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Change is coming. And its not going to beeasy.

Whether or not the Affordable Care Actpasses Supreme Court muster, it seems as

though increasing access and a push towardprevention is the way of the future. And manyfeel this will be accomplished throughmedical homes.

According to the National Academy ofState Health Policy, as of January of this year,41 states have adopted policies and programsto create medical home models.

Many of these are in the early stages ofadoption some have just passed legislationto create pilot programs, others are in variousstages of development and implementation.

There is not a lot of information from earlyadopters that provides data on cost

effectiveness and not all payers are on board.But those who have undertaken pilot projectscontend that, while it can be a challenge,physicians are generally satised with theresults and that access to care has beenimproved.

Nebraska passed legislation in 2009 tocreate two medical home projects in ruralcommunities. Margaret Brockman, co-coordinator of the states pilot program, saidphysicians at the two participating ofces arehappy with the changes, but had no idea whatthey were getting into.

Its been a lot more work than what they(physicians) ever anticipated when theyinitially went in, Brockman said. One of thebiggest transitions is understanding what their

role is in a team approach in the past, theyhave been the commander of the ship.

The doctors initially thought they had ahandle on their patients, but have since foundthat they had no idea who was and wasntgetting mammograms or immunizations, whowas getting necessary chronic care treatmentand who was unnecessarily using theemergency departments. Care coordinators(who are paid for through the pilot program)are key to tracking patient care. Leslea Roach, coordinator of the PatientCentered Medical Home Initiative in Kansas,said the eight practices they are working with

across the state were already performing manyof the tasks involved in medical homes. Still,though, it has not been a simple transition.

The weird thing about the wholetransition is they are trying to build a planewhile ying it at the same time, she said. It isoverwhelming, time consuming and there arenever enough people and staff hours to get itdone.

Most of the pilot programs focus on low-income or Medicaid patients. In Iowa, it is

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June 11-13

April 25

Calendar

3 April 2012

April 27-28

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Midwest Edition

Medical Home-Steading Takes HoldInitiatives Move Forward in Nebraska, Kansas, Iowa

Continued on Next Page

E-Mailinfo@payersandproviders.comwith

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

WEBINAR Wednesday, April 11, 2012 Noon CD

REDUCING READMISSIONS:COLLATERAL EFFECTS

Please join Maria Lopes, M.D., chief executive officer, AMC Health, and Daniel Cusator, M.D.,vice president of The Camden Group, to discuss the upcoming changes on avoiding preventablereadmissions and their financial impact on hospitals, physicians and patients.

http://www.healthwebsummit.com/pp032912.htm

http://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.ohanet.org/http://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.mha.org/mha/education/pla/index.jsphttp://www.healthwebsummit.com/pp032912.htmhttp://www.healthwebsummit.com/pp032912.htmhttp://www.healthwebsummit.com/pp032912.htmhttp://www.ihi.org/offerings/Training/ScienceofImprovement/SOIApril2012/Pages/default.aspxhttp://www.ohanet.org/http://www.mha.org/mha/education/pla/index.jsp

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Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

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In Brief

Study Shows Impact

on Worker

Productivity

When asked how stress impacts theirwork, more than half of the individualsin a recent study said it made itdifcult to focus on daily tasks.

Stress can also add to errors andmissed deadlines, cause trouble gettingalong with coworkers, tardiness andabsenteeism, according to the reportproduced last month by ComPsychCorp., a provider of employeeassistance programs.

The study examined 2,500employees and found that, when askedto rate their stress level, more than halfranked themselves as a four or ve(with ve being the most stressed out).

According to the report, ve areas

that are most likely to create stress inthe workplace are: high demands; lackof control in the way one performs hisor her work; lack of support andencouragement by the company andpeers; poor working relationships;inability for one to understand onesrole within a company; and poormanagement and communication ofchange in the workplace.

Midwest Companies

Rank High In

Wellness Ratings

Bremer Financial Corp. in LakeElmo, Minn. and Wellmark BlueCross Blue Shield in Des Moines,Iowa, were the only two companiesto receive platinum ranking inWelcoas recent Well WorkplaceAwards.

A platinum ranking is thehighest provided by the

Continued on Page 3

NEWS

Medical Homes (Continued from Page One)

utilized for Iowa Care participants thosewho are ineligible for Medicaid but who makeless than 200% or less than the federal poverty

level. In Nebraska, it focuses on Medicaidpatients.

Both of these states have the goal ofmaking the programs budget neutral. InNebraska, providers are paid $4 per Medicaidpatient per month to cover costs. In Iowa, theypay $3 to $5, which includes the monthlypayment and performance-based incentives.

Brockman said they initially tried to getinsurance providers to partner with them, butnone bit on the offer.

In Kansas, Blue Cross Blue Shield workedwith the pilot to create differentreimbursement models for providers and

provide incentives for things like chronic caremanagement.

None of the programs have been in placelong enough to get measurements todetermine if they are cost effective.

They do appear to be expanding access,though. Brockman said patient satisfaction has

increased since the beginning of their pilojust over a year ago. They are also trying toreduce the number of unnecessary emerge

room visits and rehospitalizations.In the Iowa program, the goal was to o

access to primary care by utilizing existingfederally qualied health centers as primarcare providers. Because the Iowa Careprogram offers limited benets, theseproviders assist patients in getting servicesmental health and prescriptions that are nocovered, said Marni Bussell, the programsproject manager.

Bussell said the program is helping gepatients into the system and will hopefullyalleviate the pent-up demand that could oin 2014, should the Affordable Care Act st

and increase the number of patients owininto the system.

In the end, you want to know you areproviding better value and more patient-centered care, Roach said. The idea is tohow it does and if we can sustain it. And ifcan get others to do it, it would be awesom

Bariatric Surgery New Diabetes CareProcedure May Outperform Other Treatments

A new study by physicians at the ClevelandClinic has found that bariatric surgery helpedimprove, and sometimes put patients intoremission of, diabetes.

The randomized, controlled trial,published in the New England Journal ofMedicine, included 150 patients who wereobese and did not have control over theirdiabetes. They were divided into three groups one-third received medical therapy, anothermedical therapy and gastric bypass, and thenal third had medical therapy and sleevegastrectomy.

After 12 months, 42.6% of patients whohad gastric bypass and 36.7 percent ofpatients who had a gastrectomy had normalHbA1c levels (less than 6.0). In contrast, only12.2% of patients who only had medicaltreatment had normal blood glucose levels.

After one year, patients who underwentgastric bypass or sleeve gastrectomy lost moreweight and were signicantly more successfulat controlling their diabetes, compared to

those who simply took medications, said investigator Philip Schauer, M.D., directorthe Cleveland Clinic Bariatric and MetaboInstitute in a press release. We believe thabariatric surgery represents a potentiallyvaluable strategy for control of diabetes thshould be considered in more patients whonot respond to conventional treatment.

Patients taking part in the study took aaverage of three medications each when thbegan the process. None of the gastric byp

patients used medication during the studyperiod and 72 percent of those undergoingsleeve procedure needed no medication.

Participants who had bariatric surgeryaveraged a weight loss of 64 pounds; thosewho had sleeve surgery lost 55 pounds; anthose treated with medication lost about 1There were some complications, but thetreating physicians reported that most werenot serious. The patients will be followed ffour more years to gauge long-term results the treatment.

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Page 3Payers & Providers

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*For our ads, not your hospital

NEWS

In Brief

organization, showing thatemployee wellness has becomepart of the overall businessstrategy at a company, accordingto Welcoa.

The seven benchmarks theranking is based upon include:having CEO support, wellness

teams, data collection, creating anoperating plan, choosingappropriate interventions, having asupportive environment andevaluating outcomes.

March of Dimes

Provides Guidance

On Reducing

Deliberate Pre-Term

Deliveries

In an effort to help reduce the numberof early elective deliveries in thecountry, the March of Dimes isoffering a free set of guidelines forhospitals.

The package provides steps thatcan be put in place to eliminatedeliveries before 39 weeks. Theinformation includes tools for datacollection, Grand Rounds, access toquality improvement experts andother support.

Healthcare experts have began toreach a consensus that having a childbefore a full 39 weeks of gestation canlead to development and other healthproblems for the newborn later in life.Nonetheless, tens of thousands ofsuch births are induced every year forthe convenience of both physicianand mother.

The organization plans toprovide the package free of cost to atleast 100 hospitals this year. Providersinterested in receiving the guidelinesneed to apply by April 15, 2012. Moreinformation or an application can berequest by e-mailing39weeksQI@marchofdimes.com.

The Missouri Hospital Association and theMissouri Primary Care Association released areport last month looking at promisingcollaborations between hospitals and federallyqualied health centers.

The organizations found that hospitals andclinics tend to collaborate better in urbanareas than in rural ones. In rural communities,hospitals often downplay the clinics roles toproviding care only for the uninsured or feelthey should offer services the hospitals dontlike dental and behavioral health care. Bothalso misunderstand the others nancialincentives for caring for low-income

populations.To help the two groups better collaborate,the reports authors recommend creating localhealth councils to improve communicationsamong providers and create greater access tocare.

The reports authors also identied ahandful of promising practices that were

created to address their communitys specineeds.

In the Springeld area, one group createa medication assistance program to helppatients get free and reduced-cost drugs wheeligible. They estimated the program willreduce costs to the system by $2 millionannually.

Another collaboration was meant toincrease access to dental care to reduce visito Springelds emergency departments. Theanswer was a xed-fee dental clinic which hserved more than 2,000 patients since 2009A third Springeld-based collaborative effort

was the addition of obstetricians from Coxhospital to the Jordan Valley CommunityHealth Center.

More information on the variousprograms can be found online at http://www.ahanews.com/ahanews/jsp/display.jspdcrpath=AHANEWS/AHANewsNowArticle/data/ann_032912_MO&domain=AHANEWS

number of nurses that are trained at eachsetting.

Though there may seem to be a plentifusupply of nurses in the market, a new studyfrom the New England Journal of Medicineshows there may be dramatic need in thecoming years.

Douglas Staiger, a professor at DartmouCollege in Hanover, N.H., and colleaguesstudied numbers to nd out if, in fact, theUnited States is in the middle of a nursingbubble.

CMS Provides $200M To Train NursesFive Hospitals Receive Grants to Grow Workforce

The Centers for Medicare & MedicaidServices announced late last month that itwould be providing $200 million to vehospitals who participate in training nursesthrough the Graduate Nurse EducationDemonstration.

Payments will be given out over four yearsto train nurse practitioners, clinical nursespecialists, nurse anesthetists and nursemidwives to provide primary care services.The participating organizations have not beenchosen and payments will be based on the

MO. Hospitals, Clinics CollaborateStudy Says Theres Payoff Working With FQHCs

HEALTHCARES BEST ADVERTISING VALU]

PAYERS & PROVIDERS reaches 5,000 hospital, health plan and noprot executives statewide. There is no better venue for marketin

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8/2/2019 Payers & Providers Midwest Edition Issue of April 3, 2012

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Payers & Providers Page

Not long after the passage of Affordable CareAct, on a ight from Chicago to Albuquerque, Isat next to a 70ish architectand war veteran who servedas a consultant for a militarymuseum in Washington, D.C.

On learning that I was adoctor, and someone (heassumed) who wassympathetic to hisconservative politics, theman asked, So, what do youthink of Obamas socializedmedicine plan?

The question immediatelyraised my hackles. It was notsocialized medicine, Ipointed out. It was a plan toget the 50 million uninsuredindividuals into ourhealthcare system by way of theprivate health care industry.Arent Medicare and the VAsystem socialized medicine? Iasked. The government funds and runs them.That seems socialist to me.

And then I added, It always surprises methat people who have excellent healthcare

coverage want to deny coverage to those whocannot afford it or cannot obtain it because of apre-existing condition. Taken aback, mypreviously garrulous seat mate, whom I did notwant to talk to in the rst place, suddenly grewquiet and said that he was tired and wished tosleep.

That conversation came to mind once againthis past week as I read with dismay accountsof the three-day proceedings in the SupremeCourt that will determine the fate of PresidentObamas health care plan. Justice AntoninScalias already famous (infamous?) remarkabout the similarity between buying healthcare

and broccoli in a grocery store does not makeme optimistic about which way the Court willswing.

What only a few weeks ago mostconstitutional scholars thought would be aslam-dunk win for the President seems certainto be a loss in the usual 5-4 decision thattypies the outcome of Supreme Court cases inthis highly politicized era.

Let me make it clear: there is much aboutObamacare that I dont like. It will continue togive the private insurance industry too much

power. The system will remain frustratinglybureaucratic and therefore more costly than it

ought to be. It will still telldoctors what they can andcannot do, can and cannotprescribe. Talk aboutregulation! And not by thegovernment but by themarket.

But its a start. To me thdesire to make healthcareaffordable and accessible tis a matter of social justice

Two generations ago, th

wasnt much doctors couldfor patients. In fact, it was rare for us to do a lot of haHealthcare was not a righta privilege (and sometimesdubious privilege at that).

Today, medical care haimproved dramatically, withbetter outcomes and a wide aof therapies for a wide array o

medical problems. Healthcare is a right, in myopinion, just as education is a right. And forthose of us in this country who are uninsured,sudden illness can mean nancial ruin; for tho

of us lucky enough to have insurance, premiuare high and climbing to cover not only oursebut also those who do not or cannot pay whenthey get sick. Obamacare is far better than donothing, which is what weve done for decade

If I had any inuence, Id ask the nine justo spend a week in my ofce, listening to the of my patients, a few of whom are uninsured many more who are underinsured, with highdeductibles and exorbitant medication costs. would they react to a self-employed architectwho is too young for Medicare and not a vetewho cant obtain an affordable insurance pbecause of a pre-existing medical condition? T

Justices might not change their minds, but I bethey might see that healthcare and broccoli arnotto mix metaphors and clichstwo sidethe same coin but apples and oranges.

OPINION

Enough To Put You Off Your BroccolSupreme Courts Conduct On ACA Was Inappropria

Ross Slotten, M.D., is a physician in private

practice in Chicago. He is a member of the

Payers & Providers editorial board.

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8/2/2019 Payers & Providers Midwest Edition Issue of April 3, 2012

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Call (877) 248-2360, ext. 2Or e-mail: advertise@payersandproviders.com

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*New England Journal of Medicine, 2004.

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