Institution.

While the cap on RHCP spending is $400 million annually, the authors noted that spending commitments in 2013 and 2014 were “far less,” at $178 million and $65 million, respectively. In addition, the authors wrote, “Cumulative spending for the telecommunications and Internet access funds over the first 12 years of the RHCP did not exceed the single-year cap.”

Further, they found that the 2010 National Broadband Plan to boost RHCP’s effectiveness has not been implemented (Government Health IT, 4/3).

The authors identified specific factors that could be inhibiting use, including that:

• Eligibility requirements exclude certain entities involved in care delivery;


• The landscape of the need for broadband access in the health care field is changing quickly; and


• Less than one-quarter of the total 11,000 eligible providers participate in the program, many due to the burdensome application process.

Recommendations

Based on the findings, the authors made several recommendations for RHCP, including that FCC should:

• Simplify broadband support for rural providers by clarifying the application process, accepting outcome metrics as defined by other agencies and increasing infrastructure support through the Healthcare Connect Fund to at least 85% of eligible costs; and


• Expand eligibility requirements by adopting a definition of “health care provider” that includes all entities that participate in care delivery and remote patient management.

In addition, they argued that Congress should add not-for-profit providers that serve vulnerable populations to the list of eligible organizations.

Further, the authors suggested that RHCP should be adjusted to meet the needs of a rapidly changing broadband environment by:

• Publishing a Health Care Broadband Status Report every few years; and


• Regularly updating the program’s funding guidance based on the findings of such reports (Kaushal et al., Health Affairs Blog, 4/1).

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Trios, UW Medicine to collaborate on ‘advanced services’

Trios Health and UW Medicine have agreed to a “strategic collaboration”

The pact doesn’t involve a change in ownership, control or governance for the Kennewick- or Seattle-based health systems, and it’s not a financial arrangement.

“This strategic collaboration will provide Trios Health patients prompt access to the highest level of care for advanced services while allowing the organizations to work together to continue improving the quality, safety and cost effectiveness of care in southeast Washington state,” said a joint Trios-UW news release.

UW Medicine will be the “health care system of choice for complex tertiary and quaternary care for Trios Health patients” under the agreement, the release said. Tertiary and quaternary care is the kind of advanced medical and surgical care typically provided in major hospitals in big cities, from Level 1 trauma care to organ transplants.

The agreement took effect April 1.

The new relationship is expected to mean, among other things, a more seamless process when Trios patients are transferred to UW Medicine facilities and greater collaboration with and access to UW Medicine personnel. A steering committee is forming to hammer out the details.

Trios Health has a longstanding relationship with UW Medicine, but, “We’re excited about this opportunity to solidify that relationship a little bit more,” said Glen Marshall, Trios CEO.

“We’re all being asked to do a lot more with a lot less, but I think by working together … it’s all going to be for the betterment of our patients,” he said.

Dr. Paul Ramsey, CEO of the Seattle-based health system, said the collaboration supports his organization’s mission to improve the health of the public.

“Such collaborations are vital in the process of achieving health care reform’s triple aim of improving healthcare for individuals, improving health for populations and reducing the per capita costs of healthcare,” he said in the joint news release.

He added in an interview that, “We’re very pleased with how this (arrangement) has come together.”

It’s been in the works for several months.

UW Medicine, which includes Harborview Medical Center along with several other facilities, works with other hospitals in the Tri-City area but doesn’t have similar agreements with them, Ramsey said. The pact is unique for Trios Health, Marshall told the Herald.

Officials said it could lead to further collaboration in areas from oncology and critical and cardiac care to clinical and graduate medical education.

“I really do believe it’s going to bring more advanced care to our community,” Marshall told the Herald. “I think it’s going to be a win-win-win — a win for our organization, a win for their organization and more importantly a win for our patients and the community.”

“By working together, we can more effectively lead the changes that are needed to provide better health care that’s more affordable,” Ramsey said.

In the era of federal health care reform, more and more health systems are looking for ways to collaborate. It’s a trend that’s playing out locally, with the most prominent example being the affiliation of Kadlec Regional Medical Center in Richland with the larger Providence Health & Services. Providence is based in Renton and operates in five states.

The Kennewick-based Trios Health is a public hospital district that includes the new Trios Southridge Hospital, the Trios Women’s and Children’s Hospital and a network of clinics.

Along with Harborview Medical Center, the Seattle-based UW Medicine includes Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine and Airlift Northwest.

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Mountain States, Wellmont Health announce merger details

JOHNSON CITY, TENN. — Top administrators for rival health care providers Mountain States Health Alliance and Wellmont Health System have announced plans to explore a merger.

Mountain States CEO Alan Levine said combining the two systems would create a $1.8 billion health care nonprofit and would benefit patients, employees and the communities they serve.

“We can do more together, and we will do more together than we ever could as separate systems,” Levine said. “There’s one thing I can promise our region . there are difficult decisions that lie ahead — there are difficult decisions that lie ahead for health systems all over the country — but these decisions are going to be made by people who call this place home and have to live with the consequences of the decisions that we make.”

Media report the merger would put 19 hospitals and 15,000 employees in southwest Virginia and northeast Tennessee under the control of one organization.

Mountain States and Wellmont plan to iron out details of the merger over the next several months, and then it would need approval from both states and from antitrust regulators before it is finalized.

The proposal calls for Levine to serve as executive chairman of the board of directors and Wellmont CEO Bart Hove to serve as the CEO of the new company.

“We know this announcement will spark many questions and a thirst for details,” Hove said. “While the agreement to explore the merger provides a broad framework, there is still much to determine about how a new system would look and much planning to be done.”

Two new members would be added to a combined board in addition to the president of East Tennessee State University serving as a nonvoting board member.

ETSU President Brian Noland said a merger would help the school compete for federal grants to improve the delivery of care.

“We will partner with the new system to strengthen the pipeline of physicians and health professionals, and to attract new research jobs,” Noland said. “ETSU will also partner to conduct a health needs assessment of the area, to identify gaps and help with health disparities.”

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Health care industry receives first mobile apps from Apple, IBM

Health care partnership rewards positive outcomes

A new Accountable Care Organization will soon provide guidance on best practices to Louisiana physicians. The health care company Aledade announced a partnership with Louisiana Health Care Quality Forum and the creation of a primary care physician-led ACO.

ACOs are groups of providers that aim to give care to Medicare patients in a more cost-effective way that rewards positive health outcomes rather than a high volume of health care services. After a year, Medicare calculates the savings compared to the year before and provides a kickback to the group. In this way, providers and government officials hope to save taxpayer dollars and increase quality of care.

Nadine Robin, health IT program director for Louisiana Health Care Quality Forum, said improved practices include getting patients in for follow-up visits and improving preventive care.

She said the partnership is unique in Louisiana in that it will focus on independent care physicians.

“I believe that if we do well with primary care, it will reduce costs everywhere,” Robin said.

Aledade called the partnership the first state-based Medicare ACO led by independent doctors. A press release said the emphasis will be on preventive care, referral networks, customized technology and electronic health record data.

Quality Forum, a private nonprofit, will provide guidance to the physicians and training on best practices.

Robin said they only had a few doctors signed on so far because they just announced the new ACO. They plan to recruit through 2015 and roll out the program in 2016.

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