Health Affairs

The Medicaid program is facing major new challenges.  The new health care law puts both significant new responsibilities and financial burdens on the program.  At the same time, Medicaid, as one of the three major federal entitlement programs, is a top priority for policy makers trying to address the federal government’s staggering budget deficits.  Unfortunately, as Medicaid heads into this critical period, the old design flaws that have plagued the program for decades have not been fixed. We are hoping to introduce some new thinking on an old problem: Medicaid financing. 

The ideas presented here have not been fully fleshed out or vetted with the relevant stakeholders.  They are an attempt to address a design flaw in the Medicaid program that has haunted federal and state policy makers for decades.

Medicaid is in many ways a well-designed program.  However, there has always been a problem when there is an economic downturn,  States, specifically those with balanced budget requirements, face increasing Medicaid expenses at the very time they have decreasing revenues to pay for them.  This is commonly referred to as the “counter cyclical” problem.  Whenever the ranks of the newly unemployed surge because of economic downturns, the ranks of those newly eligible for Medicaid surge as well.  The states confront fundamental challenges to their budgetary stability.  Tax revenues go down; spending goes up.  States then historically have three main options available to them:  (1) cut Medicaid reimbursement, (2) eliminate Medicaid benefits, or (3) restrict Medicaid eligibility for those not entitled by federal statute. Read the rest of this entry »

Editor’s note: Earlier this summer, on July 7, Robert Butler died of leukemia. Butler was the founding director of the National Institute on Aging, a Pulitzer Prize-winning author, and one of the nation’s leading authorities on aging and geriatrics. With the essay below by Christine Cassel, president and CEO of the American Board of Internal Medicine, Health Affairs Blog is beginning a periodic series of posts about Dr. Butler and his legacy.

As he did for many people, Bob Butler inspired me to seek a career in geriatric medicine.  When I was a young physician,  training at a prestigious medical center and set on a career in clinical research, our teachers would ask us to find young patients with unusual diseases to discuss at our teaching rounds. After rounds, we would spend the rest of the day seeing old people with common diseases—and very few teachers were interested in helping us understand how to help these people regain their ability to live their lives, to go home and take care of themselves.

Butler described this therapeutic nihilism in his prize-winning book Why Survive? and coined the term “ageism.” He vividly described the disdain and distaste for aging in American culture, and how it has led to seriously inadequate medical and social attention to those people who would most likely benefit from advances in science and social programs.

One of the most remarkable and central facts of Bob Butler’s life and his legacy is that he started with that grim and depressing statement, and from it flowed a relentlessly optimistic and generative profusion of efforts to turn the tides of ageism and change the very culture of our society to one that respects age, commits to the science and practice of better care for the disorders that limit our abilities to make the most of our older years, and creates a previously unthinkable concept: successful aging. Read the rest of this entry »

Editor’s Note: Sheldon Horowitz of the American Board of Medical Specialties (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Horowitz’s presentation and supplements his discussion.

With approximately 750,000 of the nation’s physicians certified by one or more of the 24 Member Boards of the American Board of Medical Specialties (ABMS), ABMS has a unique opportunity to further the national agenda set by the U.S. Department of Health and Human Services (HHS) to promote the adoption and meaningful use of health information technology (HIT).  By aligning ABMS Maintenance of Certification® (ABMS MOC®) with the meaningful use objectives of HHS, we can enhance the knowledge, skill and use of health IT by physicians to improve performance and patient outcomes. Read the rest of this entry »

Editor’s Note: Humayun Chaudhry, D.O., of the Federation of State Medical Boards (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Chaudhrys presentation and supplements his discussionn

In addition to Chaudhry, authors of this post include Martin Crane, M.D., the immediate past chair of the board of directors of the Federation of State Medical Boards (FSMB); Freda Bush, M.D., the current chair of the FSMB board of directors; and Frances Cain, director of the Post-Licensure Assessment System at FSMB.

As part of the solemn professional obligation they take upon graduation from medical school, physicians commit to lifelong learning in order to maintain their skills and acquire new knowledge affecting their medical practices and the care they provide their patients. Maintenance of Licensure (MOL) provides a framework by which the boards may assure the public of a physician’s ongoing clinical competence as a condition for renewal of medical licensure. As the Federation of State Medical Boards (FSMB) works with its member boards in the months and years ahead to implement MOL, it is clear that health information technology, generally, and electronic health records, in particular, will be of value as doctors fulfill that professional obligation and demonstrate ongoing clinical competence. Read the rest of this entry »

Editor’s Note: Dr Robert Laskowski of Christiana Care Health System (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Laskowski’s presentation and supplements his discussion.

The recent release of regulations that guide billions of dollars of government investment for the “meaningful use” of electronic health records poses many challenges to the current practice of medicine.   The concept of “meaningful use” embodies a call to action to use information effectively to create a new value proposition for health care –  improve safety and quality, and reduce costs. Read the rest of this entry »

Editor’s Note: Will Bloedow (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Bloedow’s presentation and supplements his discussion.

From a patient’s perspective, the increasing emphasis on an Electronic Health Record (EHR) and meaningful use, saves time, creates better outcomes and offers a sense of comfort.

I juggle health issues including a heart condition, diabetes and asthma. My EHR is essential in connecting my care team. My primary care physician, cardiologist and pulmonologist can easily and quickly reference each others notes within the EHR. The ability to electronically communicate and coordinate has helped them deliver better treatment across my spectrum of care. Read the rest of this entry »

Editor’s Note: John Toussaint of ThedaCare (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Toussaint’s presentation and supplements his discussion.

On August 5 at the National Press Club in Washington, ThedaCare, a system of four hospitals, 25 ambulatory clinics and a large outpatient behavior health center in Northeast Wisconsin, announced it will meet all current meaningful use standards by the end of 2011 through extensive training of both employed ThedaCare physicians and independent community physicians. ThedaCare believes these guidelines are important in defining how electronic health information can improve healthcare in Wisconsin and throughout the country. Read the rest of this entry »

Editor’s Note: Charles Kennedy of WellPoint, Inc. (photo and bio above), is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Kennedy’s presentation and supplements his discussion.

Authors of this post include Kennedy and Samuel Nussbaum (photo and bio above), as well as Lisa Latts, M.D., M.P.H., Vice President, Programs in Clinical Excellence, at WellPoint.

The approval of the final Health Information Technology Meaningful Use regulations is a landmark in the path toward a more efficient and effective health care system.  However, we must temper celebration of the policy achievement with the real world day-to-day challenges of deploying and meaningfully using Health IT tools.  In fact, the release of the final meaningful use regulations is the beginning of a journey that will last 5-10 years or more, and, if successful, will ultimately improve health care quality and reduce unsafe and unnecessary care, allowing greater affordability of care and providing financial “headroom” for future application of the advances in science and technology. Read the rest of this entry »

Editor’s Note: The post below is by David Blumenthal, National Coordinator for Health Information Technology, and Don Berwick, Administrator of the Centers for Medicare and Medicaid Services. Blumenthal will speak later today at a Washington D.C. event, “Advancing Electronic Health Records Adoption and Meaningful Use,” cosponsored by Health Affairs and the Health Industry Forum at Brandeis University.

On July 13, with the issuance of two regulations defining and supporting “meaningful use” of electronic health records (EHRs), our nation began in earnest its journey toward ubiquitous and effective use of health information technology. In considering the significance of this moment, it is useful to remember the events and energies that have brought us to this starting point, and to understand the many different elements that will support this initiative.

The proximate event leading us to the July 13 announcement was the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act, in February 2009. This act makes available unprecedented resources to support the nation’s transition to EHRs. In the months since its enactment, extensive preparations have been made. These constitute the operational supports for a multiyear, multiphase campaign of EHR adoption and use. But behind these preparations lies a longer and deeper history that has prepared us to seize this moment.

It was six years ago that the Office of the National Coordinator for Health Information Technology (ONC) was created. The recognition of the need for a federal leadership role reflected a growing professional and bipartisan consensus regarding the potential benefits of health information technology (IT). In the intervening years, we have also seen an increasing understanding of both the opportunities and the barriers to the dissemination of electronic health information systems.

Of even greater importance, it was a decade ago that the Institute of Medicine (IOM) published findings regarding safety and quality of health care in America in a pair of groundbreaking studies: To Err Is Human and The Quality Chasm. Those findings altered the nation’s understanding of its health care system and the results it was achieving, as well as highlighting the great potential for improvement. The IOM reports played an important part in illustrating both the need for improved information systems in health care and the potential for electronic data to help fill that need. Read the rest of this entry »

Donald Fischer of Highmark Blue Cross Blue Shield, Inc. (photo and bio above), is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Fischer’s presentation and supplements his discussion

At Highmark, we are constantly seeking new ways to work closely with our network providers to improve our members’ health, increase patient safety and reduce health care costs. We believe strongly that improved quality of care requires collaboration among members, providers, employers and health plans.  Sharing of clinical and claims data with providers, and aligning financial incentives, are critical success factors in quality improvement and are closely linked to cost efficiency. With that in mind, we developed QualityBLUE more than 10 years ago, as a pay-for-performance program for primary care physicians, formalizing our efforts to improve quality of care and leading to more cost-efficient care.  Read the rest of this entry »