1. I am an advocate of Healthcare Reform. I was disappointed in the bill that finally passed because I believe it was not a strong enough protection for consumers. Given that, I am glad we have a healthcare reform law on the books.

2. I believe that most consumers would benefit in the greatest possible way from a single payer system. This could be modeled on Medicare or utilize some other possibilities, but I think a single payer system is the only way we will ever get a healthcare system that truly meets the needs of most consumers and costs the least.

Given those assumptions, you will understand my reaction when I read a new article in FierceHealthPayer, a weekly newsletter for healthcare plan executives. If you are involved in the purchase of health insurance for your organization, the title of the article, Insurers Profit from Health Reform, will come as no surprise to you. Of course insurers are the primary ones who will profit from health reform in its current incarnation.

After dropping almost $90 million to oppose the health reform law, repeatedly claiming its provisions would raise costs and disrupt coverage, health insurers actually have benefited the most from the law, according to a Bloomberg Government report released Thursday.

The article goes on to explain that most of the increases in revenue are the result of these companies expanding into government programs. You see, even though Medicaid and Medicare are government programs, they are often administered by private insurance companies. With the expected expansion of the Medicaid program mandated by the Affordable Care Act, there should be even more income growth for insurance companies.

So who’s going to lose money on healthcare reform? Guess what….it’s us again. Those of us who purchase insurance in the private marketplace were subjected to 9% increases on average in 2011…increases aimed at covering the costs of the mandates of the healthcare reform law long before required by the law. That way, we absorb the costs and the insurance companies get to go on paying their executives outrageous salaries and making their profits.

I wonder what it will take for people to finally realize that healthcare and health insurance need not cost so much. I don’t expect it to happen as long as corporations control our government and our lawmakers. I know many folks believe the problem is just the opposite. Government should get out of the middle of the relationship between the healthcare provider and the consumer. Competition and market forces would take care of costs.

What do you think? Who will pay for care for the chronically ill . . . and the chronically mentally ill if we don’t all chip in to do it? Is there enough compassion in the marketplace to assure that children, the poor, and those unable to pay for health insurance because of mental illness will also receive good quality healthcare? Please share your thoughts. I would love some help in understanding how we can assure that we will all get the healthcare we need without spending half our income on health costs.

Our first meeting immediately after the election was highly charged. Staff had been studying President Clinton’s healthcare proposals, and the notion of controlling cost through “managed care.”

President Clinton’s healthcare proposals did not fly, but the industry picked up the notion of controlling costs by managing the care provided to consumers, and psychological practice has never been the same. For private practitioners, “managed care” continues to be a primary obstacle to the practice of psychology. Costs might have been suppressed by managing care, but some would argue that the primary effect of the managed care revolution was the creation of a new industry that made money as the middle-men at the cost of providers. Indeed, after a few years of leveling of the costs of care, the rise has been renewed and expanded.

In mid-November, the Supreme Court of the U.S. agreed to hear an appeal of the Affordable Care Act, our nation’s most recent effort to reform our healthcare system.

The Supreme Court agreed to hear appeals from the United States Court of Appeals for the 11th Circuit in Atlanta, which is the only court to have struck down the individual mandate because it overstepped Congressional authority and wasn’t justified by the constitutional power “to regulate commerce” or “to lay and collect taxes.” FierceHealthPayer, November 18, 2011

According to editor Dina Overland of FierceHealthPayer newsletter, even a complete overturn of the law would have little significant impact. She believes that consumers like the changes the law is mandating and there is no stopping this train.

Mercom Capital Group, in their HIT Report of November 21, 2011, says the same thing about the massive changes in the healthcare arena at large. Basing their conclusions on a report by PwC (PricewaterhouseCoopers, LLC), Mercom reports that health organizations will continue to move forward with changes to their health technology and other innovations because the multiple drivers in the marketplace have finally come to a head. No matter the political or the financial uncertainties, PwC believes this movement will continue. These are changes consumers like, and the movement will continue no matter which market forces might change.

In their HIT Report of November 28, 2011, Mercom reports that Harvard and Aetna will ally to work to improve healthcare costs and quality. The two have formed a research collaborative focused on improving the quality and cost of healthcare. They will use bioinformatics, the interface of computer science and information technology with the fields of biology and medicine, to analyze healthcare data in innovative ways. They will focus on outcomes of various treatments considering quality and cost, factors that predict adherence to medical and drug treatments for chronic diseases, examining how claims and clinical data can be best used to predict disease and follow outcomes, as well as other treatments of data that will emerge over time.

Where is your organization in the midst of this dramatic change in how we manage healthcare? How do you see yourself participating in the sea change that is under way? Where does behavioral healthcare fit into this picture?

Just type in your thoughts below. Thanks for commenting.

Today I received a new sort of notice from the listserv…one aimed at informing as many individuals as possible about an upcoming test of the federal Emergency Alert System.

Date:    Thu, 3 Nov 2011 12:11:48 -0400
From:    “OS OCR PrivacyList, OCR (HHS/OS)” <OCRPrivacyList@HHS.GOV>
Subject: First Nationwide Test of the Emergency Alert System; November 9 at 2pm EDT

FIRST NATIONWIDE TEST OF THE EMERGENCY ALERT SYSTEM
Test to Take Place November 9 at 2 p.m. EDT

Dear Colleagues;

We need your assistance in notifying everyone about the November 9th nationwide test of the Emergency Alert System.  Please help distribute this to all your stakeholders, as far and wide as possible, to ensure the entire community is aware that

As part of our larger efforts to strengthen our nation’s preparedness and resiliency, the Federal Communications Commission (FCC) and the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) will conduct the first nation-wide test of the Emergency Alert System on November 9th at 2pm Eastern Standard Time.

The national Emergency Alert System is an alert and warning system established to enable the President of the United States, if needed, to address the American public during emergencies.  It is another critical communications tool that can protect the public and strengthen our nation’s resiliency.  The National Weather Service, governors, and state and local authorities also use parts of the system to issue more localized emergency alerts.  The test is an important exercise in ensuring that the system is effective in communicating critical information to the public in the event of a real national emergency.

This national test will help federal partners and EAS participants determine the reliability of the system, as well as its effectiveness in notifying the public of emergencies and potential disasters both nationally and regionally.  The test will also provide the FCC and FEMA a chance to identify improvements that are needed to build a new, modernized, and fully accessible Emergency Alert System.

To support the disability community, FEMA has developed a toolkit that will allow you to reach out to your constituents and local partners.  The toolkits, attached here in multiple formats, allow you and your organization to quickly disseminate information about this test.

In addition, we’re also releasing two new videos created to support the outreach efforts of our disability community partners.   FEMA Administrator Craig Fugate has long been a champion of the whole community and ensuring that FEMA represents the diversity of the people we serve.  In one video, Neil Mc Devitt, from FEMA’s Office of Disability Integration and Coordination joins Administrator Fugate in outlining the need for the upcoming Emergency Alert System test and the accessibility challenges posed by the test.   The video has American Sign Language, open-captions, and is voiced throughout.   We’re also happy to provide a Spanish version of the message with open-captions.

If you have additional questions for FEMA-Office of Disability Integration and Coordination questions, please contact our office at

Marci Roth
Director
Office of Disability Integration and Coordination

 

*        FEMA Administrator’s Message – http://www.fema.gov/medialibrary/media_records/6407

*        ASL Video: http://www.fema.gov/medialibrary/media_records/6407

*        Spanish Video: http://www.fema.gov/medialibrary/media_records/6408

Please share this information with your constituencies, colleagues, friends, and families.   Remember, on November 9th at 2pm ET, “Don’t stress; it’s only a test.”

I was fascinated at using the HIPAA listserv for this purpose. As I read through the notice, it became clear that FEMA is quite concerned about insuring that disabled individuals of all sorts receive notice of this test so they are not alarmed when the test occurs. Using a listserv that reaches healthcare providers is actually an excellent use of this list. After all, most disabled individuals are in touch with healthcare providers.

Please feel free to pass this information…or even this blog…on to your clients. It is important that consumers of behavioral health and other health services realize that the event scheduled for Wednesday, November 9, 2011 at 2pm is a TEST of the Emergency Alert System.

Good for you to know it too!

Thanks for reading and sharing the information in our blog.

It’s time to face the facts–the American public dislikes health insurance companies. And that’s putting it mildly, considering that 70 percent of all opinions and comments about insurers posted on social media sites in the last year were negative.

(Read more: Insurers should take to social media to combat negativity – FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-should-take-social-media-combat-negativity/2011-10-07?utm_medium=nl&utm_source=internal#ixzz1aYo3DrmA 
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I can understand some of that negativity. This past summer brought major upheaval for me as I searched for affordable health insurance for our employees. I asked our insurance agent early on to get us quotes. I was appalled at what came back from the company who provides our plan. As a small group (only 8 members plus one spouse) we are subject to huge variations in cost and are very limited in benefit choices. Health insurance is our second largest expense.

I interviewed employee leasing companies and other groups that claim to make you part of a larger group so you can benefit from lower pricing structures. Unfortunately, none of them were able to save us enough money to justify the severe limitation in benefits or the cost of membership. We ultimately bought a plan that increases copays and deductibles, but maintains most of the benefits we had….we think. How the insurer will choose to interpret those benefits when one of us actually needs to take advantage of them remains to be seen.

My experience is no surprise. Employers across the nation were faced with a  9% average increase in family premiums in 2011 while many of us were presented double digit increases, in spite of the recession.

The article mentioned above suggests that insurers should get involved in social media to combat their negative perception by the public. They should

Create a social media policy and then get out into the social world and establish a strong, positive presence. Tweet some healthful recipes, post exercise tips on Facebook, make announcements on Google+.

Whatever your specific strategy, though, make sure you monitor all social media sites for comments made about your company and then contact the poster to try and resolve the problem. Even if you can’t fix the particular issue, say because someone is griping about the lack of universal health insurance, you’ll have made an effort to connect with the public, which over time just might change their perception of the industry. - Dina (@HealthPayer)

In other words, they should get their marketing people to work in the social media sphere. Don’t do anything real to correct the negative perceptions of the public, just do your best to appear to care and to look good. Don’t let anybody realize that one of the major reasons the cost of healthcare is so high in the U.S. is because of the part played by the cost of health insurance.

I was rather distressed by that recommendation. Don’t do anything real…just do your best to appear as if you care about these negative perceptions.

I wonder what your experience is with health insurers. Does your organization provide health insurance for your employees? Is everybody satisfied with their plan and the cost of it? Have you ever made a negative comment about your health insurance on Facebook or Twitter? Ever made a positive one?

Please share your comments below.

WellPoint, a BlueCross collaboration, is the largest provider of health benefits in the country. Their plan is to utilize Watson to sift through their patient databases to make diagnosis and treatment recommendations to WellPoint physicians.

This idea is not at all far-fetched and certainly a reasonable way for IBM to make some money off their huge research and development investment in Watson. They have also purchased some other companies that position them well for movement into the medical sphere.

Over the last four years, IBM has spent more than $7.8 billion to acquire database analytics specialists Cognos and SPSS, both formerly public, as well as data warehouse company Netezza, along with other private companies. In the first half of 2011, IBM spending on research and development exceeded $3.15 billion.
—International Business Times, 9/19/2011

What WellPoint is proposing to do is a starting point for a task all EMR’s will ultimately need access to and participation in. In order to meet the requirements for ARRA stimulus funds, eligible providers will need to utilize their EMR’s to help them make clinical decisions.

Clinical Decision Support (CDS) is a process whereby the physician gets notices and alerts from their software to assist them in making clinical choices that are based on data and evidence rather than memory and intuition. The Centers for Disease Control and Prevention (CDC) hopes to see public health organizations utilizing population data and statistics to guide their choices. They believe this will be one of the most impactful effects EMRs can offer the public health. The Office of the National Coordinator for Healthcare IT (ONC) wants to see individual physicians using Clinical Decision Support to advise their patients. Clearly, WellPoint plans for this level of intervention: physicians will have access to the data Watson can provide to assist them in making diagnoses and recommending treatments.

We talked in this blog about some of the potential benefits of CDS back in 2009. Since then, research on the benefits of supported clinical decision making has continued. A Google Scholar search of ’decision support emr’ results in 16,800 hits. There have also been noted some shortcomings, most notably a phenomenon called ‘alert fatigue‘, wherein a provider gets so many alerts and notices that they stop attending to them or turn them off altogether. Obviously, we have lots to learn about how to present information to healthcare providers so they can use it most effectively for the benefit of their patients. WellPoint has decided to dive right in!

What do you think about being diagnosed by a computer? Will it be more effective or less so? What is the relevance of CDS for behavioral health?

Please share your thoughts below.

Ms. Overland’s review of the Institute of Medicine’s (IOM) report on pain and prevention cited some facts I had not heard.

Chronic pain affects 116 million Americans–that’s more people than affected by heart disease, cancer, and diabetes combined–and costs the United States
$635 billion each year. That’s what the Institute of Medicine (IOM) found in its report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research.

If that’s not jarring enough, here are some more staggering facts: The United States spends $2 trillion on healthcare, but only 4 cents of every dollar goes to prevention and public health, despite being among the best tools to reduce spending. For every $1 invested in prevention, we save $6 in projected healthcare costs, says Sen. Tom Harkin (D-Iowa), who participated in the Department of Health and Human Services (HHS)’s announcement
of its guidelines to incorporating prevention throughout the healthcare industry.

***

[Read more: An ounce of prevention could heal a pound of pain - FierceHealthPayer http://www.fiercehealthpayer.com/story/ounce-prevention-could-heal-pound-pain/2011-07-01?utm_medium=nl&utm_source=internal#ixzz1RMhp77eN

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I could not help but think about the number of people who would never have become substance abusers if their chronic pain had been addressed and treated at an early stage. How many behavioral health clients have you treated for depression after years of experiencing intractable pain?

The IOM and HHS see the coordination of care among primary care providers and specialists as the best way to address early intervention and prevention of pain. What role should mental health and substance abuse providers play in this coordination? How many of your patients also experience chronic pain? Where do behavioral health providers fit in?

Please share your thoughts and comments below. What role do you want to play in diminishing healthcare costs? Who should we see when it hurts?

Lots of folks have been waiting to see what kind of fines the OCR would impose upon organizations found responsible for breaches. We are beginning to find out.

On February 14, 2011, HHS entered into an agreement with Massachusetts General Hospital in which the hospital organization agreed to pay $1 million because of the loss of data of 192 patients of one of its outpatient practices. The information lost was on paper and was lost on a subway train. The hospital also agreed to enter into a Corrective Action Plan (CAP) including the implementation of policies and procedures to protect the PHI of its patients.

For those of you who thought these requirements do not affect you if you do not keep any patient information in an electronic form, it is clear that is not how OCR views it. Paper is also vulnerable and OCR is determined to protect that PHI.

The second announced fine was placed on Cignet Health of Prince George’s County Maryland. They were fined $4.3 million. They were accused of denying 42 patients access to their medical records, failed to cooperate with OCR in their investigation of the complaints, indeed failed to reply to OCR’s notifications. OCR determined that “the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule.”

For those of you who have thought that not keeping records of treatment might be the safest course of action, please think again. If you cannot provide the record when a patient requests it, they have every right to complain and to seek a judgement against you.

Of course, your organizations all have Privacy Policies. Do you know what they are? Do you follow the Procedures that your organization has developed? Does everyone? Part of the requirement is that employees be properly trained in what the policies and procedures are and that their training is regularly refreshed. Oh, and yes, part of the requirement is that the Privacy Officer makes sure the owners of the practice or the Executive Director or Board of Directors is well-informed about how the policies are implemented.

How is your organization doing with the stricter Privacy Rule requirements imposed by the HITECH Act? Please share your thoughts, fears and struggles with these requirements and how they affect your organization. Just enter your comments below.

The American Psychiatric Association(aPa) participates in the Mental Health Parity Watchalong with 11 other organizations. This organization is aimed at educating the public about parity, recording and appealing problems experienced by consumers in accessing mental health benefits, and in general facilitating the broad dissemination of information about the parity law. The aPa reportedon it’s intervention with BCBS-IL regarding their new requirements for preauthorizations for mental health treatment. While BCBS-IL rescinded their requirement for 2011, it is this kind of action by insurers that the law was meant to prevent.

Companies like Aetna have added pages to their web sites on mental health parity. These are designed to communicate directly to members and panel providers what positions the company has decided to take relative to the law. This can be an excellent way for consumers who have health insurance to learn how their insurer plans to address the requirements of the law.

As part of the parity implementation coalition mentioned above (Mental Health Parity Watch), the National Council has produced fact sheets and other resources aimed at educating consumers and answering questions about the law. Their are additional resources available on their blog page including summary of the law, FAQ, and a Parity Toolkit.

What has been your organization’s experience with the parity legislation so far? Have you found that insurers are moving forward with equivalent benefits and preauthorization policies for both physical and mental health? If you have run into difficulties, what have they been and how have you handled them.

Please share your experience to date. Thanks for your comments!

This attempt to integrate care will likely have major impacts on how behavioral health care services are provided to the seriously mentally ill and chemically dependent populations. The National Council has been actively involved in this movement and has received funds to found the Center for Integrated Health Solutions.

The National Council for Community Behavioral Healthcare has won a competitive cooperative agreement from the U.S. Department of Health and Human Services (HHS) to establish the Center for Integrated Health Solutions. The Center will address the comprehensive health needs of clients with mental illnesses and/or substance use disorders by improving the coordination of healthcare services in publicly funded community settings. The Center is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources Services Administration (HRSA).

In that role, on January 19, 2011, the National Council participated in an extremely informative webinar on current integration projects initiated by community behavioral health organizations. Each of the organizations that participated came to their ‘Health Home’ program in a different way and developed programs using different models. The presentation made clear that there are likely to be as many ways to accomplish the purpose of integrating health care for the most vulnerable populations as there are organizations that will provide that care. Even so, there are significant issues to be considered, challenges to be met, and goals to be accomplished for the establishment of a successful program.

A recording of this webinar is to be posted at http://coce.samhsa.gov/ at an indefinite date. Information about Co-Occurring Disorders Integration & Innovation can be obtained at contact@codimail.org. 

The hope that these programs can provide more effective health care at a lower cost is high. I am sure we will all be watching carefully to see how these and other initiatives progress.

I invite those  of you who have interest and experience with integrated care to share your perspectives. Your input will be valuable to your colleagues.

Starting in January 2011:

• States may now amend their Medicaid programs to provide Health Homes and chronic disease management, including behavioral health services;
• Closing the ‘Donut Hole’: Drug companies will grant a 50% discount on brand-name drugs for Medicare recipients who reach the donut hole in 2011;
• Free Medicare Preventive Benefits including annual wellness visits are available;
• A 10% increase in Medicare payments for primary care providers will start;
• Insurance companies must spend at least 80-85% of consumers’ premiums on paying for patient care rather than administrative costs or profits;
• CMS will begin to reform itself to accomplish delivery system and payment reforms that will save money and improve the quality of care; and
• Long-term care insurance for the purchase of home- and community-based services will become available. Community Living Assistance Services and Supports (CLASS) is a voluntary insurance purchase program.

The National Council has established a Mental Healthcare Reform blog that focuses on Healthcare reform. There you can find discussion of all of the changes as they occur along with implications of those changes. Don’t miss out on information your organization may need. Subscribe to the blog today.

Of the items listed above, only the first is likely to affect some behavioral health care providers in any significant way. Please let us know if your state is experimenting with medical/health homes within their Medicaid plan. How do you expect that to affect mental health providers?

Please share your thoughts . . . especially those of you who are participating in one of these pilot projects.