Saturday, November 26, 2005

HHS Press Release 10/6/2005

HHS Awards Contracts to Advance Nationwide Interoperable Health Information Technology Strategic Partnerships with Public-Private Groups Will Spur Health IT Efforts
The Department of Health and Human Services (HHS) today awarded three contracts totaling $17.5 million to public-private groups that will accelerate the adoption of health information technology (health IT) and the secure portability of health information across the U.S. These groups will form strategic partnerships to develop the building blocks necessary for achieving the President’s goal of widespread adoption of interoperable electronic health records (EHR) within 10 years.
The health IT partnerships will: create and evaluate processes for harmonizing health information standards; develop criteria to certify and evaluate health IT products; and develop solutions to address variations in business policies and state laws that affect privacy and security practices that may pose challenges to the secure communication of health information. As part of the contracts, these partnerships will deliver reports to the American Health Information Community (the Community), a new federal advisory committee that is chaired by Secretary Leavitt and charged with providing recommendations to HHS on how to make health records digital and interoperable.
“These partnerships represent fundamental steps toward achieving the President’s goal of widespread use of electronic health records,” HHS Secretary Mike Leavitt said. “Given what we recently experienced with Hurricanes Katrina and Rita, the need for portable patient information that can follow the patient has never been more important.”
These three partnerships were established through contracts between private, non-profit entities and HHS. They are the result of three government Requests for Proposals (RFPs) that were announced by Secretary Leavitt and Dr. David Brailer, National Coordinator for Health Information Technology, last spring. The fourth RFP, for development of nationwide health information network (NHIN) architectures, will be awarded to one or more contractors later in 2005. HHS released the RFPs after receiving public comment on how best to achieve nationwide interoperability of health information through a Request for Information (RFI), published in January 2005.
“These contracts are a significant milestone in a broader strategy to spur technical innovation for nationwide sharing of health information and adoption of electronic health records,” said Dr. David Brailer. “This work will set the stage for an Internet-based architecture that will allow secure, timely and accurate exchange of health information among patients, clinicians, and other authorized healthcare entities.”
Contracts have been awarded to the following organizations:
Standards Harmonization Process: $3,300,000
Harmonization of data standards is fundamental to the success of widespread interoperability -- the seamless and secure exchange of patient information electronically. Today, there are many standards for health information exchange, but there are variations and gaps that hinder interoperability and the widespread adoption of health IT.
HHS has awarded a contract to the American National Standards Institute (ANSI), a non-profit organization that administers and coordinates the U.S. voluntary standardization activities, to convene the Health Information Technology Standards Panel (HITSP). The HITSP will bring together US Standards Development Organizations (SDOs) and other stakeholders. The HITSP will develop, prototype, and evaluate a harmonization process for achieving a widely accepted and useful set of health IT standards that will support interoperability among health care software applications, particularly EHRs.
Compliance Certification Process: $2,700,000
More then 200 EHR products are on the market, but there are no criteria for objectively evaluating product capabilities. This limits widespread investment in, and uptake of, these tools and hinders informed purchasing decisions. There are also no criteria by which communication architectures can be standardized in a way that would allow two different EHRs to communicate with each other.
HHS has awarded a contract to the Certification Commission for Health Information Technology (CCHIT) to develop criteria and evaluation processes for certifying EHRs and the infrastructure or network components through which they interoperate. CCHIT is a private, non-profit organization established to develop an efficient, credible, and sustainable mechanism for certifying health care information technology products. CCHIT will be required to submit recommendations for ambulatory EHR certification criteria in December 2005, and to develop an evaluation process for ambulatory health records in January 2006. Criteria will include the capabilities of EHRs to protect health information, standards by which EHRs can share health information and clinical features that improve patient outcomes.
Privacy and Security Solutions: $11,500,000
Regulations promulgated pursuant to the Health Insurance Portability and Accountability Act (HIPAA) established baseline health care privacy requirements for protected health information and established security requirements for electronic protected health information. Many states have adopted policies that go beyond HIPAA. The manner in which hospitals, physicians and other health care organizations implement required security and privacy policies varies and is tailored to meet their individual organizations’ needs. These variations in policies present challenges for widespread electronic health information exchange.
The Health Information Security and Privacy Collaboration (HISPC), a new partnership consisting of a multi-disciplinary team of experts and the National Governor's Association (NGA). The HISPC will work with approximately 40 states or territorial governments to assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices which may pose challenges to interoperable health information exchange. Overseeing the HISPC will be RTI International, a private, nonprofit corporation who has been selected as the HHS contract recipient.

Friday, November 25, 2005

Medicare Press Release 4/11/2005

MEDICARE ANNOUNCES FUNDING FOR HEALTH INSURANCE COUNSELING PROGRAMS FOR 2005
SHIPS AWARDED $31.7 MILLION TO HELP INFORM BENEFICIARIES ABOUT NEW DRUG COVERAGE

Today the Centers for Medicare & Medicaid Services (CMS) announced a 50 percent increase in funding for the State Health Insurance Assistance Programs (SHIPs). SHIPs are a key partner in Medicare’s Education and Outreach effort to insure that everyone with Medicare knows they are eligible for prescription drug coverage, that they will have a choice of at least two plans, and that there will be extra assistance for those in need.

This significant increase in funding, a total of $31.7 million, is a sign of confidence in the 12 year partnership between CMS and the SHIP network. It is also clear evidence of CMS’ strong belief and commitment to one-on-one counseling and assistance to people with Medicare and their families, especially as they need to learn and make decisions about the new Medicare prescription drug coverage that becomes available next year.

In the first ever forum of all the 54 SHIP State Directors and the entire network of over 1,200 local SHIP program coordinators and volunteers, HHS Secretary Mike Leavitt said, “We have a tremendous challenge before us in educating the 41 million Medicare beneficiaries. You and the 10,000 counselors you mobilize in the SHIP network are key partners. Together we must insure that America ’s Medicare beneficiaries and people with disabilities are fully informed of the new prescription drug coverage and are able to make confident decisions on what is best for them. This mission requires your best efforts”

The significant increase in funding brings increased performance requirements for all the SHIPs across the U.S. and the territories. It also brings increased commitment from CMS to continually educate the SHIP network and provide accessible and on-going training to insure that the network is fully capable of utilizing all of CMS’ online and other support tools.

“The SHIPs’ role in helping seniors and people with disabilities is crucial, not only for the new prescription drug benefit but also helping people get the best care for their own needs in our increasingly sophisticated health care system, “ said CMS Administrator Mark B. McClellan, M.D., Ph.D. “The SHIPs are the key foot soldiers in providing one-on-one assistance for Medicare beneficiaries to help them get the best health care.”

While general enrollment for the new Medicare drug coverage begins on November 15 of this year, education and awareness counseling is important right now. The community-based SHIPs will help drive increased awareness through the coming months to enable people with Medicare to make informed decisions about their health care and prescription drug coverage needs. CMS expects the network to provide personalized counseling to as many as 5 million beneficiaries as part of their effort.

In his discussion with the SHIP directors, Secretary Leavitt said, "While you, the SHIPs, are key in this effort, you will not be alone. This is a government wide effort, HHS (including CMS and the Administration on Aging), the Social Security Administration and other federal agencies, and the entire national and local aging network will be devoted to insuring that all people with Medicare are aware of the new prescription drug coverage and able to make a confident decision on what is best for them when they can begin enrolling on November 15.

Thursday, November 24, 2005

Kaiser Permanente Press Release 9/13/2005

Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals Continue Positive Performance

Oakland, Calif. - Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and their subsidiaries (KFHP/H) are showing continued positive financial performance and membership growth through the third quarter of 2005.

Operating margin for the third quarter was 2.5 percent, leaving the overall operating margin for the first nine months of the year at 4.4 percent. At the same time, membership continues to grow, up 151,000 members for the year, to nearly 8.4 million.

"We are on course with our operating performance," said KFHP/H Chairman and CEO George C. Halvorson. "Wise use of our membership dollars allows us to fund our new hospitals, seismic retrofitting, facility improvements and KP HealthConnect, our new electronic physician-support tool."

Kaiser Permanente also uses its operating revenue to fund wide-ranging community benefit programs aimed at improving the health of the communities it serves, through research, community-based health partnerships, direct health coverage for low-income families, and collaborations with community clinics, health departments and public hospitals.

For the third quarter of 2005 (July through September), Kaiser Permanente's 2.5 percent operating margin was achieved on operating revenues of $7.8 billion. Net income was $305 million and operating income totaled $197 million.

That compared to a 6.5 percent operating margin in the third quarter of 2004, achieved on operating revenues of $7 billion. Net income for that quarter was $470 million and operating income totaled $461 million.

"Our 2005 third-quarter results are on plan and reflect our continuing investments in improving access to and quality of health care provided to our members," said Kathy Lancaster, KFHP/H senior vice president and chief financial officer. "Historically, results in the first half of the year are strongest, in part because a significant portion of rate increases go into effect in January, while cost increases occur throughout the year."

For the nine months ending September 30, 2005, the operating margin of 4.4 percent was achieved on operating revenues of $23.3 billion. Net income was $1.2 billion and operating income totaled $1 billion. For the first nine months of 2004, operating revenues totaled $20.9 billion. Net income was $1.3 billion and operating income totaled $1.2 billion.

Kaiser Permanente's capital investment for the first nine months totaled $1.6 billion, compared to $1.4 billion for the same period last year.

"Sufficient margins to meet our capital needs are important as construction costs continue to increase," Lancaster said.

Kaiser Permanente has 26 new or expanded hospitals either planned or under construction, including 13 of which are seismic-replacement hospitals required by the state of California. Seven are new hospitals, and six are expansions of existing hospitals to accommodate growth. More than half of the construction projects are expected to be under way by the end of 2006. The total capital project cost for Kaiser Permanente is expected to be in excess of $20 billion through 2012 for hospitals, medical office buildings, other facilities and technology improvements.

Implementation of KP HealthConnect, Kaiser Permanente's state-of-the-art electronic medical record system, is under way, and will be fully deployed nationwide over the next several years. This initiative involves the development and deployment of an integrated nationwide information system that combines patient records with best clinical practices, appointments, registration, and business systems. Through this advanced technology, Kaiser Permanente will eliminate inefficiencies and reduce the error rate inherent in paper-based systems.

"KP HealthConnect is key to making our members true partners with their physician and the rest of their care team in monitoring, maintaining and improving their health," Halvorson said. "Every major policy leader in health care is promoting the benefits of electronic medical records in improving the quality of care, and Kaiser Permanente is in the forefront of making that a reality."

Kaiser Permanente's success in meeting the needs of its members is the result of "its dedicated physicians, nurses, caregivers, technical, administrative and clerical staffs," Halvorson said. "Our labor management partnership is also one of the major factors that set us apart in addressing the health needs of our members and communities."

Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a nonprofit; group practice prepayment program with headquarters in Oakland, Calif. Kaiser Permanente serves the health care needs of more than 8.3 million members in 9 states and the District of Columbia. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 145,000 technical, administrative and clerical employees and caregivers, and more than 12,000 physicians representing all specialties.

Except for historical information contained herein, the matters discussed in this media release are forward-looking statements that involve risks and uncertainties. Actual results may vary significantly based on a number of factors including, but not limited to: the impact of competitive products and pricing; government regulations; health care legislation; changing membership requirements, and the change in economic conditions of the various markets the organization serves.

Wednesday, November 23, 2005

Urban Institute Press Release 10/1/2002

WASHINGTON, D.C., October 1, 2002—Despite mounting budget pressures, State Children's Health Insurance Program (SCHIP) directors in 13 key states have so far resisted cutbacks in program eligibility and benefits, according to a new survey of program administrators and other officials conducted this summer by Urban Institute researchers for its Assessing the New Federalism (ANF) project.

But such restraint may not last. With 3.8 million children enrolled nationally in SCHIP, the joint federal-state program is facing its first real fiscal challenge as states contend with deficits surpassing $36 billion in fiscal year 2002.

The states surveyed—Alabama, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, Texas, Washington, and Wisconsin—account for 64 percent of SCHIP enrollment.

The survey findings are reported in "SCHIP Dodges the First Budget Ax" by Urban Institute health policy researchers Embry Howell, Ian Hill, and Heidi Kapustka. In most of these states, they observe, SCHIP is under exceptional pressure because of constricting state budgets, rapid growth in enrollment, or the lack of carryover SCHIP funds from earlier years. During the first year under the budget ax, however, SCHIP directors report very few cutbacks, especially in eligibility or benefits. Only New Jersey, with swiftly rising enrollment and a large forecasted deficit, restricted eligibility, but for parents and not for children.

No state cut its benefit package this year; in fact, Colorado, Florida, Mississippi, and New York enhanced their benefits, primarily for dental care, reflecting policy changes from prior years that were put into place in 2002. Many ANF states have reduced their outreach efforts, because of a perception in some states that there is less need to advertise a mature program. In addition, New Jersey began raising its premiums and Texas imposed additional copayments on some services. Only Minnesota has cut, by 0.5 percent, reimbursement rates to health plans. As for the future, the SCHIP directors indicate more states are considering cuts than expansions.

Why Is SCHIP Resilient?

SCHIP directors identified a number of reasons why the program has been largely immune from significant cuts this year:

SCHIP is widely viewed as successfully addressing a vital need.
SCHIP is not seen as overly costly, especially compared to Medicaid.
Governors and legislators like programs they feel they can control, and the fact that SCHIP is generally not an entitlement reinforces this attribute.
High federal match rates make it extremely difficult to justify major program cuts.
No governor or legislator wants to cut a program that explicitly serves children, especially during an election year.
If state budget difficulties continue, SCHIP enrollment climbs, or federal funding becomes uncertain, Howell, Hill, and Kapustka conclude, states will likely look for further cuts.

States with parental coverage may first cut those benefits before reducing ones for children, say the authors. "If they do modify their SCHIP programs for children, they are likely to make minor modifications initially, in the hope that the gains in access to care for low-income children will not be reversed," they add.

SCHIP Succeeds with Near-Poor Children, but Doesn't Dent Trend for Poor Kids

In a related study, "Five Things Everyone Should Know about SCHIP," Lisa Dubay, Ian Hill, and Genevieve Kenney provide a concise reading of SCHIP on its fifth anniversary, recapping how

states have taken advantage of SCHIP's flexibility;
SCHIP funds have been plentiful, but may run short;
coverage gains have occurred for many children;
most uninsured children could be covered by SCHIP or Medicaid; and
further improvements are needed in both SCHIP and Medicaid.
The uninsurance rate for near-poor children, the focus of SCHIP, declined from 23.3 percent to 17.5 percent between 1996 and 2000. During that period, the number of uninsured near-poor children (whose family income is between 100 and 200 percent of the federal poverty level) dropped by just over a million. The researchers attribute much of the drop to expansions in SCHIP eligibility and to outreach and eligibility simplification by both SCHIP and Medicaid. An estimated 2.7 million near-poor children, however, remain without medical coverage.

For poor children (those below 100 percent of the poverty level), the rate of uninsurance and its trend are much less encouraging, say Dubay, Hill, and Kenney. This group's uninsurance rate has been stagnant at around 27 percent from 1996 to 2000. At about 21 percent of all children, the 4.5 million poor uninsured kids make up almost 46 percent of uninsured children.

Parents are not enrolling their children for a number of reasons, including:

not knowing that the programs exist, that their child is eligible, or that welfare is not a prerequisite for Medicaid/SCHIP enrollment;
administrative hassles with enrollment, such as documentation requirements or language barriers; and
not wanting public insurance coverage for their children.
"Addressing these issues requires additional resources, but emerging funding problems and the recent economic downturn may make it difficult for states to attack these issues," Dubay, Hill, and Kenney say.

Complicating SCHIP's fiscal future, they note, is the so-called "SCHIP dip," which saw federal funding start at $4.2 billion in fiscal 1998 and drop to $3.1 billion for fiscal 2002 through 2004. "The question," they point out, "is whether states can preserve and even build upon the gains they have made in providing insurance coverage to children, when state budgets are under so much strain and federal funding is uncertain."

Tuesday, November 22, 2005

National Academies Press Release 5/21/2002

UNINSURED ADULTS MORE LIKELY TO DIE PREMATURELY WASHINGTON -- Americans without health insurance are more likely to have poorer health and die prematurely than those with insurance, says a new report from the National Academies' Institute of Medicine. Uninsured patients with colon or breast cancer face up to a 50 percent greater chance of dying than patients with private coverage. Uninsured victims of trauma also are more likely to die from their injuries. Being uninsured for even a year appears to diminish a person's general health."Because we don't see many people dying in the streets in this country, we assume that the uninsured manage to get the care they need, but the evidence refutes that assumption," said Mary Sue Coleman, co-chair of the committee that wrote the report, and president, Iowa Health System and University of Iowa, Iowa City. "The fact is that the quality and length of life are distinctly different for insured and uninsured populations."The committee examined the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million -- one in seven -- working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. A future report will look at how the lack of health insurance affects children and pregnant women. Adults with public coverage, such as Medicaid, are a distinct group as well since they tend to be in significantly worse health than those with private insurance and even in somewhat worse health than those with no insurance. Adults qualify for Medicaid because they are poor or have already incurred unaffordable medical expenses. In addition, low-income adults eligible for Medicaid often do not apply for it until they are sick. Uninsured cancer patients die sooner than people with insurance do, largely because of delayed diagnosis, the report says. The uninsured are less likely to receive timely screening services such as mammograms, Pap tests, and colon exams. By the time cancer is diagnosed in uninsured patients, it is more likely to be at an advanced, often fatal, stage. Likewise, uninsured patients tend to reach severe renal failure before they begin kidney dialysis.The longer diabetics go without health insurance, the greater the chance they will experience uncontrolled blood-sugar levels, the report says. Studies show that 25 percent of adult diabetics who were uninsured for a year or more went without a checkup for two years, compared to 5 percent of diabetics with insurance. Uninsured diabetics also are less likely to receive regular foot and eye exams, which can help prevent blindness and amputations.Uninsured adults with hypertension or high cholesterol are less likely to monitor their blood pressure or stay on drug therapy -- if they are fortunate enough to be screened at all, the report says. Patients admitted to emergency rooms with severe uncontrolled hypertension are more likely to be uninsured.Uninsured adults with HIV infection or AIDS are less likely to receive the highly effective "drug cocktails" that have become the standard treatment in the past five years, the report says. And when they do get the newer drug therapies, their wait to receive treatment has been an average of four months longer than that of patients with private insurance. Providing health insurance to HIV and AIDS patients has been shown to significantly reduce death rates."It wasn't difficult for us to conclude that if the uninsured became insured on a continuous basis, their health would improve and they would live longer," said committee co-chair Arthur Kellermann, professor and chair, department of emergency medicine, and director, Center for Injury Control, Emory University School of Medicine, Atlanta.Mentally ill patients with insurance that covers their treatment are more likely to receive appropriate care than those with no insurance, the report says. Even when health insurance does not specifically cover mental-health expenses, just having it increases the likelihood that someone with depression or anxiety will receive some care. People with severe mental illnesses such as schizophrenia or bipolar disorder have trouble keeping health insurance coverage after diagnosis because they have difficulty holding down jobs. Until they gain public insurance coverage, these patients face delays in receiving appropriate services.To see how uninsured patients fare in a hospital setting, the committee focused on two conditions for which most people are treated regardless of whether they are insured: traumatic injuries and heart attacks. It found that uninsured persons with traumatic injuries are less likely to be admitted to the hospital, receive fewer services if they are, and are more likely to die than insured victims. One statewide study of car crash victims discovered that uninsured victims had a 37 percent higher mortality rate. Another statewide study found that although uninsured trauma patients were just as likely to be placed in intensive care, they were less likely to be operated on or to receive physical therapy.Research also shows that uninsured patients hospitalized for a heart attack have a greater risk of dying during their hospital stay or shortly thereafter than patients with private insurance. They also are less likely to go to a hospital that performs angiography or other catheterization techniques, and even if they do, they are less likely to receive such sophisticated procedures.Studies that have monitored the health of people who had no insurance or temporarily lost it for a period of one to four years show that a person's overall well-being suffers during the time they lack coverage. The decline in health caused by a lack or loss of coverage is most profound for adults between 55 and 65 years old, the report says. Symptoms of worsening health might include high blood pressure, greater difficulty climbing stairs or walking, or a decline in general self-perceived wellness.Health insurance strategies that target the entire uninsured population would be more likely to produce greater health benefits and increase life expectancy than "rescue" programs aimed only at the seriously ill, the committee said. Being uninsured magnifies the health risks for chronically sick and mentally ill patients, as well as for groups that are already at greater risk of poor health, such as racial and ethnic minorities and adults with low incomes, the committee said. It added that increasing health insurance coverage would reduce some, but not all, of the disparities in health care experienced by racial and ethnic minorities.The committee noted that the research literature on which it based its findings probably understates the differences in health outcomes between insured and uninsured adults. The studies cannot account for the experiences of those who do not seek treatment, and uninsured adults are less likely to seek treatment.The report is the second of six that will constitute an extensive review of research intended to paint an accurate portrait of who lacks health insurance and why, along with the personal, social, and economic consequences. Rather than add to the many policy recommendations already on the table, the study is designed to lay the groundwork for a more informed and productive public debate about health care coverage. The committee's final report, however, will identify promising strategies for addressing the problems of uninsurance in the United States.The study is being sponsored by the Robert Wood Johnson Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Monday, November 21, 2005

Assurant Press Release 10/4/2005

Assurant Health’s John Alden Life Insurance Company Introduces Affordable EleMed™ Plan In Pennsylvania
Unique Group Plan Provides Small Businesses With Flexible Health Insurance Options For Uninsured Workers
Milwaukee – October 4, 2005 – Assurant Health launched today a new small group medical product – EleMed™ – in Pennsylvania that gives area small businesses an economical way to offer basic healthcare coverage to low-wage employees. The EleMed product is underwritten by John Alden Life Insurance Company and marketed by North Star Marketing.EleMed targets the growing population of employed but uninsured workers, a category that now includes nearly one-third of the 1.4 million Pennsylvania residents who live without health insurance.* These workers are either employed by small businesses that cannot afford benefits-rich traditional plans, or they cannot afford to participate in the plans their employers offer. Assurant Health developed EleMed based on consumer research conducted in markets across the country. Surveys showed that when small business owners consider purchasing or renewing health insurance, the determining factor is not services or accessibility, but cost. “EleMed targets an underserved market segment—start-up enterprises with tight budgets; businesses that operate in low-margin, low-wage industries like retail; and businesses that are especially vulnerable to sharply rising energy costs,” said Dave Keller, vice president of group marketing with Assurant Health. “With EleMed, more business owners can offer the health insurance benefits so important to attracting and retaining good workers.” EleMed combines low monthly premiums with benefits structured to address the needs of low-wage employees. Employers can choose from three plans that offer varying deductibles and co-pay structures. All feature generous first-dollar benefits on the services employees use most, including office visits, preventative care and prescriptions. Employees also benefit from an extensive healthcare network that gives them access to quality healthcare facilities and doctors at discounts of up to 60 percent. Keller concluded, “At Assurant Health, we are committed to helping reduce the country’s growing uninsured population, one business at a time.”