U.S. health care spending experienced historically low rates of growth in 2009 and 2010 according to the annual report of national health expenditures (NHE) from the Centers for Medicare & Medicaid Services (CMS) published in the January issue of the journal Health Affairs.

Analysts at CMS report that the increase in spending for 2009 represents the lowest rate of increase in the entire 51 year history of the NHE.

The low rate of growth, the data show, reflects lower utilization in health care than in previous years. The report notes that U.S. health care spending grew only 3.9 percent in 2010, reaching $2.6 trillion or $8,402 per person, just 0.1 percentage point faster than in 2009.

Private businesses financed $534.5 billion, or 21 percent of total health spending in 2010, down from a 23-percent share in 2007.

Other major findings from the report include:

Hospital spending grew 4.9% in 2010, down from 6.4% in 2009. Median inpatient hospital admissions declined in 2010 and increases in emergency department and hospital outpatient visits grew more slowly in 2010 than 2009.

There was a drop in total physician visits from 2009 to 2010 and this drop accounted for the 2.5% increase in physician and clinical services spending in 2010 compared to 3.3% increase in 2009.

Retail prescription drug spending only increased 1.2% in 2010 due to slower growth in the number of prescriptions filled, continued increase in use of generics, lower base costs due to loss of several significant patents, fewer introductions of new drugs, and an increase in Medicaid drug rebates.

Private health insurance, including the portion contributed by employers, saw an increase of 2.4% in premiums in 2010, only slightly below the 2.6% increase in 2009. A decline in private health insurance enrollment, increases in cost sharing, and a shift by some consumers to lower-cost plans, resulted in this slight slowdown.

Out-of-pocket spending grew more rapidly in 2010 (1.8%) than in 2009 (0.2%) reflecting the higher cost-sharing requirements, consumers shifting to lower-cost plans with higher deductibles and/or copayments, and the continued increase in those losing their health insurance.

The federal government financed 29% of total health spending in 2010, up from only 23 percent in 2007. Private businesses financed 21% of total health spending in 2010.

Read a summary with more details.

In the field of medicine, the customer is not always right, but that doesn't necessarily stop physicians from ordering tests and procedures that may not be strictly medically indicated when their patients request such tests or procedures.

Recognizing this problem, the American Academy of Family Practice (AAFP) has joined with 10 other organizations in the Choosing Wisely campaign, which is designed to develop a series of evidence-based lists of medical tests, procedures and other services that patients and physicians should question.

Originally piloted by the National Physicians Alliance, the goal of the lists is to help physicians and patients think and talk about overuse or misuse of health care resources and they are designed to help reduce the estimated 30 percent of the cost of care in the United States that is attributed to unnecessary tests, procedures, medical appointments, hospital stays and other services that may not improve people's health.

"Physicians play a leading role in addressing problems with our nation's health care system," said Christine Cassel, M.D., president and CEO of the American Board of Internal Medicine Foundation, in the news release. "By identifying specific procedures or tests that may commonly be ordered, but (are) not always necessary to improving patient care, we're kicking off an important and overdue conversation about making wise choices in health care. Everyone -- providers, patients and others -- plays a part in being better stewards of the system's finite resources." 

The lists will be available in April so check back here for an update at that time!

According to a recent article by Lisa Gillespie in Employee Benefit News...

A new ADP survey shows a wide gap between the goals and reality of how employees understand their benefit plans.

Eighty percent of human resources decision-makers believe it's important for employees to fully understand their benefit options, yet they estimate only about 60% of their own employees do – a finding with serious implications for how companies communicate one of the most important parts of their employees' total compensation.

Other major findings of the survey include:

• Over half of the mid-sized employers and over one-third of the large employers don't even have employee communications budgets
• Although the majority of respondents believe decision support tools help employees understand their benefits, the majority indicate they do not offer such tools to their employees.
• Nearly 90% of large companies and 70% of mid-sized companies host web portals with employee benefit information. Fewer than 50% of the respondents offer mobile applications, but the majority believe these are "important".

Do your employees understand their benefits? Do you have an employee communication budget? Do you provide decision support tools to your employees?

Read the complete article for more details.

Memphis Business Group on Health (MBGH) and the employer-driven hospital quality watchdog, The Leapfrog Group, announce that the 2011 results from the annual Leapfrog Hospital Survey indicate that hospitals in the greater-Memphis area, which includes West Tennessee, Eastern Arkansas, and North Mississippi, are making progress in eliminating early elective newborn deliveries. In 2011 57 % of reporting hospitals in this region kept their early elective delivery rate to 5% or less, compared to 20% of reporting hospitals last year. We also saw more hospitals reporting in 2011 (14) than in 2010 (10). 

See the specific results for Greater-Memphis area hospitals.

“Of the hospitals in our region that reported an elective delivery rate in 2010 and 2011, 70% improved their performance. This is extremely promising news. We are making a difference in the lives of women and newborns,” said MBGH CEO Cristie Upshaw Travis.

The only way to get hospital-specific information about this practice is through the Leapfrog Annual Hospital Survey, which is organized and lead by the Memphis Business Group on Health for the greater-Memphis area. Since Leapfrog highlighted this unsafe practice nationally and MBGH highlighted it regionally last year, early elective deliveries has emerged as a priority issue for dozens of national and local health organizations, the National Priorities Partnership, and policymakers through the Department of Health and Human Service’s Partnership for Patients campaign.

Experts, including those from the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection, the Institute for Healthcare Improvement (IHI), and the March of Dimes, caution that a baby needs at least 39 completed weeks to fully develop. Some complications experienced by early term infants include respiratory distress, temperature instability, increased bilirubin resulting in in-hospitals treatment, infection, longer-hospital stays, and higher mortality rates.

Watch a video on MBGH's YouTube Channel on the importance of carrying a baby to full-term.

From the National Business Coalition on Health:

The Catalyst for Payment Reform released a tool (see model health plan contract language) to unite employers and other health care purchasers around the shared goal to make 20% of health care payments based on value by 2020.

This tool will help MBGH with our efforts to reform payment in the greater Memphis area. The model contract highlights immediate opportunities to reform how health plans pay doctors and hospitals. Together with CPR’s health plan RFI (request for information) questions on payment reform, which purchasers use for selecting health plans, the contract language outlines bold purchaser expectations for progress on payment reform by their contracted plans or third party administrators.

Expectations include advancement toward: value-oriented payment; quality and price transparency; comprehensive consumer decision-support tools; and monitoring of the level of competition among providers.

CPR's RFI and eValue8 have been synched as much as possible to drive consistent expectations from purchasers to health plans around payment reform.

MBGH members and other self-insured employers are encouraged to adopt the model contract language to move the Memphis market toward payment methodologies that are aligned with our expectations for high quality, safe, and efficient care.

On Friday, January 13, 2012, the Centers for Disease Control and Prevention (CDC) announced that Shelby County was one of 7 sites nationally selected for their National Healthy Worksite Initiative. Viridian Health Management, based in Phoenix, AZ, is implementing this initiative in all 7 sites. MBGH is working with CDC and Viridian to identify interested employers in Shelby County and we hope that several of our members will apply!

As a selected site, 15 employers from Shelby County will be participating in a two year program to implement program, policy and environmental supports for physical activity, nutrition and tobacco use. These participating employers will receive intensive, on-site support to build a worksite health program that is tailored to their organization and the needs of their employees. Support will include:

• Assistance in building a worksite health program

• On-site health assessment and evaluation

• On-site program management support/capacity building

In addition, participating employers will receive training, technical assistance, and will engage with other local and national participating employers and experts.

Eligible employers must:

• Have fewer than 1,000 full-time employees (although there are special provisions for autonomous divisions of larger employers)

• Offer health insurance to eligible employees

• Demonstrate capacity commitment and meet program requirements

• Not currently have a comprehensive wellness program in place (although eligible employers may already have some of the components of a wellness program).

Get a copy of the eligibility details.

The program targets small to medium sized employers and will include employers in each size category (100 or fewer full-time employees: 101-250 full-time employees; 251-1,000 full-time employees).

Interested Shelby County employers can apply for the program between January 20, 2012 and February 24, 2012 by filing a certification form on the National Healthy Worksite Initiative website. More details regarding employer eligibility will be provided on the certification form itself once it is available. Invitations for participation will be made in May 2012.

Two webinars will be held on January 20, 2012 so if you are interested in participating in the program, please click the time below and register for one of the webinars. Both webinars are identical so you only need to register for one webinar.

11:00 AM to 12:00 PM CENTRAL

2:00 PM to 3:00 PM CENTRAL

You can review the webinar slides if you can't make the webinar.

Get answers to Frequently Asked Questions from employers about the program.

Shelby County was selected based on prevalence of chronic disease, health outcomes, and healthy behaviors; availability of community resources to support a sustainable program (including MBGH!); and high health disparities. Read more on the site selection process in the webinar slides above.

Don't hesitate to get in touch with Cristie Travis if you have any questions or need additional information! 

Proposed recommendations for the Tennessee Health Insurance Exchange encourage health plans and employers to establish expectations about personal responsibility and engagement through benefit designs in the Exchange.   The wellness program could provide some sort of "good driver discount" in the form of a lower premium or other incentives to those enrollees who satisfy these standards. Having the exchange plans offer these incentives will make it easier for larger employers too!

Here is an excerpt from the "Best Alternatives to a Federal Insurance Exchange in Tennessee" published by the Tennessee Insurance Exchange Planning Initiative on October 21, 2011.

" Overview Stakeholders have emphasized that wellness is a significant concern and the “on-boarding” of newly-insured enrollees offers an opportunity to set expectations in this regard. The PPACA requires plans to implement wellness programs and provide services that will encourage and enable enrollees to improve their health status. PPACA also removes the ability of issuers to consider the health status of people enrolling in health plans when establishing premium rates. The law requires issuers to accept all eligible applicants regardless of an individual’s health status. Wellness incentives and rewards must comply with other federal rules related to nondiscrimination.

Options Available to Tennessee If Tennessee operates the exchange, the state would have the opportunity to emphasize the importance of prevention and wellness by harnessing the power of market-based solutions. Accordingly, the exchange may create incentives designed to support and coach enrollees to maintain healthy lifestyles and take responsibility for their medical conditions.

The State of Tennessee recently implemented a large, program-wide wellness incentive for the 200,000+ adults in its public employee health plans. Beginning in 2011, the State offers a "Partnership PPO" with a lower premium and low member cost-sharing -- but eligibility is predicated on the member's completion of a health questionnaire, biometric screening, etc. Members who do not agree to the terms of this "Partnership Promise" must enroll in the Standard PPO, which has a higher premium and higher member cost-sharing.

In developing in the Partnership Promise, the State conducted an exhaustive review of the scientific literature, government reports, available unpublished manuscripts, and materials from the National Business Group on Health and others. Though this process, we were able to tailor an approach that we felt would be most likely to succeed in our market.

Tennessee’s approach was inspired in part by approaches akin to that described by Ian Ayres of Yale Law School in his book, "Carrots and Sticks." He cites on example of BeniComp, an Arkansas-based company, that has achieved renown for its wellness efforts:

• BeniComp Advantage has caused a stir in the group insurance industry by providing companies with plans that lower an employee's deductible by hundreds of dollars each year if the employee meets certain National Institutes of Health wellness goals. 'It's like a good-driver discount for health insurance,' [BeniComp President Doug] Short said. For example, in Benton County, Arkansas, the BeniComp plan came in and raised health-care deductibles for county employees from $750 in 2004 to a whopping $2,750 in 2005. But the employees can reduce their deductibles to as low as $500 if they don't smoke, are not overweight (with a BMI of less than 24.9), and have low cholesterol (LDL under 160), low blood pressure (lower than 140/90), and low glucose (under 126).

In essence, the wellness program could provide some sort of "good driver discount" in the form of a lower premium or other incentives to reward enrollees who meet specific health measurement criteria that are within their control. To comply with federal non-discrimination requirements, though, there would need to be reasonable alternatives to qualify for incentives for those enrollees for whom it is unreasonably difficult or medically inadvisable to achieve the standards.

Specific options available to the state to increase the utilization of wellness programs in exchange plans include:

• Provide incentives for health plan issuers who develop innovative wellness programs; and/or
• Require QHPs to include in their consumer publications and on-line plan materials detailed information describing wellness program services and how the company protects the privacy and personal health information of all program participants.

With respect to risk assessment or questionnaires, stakeholders noted that consumers could confuse these with medical underwriting practices (which the PPACA prohibits beginning in October 21, 2011 2014). Stakeholders suggest that any health risk assessment process occur only after an individual has enrolled in a plan. As a practical matter, such questionnaires should be at least 30 days following the completion of enrollment in order to reduce confusion among new members about enrollment, coverage and the new incentives.

Ensuring a Stable and Competitive Market Wellness programs provide a valuable opportunity for health plans to identify enrollees at risk for health problems and work with enrollees to develop a patient-specific program for achieving maximum health care results. A successful, market-based program will not only improve the health of enrollees and prevent future complications among those with chronic conditions, but will also encourage personal responsibility and provide enrollees with the information they need to take control of their personal health care. The state will continue to work with health care experts and behavioral economists to identify additional program options that are compliant with federal requirements, and invites stakeholder input to on wellness incentives in exchange plans."

Read the full white paper.

Labor and delivery account for nearly 25% of all hospitalizations for many employers, and costs associated with pregnancy and its complications are a driving factor in the rising costs of health care. The growing use of medically unnecessary interventions is increasing costs and complications among mothers and babies, with no evidence of improved outcomes.

The Catalyst for Payment Reform (CPR), an independent, non-profit corporation working on behalf of large employers to catalyze improvements in how we pay for health services and to promote better and higher-value care in the U.S., has issued an Action Brief designed to help employers understand the issue and actions they can take to improve the cost and quality of labor and delivery for those on their health benefit plan.

According to CPR, major actions employers can take include:

USE CPR’s health plan request for Information (RFI) questions and model contract language available at catalyzepaymentreform.org/RFI.html

ENCOURAGE your insurer or third party administrator (TPA) to:

• Create payment contracts with providers and hospitals that remove perverse incentives for today’s high rates of intervention in labor and delivery, including unnecessary cesarean deliveries;
• Encourage or require hospitals and physicians to implement a “hard stop”policy on elective inductions prior to 39 weeks;
• Require pre-authorizations for any elective deliveries prior to 39 weeks for hospitals that do not have a “hard stop” policy;
• Incorporate maternity quality metrics in performance-based payment contracts;
• Provide members with information on the quality of maternity care across the physicians, midwives and hospitals in its network;
• Educate members, network physicians, and hospitals about high-quality,safe, cost-effective maternity care; and,
• Credential and reimburse certified nurse midwives to provide maternity care in a hospital setting.

STAND by your plan during contract disputes with providers regarding programs that incentivize members to seek evidence-based maternity care.

EDUCATE employees on the importance of full-term births and the health consequences of elective inductions and cesarean deliveries.

IMPLEMENT benefit design changes and shared-decision making tools to encourage pregnant mothers to make informed and evidence-based decisions about when and how they deliver their babies.

Memphis Business Group on Health provides information on the progress Memphis-area hospitals are making on reducing elective deliveries before 39 weeks. Check out hospital performance on normal deliveries on the Leapfrog Annual Hospital Survey. Click "click to change treatment" button on the left and add Normal Delivery. Click the "I" for each hospital to see their rate of elective deliveries before 39 weeks. The goal is to have less than 5%!

Read the full Action Brief.

In 2012, MBGH is offering a series of Benefits Basics webinars, designed to "fill the gap" for educational programming geared toward new hires, where other programs are not readily available from reliable training sources (such as ISCEBS or WEB). These "101" level classes are for MBGH members-only and oriented toward new benefits staff, or individuals in need of refresher information.  Programs will be taught by seasoned benefits professionals and are being sponsored by the Health Action Council of Ohio, MBGH's sister coalition and member of the National Business Coalition on Health.

During each webinar, participants will learn the fundamental aspects of each topic, develop an appreciation of the covered subject's interplay with other benefits and regulations and receive practical tips for benefits management.

Webinars are offered the 2nd and 4th Thursday of each month, from 11:00-12:00 noon CT and have been scheduled through June 7, 2012. 

The full Benefits Basics schedule is below, and includes two "Hot Topic" sessions that have been augmented to include the practical administration of MH/SUD benefits and HRAs/HSAs.

1/12 - Vendor management - handling RFPs, what to consider in contracts
1/26 - Paying benefits, assignment of benefits including COB and subrogation
2/9 - COBRA - what it is, how to manage
2/16 - Compliance Hot Topic + Mental Health/Substance Use Disorder - MHPAEA
3/8 - Pharmacy benefit management - pricing, carve-out options
3/22 - Managing large claims - vendor reports, how to communicate
4/12 - Non-discrimination testing - required tests and calculations for plans, inc. 105(h) and 410(b)
4/26 - Compliance Hot Topic + HSA/HRAs - Rules for each type of account/plan, administration and compliance issues
5/10 - Handling benefits during employees' leaves - FMLA, USERRA, ties to COBRA5/24 - 5500s - definition, requirements
6/7 - Voluntary benefits - health related: dental, vision

MBGH member organizations receive up to 5 complimentary registrations to use at any time during the January 12 - June 7 series. Additional registrations are only $35 each. You are welcome to have colleagues join you in your office for the webinar at no additional charge.

Go to the MBGH Calendar to register for each event.

Thank you to Health Action Council of Ohio for letting MBGH members participate!

Get the answer by reading the full document (or the Executive Summary), “Best Alternatives to a Federal Insurance Exchange in Tennessee”, just issued by the State of Tennessee Insurance Exchange Planning Initiative (the Initiative).

The report provides a comprehensive analysis of the governance, structure, processes of an insurance exchange and suggests how Tennessee may want to address the issues to ensure a stable and competitive market in the state.

The Small Business Health Options Program (“SHOP”) is the exchange that is applicable for employers. Major issues that impact employers include:

Eligible employers: Federal regulations allow employers with less than 101 employees to participate in the SHOP. However, states are allowed to restrict participation to employers with less than 51 employees until January 1, 2016 when the exchange is open to employers with less than 101 employees. All employers can participate in the exchange beginning 2017. The Initiative is recommending that Tennessee only allow employers with less than 51 employees to participate in the SHOP. There are an estimated 225,000 employees that would be eligible to participate in the SHOP through their employers that meet this size requirement.

Benefit design: The SHOP exchange in Tennessee would allow unlimited benefit design variation. This contrasts with the individual exchange in which the state may limit the number of available benefit design in order to not overwhelm individuals with too many choices and decisions.

Insurance agents: Only agents accredited by the state will be able to participate in the exchange and small groups purchasing through the SHOP will be required to work through an accredited agent or broker for the first two years of the SHOP. Agents can freely negotiate commissions with issuers and transaction, consulting and assistance fees with small groups.

Plan choice: Employers can select a single qualified health plan from the SHOP to offer their employees (employer choice) OR the employer can allow their employees to select from several or all of the plans in the SHOP (employee choice). However:

• The SHOP would not require insurers to participate in the employee choice option
• Insurers are allowed to have different premiums for the same benefit design/product for employer choice and employee choice approaches
• Employers would be allowed to contribute defined amounts to the premium vs. paying a proportion (percentage) of the premium in the employee choice model.

Wellness: Benefit designs within the exchange can provide incentives for enrollees to be more actively involved in their health and wellness by allowing incentives for completion of health questionnaires and biometric screening; maintaining  normal BMI, cholesterol, blood pressure and blood sugar levels.

Geographic Rating Areas: There are likely to be 12-15 different geographic rating areas in the state, reflecting patterns of health care utilization and cost. Such an approach would help ensure that low-cost geographic areas are not subsidizing the high-cost areas.

Exchange sustainability: Users of the exchange would pay for the operating costs of the exchange through some type of administrative fee in order to minimize any tax burden on state taxpayers. Employers would be paying these fees either directly through assessed fees or indirectly through fees added to premiums or administrative costs passed on through qualified health plans.

Initiative staff is currently traveling the state to present the major components of the white paper and getting feedback and input before the report is finalized and submitted to Governor Haslam.

MBGH is a co-sponsor of The Memphis “listening session” scheduled for November 17, 2011 from 6:00 pm to 8:00 pm at the Fogelman Executive Center at the University of Memphis. Register here for the meeting.

In addition to listening sessions, comments can be submitted by email at insurance.exchange@tn.gov.

In July of this year, MBGH sponsored the “Believe in a Healthy Memphis: 2011 Let’s CHANGE Summit” in collaboration with the Shelby County Health Department and Healthy Memphis Common Table. Ham Smythe, President of Yellow Cab and Checker Cab, was an active participant in the  “Where We Work” group, which detailed the options employers could explore to stimulate healthy lifestyles in employees.

This was not the first time Smythe had explored the options he had to encourage healthy in his employees. In March, he met with Cristie Upshaw Travis, CEO of MBGH, to get some specific advice about steps he could take to create a culture of health at his company. Travis suggested three areas for focus: healthy eating, active living, and tobacco cessation. Smythe explains the motives behind his actions toward a healthy workplace: “It’s an act of self-interest. Healthier employees will take fewer sick days and have a happier outlook. Customer service will improve, along with general morale around the office.”

Smythe goes on to explain: “MBGH enlightened me regarding how I could approach providing healthier options for my employees. When these changes are implemented, I realize that it’ll be up to me to lead by example. MBGH assisted me in realizing that not every solution is necessarily an expensive one, and helped me to approach the dilemma creatively rather than to simply throw money at the issue.“

Smythe certainly has been creative in his healthy solutions. “I sit on a stability ball when I’m at my desk,” he says with a chuckle. “Obviously I can’t force people to take the steps I’ve taken toward being more conscientious of my health, but I can show them how. MBGH made me aware that top-down leadership is required when making changes like this.”   

At the Summit, the “Where We Work” group decided to recruit employers to offer healthy choices in their vending machines, cafeterias, and meetings. Since attending the Summit, Smythe has illustrated the relative ease with which healthy changes can be implemented in the workplace. Early in the Fall, he contacted Travis, asking for the name of a healthy vending machine company, and starting in November, the old machine is out and the new, healthy one is in. The process took only a few months.

In addition to utilizing healthy vending machines at the workplace, Smythe has cut out all unhealthy snacks from work gatherings. “No more donuts – we eat granola snacks instead,” he says. “We’re also trying to explore healthy options regarding what employees can do when they’re on their own time. I’ve also created a program in which employees are reimbursed a percentage of any tools they may utilize to quit smoking. The options are out there. You just have to grab them.”

Travis expressed excitement about the steps Smythe has taken: “Ham followed our advice to the letter! He addressed all three important areas that we pointed out to him at our first visit: healthy eating, active living, and tobacco cessation. The changes he made were simple, accomplished quickly, and weren’t costly. Other employers can make these changes as well.”  

For information on how you too can make these changes at your workplace, contact Cristie Travis at ctravis@memphisbusinessgroup.org.

It seems a week does not go by without at least one physician practice forming a partnership or being acquired by a Memphis area health system.

The most recent announcement, just today, was Methodist's acquisition of Eastmoreland Internal Medicine.

Have you tried to keep up with who owns who? Check out a list developed by doing searches on the Commercial Appeal and Memphis Business Journal websites for Methodist and Baptist.   Although the list may not include all health system-owned physician practices, it does give you a flavor for how much has changed for these two health systems just in the last year!  

MBGH's search has been augmented by a 12.1.11 Memphis Medical News article. The article also includes a list of practices purchased by St. Francis.

Want more on why this is happening? Read an article from Manoj Jain, MD for some background and check out the presentations Baptist Memorial Medical Group, Health Choice, and UT Medical Group made at MBGH's September 8 Annual Conference to have a better understanding.

Well, not quite a blog in the truest sense, but a Facebook version of a blog. Here is a recent conversation on Facebook about public reporting of hospital infection rates! Bottom line, whose burden is it? The hospital's burden of data collection, measurement and reporting? Or the patient's burden of dieing or going through the pain of treatment to survive? At some point we have to get to the bottom line. We all deserve to know the basics about the quality of the hospitals that serve us. Thank goodness the hospitals in Memphis get this and report!(see their results) If you are interested in joining the Facebook group for "Transformation Has Begun" where these conversations happen daily, let me know at ctravis@memphisbusinessgroup.org. Give me your facebook information and join the conversation.

P:Three big hospitals stop publicly reporting infection data-per Consumer Reports...and there's more... Two of them are in Aligning Forces markets. (Cleveland and Detroit). Terrible. Really."Three big-name hospitals stop publicly reporting some infection data - Consumer Reports Health News ... Three large hospital systems—Cleveland Clinic, Henry Ford in Detroit, and Parkview Health in Fort Wayne, Ind.—have stopped reporting data on hospital-acquired infections to the Leapfrog Group, a nonprofit organization in Washington, D.C., according to our updated hospital Ratings. That deprives...

M: Wow. Let's wait and see how (or if) local media and patient advocates react ·

D: Wait - I was about to pop a blood vessel over this (Cleveland Clinic???) but the CU article says they only stopped reporting to Leapfrog Group - they're still reporting to CMS. Am I missing something?? Is there a special problem in not reporting to Leapfrog, which (the CU article suggests) requires a different format?

S: That's an excellent question, D. We know that leaders in the field are really struggling with the reporting burden when there are nuanced differences in measures or the formats or whatnot. 

B: Leapfrog is the only source of data on central line infections (and other important metrics like safe practices, unsafe early deliveries, and many others) that is publicly reported by hospital on a national level. That's where Consumer Reports gets the data they reference and why Leapfrog reporting is important to them. Leapfrog is nonprofit and does not charge hospitals to complete the survey. Hospitals tell us it takes 40-80 hours of staff time per hospital. That doesn't seem like an untoward burden to give consumers information they deserve before entrusting their lives in a hospital

S The HUGE difference here centers on public reporting. Transparency leads to improvement. At a minimum, it's a 'reputational incentive'. 

D: So, I don't get it - Leapfrog is non-profit, so is CMS (duh); is CMS data not publicly viewable?? And CMS doesn't charge for it, right?? That may be the case - I don't know this area, that's why all my stuff has question marks.:-) I would sure as hell hope that the taxpayer-funded CMS data would be visible to taxpayers, along with all the other HHS data that's recently been liberated - but maybe it's not! Would we (whoever that is) be happy with publishing all the CMS data? Or are there folks who are deeply committed to Leapfrog, for some reason? (Pardon my naivete)

B: CMS doesn't yet publicly report CLABSI data by hospital (nor many of the other measures on Leapfrog's survey). 

D: OH. Well that IS something! Whose a$$ do I kick about THAT?? How about if we ask Cleveland & others to PUBLISH what they send to CMS?? >

B: Go ahead. That's all Leapfrog does. The problem is you can't get your measurement experts to examine the report and make sure it's the right time period, right specs, etc. Nor can you compare them to all the rest of the hospitals nationally unless you use Leapfrog.

S: THERE'S an idea. But it's powerful when it's presented in context of how other hospitals are doing. Leapfrog does that. If each publish their own data, then it forces the patient to piece together the information from many different locations, likely described in different ways, etc. Ugh.

Cristie Upshaw Travis S, you are right on! Leapfrog and our Regional Roll Outs have had the courage, and I do mean courage, to ask hospitals to report this information and to be held accountable for their results and progress! Over 1200 hospitals report this information because organizations such as Memphis Business Group on Health ask them to do so! Over time others have asked them to report, but more than likely it is not as timely and often the results are presented in a way that the variation among hospitals is not even presented in such a way that patients and purchasers can see the differences! I could go on (LOL), but enough said. Those of us that have been committed to LF for 10+ years and have seen the difference it makes in our market are passionate (as you can tell

Cristie Upshaw Travis And, D I'd be glad to help you with your task at hand!!!

D I'll just say that this discussion is quite educational for me. Suddenly I have a much clearer sense of why it's so hard to improve things. Imagine a class of 7th graders whose parents - or principals - can't see their report cards. No real consequences for crappy performance, no rewards for improvement. Boy. Well, I don't know executives at Cleveland, but that's never stopped me... btw, in 2006 my hospital started posting their CLABSI rates on their website, and blogging about the push to zero. A few months later I learned I would get a treatment that's delivered by central line, with four separate insertions. It was, um, interesting to chat with the surgeons as they were inserting them. It made it all very relevant, suddenly. At first the hospital's competitors said it was irresponsible of the CEO to blog about it. "You're endangering your hospital's reputation." Really?? That's how Boston hospital community thinks - reputation over all? But that was a ruse; when the numbers dropped and hit zero for a couple of months, the same competitors accused him of grandstanding for marketing purposes. :-) These guys crack me up ... until I think about the consequences for families. It never occurred to me that those guys don't have ANYONE examine THEIR numbers, so they can be as schlocky as they want. Hm.

S: Oh my god, I think I've fallen in love with you, D. You GET it.

P: Wow, I leave FB for a bit and there's a giant conversation...

D: Er, S gee thanks :-), I think, but ... out of curiosity, are you talking about the years-ago episode, or today's news at the start of this thread?

P:This point about measurement and reporting burden about something so critically important to patients, consumers and the public makes almost no sense to me. Failure to work as hard as possible to get information like infection rates out to the public is really indefensible. Pathetic.

Cristie Upshaw Travis I couldn't agree more P! Whose burden is it any way? The hospitals to report or the patient's to experience the infection and either die or go through a lot to survive? Sorry to be so blunt, but at some point we have to get to the real point. But, to be balanced, we need to be sure that we are focusing on the stuff that really makes a difference. If it doesn't, let's not go there. If it does, let's go there! The obligation on our end is to know what leads to best outcomes and measure that and the outcomes but little else. When we can get to only outcomes, that will be nirvana!

The IOM recommended that HHS develop an EHB package by May 2012. The high-level recommendations are as follows:

1. The EHB package should be adjusted so that the expected national average premium for a “silver” (second-lowest-price) plan is actuarially equivalent to the average premium small employers would have paid in 2014 for a typical plan.

2. The HHS Secretary should establish a framework for monitoring EHB implementation and updating that accounts for changes in provider payment rates, financial incentives, practice organizations, and other relevant matters. (IOM recommends that this be done by January 2013)

3. The Secretary should update the EHB package to make it more fully evidence-based, specific, and value-promoting — explicitly incorporating costs and a public process to gain input on the updates.  (IOM recommends that this begin in January 2016)

4. State should have flexibility in adopting variants of the federal EHB package, provided that modifications are consistent with the federal package, not significantly more or less generous, and are subject to public input.

5. Establish a National Benefits Advisory Council, with members appointed through a nonpartisan process, which should make recommendations annually stemming from its oversight of the EHB package.

For details on these high-level recommendations and more on the EHB, read Kavita Patel's Health Affairs blog post..

Memphis Business Group on Health is proud to be the Leapfrog Regional Roll-Out for Memphis and West Tennessee and to serve as Vice Chair of the Leapfrog Board of Directors. We are excited to see that public reporting of hospital acquired infections is resulting in improved care for patients. MBGH has been working with our Memphis hospitals to report this information since 2009. Thank you to these hospitals for being willing to report and for focusing on improvement. Memphis area results can be seen at http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=zip&zip=38120&radius=100&cols=oa.

From The Leapfrog Group: October 19, 2011 – Today, as the Centers for Disease Control and Prevention (CDC) announced that hospitals and other health care facilities are doing a better job of preventing four common infections, The Leapfrog Group’s CEO, Leah Binder, pointed to the importance of transparency and public reporting in helping to reach this outcome.  

Binder noted, “We are pleased to see these improvements in rates of infections in hospitals and applaud organizations, that are, like Leapfrog, pushing for continued improvement. For us, this points to the importance of publicly reporting hospital performance on important safety measures. According to today’s announcement from the CDC, the infection rates that declined most significantly, by 35%, are central-line associated blood stream infections in critical-care patients. The Leapfrog Group began collecting and publicly reporting out these data for almost 1,000 hospitals nationwide in 2009 so that consumers who wish to go to hospitals with zero or low infection rates can now make an informed choice. The hundreds of purchasers who have led the Leapfrog campaign for transparency in hospital safety and quality take great comfort in this progress and recommit themselves to getting even more hospitals to report publicly to Leapfrog’s annual hospital survey in the future.”

Through its annual survey, The Leapfrog Group asks hospitals to report their rates of central-line associated blood stream infections utilizing the same measure as the CDC/NHSN. Hospital rates of infections per ICU type can be viewed at www.leapfroggroup.org/cp. In addition, this year, Leapfrog completed a qualitative study to begin to understand how community hospitals were able to get to and maintain a rate of zero central-line infections in ICUs. The study, entitled “Getting to Zero: Reducing Rates of Central-line Associated Blood Stream Infections in Community Hospitals,” found that all four hospitals involved in the study used a checklist and guidelines promulgated by the Agency for Healthcare Quality and Research (AHRQ) and the CDC. (Download the report at http://www.leapfroggroup.org/media/file/Final_GettingToZero.pdf)

A hospital’s full safety and quality results from the 2011 Leapfrog Hospital Survey can be viewed at www.leapfroggroup.org/cp. In addition to hospital rates of central-line associated blood stream infections, visitors can also find information, by hospital, on rates of other hospital-acquired conditions, survival rates for certain high-risk surgeries, rates of early elective deliveries, and much more information about a hospital’s safety and quality.

The Leapfrog Group (www.leapfroggroup.org) is a coalition of public and private purchasers of employee health benefits founded a decade ago to work for improvements in health care safety, quality, and affordability. Leapfrog purchaser members use hospital survey results in contracting, open enrollment with their employees and other public reporting, benefits design, and value-based purchasing programs.

If I were King, and could wave my magic wand, my three wishes would be (ooops, I think I am mixing metaphors, oh well):

Engage my employees as partners with me in the quality and cost of their health benefits. I would Implement a benefit design similar to the State of Tennessee, offering lower payroll deduction for premium co-shares, lower deductibles, lower co-pays, and lower co-insurance in exchange for employees and their families taking an HRA, getting their biometrics, and agreeing to condition management and/or health coaching.

Bring health care services on-site, similar to Shelby County Schools, making health care services more readily accessible for my employees and staffing the on-site clinics with health care providers that understood the value of managing the care of my employees to get the highest quality care at a reasonable cost and get them back to work as quickly as clinically appropriate. This "wish" may not be practical for everyone, but for many it is a viable option and should be considered.

Look around me and change those things at my work-site that are relatively "easy" to change, but can have a huge impact on the health of my employees, like First Horizon has. Easy things like offering healthy choices in my vending machines;  healthy options in my cafeteria: encouraging employees to take the stairs: mapping out a walking path in my parking lot or on my grounds, or nearby neighborhoods. And becoming a smoke-free campus. After all, actions speak louder than words. If I didn't do these things, what would make my employees think I was serious about the benefit design or clinics?

Work with a health plan that cares about the things I care about. After all, I am paying them big bucks to help me manage the cost and quality of the health benefits I offer my employees. The health plans I use better score well on eValue8 and pass the test because if they don't I will either find one that does or work with the one I have to become more responsive.

Be sure that the hospitals and doctors that are in my plan are committed, by being willing to publicly report to The Leapfrog Group and Healthy Memphis Common Table, and focus on improving patient safety and quality so I don't waste my healthcare benefit dollars paying for mistakes that happen, healthcare acquired conditions, or inefficiencies due to unnecessary tests or medical treatments.

If I were King, had a magic wand, or three wishes (ok, maybe 5) this is what I would do and I would do it now!.

Cristie

The National Business Coalition on Health's (NBCH) Action Brief on Hospital Patient Safety, lays out the issues, details how health plans across the country are or are not working to improve safety, and details actions employers can take to have an impact on patient safety for their employees.

2011 eValue8 results were used to track how health plans are or are not working to improve safety. MBGH is an active participant in the eValue8 process and this year both BlueCross BlueShield of Tennessee and CIGNA of Tennessee provided information for Memphis-area purchasers through eValue8.

Specific actions employers can take to impact safety include:

• Asking their plan what they're doing, how they compare, and how they can improve
• Not paying for hospital acquired conditions and serious reportable events
• Encouraging (or requiring) plans and hospitals to publicly report. Here is Memphis, MBGH works with hospitals to report through The Leapfrog Group's Annual Hospital Survey, which meets all of NBCH's recommendations for public reporting.
• Make high performing networks available to employees.
• Raise awareness about patient safety among employees. MBGH offers a "Getting Quality Care" employee communication tool kit for members and helps re: implementation. Give us a call to learn more!
• Join the Partnership for Patients. MBGH is a member and is working with our members to implement the Partnership goals.
• Join their regional business coalition on health! MBGH is excited to talk with any employers about the benefits and value of MBGH membership, both for the impact on the community and the impact on the quality and cost of the employer's health benefits.

Read the Action Brief.

Maybe it's time for the private sector to look at how state governments are ratcheting up the requirements for employees to get health benefits and follow suit.

Whether it is called the Health Enhancement Plan, like it is in Connecticut, or the ParTNers for Health Plan, as it is in Tennessee, state governments are offering new plans that offer lower employee costs (through payroll deductions, deductibles, co-pays, co-insurance) in exchange for employee engagement in health risk identification, prevention, and/or condition management.

Employees seem to "get it". In Tennessee almost 80% of eligible employees chose the ParTNers Plan, which was effective January 1, 2011. In Connecticut, 96% selected the Health Enhancement Plan which is effective October 1, 2011.

And in Tennessee, preliminary reports indicate that 90%+ of those in the ParTNers Plan met the requirements to stay in the plan.

Clearly these plan designs are capturing the attention of employees and there appears to be very little push back (although I am sure they are not without issues!).

Private sector employers, take a look at these plans and think about adopting something similar if you have not already done so! You can always point to the State as someone that has paved the road for you and give you some "cover" if you need it.

Learn more about the State of Tennessee ParTNers for Health Plan

Learn more about the Connecticut Health Enhancement Plan

Great article from Milliman explaining why something has to be done to address adverse selection in health reform. If it is not the individual mandate, what will it be?

As Tom Snook, Principal & Consulting Actuary, Milliman Inc., says, people will operate in their own economic self-interest. If they are healthy and the cost of health insurance is high, they will not purchase health insurance, especially if it is not highly subsidized by their employer. If they are sick, they are more likely to purchase health insurance. With fewer healthy people buying health insurance and most sick people buying health insurance, you can see that the overall cost of health insurance will be high!

Under Health Reform, the traditional ways of mitigating the risk of adverse selection were taken away: coverage denials; charging higher premiums for those with pre-existing conditions. In exchange for taking these traditional techniques away, the individual mandate and the employer "pay or play" provisions were enacted.

If the individual mandate goes away the plan falls apart. Traditional techniques to manage risk are gone, but nothing new is in their place. This is a very sobering thought and one employers need to understand since you will be left holding the bag in your employer-provided health plans!

Read the Milliman article.

On August 1, the Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) issued detailed guidelines (http://www.hrsa.gov/womensguidelines/) for group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act (PPACA). A fact sheet is also available at the HealthCare.gov portal.

These guidelines supplement the IFR on general preventive care requirements issued in July 2010 and have the effect of expanding on the list of preventive health care services that must be covered on a first dollar basis. Specifically, all non-grandfathered health plans (both insured and self-insured plans) will need to include these services without cost sharing for plan years beginning on or after August 1, 2012. The guidelines specifically address preventive health services that must be offered to women at no additional cost, such as:

• Well-woman visits;
• Screening for gestational diabetes;
• Human papillomavirus (HPV) DNA testing for women 30 years and older;
• Sexually-transmitted infection counseling;
• Human immunodeficiency virus (HIV) screening and counseling;
• FDA-approved contraception methods and contraceptive counseling;
• Breastfeeding support, supplies, and counseling; and
• Domestic violence screening and counseling.

In related news, on August 1, the U.S. Treasury Department, Department of Labor (DOL) and HHS released an amendment to the original preventive care IFR, providing an exemption for “religious employers” from the provisions of PPACA regarding coverage for contraceptive services for women and sets forth a definition for “religious employer” for that purpose.

As explained in background to the amendment, it “is intended to reasonably balance the extension of any coverage of contraceptive services under the HRSA Guidelines to as many women as possible, while respecting the unique relationship between certain religious employers and their employees in certain religious positions.”  

The Obama Administration is seeking comments on the amendment to the preventive care IFR amendment until 60 days after it is published in the Federal Register, expected within the next several days, meaning that comments will be due in early October. (Source:National Business Coalition on Health; American Benefits Council, August 2, 2011)

Currently, the value of health insurance coverage provided by employers is not subject to payroll or income taxes.

Recent budget calculations indicate that this is the federal government’s largest tax expenditure, at a cost of more than $1 trillion over the next five years (though this also includes the employer deduction of these costs as a business expense), and the Joint Tax committee has estimated the cost of the tax expenditure for the employee exclusion for health insurance alone at $659 billion for 2010 through 2014.

The congressional panel may seek to cap and/or phase out the health insurance tax exclusion over time and/or based on the employee’s income level. The National Commission for Fiscal Responsibility and Reform (NCFRR) final report proposed instituting a cap at the 75th percentile of health insurance premium levels starting in 2014, with the cap frozen in nominal terms through 2018 and phased out by 2038.

It is noteworthy that no proposals have been floated to limit the employer's deduction for its expenses in providing health coverage, which are currently considered “ordinary and necessary” business expenses under the tax code.

In conjunction with limiting or eliminating the tax exclusion for workers, the panel may also seek to lower the excise tax on employers and insurers for high-cost “Cadillac” plans. The NCFRR final report recommended modifying the tax from its current 40 percent to 12 percent.

Source: National Business Coalition on Health

As it turns out, wrong site surgeries happen for many reasons and often the cause for the mistake happens before the patient is even scheduled for surgery.

 A new initiative of the Joint Commission Center for Transforming Healthcare believes that wrong site surgery should NEVER happen, so it has quite a challenge since, on average, 40 wrong site surgeries occur every week across the country and such surgeries are the most frequently reported sentinel events at hospitals.

Pilot hospitals are using principles from Six Sigma and Lean Manufacturing to identify the causes of wrong site surgery and to develop solutions.

Arm yourself and your employees with the list of common causes for wrong site surgery that have already been identified. Some of the causes that patients can watch out for include:

• Surgeon does not mark site in the pre-op/holding area

• Inadequate patient verification

• Site mark(s) removed during prep or covered by surgical draping

Check out the full list.

See a related blog post on how a wrong site surgery impacted a young boy and his family. We should never forget the faces that go along with the statistics about wrong site surgery and other medical errors.

See an earlier blog post on wrong site surgery from the Archives of Surgery.

As you can see, wrong site surgeries get a lot of attention but we still have them! It's time to get it right and that is what this Joint Commission project is all about.

Embracing the belief that providing on-site medical care can keep employees healthy and productive and save money, more and more employers are opening their own state-of-the-art health centers.

Mercer reports that, nationally, 15% of employers with more than 500 employees have health centers, up 4 percentage points from last year. The larger the employer the more likely they are to have on-site centers.

These centers are moving beyond urgent, now offering preventive services, such as mammograms and prostate screenings , pharmacies, allergy shots, physicals, and some clinics are even offering dental services.

Qualcomm reports reduced emergency room visits, hospitalizations and medical claims since having its on-site clinics.

Workers like the convenience of having medical services close at hand. It saves them a lot of time and many as one employee put it "I don't go to outside doctors anymore".

Learn more from the Los Angeles Times article..

Every employer MBGH talks to says they want to increase the “health engagement” of their employees, but the strategies they have used so far just have not been successful. Does this sound like you?

If so, plan to attend MBGH’s Annual Conference “Got the Health Reform Blues?” on September 8, 2011 and hear John Moses, Principal at AON Hewitt, talk about the new “marketing” principles that employers should adopt to lead employees to short-term action and long-term behavior change.

John suggests that employers just will not succeed in engaging employees if they continue to use the approaches used for the past 20-30 years. These approaches were based on the premise that if employees understood their benefits and the issues around health, they would use their benefits wisely and make wise choices for their health. This education approach has had some limited success, but as John puts it “providing lots of education year after year hasn’t solved our problem. That means simply turning up the volume on education hasn’t worked”.

The bottom line is that employers have not provided a compelling, relevant case for why their employees should take action. Key ingredients to getting employees to take action are motivation and facilitation (making things easier for people to do). John suggests that there are four marketing principles employers should use to better engage their employees:

Benefits marketing principle #1: People get distracted and forget; repetition, across time, is vital.
Benefits marketing principle #2: Targeting fuels motivation and improves outcomes.
Benefits marketing principle #3: Wants are more important than needs.
Benefits marketing principle #4: Your “hero” is the customer, not the plan or program.

To John, these principles are easy to implement, but the real challenge is letting go of the old approaches, and old habits.

John knows what he is talking about. He has a PhD in psychology and is AON Hewitt’s communication behavioral change thought leader.

Register by July 15 to get reduced conference registration pricing and come learn directly from John how to increase your employees’ engagement in their benefits and health!

Every year 1,300 to 2,700 Americans are harmed by wrong-site errors. Even after all the attention to this issue since 1999, brought to light by To Err is Human, and an understanding that it is possible NOT to have these injuries, highlighted in 2001 in Crossing the Quality Chasm, these numbers are not going down and people are still harmed.

It is critical to put a face on this problem. It is not just numbers, it is people that are harmed -- it can be you, your family, your co-worker, your hairdresser, your pastor, your neighbor.

Read this article to see what a never-event looks like and how it affects people!

MBGH, through our Leapfrog participation, is challenging our hospitals to eliminate never-events and to apologize to patients and families when they do occur, not charge the patient or the insurance company for the never event or any procedures needed to correct the mistake, to report the event to appropriate organizations, and to perform a root cause analysis to identify why the event occurred.

Major findings from McKinsey's early 2011 survey of 1,300 employers include:

• Overall, 30 percent of employers will definitely or probably stop offering employer-sponsored insurance (ESI) in the years after 2014.
• Among employers with a high awareness of reform, this proportion increases to more than 50 percent, and upward of 60 percent will pursue some alternative to traditional ESI.
• At least 30 percent of employers would gain economically from dropping coverage even if they completely compensated employees for the change through other benefit offerings or higher salaries.
• Contrary to what many employers assume, more than 85 percent of employees would remain at their jobs even if their employer stopped offering ESI, although about 60percent would expect increased compensation.

The White House disagreed with the study indicating that the Congressional Budget Office, Rand Corp., and the Urban Institute all found that the existing employer-sponsored model would see little change due to health reform.

Read the complete McKinsey report.

Recent research indicates that "sitting can be lethal". With the increase of "knowledge workers" who are tied to their desks on the phone, webinars, computer and in long conference room meetings, employers should start thinking about how to keep these employees active throughout the day, improving employee effectiveness.

Here are a couple of articles from Inc.com offering suggestions on how to get your employees up and moving while they are doing their jobs and on how to establish a wellness program. Good information that will help you re-think how knowledge workers spend their time at your worksite.

How to Build a Wellness Program

51% of those responding to MBGH's informal Facebook poll on what work place policy change they would support to improve health voted for "no tobacco use on property". This is exciting news as decreasing the number of tobacco users is a high priority to improve the overall health of Tennesseans and the nation!

Recent legislation that banned or restricted smoking in the work place has gone a long way in improving the health of your workforce by eliminating second hand smoke and encouraging many smokers to quit! But the law allows employees to smoke in designated areas outside, making it easy for smokers to still smoke on work breaks or lunch.

Employers can kick it up a notch and ban tobacco use any where on their property or campus. First Horizon, Baptist Memorial Health Care, Methodist Healthcare and St. Francis are examples of employers that have done just that -- banned tobacco use any where on their campus.Check out MBGH's Tobacco Cessation Benefits Tools & Solutions Center for tips and resources on how to take this important step.

35% of respondents indicated they would support increasing healthy options in vending machines. Creating an environment that makes healthy eating easier is a key strategy for employers. Other ways employers can make the healthy choice the easy choice is to serve healthy meals at meetings and events, always offer water as a beverage, eliminate sugary drink options, and serve smaller portions for dessert.

MBGH has tools & solutions to help employers create a healthy environment for their employees, so let us know how we can help!

On May 24, 2011, the U.S. Treasury Department and Internal Revenue Service (IRS) released Revenue Procedure 2011-32, which lists the 2012 indexed amounts, adjusted for inflation, for health savings accounts and high-deductible health plans (HDHPs). (In some cases, this resulted in no change from the prior year.) The following table lists the 2011 amounts and the new 2012 amounts: The Revenue Procedure is effective for calendar year 2012.  (Source: CQ HealthBeat)

In the first of a two-part interview with Dr. Cathy Baase, Global Director of Health Services for Dow Chemical, The Benfield Group's article outlines the key philosophy and approaches Dow has taken over the past 20 years to increase value to Dow by improving employee health.

Central to Dow's approach is their map which focuses on employee effectiveness and illness/injury management.

As you can see, the common element between employee effectiveness and illness/injury management is benefit design. MBGH has been working with our members for the past 3 years to focus on value-based benefit design that motivates and supports employees to stay as healthy as possible for as long as possible and to use high-value healthcare services. In many ways, benefits and benefit design are the strongest levers employers have to impact employee effectiveness and illness/injury management. Dow believes that taking this approach results in improved performance for the entire company.

What does your organization's map look like? Do you even have a map that helps you think through and organize your overall approach to employee effectiveness and illness/injury management? Does that map directly link to your organization's overall performance, including financial success?

Read The Benfield Group's entire interview with Cathy Baase. Let MBGH know how we can help you map your approach and fill in the blanks!

Who better to help you beat the health reform blues than Suzanne F. Delbanco, PhD., executive director of Catalyst for Payment Reform (CPR).

Delbanco is joining Peter Hayes, Principal for Healthcare Solutions and formerly with Hannaford Supermarkets, and John Moses, PhD, thought leader for behavior change and measurement with AON Hewitt, as national keynote speakers at MBGH September 8, 2011 Annual Conference, “Got the Health Reform Blues?”.  

CPR is working to coordinate action among the largest purchasers of health care and health plans to reform the way we pay for health care in the U.S. to improve quality and cost.   CPR believes that instead of just letting our current health care payment systems continue to drain value out of the care purchasers buy, new systems of payment need to be designed and implemented to “signal” the expectations purchasers have for better care.

Suzanne leads CPR’s efforts to get to these new payment systems by establishing a purchaser call to action, developing a payment reform toolkit, establishing a national payment reform scorecard to track progress in changing payment methods, and policy/advocacy.

The payment reform toolkit, built specifically for employers and purchasers with their needs and desires in mind, includes:         

• A payment reform framework, that helps build a common understanding and language for payment across different stakeholder groups
• A market assessment tool that provides purchasers in as specific market, such as Memphis, a process for assessing the value, and unintended consequences of different payment models
• Action briefs (currently in production) which will provide in-depth review of payment model options, evidence of their impact, and steps purchasers can take to move forward.
• Common RFP/RFI and contract language purchasers can use with health plans to achieve their desired results around payment reform.

Learn more about CPR and Suzanne Delbanco and register to come hear Suzanne in person at “Got the Health Reform Blues?” on September 8, 2011.

Few tasks in benefits management are more time-consuming and expensive than performing due diligence on vendors or potential vendors. Starting now MBGH members can supplement or replace vendor due diligence with information from The Leapfrog Due Diligence Cooperative.

This vendor due diligence information can save MBGH members tremendous time, resources and money. Plus, you have the peace of mind that comes with knowing you’re making the right decisions.

This information is available at no cost to MBGH employer members through MBGH’s membership in The Leapfrog Group.

You must register with The Leapfrog Due Diligence Cooperative to access this member benefit. To register, go to http://www.leapfrogduediligence.org/join-the-cooperative.html. Make sure you indicate you are a member of MBGH on the enrollment form. Once you submit your enrollment form, Leapfrog will confirm you are an MBGH member and then email you a password.

With your password you can:

• Save time and money by accessing vendor due diligence reports developed by Leapfrog
• Receive updates when new vendors are added
• Gain access to a directory of programs that have already been evaluated for quality and cost-effectiveness by Leapfrog
• Use reports and tools to compare among vendors to select the one most appropriate for your employees.

Keep an eye out for a new Cooperative tool now under development. The ROI calculator (coming soon) will let you determine a vendor’s impact for your specific organization!

Refer your vendors to participate in this process
If you have a vendor or potential vendor for whom you would like Leapfrog to perform due diligence, let MBGH know. We’ll approach them about the process for you. Potential vendors could include:

• Disease management programs
• Wellness programs
• Consumer-driven health care programs, such as HSAs
• Prescription benefits management services
• Specialty and high-performance doctor and hospital networks

For more information and to register, go to http://www.leapfrogduediligence.org/join-the-cooperative.html

Our members said they wanted it, and we listened. In the most recent MBGH user survey, worksite health promotion ranked number one as the most important learning topic. That’s why MBGH created a new Tools & Solutions Center dedicated to Health Promotion Benefits.The center is available to MBGH members, affiliates and conference sponsors at the Patron and Partner level. Your login is your email address and the password is  mbgh  .

This center includes information from the National Business Coalition on Health (NBCH) that is available free to our members through MBGH’s membership in NBCH. The new center includes:

• Benefit design information, including information from The State of Tennessee ParTNers for Health and the Methodist Healthcare My Healthy Living Plan.
• Business case information, including a comprehensive evidence review of return on investment of different types of health promotion strategies conducted by NBCH.
• Case studies from national employers (e.g., University of Louisville, Georgia Power, Lowe’s) detailing their key strategies, program components, and evaluations and results.
• Sample policies and program descriptions from MBGH members (Rhodes College, First Horizon)

As with our other Tools & Solutions Centers on tobacco cessation benefits, diabetes benefits, and pharmacy benefit management, new resources will be added to the center over time, so check back frequently!

Memphis Business Group on Health has been appointed to the Measures Applications Partnership (MAP), a consensus-based entity advising the U. S. Department of Health & Human Services (HHS) on the best measures to use in public reporting, value-based payment, and other programs.

Established by the National Quality Forum, the MAP brings together stakeholder groups in collaboration that balances the interests of consumers, businesses and purchasers, labor, health plans, clinicians and providers, communities and states, and suppliers. MBGH is representing employer purchasers on the Hospital Workgroup and the Ad Hoc Safety Workgroup..

The Hospital Workgroup will identify critical gaps in hospital quality measures and endorsements and identify performance measures for cancer hospitals, The Ad Hoc Safety Workgroup will identify critical gaps in hospital readmission and hospital acquired condition quality measures and endorsements and develop a strategy for coordination across public and private purchasers and payers regarding hospital readmission and hospital acquired conditions.

MBGH is one of 60 organizations, 40 individual experts, and eight federal agencies collaborating through the MAP.

The good news for Memphis is that our total cost of healthcare for a typical family of four covered by a PPO increased only 5.7% from 2010 to 2011 compared to a national increase of 7.3% during that same time period. Memphis costs are now 4.3% above the national average, down from 6% above the national average in 2010.

The Milliman Medical Index looks at costs paid by the employer and the employee at a national level and at several key markets throughout the US, including Memphis.

Because Memphis' costs increased below the national average, Memphis moved down the list of highest cost markets from 5 to 6, switching places with Philadelphia, PA.

The bad news for Memphis is that costs did increase $1,089 from 2010 to 2011.

Other national major findings from the Milliman Medical Index 2011 include:

• Employees' share of the total cost increased from 36.8% in 2005 to 39.7% in 2011
• Increases in facility spending (inpatient and outpatient) account for over 60% of the total increase cost of healthcare
• Outpatient facility care increased 10% and was the cost component with the greatest increase.
• Inpatient utilization was flat but total cost per day increased 8.3%
• Employees bore the greatest share of the increase in total cost of healthcare with their payroll deductions increasing 9.3% and out-of-pocket cost sharing increasing 9.2%.
• Employers experienced a 6.0% increase in their total cost of healthcare.

Read the entire Milliman Medical Index 2011. You can also read the Milliman Medical Index 2010 for comparisons.

Health Reform Update from the National Business Coalition on Health

The National Association of Insurance Commissioners (NAIC) is considering whether to endorse legislation that would remove broker and agent commissions from the medical loss ratio, a calculation that could give consumers valuable insights about the proportion of their premiums spent on health care costs compared with administrative expenses and salaries. Removal would have far-reaching implications for the reliability of the MLR as a measure of a health plan's value, for the broader goal of improving quality and controlling costs, and for the NAIC itself.

Last year, the NAIC recommended that HHS adhere to the law's requirement that brokers' and agents' fees be included in the MLR. That position resulted from a thorough process that included input from interested groups representing consumers, insurers, brokers and agents, and others. The recommendation represented an equitable balancing of numerous perspectives, and HHS adopted it virtually unaltered.

The brokers and agents responded by waging an intensive lobbying campaign urging the NAIC to endorse a bill by Rep. Mike Rogers, R-Mich., that would remove these payments from the MLR calculation. Some of the NAIC consumer representatives strongly opposed such a move, arguing that the economic consequences for consumers and the government had not been adequately examined. The NAIC elected to study the issue further before making a final decision, which could come this month.

Numerous organizations representing consumers and patients believe that, for the MLR to be a meaningful measure of consumer value, broker and agent fees must be included in the calculation as an administrative expense. Excluding these fees would essentially hide a significant driver of premium costs and undermine an important opportunity to contain unnecessary administrative expenses. It would also dilute the law's efforts to make health insurance more transparent and comprehensible, and to empower consumers to make informed decisions when choosing a health plan. (Source: NAIC consumer advisory group, May 10, 2011)

Health Reform Update from National Business Coalition on Health

As NBCH and many organizations are preparing to submit comments to HHS on the ACO federal regulations, the nation’s highest-profile health care centers — the Cleveland Clinic, the Mayo Clinic, Intermountain Healthcare or the Geisinger Health System —have so many concerns with the proposed rule to create ACOs that they doubt that they will participate.

The 2010 health care law (PL 111-148, PL 111-152) created the authority to establish ACOs — networks of providers within the Medicare system that include physicians, hospitals and health systems. The aim of the integrated networks is not only to improve the quality of care but also to save money, with any savings to be shared by the government and the ACOs. The Centers for Medicare and Medicaid Services (CMS) released a proposed rule at the end of March that spells out the details of how the program will work, how much financial risk medical providers will face, and what type of data the organization need to collect.

Interviews with officials at integrated care organizations yield a similar reaction to the proposal: The idea behind the Medicare rule is a good one. But there have to be major changes to the details before the program would be workable. Even the most sophisticated health care systems in the nation, which have already adopted a number of the practices that Medicare officials want providers to carry out, say there isn’t enough incentive for them to apply to become an ACO under the Medicare proposal.

But the fact that the even the institutions that were the inspiration for the program are reluctant to participate unless big changes are made shows that CMS officials face a tough task. Officials who are weighing changes to the proposal before they finalize it later this year will have to consider how far they want to go to attract interest. The complaints against the proposed rule are many and multi-faceted.

One basic issue is that all institutions who sign up will face a financial risk if they do not generate savings required by the rule. The proposal suggests a two-track system. Providers could choose to get a bigger financial reward if they subject themselves to penalties starting in the first year. Or they could have the potential of a less generous reward if they choose to wait until the third year of the program to face penalties. Many providers had expected the program to offer a way for institutions to get bonuses without having to face penalties and were disappointed that the rule proposes a potential financial hit for any group that doesn’t find required savings.

Because of all of the concerns, many of the nation’s top integrated care institutions are concluding that the start date of Jan. 1, 2012 needs to be delayed. Health center officials say it will be hard to review the requirements in a final rule, which isn’t expected to be released before late summer at the earliest, meet financial requirements, set up quality metrics and enroll by Jan. 1. (Source: CQ HealthBeat, May 6, 2011)

Read Forbes Magazine article outlining major concerns.

The Memphis Business Group on Health (MBGH), Memphis’s only non-profit organization focused on employee health and wellness issues from the employers’ perspective, recognized two health insurance companies and five regional hospitals for their progress toward improving health care quality in the region in 2010.

BlueCross BlueShield of Tennessee and UnitedHealthcare of Tennessee were recognized for scoring in the top 15% on several aspects of eValue8, the leading evidence-based health plan evaluation program widely used by business health coalitions, their purchaser members, and national employers to assess and manage the quality of their healthcare vendors.

Baptist Memorial Hospital for Women and St. Francis Hospital-Memphis were recognized for their exceptional performance on the Leapfrog Hospital Survey for reducing the number of elective deliveries performed before the baby was full term.

Methodist LeBonheur Germantown, Methodist Hospital South, and the Regional Medical Center at Memphis were also recognized for good performance on this measure in the survey.

Read the full article.

Memphis Business Group on Health is the first employer/employer group in Tennessee to sign the pledge to support the "Partnership for Patients'

Partnership for Patients: Better Care, Lower Costs was launched today, April 12, 2011, by HHS Secretary Sebelius and CMS Administrator Berwick along with consumer groups, industry representatives, and other key stakeholders, including the Leapfrog Group and the National Business Coalition on Health. MBGH was the first Tennessee employer group to sign on for the initiative.

The two goals of this new partnership are to:Keep patients from getting injured or sicker.

• By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.Help patients heal without complication.
• By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010.  Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

By signing on to this initiative, MBGH agrees to work with our employer members to:

• Use market-based incentives, that may include payments, to promote improvements in safety and other dimensions of quality and value;
• Work with other private payers, states and the federal government to align efforts to measure performance on quality and safety – so that patients and clinicians have the best possible information and the burden on hospitals and other providers is minimized; and
• Share information with their employees, members or beneficiaries so they can engage as active partners in getting better, safer care.

MBGH continues to support and value diversity in publicly reporting hospital performance from a variety of stakeholder groups, including employers. Different stakeholder groups need different information for decision making and it is a strength of our current system that there is a diverse set of voices and opinions, which we believe accelerates progress and improvement. We hope that, as part of this initiative, Medicare and Medicaid will share data with regional health improvement collaboratives, so the entire community can benefit from the wealth of information this data will provide on the quality and cost of care in the Memphis area.

MBGH joins with our national partners, National Business Coalition on Health, and The Leapfrog Group in supporting this important initiative. 

Martha McGeachy (shown on her bike), Benefit Services Manager at Rhodes College, gets to the bottom line quickly about why Rhodes has ramped up their health and wellness programs, "We think these programs serve the College and our employees by raising awareness of healthy lifestyles and building a sense of community.  The benefit to our health plan is more long-term, but with diligence and patience we believe we will see good results."

And, Rhodes, an MBGH member since 1990,  has taken full advantage of all of MBGH's programs designed to improve the health and wellness of employees. For example:

• Rhodes is paving the way for other MBGH members by being the first to roll out the MBGH Employee Communication Campaign: Getting Quality Care.
• The college piloted Move More Eat Better worksite wellness program for its employees in partnership with the Shelby County Health Department and MBGH.
• And MBGH helped organize the annual employee health fair Rhodes held last week!

But these aren't the only health promotion and wellness initiatives at Rhodes. In a deliberate plan to reach as many employees as possible with their wellness initiatives, Rhodes offers a broad array of programs including Weight Watchers at Work; monthly Power Hour sessions on stress, managing a career and personal life, financial management, and healthy lifestyles; mobile mammography; and an employee assistance program through Concern.

A signature wellness initiative at Rhodes is the Faculty and Staff Health Trek Program.The Trek is a ten-month program that begins on September 1 and is a motivational tool where employees earn wellness miles for healthy activities from flossing their teeth to running a marathon. In this program employees covert healthy lifestyle choices, activities, and preventive services into "miles". Employees receive prizes as their miles add up. This virtual "trek" is across Tennessee, from Memphis to Johnson City and back and is tracked on a map. Through March, over 17,000 wellness miles had been logged!

Rhodes calls its program "WellnessWorks@Rhodes" and it is clear that indeed it does!

Peter Hayes will join John Moses, PhD, thought leader for behavior change and measurement with Aon Hewitt, and Suzanne F. Delbanco, PhD., M.P.H., executive director of Catalyst for Payment Reform as national keynote speakers at the MBGH Annual Conference on September 8, 2011.

Prior to becoming Principal with Healthcare Solutions, Peter worked for Hannaford Supermarkets for 20+ years, managing the company’s health care for approximately 15 years.

At Hannaford, Hayes’s aim was to develop a culture of health and wellness, and establish Hannaford as a "health destination” — spearheading a progressive, collaborative effort among associates, customers, providers and the larger community.

Hannaford’s dynamic, innovative approach reduced health care costs and, over just a few years, dramatically reduced health risks. In the first year of the initiative, 26% of associates were at risk for high cholesterol; in the following year, that figure dropped to 13%. Similarly, 20% of Hannaford associates were, at the outset, smokers; a year later, only 10% were still smoking.

At Hannaford, Peter was able to show that through innovative, and some would say aggressive, supply chain management practices, employers can use “markets” to drive increased value. For example:

• A cost and quality analysis at Hannaford showed patients could get higher quality, less expensive hip surgery in Singapore than in Maine. When local hospitals refused to lower prices and increase quality, Hannaford implemented a benefit design that incented patients, and a care giver, to go to Singapore for hip surgery. Immediately, local hospitals stepped up and met Hannaford’s original requirements and not a single employee went to Singapore for surgery.
• Hannaford asked local labs to electronically feed lab results into employees' personal health records (PHR). Believing that lab results should only be sent to the physician for discussion with patients, the local labs did not agree to Hannaford's request. Peter moved Hannaford’s lab business to a national vendor that agreed to the electronic feed into the PHRs. Once again, local labs changed their minds and built the electronic interfaces Hannaford requested.

Employers need to be clear about what they want and why and Peter says the best way to do that is to have a comprehensive health strategy that drives your decisions. Ultimately, Hayes wants to engage community partners in efforts to reduce overall U.S. health care costs from 18% to 10% of GDP — clearly a monumental task.

Peter’s philosophy is based on Albert Einstein’s famous quote (paraphrased):  “You can’t solve problems by using the same type of thinking that created the problem in the first place”.

Want to hear Peter address these and other issues in person? Be one of the first to register for MBGH’s September 8, 2011 Annual Conference and get your seat now.

Why does MBGH member First Horizon invest so heavily in the health of their employees? CEO Bryan Jordan puts it this way, "Our employees are our competitive advantage so we invest in programs designed to encourage them and their family members to lead healthy lifestyles, and they've responded enthusiastically," As you will see, First Horizon has implemented a comprehensive program to support this belief.

On July 4 last year, the company declared its independence from tobacco and implemented smoke-free campuses so there is no smoking any where on First Horizon property. The move enabled First Horizon to be accredited with the CEO Cancer Gold Standard. This accreditation recognizes First Horizon’s overall commitment to reducing the risk of cancer in the workplace through lifestyle change, early detection and access to quality care.MBGH members can get copies of the materials First Horizon used to communicate this program to their employees as well as First Horizon's tobacco cessation benefit plan on our Tobacco Cessation Benefits Tools & Solutions page.

This year, First Horizon was recognized nationally for providing a Psychologically Healthy Workplace Best Practice for their myPLAN performance management program.  And, on the state level, the financial services company won the Psychologically Healthy Workplace Award for the state of TN. Memphis Business Group on Health recruited First Horizion to apply for both of these special recognition opportunities.

In First Horizon's Virgin Health Miles program, employees wear digital pedometers to track their activity levels and get regular biometric screenings. Employees can earn up to  $600 a year by participating in the program. First Horizon also sponsors Weight Watchers at Work, mobile mammography, seasonal flu shots, lunch and learns with wellness topics, and a telephone-based health coaching program.

For First Horizon, employee health is an investment and a key business strategy.

MBGH Salutes Winners of the Memphis Business Journal’s Mid-South’s Healthiest Employers Awards

Adams and Reese (1-99 employees) was recognized for a combination of health initiatives, including discounted gym memberships and a cash incentive weight loss program.

Ring Container Technologies (100-499 employees) earned the award for creating a culture that included personal health coaches for all employees and walking meetings at the company’s on-site walking track.

Evergreen Packaging Inc. (500-plus employees) won for, among other initiatives, providing health coaches, an on-site clinic and pharmacy and subsidizing discounts on personal trainer and gym fees.

Well done and we look forward to seeing the innovative programs from even more employers next year!

• Getting care that is best for your condition?
• Getting care when you need it?
• Getting care from skilled & knowledgeable professionals?
• Getting care that does not harm you?

44% of those responding to MBGH's informal Facebook poll chose "getting care that is best for my condition". 20% chose "getting care from skilled & knowledgeable professionals".

As you may have guessed, all four of these choices are components of getting quality care. But, it is interesting how we prioritize them when we get our own care. These four aspects of quality are presented as part of MBGH's Employee Communication Campaign: Getting Quality Care.

Polls are very "democratic" on Facebook, or at least they are when you forget to mark the box indicating you DON'T want people to add other possible responses. So, given we have a very engaged following, two additional responses were added:

22% chose the added response of "That I can afford to pay for it" and 11% chose the added response of "I just want to stay healthy".

I love these additions. In truth, if you cannot afford to pay for care you often don't even go to get care, so getting quality care is rather moot at that point. On the other end of the spectrum, if you are healthy, you don't need to get care, so getting quality care is moot at that point too.

 We indeed have a smart following on Facebook! Please "like" us on Facebook and join in on the conversation!!

Are Memphis Employers Kinder and Gentler Than Their National Counterparts?  

MBGH decided to find out. We separated out the responses of Tennessee employers to a national survey of employers and then compared them to national responses.  Most of the Tennessee respondents were from Memphis, giving us insight into what Memphis employers are thinking and doing!

And, it's surprisingly different. Take a quick look at these easy-to-read findings.

Insurance brokers, concerned that their livelihoods could be significantly impacted with the implementation of health insurance exchanges, are working hard to be sure they continue to play a role and earn agent commissions.

Efforts include working with the National Association of Insurance Commissioners to get Congress to exempt broker/agent commissions from the medical loss ratio requirements; introducing a bill in Iowa that requires individuals and small employers to use a broker to purchase on the exchange; and in some states, broker/agents are sitting on the governance boards of exchanges.

America's Health Insurance Plans, the trade association representing health plans, supports the continued role of broker/agents.

The role of broker/agents is being defined now in Tennessee. A Broker/Agent Technical Advisory Group has been established at the State to develop proposals on the role and compensation of broker/agents in Tennessee's Health Insurance Exchange. To date, no formal proposals or decisions have been made, but the following items are being discussed:

• Requiring broker/agent involvement in the small business exchange products.
• Allowing broker/agent involvement in the individual exchange products.
• Leaving broker/agent compensation to be negotiated between the carrier and the broker/agent, but must be the same for products sold in the exchange and products sold outside of the exchange to discourage adverse selection.
• Broker/agent credentialing criteria required by the state.

Read about the decisions that will be discussed at the March 25, 2011 Agent Broker Technical Advisory Group meeting as well as minutes of the January meeting.

Read the Kaiser Health news article on broker/agent activity nationally.

Cristie Upshaw Travis, CEO of Memphis Business Group on Health, will moderate a panel discussion on health issues that affect the workplace after the awards breakfast for the Mid-South's Healthiest Employers on Friday, March 25, 2011.

The Mid-South's Healthiest Employers awards are presented by the Memphis Business Journal, partnered with The Church Health Center, and sponsored by CIGNA, the Y, and Methodist Healthcare.

The awards breakfast will recognize local, Memphis-area employers for their commitment to worksite wellness programming, as reflected in how the employers scored on HealthiestEmployers assessment (www.healthiestemployers.com).

Dr. Bob Waller, former CEO of The Mayo Clinic, will deliver the keynote address. Cristie Upshaw Travis will moderate a panel discussion with Bill Hoagland (CIGNA), Dr. Scott Morris (The Church Health Center), Keith Johnson (the Y), and Gary Shorb (Methodist Healthcare) about health issues affecting the workplace, including the latest on health reform.

Cristie Upshaw Travis, CEO of Memphis Business Group on Health, talked with Richard Banks, blogger for the Memphis Business Quarterly's Business Minded Blog, about a critical component of healthcare reform, state health insurance exchanges, and how exchanges will impact Memphis businesses.

Read the complete post to learn the basics about exchanges. Get information about how Tennessee is planning to implement exchanges by clicking "Health Insurance Exchange" tag at the end of this post or on the right hand navigation. These posts also  provide additional resources to help you understand the full impact of exchanges in the health reform legislation.

Cristie Upshaw Travis, CEO of Memphis Business Group on Health, helps Richard Banks, blogger for the Memphis Business Quarterly's Business Minded Blog, get, what he refers to as, a "semblance of comprehension" about what health reform means for business. In this first installment of a series of postings on the realities of health reform, Banks talked with Travis about decisions both large and small employers are making now that "sidestep" some of the early provisions of health reform, at least for now.

Read the complete blog and learn more about the "Paw Paw" provision (aka Grandfathering).

Segal's December 2010 Health Reform Insights focuses on the impact of health reform on dental and vision benefits.

Segal finds that self-insured dental and vision plans that are NOT separately elected and paid ARE subject to health reform. However, exemptions ARE granted for dental and vision plans that have a participant election and contribution.

Interestingly, the 2010 Dental Benefits Enrollment Report, shows a decline in dental benefit enrollment for the first time since enrollment began to be tracked in 1994.

MBGH Reports summarizes the MBGH & Shelby County Health Department (SCHD) project collaboration to improve the health of employees by conducting the SCHD health promotion program at Memphis employer worksites. In addition to a project summary, the report presents major findings and recommendations to help the program be relevant, effective and marketable to the employer community.

All MBGH employers would offer the program to their employees again and employees gave the program high ratings for meeting their expectations and needs to help them jump start their efforts to improve their health.

MBGH will be working with the SCHD to bring this program to more employers in 2011.

Andy Webber, CEO and President of the National Business Coalition on Health in Washington, DC, addressed a room full of Memphis employers and community leaders at Christian Brothers University on December 14,2010, on "Health Care Reform: The Uncertain Journey Forward"

Andy suggested there are three chapters in health reform, each of which include key decisions for employers:

Chapter 1: Health Insurance & Benefits Regulation

Will employers choose to continue grandfather status for their health plans considering the restrictions on making plan changes in copays/deductibles, employee premium contributions? An informal poll of those attending the meeting showed that slightly more than 50% had already forgone grandfather status.

Chapter 2: Coverage Expansion

Will employers, of all sizes, continue to offer health insurance once there are functioning & effective state health insurance exchanges?

Cristie Upshaw Travis, Memphis Business Group on Health, provided an update on the planning for Tennessee's state health insurance exchange, noting that Tennessee will, most likely, establish it's own exchange (vs. join the Federal exchange) and will not define minimum essential coverage above the Federal standards. Options briefing papers are being prepared for incoming Governor Bill Haslam and key decisions will be made by February re: how best to move forward. MBGH is actively participating in the planning for Tennessee's health insurance exchange and will keep Memphis-area employers updated throughout the process.

Chapter 3: Health System Reform

Health system reform includes health care delivery system reform and restructuring; value-based purchasing and payment reform; and improvements in population health.

Will employers engage in Memphis-area opportunities to support and help shape local reforms to improve the health status of employees and the community and manage costs effectively?

Memphis Business Group on Health is actively involved in a community-wide effort addressing payment reform, tracking the development of accountable care organizations, and evaluating opportunities for employer-based payment reform pilots.

All Memphis-area employers can stay up-to-date on the latest in health reform news on MBGH's blog. MBGH members have access to a comprehensive Healthcare Reform Resource Center in the member's section of MBGH's website.

On December 2, 2010, HHS released "Healthy People 2020", updating goals and objectives for improving the health of our nation over the next decade (replaces Healthy People 2010). Visit the Healthy People 2020 website for details.

Overarching goals include:

1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
2. Achieve health equity, eliminate disparities, and improve the health of all groups.
3. Create social and physical environments that promote good health for all.
4. Promote quality of life, healthy development, and healthy behaviors across all life stages.

This year, two new objectives and strategies align directly with the work of Memphis Business Group on Health:

1. Prevent, reduce, and ultimately eliminate healthcare-associated infections (HAIs) (Leapfrog ICU infection rates)
2. Facilitating the meaningful use of health IT and exchange of health information among health care and public health professionals (Leapfrog computerized provider order entry systems; Midsouth eHealth Alliance health information exhcange)

Other objectives and strategies that align with MBGH's work include:

1. Decreasing tobacco use among workers: Incentives and competitions to increase smoking cessation & smoke-free policies to reduce tobacco use (MBGH's Tobacco Cessation Benefit Tools & Solutions Center)
2. Reducing exposure to environmental tobacco smoke: swmoking bans and restrictions (MBGH's Tobacco Cessation Benefit Tools & Solutions Center)
3. Obesity prevention and control, interventions in community settings: worksite programs. Worksite nutrition and physical activity programs designed to improve health-related behaviors and health outcomes (MBGH's partnership with the Shelby County Health Department for Eat Less, Move More; MBGH Virgin HealthMiles employer-based physical activity program)

Other health goals included in Healthy People 2020 include:

1. Cutting adult obesity rates from 34% to 31%;
2. Reducing heart disease and stroke deaths by 20%;
3. Cutting cancer deaths by 10%;
4. Reducing new diabetes cases by 10%; and
5. Reducing cases of food poisoning from E. coli, salmonella and other microbes.

Healthy People 2020 provides a MAP-IT action plan example for worksite wellness committees.

Key measures included in the Deficit Panel's recommendations include:

Repeal of the long-term care insurance provisions of Health Reform

Changes to Medicare benefits, including increasing co-pays, deductibles

Eliminating availability of, or revising, the "wrap-around" Medigap policies seniors use to defray the cost of Medicare co-pays and deductibles (which shield them from the cost implications of seeking care)

Phase-out of federal tax break for employer-provided health insurance

Issuing Federal employees fixed-rate vouchers to purchase health insurance in the open market

Changes in payment methodologies for physicians, moving from volume-based pay to quality-based pay

According to the State of Tennessee Insurance Exchange Planning Initiative, "Key stakeholders now express (in writing) their preference that Tennessee operate the exchange instead of the federal government. 

These groups include all of the major insurers, both major associations for brokers and agents (i.e., Tennessee division of the National Association of Health Underwriters (NAHU) and National Association of Insurance and Financial Advisers (NAIFA) in Tennessee), Tennessee Medical Association (TMA), Tennessee Hospital Association (THA), Tennessee Health Care Campaign, National Federation of Independent Business (NFIB), Tennessee Primary Care Association (TPCA), and American Cancer Society-Tennessee Chapter. 

No group has expressed a preference for a federally-run exchange."

Other updates re: the Insurance Exchange Planning Initiative include:

The State will procure services of an actuarial consultant as well as policy and operations consultant.

A health care provider and advocate roundtable discussion is scheduled for December 8 in Nashville.

Read the entire update.

Read the Employee Benefit News article regarding final GINA requlations issues November 9, 2010.

Get a copy of the Federal Register for GINA regulations.

According to Employee Benefit News, "GINA and its new implementing regulations:

 • Prohibit the use of genetic information in employment decisions, including those concerning hiring, firing, compensation, and terms and conditions of employment;

• Generally bar employers from requesting, requiring, or purchasing genetic information, other than to comply with the Family and Medical Leave Act or similar laws, for use in genetic monitoring related to toxic substances in the workplace, or for DNA analysis for law enforcement purposes;

• Permit employers to request genetic information in connection with a wellness program, provided, among other things, that an employee consents to receive such request, and any financial inducement for providing such information is also available to employees participating in the program who do not do so (e.g., they provide other information that is not genetic information);

• Require that genetic information be maintained as a confidential medical record, strictly limiting its disclosure; and • Provide broad remedies for individuals whose genetic information is acquired, used, or disclosed in violation of GINA, and protect employees from retaliation for exercising rights under GINA."

The National Business Coalition on Health released its national eValue8 2010 report "Engage...Focus...Improve" on November 16, 2010. The report provides a snap shot of health plan performance on key elements including consumer engagement, provider measurement, pharmacy management, prevention/health promotion, chronic disease management, behavioral health management. This year, for the first time, eValue8 also measured plan performance in reducing waste and inefficiencies in the delivery system, such as preventable admissions, overuse of selected procedures, and avoidable costs.

Three Tennessee PPO health plans participated in eValue8 this year -- BlueCross BlueShield of Tennessee, CIGNA of Tennessee, and UnitedHealthcare of Tennessee. MBGH released our report "A Guide to Tennessee Health Plan Performance: eValue8 2010" at our September 9, 2010 Annual Conference.

Two of the three participating Tennessee plans were highlighted in NBCH's national report because they scored in the top 15% nationally on select modules:

• BlueCross BlueShield of Tennessee scored in the top 15% nationally for:
  • Consumer Engagement
  • Provider Performance Measurement
  • Chronic Disease Management
• UnitedHealthcare of Tennessee scored in the top 15% nationally for Consumer Engagement.

As MBGH reported in "A Guide to Tennessee Health plan Performance, eValue8 2010", all three of our participating plans have made improvements in these very modules. It is clear that their improvements have placed these plans in the top tier of plans nationally.

BlueCross BlueShield of Tennessee's work with Health Dialog to microsegment members to customize plan communications was recognized as a promising approach to increasing member engagement.

Congratulations to BlueCross BlueShield of Tennessee and UnitedHealthcare of Tennnessee for this accomplishment!

It doesn't take a rocket scientist to draw the conclusion that we still have unsafe, expensive healthcare in the US, and right here in Memphis, when you read the headlines of recent reports:

AHRQ: Rate of Adverse Events in Medicare Cases "Disturbing"

Case 34-2010: A 65-Year Old Woman with an Incorrect Operation on the Left Hand

Surgery on Wrong Patients, Surgical Sites Persists, Study Finds 

Top 10 Most Costly, Frequent Medical Errors

These articles not only focus on the poor quality of our care and the impact on patients, which often includes death, but make it clear that poor quality results in excessive costs -- costs that were avoidable; costs that we as purchasers should not have had to pay. This cost is not minimal, it is significant with estimates at almost $20 billion per year in the U.S.

At the same time we see excessive, avoidable costs due to poor quality and unsafe care, we learn that right here in Memphis, we as a community spend approximately $121 million annually on potentially avoidable, primary care sensitive non-urgent care in our area emergency rooms (source: Healthy Memphis Common Table using estimates from the Center for Healthcare Economics at the Unviersity of Memphis).

I have just returned from the Annual Conference of the Naitonal Business Coalition on Health in Washington, D.C. This issue of poor quality and high cost was an underlying theme, even when hearing the latest on health reform. For example:

Secretary of Health and Human Services, Kathleen Sebelius stated that the U.S. is not getting our money's worth from our healthcare spend

Richard Trumka, President of the AFL-CIO, said that it is time to stop focusing on how we share the cost of healthcare between employers and employees re: benefit design and aggresively address the underlying problem: poor quality, high cost, and waste in the health care delivery system.

But, what can we as purchasers do about this unacceptable situation? Here are actions we CAN take:

We can demand that Memphis hospitals adopt & implement The Leapfrog Group Never Events Policy. Not all of our Memphis hospitals have yet implemented this policy which includes hospitals and doctors apologizing for their errors. See Memphis hospital performance on this policy and prior blog post. MBGH is leading efforts in Memphis to implement this policy.

We can shine the light on those Memphis hospitals and physicians that are adopting the practice of "early dispute resolution" which can more quickly resolve medical error cases to both the satisfaction of patients and their families and the provider. Read an article on this approach. A workshop on early dispute resolution was held in Memphis on October 1, 2010.

We can change how we pay for care. Purchasers must push their health plans and the delivery system to align economic incentives with the outcomes we desire. Our current fee for service payment model actually financially rewards poor quality by paying twice, once for the mistake and once to fix the mistake. We pay for the waste, we pay for the avoidable emergency room visits. MBGH is representing Memphis-area purchasers in a community-wide effort through the Healthy Memphis Common Table as we grapple with how to change payment to get the system we want and deserve.

We can structure our benefit designs to motivate employees and their families to seek care at higher quality, less harmful, more efficient providers. Now this will take courage, as we have been hesitant to aggressively share this information with employees, but we must begin to do so as it is only right to share information we have on provider quality with employees. MBGH provides tools to help our members take this bold action.

So, there is much we can do and we need to step up the plate and do it! Make a 2011 New Year's Resolution to do your part in changing a broken system that too often delivers poor quality, wasteful care.

MBGH hosted a successful Value-Based Insurance Design webinar on Thursday, November 4,2010 with A. Mark Fendrick, MD, co-Director of the Center for Value-Based Insurance Design at the University of Michigan.

MBGH  has been working with Mark since February 2008, when MBGH launched our value-based benefits initiative to educate our members and Memphis-area employers on the principles of value-based benefits and to assist them in identifying opportunities to deploy those principles in their own health benefit offerings.This initiative supports the Aligning Forces for Quality project consumer engagement strategies to motivate people to use high value health care services to help them stay as healthy as possible for as long as possible.

Key takeaways from the webinar include:

• The focus should be on getting the most health possible for the dollars invested.
• Co-pays, deductibles, and other financial tools used in health benefits should not be "one-size-fits-all" but should be lower or non-existent for those health services we want employees to use and higher for health services that have little or no value.
• Value-based insurance design is not designed to save money in the short-term, but to increase the amount of "Health" for the dollars spent. However, if deployed with a balance in increasing co-pays and deductibles for low-value services, value-based benefit design can be cost neutral or produce savings over time.
• Value-based insurance design is baked into Health Reform and due to early bi-partisan support for the approach, should continue even if the Republicans are successful in revising the legislation.

The November 2, 2010 edition of Health Affairs is dedicated to value-based insurance design. Mark's article on ""Applying Value-Based Insurance Design to Low-Value Health Services" is especially interesting.

MBGH's report on our 2008 project drilling down into employers' health plan data to determine if diabetics were receiving high value services will provide you with a general understanding of how to identify opportunities within your plan to implement value-based insurance design.

Should the state of Tennessee establish its own health insurance exchange or tap into the national, federal exchange? That is the question being considered by the State of Tennessee under a $1 million grant from the federal government.

I attended the "kick-off" meeting on October 22, 2010 for Tennessee's evaluation of the whole health insurance exchange issue. About 200 of us gathered in the central Nashville library to hear about the proposal TN had made for planning grant funds from the Feds to evaluate the health insurance exchange issue in more detail.

I came away with a few thoughts and observations:

Most likely, if the State of TN moves forward to establish its own exchange, it will do so in an incremental manner. At first, I thought this was unnecessarily cautious. However, there can be a multitude of "unintended consequences" of establishing exchanges. For example, insurance companies could decide to "exit" TN if our requirements in exchanges are too rigorous.If many insurance companies exit, we would only be left with a few choices, and that may not be a good thing. So caution may be good.

The exchange will have more sweeping responsibilities than I realized.  In addition to the more well-known responsibilities of defining and certifying qualified health plans for the exchange and offering web portals for both individual and small group plans, responsibilities also include:

• Determining eligibility and enrolling applicants in TennCare, CHIP, and Federal health insurance subsidies/tax credit programs for insurance through the exchange;
• Verifying exchange and subsidy eligibility for those whose employer-sponsored health insurance is "unaffordable";
• Administering the exemption process for the individual mandate requirements;
• Operating a navigator service offering consumer assistance programs.responsibilities.

Tennessee is looking for experts to help guide them through this process. They are establishing at least two "Technical Advisory Groups" or "TAGs" -- one for underwriters, actuaries and the like and one for brokers/agents. More TAGs will be established if the decision is to move forward to establish an exchange.

Of course, all of this gets complicated in TN because we will have a new Governor in January 2011. Both leading candidates for Governor have been briefed on these issues and are kept up to date on developments. I assume that State staff will be briefing the newly elected Governor in January. However, TN does not need to make a decision on whether or not to establish an exchange until next summer.

To keep up with the evaluation of exchanges in TN, go to www.tn.gov/nationalhealthreform. All documents will be posted at this site. In addition, MBGH will integrate these documents and TN exchange developments on our members Healthcare Reform Resource Center. So check our website regularly for updates.

Read the discussion paper on establishing an exchange in TN.

View the powerpoint presentation for the October 22, 2010 kickoff meeting.

Learn about exchanges in MA, UT, & CA to understand what might happen in TN

From Business Insurance, S&P Healthcare Indices reports that for the 12-month period ending August 2010, per capita health care costs for commercial plans,including self-insured, increased 8.66% compared to an increase in Medicare per capita cost of only 5.08%.

Hospital services accounted for the greatest difference between commercial & Medicare with commercial experiencing a 9.66% increase and Medicare having a 4.48% increase.

A 3-year, incentive-based wellness program for the employees of Sentara Healthcare had a 6:1 return on investment, saved approximately $3.4 million in healthcare costs, and resulted in health improvement for nearly 80% of the employees that participated in the program.

Major program components included:

• Completion of a voluntary personal health profile to identify risk factors
• Employees with low risk factors were awarded a $500 annual premium reduction
• Employees with 2+ risk factors could earn the premium reduction by working with a health coach
• Employees with targeted conditions or who were pregnant could earn additional incentives (up to $460/year) if they worked with disease managers

Employees who declined to participate in the program gave up these discounts.

Read the case study.

Most favored nation pricing means that you (or your health plan) have the best pricing a hospital or physician practice gives any plan.On the surface, this looks good; after all, all other payors will pay more than you. However, all may not be good at all. If the price you have as the floor is a high price, then you and everyone else pays more than you really should be paying, leading to higher overall health care costs in your market.

This is just one of the issues being litigated in the Federal suit against the BlueCross BlueShield of MIchigan plan.

This article is a must read for all employers as even with "most favored nation" pricing, you should know whether that is a good deal or not a good deal! Just having the best pricing in a market is not enough.

Read the article for more information.

According to a report published in the October issue of the Archives of Surgery, introducing the universal protocol endorsed by the Joint Commission in 2004 has NOT reduced the frequency of such medical errors as wrong site surgery or wrong patient surgery, Read a summary of the report.

The protocol requires 3 steps:

• Pre-procedure verification
• Marking the correct surgical site
• Taking a "time-out" for the surgical team just before surgery.

Diagnostic mistakes and poor communication were the primary causes of wrong patient surgery. Errors in judgment and not taking the "time-out" were the primary causes for wrong-site surgery.

But even if the right process is followed, mistakes continue to occur, primarily, according to the study's author, because of "culture", which needs to move from a culture of blame to a culture of patient safety and accountability.

Until that culture change occurs, we all need to arm ourselves, families, and employees with the knowledge of what the protocol should be and holding our providers accountable for using the protocol.

We can also arm ourselves with knowledge about the policies, procedures and outcomes of the hospitals in our community. The Leapfrog Group website reports Memphis-area hospital results on their "never-events" policy, which includes:

• Acknowledging these types of errors that should never happen;
• Apologizing to the patient and family;
• Not charging the patient or insurance company for the error or any cost due to the error;
• Performing a root cause analysis of why the error occur so that process improvements can be put into place to prevent the error from occurring again; and
• Reporting the error to proper accrediting and/or licensing authorities.

Check out Memphis-area hospital performance on  "managing serious errors". Delta Medical Center, the Methodist Healthcare hospitals, the MED, the St. Francis Healthcare hospitals, and St. Jude Childrens Research Hospital all indicate that they DO follow the Leapfrog Group policy, The Baptist Memorial Health Care hospitals indicate they DO NOT follow the Leapfrog Group policy.

There is something we as patients and purchasers can do to help decrease medical errors and getting hospitals to implement The Leapfrog Group Never Events Policy is one of them.

Effective January 1, 2011, employees must have a "prescription" to purchase over-the-counter medicines and drugs if they are to be categorized as "medical care" for purposes of the employer health plan and health savings accounts.

Click here to read this concise summary from Alston & Bird and published in Employee Benefit News of the recently released IRS notice which provides clarifications around:

What is a medication or drug?
When is a medicine or drug considered prescribed?
What documentation is required for OTC medications?
What is the effective date?
Do cafeteria and HRA plans need to be amended?
What steps should be taken?

MBGH released its 2010 eValue8 report on Tennessee Health Plan Performance at the MBGH Annual Conference on September 9, 2010. This annual report is prepared in conjunction with HealthCare 21, the business coalition in middle & east Tennessee. Click here for a copy of the report.

This year, MBGH reports on the progress these health plans have made collectively in the past three years as well as each plan's specific progress.

Although there has been good improvement in the areas of consumer engagement, provider measurement and chronic disease management, Tennessee HEDIS scores have not improved, compared to the rest of the U.S.

MBGH is currently working on a second report which shows health plan performance on those eValue8 measures that drive improvement in health status and cost efficiency and details actions plans are taking to move HEDIS scores.

Mini-med plans provide only the very basic health care coverage in order to keep premiums affordable and are usually offered to seasonal, part-time, temporary, blue-collar, and entry-level employees. Firms that offer mini-med plans include McDonald's, Waste Management, Dollar Tree, and TN's own, Gaylord Properties in Nashville.

Health reform will significantly impact these plans in 2014 and it is possible that this option will disappear completely because mini-med plans do not generally cover the list of "essential benefits" defined in health reform. Those currently covered under mini-med plans would likely go into the health insurance exchanges and probably be eligible for subsidies, which would result in penalties for their employers. For some employers, the penalty could put them out of business.

 Click here to read the Employee Benefit News article outlining the issues for mini-med offerings.

10/1/10 Update: McDonald's is considering dropping health insurance coverage for 30,000 employees covered under their mini-med plan, citing the insurance carrier's unwillingness to comply with new health reform requirements for percent of premium that must be spent on medical claims. So, it's not just the "essential benefits" requirements, but also the medical loss ratio requirements that are impacting mini-med plans. McDonald's is seeking a waiver from the requirements for this mini-med plan. Click here to read WSJ article.

Survey results released over the past 2 weeks clearly indicate that employers of all sizes will be asking their employees to share in healthcare cost increases expected in 2011.For example:

Large Employers: The National Business Group on Health's survey of 72 large employers found employers expect an average trend increase of 8.9% in 2011. 63% will increase employee percentage contribution to premium cost, 46% will increase out-of-pocket max, and 44% will increase in-network deductibles.61% will offer a Consumer Directed Health Plan, with 20% of those offering it as a "full" replacement. Click here for a copy of the survey results.

Small Employers: The Memphis Business Journal reports that small employers in the Memphis market are raising co-pays, deductibles and using more consumer driven health care programs. An area broker estimates that employers now cover 50-75% of the premium cost, when historically they may have covered 100%. Click here to read the Memphis Business Journal article.

Both large and small employers are estimating that health reform will significantly change how they offer health benefits.

Large employers: 53% are moving ahead with planned changes for 2011 while 19% will make some changes but are scaling back due to the uncertainty of reform. Many large employers are willing to lose their plans "Grandfather" status and rate the flexibility of making plan design changes more favorably than retaining "Grandfather" status.Click here for an article releasing these survey results.

Small employers: Memphis area brokers predict that employers with 50 or fewer employees are being hit the worst and that many small employers will just terminate their plans "in order to survive". Many small employers are just waiting to see what the carriers do next year re: rate increases before deciding how to move forward.

Bottom line, it looks like 2011 will be messy for employers and their employees. That is why it is imperative that employers work collectively through MBGH to push the health care delivery system to become more efficient and to use health care dollars to produce real value for both their patients and for the employers investing so much in health benefits.If we are not successful in working the estimated 30% of the waste out of the delivery system, we will not be able to afford health care moving forward.

Employers need to move to health benefit models that increase the likelihood of decreasing waste through active employee engagement in their benefits and in healthcare delivery system payment models that reward efficiency and penalize waste. MBGH helps our members build the strategy that will work for them to improve both the cost & quality of their health plans. Clearly health reform is making that strategy even more important!

Check out how wireless technology is now being used to help manage patients from home & the other innovations being developed to improve care & increase efficiency. How do you plan to incorporate this type of technology into your employee health benefit plan?

Memphis employers, employees & their families will definitely be affected by the latest trend to hit the healthcare delivery system: Accountable Care Organizations (ACOs). The concept is not entirely new but is a new version of an old idea: paying systems of care to be accountable for the health and health care of a group of people.

So why all the buzz? Well, the recently passed Health Reform law requires Medicare to begin to work with these types of systems in 2012. Hospitals, physicians, & health plans are all scrambling to understand what an Accountable Care Organization is and to decide if they want to form one or join one. Right now, there is no official definition for an Accountable Care Organization so different models are being developed and implemented.

Right here in Memphis, Methodist Healthcare has been working on this concept for 18 months and is in the final stages of developing a strategy to get their toes wet in the ACO world. They plan to take a mesaured, incremental approach, working first with their own employee health plan and their Medicare Advantage plan. If successful, they will build on this foundation and begin to work with other employers & health plans. We imagine that other Memphis hospitals will also move in this direction.

The New Health Dialogue blog from New America's Health Policy Program has published a 4-part series to help us all understand ACOs. These blog posts are short and quickly get to the major important issues re: ACOs, so I recommend that you read them.

Click here to read what an ACO is
Click here to read who is forming ACOs.
Click here to read about ACO payment structures.
Click here to read how ACOs are positioned in Health Reform.

See a video "Creating Accountable Care Organizations", a roundtable discussion, from the New England Journal of Medicine.

MBGH is monitoring this new delivery system and payment model on behalf of our members. We will keep you up to date and will also advocate on behalf of employers and your employees and their families to ensure that these new systems support high quality, affordable health care.

A Hewitt Associates survey of 466 large employers released on August 10, 2010 indicates most expect to lose their Grandfather plan status in the next two years, and for sure by 2014. Reasons sited for loss include changes they plan to make regarding:

• Plan design (72%)

• Employee premium subsidy (39%)

• Insurance carriers (16%)

• Union contracts (15%)

These employers indicate that overall health benefit strategy is more important than preserving Grandfather status long-term. In addition, most of these employers already comply with health reform requirements for non-Grandfathered plans, so losing Grandfather status would not add significant costs to the plan.

Click here to read an Employee Benefit News article on the survey results.

Yet another study reveals the direct connection between poor quality of care and increased cost. Milliman's recent study for the Society of Actuaries found that, in 2008, avoidable medical errors added $19.5 billion to the US healthcare bill. This cost is not the full cost, because it only captures those errors that can be identified based on an analysis of health care claims.

Major findings include:

Memphis-area employers and employees are experiencing these errors and costs too. MBGH's work with hospitals and doctors to reduce avoidable medical errors through our Leapfrog initiative (click here to see Memphis-area hospital results); expecting health plans to contract with high performing providers through our eValue8 initiative (Click here for 2010 eValue8 report); and improving ambulatory care through the Healthy Memphis Common Table's Aligning Forces for Quality initiative all contribute to helping reduce costs due to poor quality in Memphis.

Click here to read an article summarizing these findings.

Compliance with the new medical loss ratios by health plans could cost health insurance companies much more than originally predicted according to a recent study conducted by Weiss Ratings.

Margins for health insurance companies already complying with medical loss ratio and other health reform requirements in 2009 had margins (on average) of only 0.7% while companies not yet complying had margins (on average) of 6.3%. Complying companies actually had negative margins from premiums with investments pulling them into positive margin range. Weiss predicts that if investment income declines, many insurance companies could become financially unstable post-health reform.

Click here to read the full article.

Click here to read the HHS fact sheet on the new internal/external appeals rules for NEW health plans. Grandfathered plans are not impacted by the new rules.

The new rules provide health plan members with the ability to appeal denials to an outside, independent decision-maker. The National Association of State Insurance Commissioners is encouraging states to adopt these same appeals procedures. If states do not, members will have these same rights through the Federal regulations. NEW self-insured health plans will be subject to these regulations as will all new individual health policies.

Memphis Business Group on Health (MBGH) applauds Methodist Le Bonheur Healthcare (Methodist) for making their quality of care report card public on their websites. Specifically, MBGH is pleased with this initiative for the following reasons:

• MBGH has been working with Memphis-area hospitals since 1997 to improve transparency. As advocates for our member employers, we’ve consistently pressured hospitals to measure and publicly report their performance and to use this information to improve the quality of care they provide.

• MBGH has been asking Methodist to report quality information separately for their adult hospitals since 2002. In response to our request for Methodist to participate in our Leapfrog initiative, they have responded to The Leapfrog Group Annual Hospital Survey separately for each adult hospital. Until now, other publicly available quality reports have only been at the system level, essentially reporting average performance across the system. System-level reporting has not been useful to employers as they try to educate their employees about selecting hospitals that provide higher quality care. In this new initiative, Methodist is reporting quality information by facility which is a significant advancement.

• MBGH has asked Memphis-area hospitals to report their performance on a regular basis, which allows employer purchasers and employees to track performance over time, including whether hospitals improve performance or if there is lack of improvement. Methodist has committed to reporting this information regardless of whether it shows they are providing quality care or if they need to improve, thereby providing the good news and the not-so-good news.

This initiative is an excellent first step in increasing transparency with area employer purchasers and employees/potential patients. MBGH asks that all Memphis-area hospitals look to this as a local transparency standard they should try to meet and exceed.

As this initiative takes root, MBGH asks all Memphis-area hospitals, including Methodist, to add additional critical information to their online information. Information on outcomes, such as survival rates/mortality rates; structure measures such as staffing in ICUs and computerized physician order entry; and hospital acquired conditions, such as falls, pressure ulcers, and infections is already available and would not require significant work to add to the reports.

Gary Shorb, President and CEO of Methodist Le Bonheur Healthcare, emphasizes their commitment to working with MBGH and purchaser employers to provide additional information that is useful to employers and their employees. MBGH is meeting with Gary and senior Methodist staff on July 26 to work out the specifics and timeline.We will keep you up-to-date as details are finalized.

We welcome the opportunity to work with other Memphis-area hospitals, as well, as they develop their transparency strategies.

In the meantime, we encourage you to access and use the Methodist Healthcare information by clicking below:

Methodist Healthcare Adult Quality

Le Bohneur Children’s Hospital Quality