CareSource Clinical Practice Registry – The Perfect Tool to Streamline Your Practice

Nov 16th, 2010 | by OurHealthCareSource.com

Earlier this year, we launched an innovative, online tool for provider practices called the CareSource Clinical Practice Registry. We’ve seen adoption of the tool really take off mainly because the kind of information that the Clinical Practice Registry provides has traditionally been elusive when it comes to Medicaid patients.

A provider in our network – Dr. Barb Bennett, Family Practice Physician and past president of the Ohio Osteopathic Association – was kind enough to provide her points of view regarding the tool, and how it helps her organize her practice.

The primary benefit of the CareSource Clinical Practice Registry is population management. Providers can quickly and easily sort their CareSource membership into actionable groupings. It is a proactive approach to patient care and helps place emphasis on the need for preventive care.

For example, a Primary Care Provider (PCP) can sort the list to identify all of those with chronic conditions like diabetes. From the list of diabetics in the practice, the provider can identify those who need to come in for a visit, and proactively call to schedule an appointment. The report is color coded, so the provider can identify areas of focus. It can also be downloaded as a PDF or in an Excel spreadsheet format.

The Registry also impacts HEDIS scores. It helps identify many HEDIS mandated screenings, including women’s health and well-child screenings. By identifying the HEDIS screenings through the Registry, HEDIS quality scores improve, and most importantly, so do the health of our members.

A Year of Milestones

Oct 6th, 2010 | by OurHealthCareSource.com

This year has marked a series of milestone anniversaries for many of our nation’s most well known public programs. Programs that have become synonymous with stability, security and health care. They are: Social Security, Medicare and Medicaid. And, let’s not forget one of the most significant pieces of legislation our nation has seen in the last 20 years – the Americans with Disabilities Act (ADA).

You may be wondering why a large health plan like CareSource would care about the ADA or public programs in general. It’s actually pretty simple. It’s because each of our members is touched by at least one of these programs every day. Moreover, our members have tenaciously navigated the pitfalls of bureaucracy to secure and retain a benefit that is fundamental to their sheer existence. And, a good portion of them are just beginning to realize the opportunities that now lay before them as a result of the ADA (which, by the way, strives to remove significant barriers for individuals with disabilities. More on this later.)

Social Security – Celebrating 75 Years of Security
Despite being well past the age where most Americans can begin to receive benefits, the Social Security program is still viewed as one of the most important programs in our country. In fact, according to the AARP, nine out of ten adults held this view consistently in 1995, 2005 and 2010. Social Security underscores the importance of many of the values we advocate for today – independence, safety and financial peace of mind. As technology and innovation allow us to live longer, these values will remain essential to a more secure and productive tomorrow.

Medicare and Medicaid Turn 45
When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, do you think he ever dreamed it would result in health coverage for more than 100 million Americans just 45 short years later?

It’s a dream that many of us are proud to fathom. It’s a fiscal challenge we’d like to forget. But without these two programs, America would be a very different place. While not necessarily perfect, these programs have driven us as a society to build a health care system that allows us to live longer, employ millions of Americans and provide the strength a nation needs to forge ahead. Yes, some might agree that we have lost our footing along the way, but the passage of the Patient Protection and Affordable Care Act will be a milestone that will be celebrated just four short years from now.

ADA Celebrates 20 Years
July 26, 2010 marked the 20th anniversary of this historic legislation enacted to break down barriers in housing, the workplace, schools, malls, telecommunications and public transportation for people with disabilities. Despite its worthwhile advancements, leading advocates realize there is still much more work to be done. Our nation has focused heavily on supporting disabilities financially and medically, but not really as much on merging these ideals in a way that fosters inclusion and independence.

As we reflect on the needs of the more than 65,000 members with disabilities we serve in Ohio and Michigan, it is with great humility that we continue our advocacy to extend our reach to cover more individuals with disabilities. Doing so will ensure that they receive health care in a way that is person-centered, comprehensive, coordinated and in a setting where they can thrive and succeed.

Charting New Milestones
As a non-profit health plan, we recognize the foundation these programs have established for the current generation and for generations to come. The programs mentioned above as well as countless others have truly inspired the advent of companies like ours that are adamantly focused on supporting the underserved. In this commemorative year, we want to take this opportunity to honor each person who works tirelessly every day to help our nation’s most vulnerable reach their next important milestone. Happy Anniversary!

Health Care Reform is easy…isn’t it?

Aug 26th, 2010 | by OurHealthCareSource.com

Earlier this summer, our company hosted a retreat which included two national speakers– Dr. David M. Cutler and Thomas Dehner, JD. We invited these leading health care experts to meet with us because of their insights into health care reform, and the transformation that is currently taking place in this industry.

A little background on Dr. Cutler – he is a Harvard professor, and he served on the economic council during the Clinton years. More recently, he was senior health care advisor to President Obama. And, he is intimately involved in strategies around financing health care in our country. So his points of view were particularly eye-opening.

As the Massachusetts Medicaid director, Thomas Dehner led efforts related to the Medicaid components of the Massachusetts Health Care Reform Law. Now a principal with Health Management Associates, Inc., his viewpoints on lessons learned and future implications were also very enlightening.

There was a point in the presentation where Dr. Cutler gauged the difficulty for the health care industry to convert. He proclaimed the following:

• Insurance reform is easy
• Coverage expansion is more difficult (he called it Medium)
• Improving the value of care is the most difficult (or Hard)

It was an interesting assessment, and it sparked a lot of conversation.

Insurance Reform is Easy
First off, none of what needs to happen within the health care system is easy to change. But what makes insurance reform “easier” than transforming other aspects of the health care system is because insurance reform relies heavily on policy and laws. The introduction of federal policy allowing parents to keep their children on their health plan until age 26 is a perfect example of how policy can quickly affect immediate change.

Coverage Expansion is Medium
Expanding health coverage to more Americans is certainly a more difficult goal to achieve. Two reasons expansion is harder:

1. The exchange could create a mass rush to the health care “storefront”. People who have not had access to health care will now be eligible, and that may empower a lot of people to act. How will our system react?
2. At the same time, it’s also difficult to get people to enroll. Dehner said this is “a close-to-impossible job” despite the federal dollars set aside for outreach. Communication and promotion will be the key to educating the public about the availability to get coverage. But even with substantial outreach, there will be plenty of people that are eligible for public health care programs and subsidies, but just won’t know it or don’t recognize ongoing health coverage as a priority. So finding these people and getting them into the system presents a challenge.

Improving the Value of Care is Hard
This is by far the most difficult area to transform—but not impossible. All players within the health care arena are being pressured to find ways to reduce cost while increasing quality…and that can sometimes appear to be an oxymoron. But we are already seeing solutions that will help move this goal along:

• Technology
  The more we integrate technology into the health care system – and that includes technology that provides information, not just devices – the better coordinated the system will be, and the better doctors will be at providing the right kind of care at the right time and place.
• Case Management/Coordination
  What case management and health care coordination does is put prevention and wellness at the center of caring for patients. By integrating case managers more into the system, patients, providers and insurance companies can be held more accountable, helping increase quality of care. Also, case management ensures that patients are using the health care system responsibly, and that lowers cost.
• Streamlining Administrative Duties
  It’s estimated that highly trained registered nurses spend one-third of their time charting patient status and there are more administrative personnel on staff than nurses. That’s a lot of resources being devoted to what could be considered “lost productivity.” The industry needs to continue pursuing automation and streamlining this aspect of the business-side of health care.

Hard, Harder, Hardest – But Worth the Pursuit
There are many challenges ahead for this industry. But so much progress has already been made in a very short time. As long as the players within the health care industry continue to collaborate, we will reach our goal. And once we’ve reached our destination as an industry, we’ll look back and understand that the pursuit was worth it. Because we’ll all eventually benefit from the transformation of health care.

What do you think are the hardest aspects of health care reform to further implement?

Medicaid Extension Provides Much Needed Relief

Aug 12th, 2010 | by OurHealthCareSource.com

On behalf of the 844,000 Medicaid consumers we serve, we thank you, Congress, for extending $16 billion in enhanced Medicaid funding to assist states who are experiencing the worst budget shortfalls in history. Our government did what’s right and necessary for people who are desperate for help today.

Nearly 3.3 million more people were enrolled in Medicaid in June 2009 when compared to June 2008 (based on Kaiser Commission on Medicaid) and states are financially strapped – three-fifths of them have expressed a critical need for assistance with its Medicaid programs. Plus, many families continue to feel the burden of the Great Recession as demonstrated by the U.S. unemployment rate of 9.7% (June 2010). It is our obligation as a country that believes in providing opportunity for all to take care of those that need help. And that’s what Congress did this week by a vote of 247 to 161.

Again, thank you, Congress for leading our nation out of the Great Recession.

Medicaid Extension is Vital to the Underserved

Aug 2nd, 2010 | by OurHealthCareSource.com

In this tumultuous and uncertain political year, some things are very clear. State budgets are facing serious deficits. For millions of Americans, the Great Recession is not over. We see it firsthand here at CareSource. In fact, as the nation’s second largest Medicaid health plan, we know there are 844,000 CareSource members who are faced with the realities of the economic downturn each day. Subsequently, this has increased the demand for Medicaid and other important services families need to survive. Simply put, Washington must do more to address the devastating impact of these tough economic times.

Every day, we see the consequences of high unemployment in our states. With more people out of work, more families are relying on Medicaid to provide essential medical care. Any delays may force families who are already struggling to maintain basic necessities to forgo the health care coverage they fundamentally deserve and more importantly – the coverage they desperately need.

Yet efforts in Congress to approve a six-month extension of higher federal Medicaid assistance to the states are being blocked. Instead of voting as if the economy is strong, Congress should take the pressure off states by passing this temporary extension now. Otherwise we could see drastic cuts in health care for the most vulnerable, education, and other critical services. These cuts will only delay the day that we will see the economy actually recover.

Sincerely,
Janet Grant
External Affairs
CareSource

Moving Hope To Reality

Jul 22nd, 2010 | by OurHealthCareSource.com

Dear President Obama,
Thank you…thank you for the release of the Patient’s Bill of Rights. This public proclamation that describes how patients will be protected by the rising costs and complexities of the health care system is exactly what this country needs. It is fundamentally consistent with the philosophies of our nation. The Patient’s Bill of Rights builds a foundation that allows opportunities to exist, opportunities open to all, and most notably our country’s underserved population.

Underserved people continue to suffer in our country. And one of the most profound challenges to this demographic is having the forum to voice opinion. Underserved communities struggle to be heard…struggle to tell their stories…struggle to instill empathy in those most able to be helpful.
The Patient’s Bill of Rights gives the underserved a voice. It protects them from elements that have been traditionally uncontrollable. It protects our children, it protects those with pre-existing conditions, and it protects women. But most importantly, it protects the integrity of our country and the goodwill we extend to our citizenship.

So thank you, Mr. President, for embracing our country’s underserved, and moving hope to what is tangible. And we’re happy to answer your request and spread the word about the new Patient Bill of Rights.

The Patient’s Bill of Rights
“Starting in September, some of the worst abuses will be banned forever. No more discriminating against children with pre-existing conditions. No more retroactively dropping somebody’s policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.” – PRESIDENT BARACK OBAMA

President Obama announced a Patient’s Bill of Rights made possible under health reform—a basic set of consumer protections.

The Patient’s Bill of Rights:

1. Prevents insurance companies from canceling your policy if you get sick. Right now, insurance companies can retroactively cancel your policy when you become sick if you or your employer made an unintentional mistake on your paperwork.
2. Stops insurance companies from denying coverage to children with pre-existing conditions. Beginning in September, discrimination against children with pre-existing conditions will be banned—a protection that will be extended to all Americans in 2014.
3. Prohibits setting lifetime limits on insurance policies issued or renewed after Sept. 23, 2010. No longer will insurance companies be able to take away coverage at the very moment when patients need it most. More than 100 million Americans have health coverage that imposes lifetime limits on care.
4. Phases out annual dollar limits on coverage over the next three years. Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for your health care. For the people with medical costs that hit these limits, the consequences can be devastating.
5. Allows you to designate any available participating primary care doctor as your provider. You’ll be able to keep the primary care doctor or pediatrician you choose, and see an OB-GYN without referral.
6. Removes insurance company barriers to receiving emergency care and prevents them from charging you more because you’re out of network. You’ll be able to get emergency care at a hospital outside of your plan’s network without facing higher co-pays or deductibles or having to fight to get approval first.

The 2010 Census – It’s easy. It’s important. It’s safe.

Apr 1st, 2010 | by OurHealthCareSource.com

It’s that time of year again. Census time. Yes, this year we have to take 10 minutes out of our busy schedules and answer 10 easy questions… and we’re done – for 10 years! Simple questions that determine how $400 Billion – yes, that’s BILLION -get distributed to each state.

During the 2000 Census collection, over 70% of Americans sent their surveys back as instructed. But many surveys had to be completed with the help of U.S. Census workers who traveled door to door canvassing the streets to find individuals who just couldn’t find the time to make this a priority. And why shouldn’t they just wait for a knock on the door?

Get this: For each percentage point we can raise the response rate, the feds reportedly will save about $85 million on door-to-door workers. Isn’t that reason enough?

But the population that traditionally struggles to complete their Census forms is the people we serve each day here at CareSource. Why? Because this population tends to be transient – not typically staying at one residence for any prolonged period of time. They also may not have an official address, or they may be homeless, or they live in a communal living situation. Whatever the case, during this census period, it’s extremely important that we get the people in our underserved communities counted.

That’s why CareSource is joining the national effort to reach out to our members to reinforce the importance of completing their census form. Our 820,000+ members qualify for Medicaid coverage and have income below 200 percent of the poverty level. Because the deadline is quickly approaching, we are posting information to our Web site as a reminder for both members and our vast provider network (22,000+ providers, 210 hospitals). We’re also adding a hold message on our customer service line (pending state approval) to encourage our members to “Be Counted” and why it’s so important.

But we didn’t stop there. As a large employer, we have also encouraged our 900 employees to complete their census forms and have reiterated why it’s so important for a publicly funded, not-for-profit company like CareSource to support this national endeavor. Recurring messages will be sent to employees to provide constant reminders prior to the April 15th deadline.

According the NAACP and the federal government, here is why it is so important to get everyone counted – especially families struggling with poverty:

• Federal Funds: For each 100 people not counted, a community risks losing an estimated $1.2 million over the next decade for federally funded programs including: Medicaid, public housing assistance, child health programs, Head Start, transit programs, and more.
• Political Representation: States use census numbers to redraw all political boundaries and determine which states gain or lose representation, including Congressional Districts, state house and senate districts for city councils, school committees and county board.
• Public Infrastructure: All levels of government rely on census numbers to locate vital public works like schools, health centers, public transportation, highways, and affordable housing.
• Private Investment: Businesses large and small use census numbers to identify new markets, select sites for operations, make investment decisions and determine the goods and services offered.

When families do not participate in the census, it means their communities lose access to money, resources and power. On behalf of our country’s underserved communities, please encourage the families and organizations you interact with to complete and return their census form. It’s easier than ever. The 2010 Census form asks 10 questions and takes about 10 minutes to complete. But the key is – IT MUST BE MAILED BACK TO BE COUNTED. Simply mail it back using the postage-paid return envelope by April 15, 2010. Telephone assistance in filling out the form is also available by simply calling 1-866-872-6868.

For those who do not respond, census workers will visit households that do not return forms to take the count in person. But don’t forget – the higher the participation rate, the cheaper the census will cost taxpayers. Just think – if we increase the rate of response from 70 to 80 percent, that’s an estimated $850 million in savings!

It’s easy. It’s important. It’s safe. For more information about the 2010 Census and the “Take 10″ initiative, visit www.2010census.gov.

Money Can’t Solve Everything…Some Issues Require a Shift in Behavior

Mar 8th, 2010 | by OurHealthCareSource.com

I read an interesting opinion piece today by Rep. Joe Baca (D-California) in the Huffington Post. He brings up an issue that he feels hasn’t been addressed enough in the health care reform debate – “emergency care in many of our nation’s hospitals is in bad shape, and doctors and patients are paying the price.” The article goes on to explain that hospitals are in bad shape because of their requirement to provide emergency care for any and all people whether they have insurance or not. He cites the unfortunate fact that over 70 hospitals in his state have closed down due to financial pressures.

His solution: “adequately reimburse for the mandated emergency services they provide.”

This is certainly a solution, and probably a fair one at that – hospitals should be reimbursed appropriately for the services and care they provide. But part of the reason why the financials of our hospital’s emergency rooms are an issue is due to how they are being used. Too many people use emergency rooms as a primary care facility – seeking medical care for the flu or a sore throat or a minor fever.

This is a behavioral issue, not necessarily a money issue. We as an industry need to do a better job in educating people on how to responsibly engage the health care system. This is particularly important for the underserved population that accepts publicly funded health coverage. As a Medicaid managed care company, we believe this is a significant part of our role since many of our members are faced with poverty and typically access health care when and where it is most convenient. It’s why we assign case managers to our members. It’s why we look closely at ER utilization rates to identify opportunities to reach out to our members and educate them on appropriate usage. It’s why we have a 24-hour nurse line devoted to helping our members determine if their medical condition is a true emergency. It’s why we provide value-added services to our members like transportation to doctor appointments.

But providing these services must be balanced with patient accountability and sufficient access to primary care providers. The entire industry – insurance plans, providers, hospitals, advocacy groups, government – needs to embrace the idea that educating people about proper health care engagement is a critical strategy to lowering costs and increasing quality of care.

We certainly see the prospect of increasing Medicaid eligibility nationwide as a positive step toward helping underserved people access care without sending them to bankruptcy court. But giving people a shiny, new medical card means little without investing in resources which guide people to the appropriate setting – especially those who are more worried about where to get their next meal or how to put off an eviction.

People need to understand the difference between an emergency and non-emergency medical need. People need to understand the potential impact they have on the system when they miss a doctor’s appointment. Or the effect it has on the system when a person decides not to take his/her medication as prescribed.

This needs to become an industry effort. We can keep on throwing money or taking away money from various aspects of the health care system. But when it comes down to it, we need to address the behavioral aspect of users. We need to educate people about how to engage, and we need to find creative ways to do so.

What ideas do you have around how to better educate people about accessing the health care system?

Reconciliation as a last resort? Yes, it should be.

Feb 24th, 2010 | by OurHealthCareSource.com

So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.

This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.

So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.

The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?

Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?
All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.

It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.

A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?

Honoring the Health Care Presidents

Feb 11th, 2010 | by OurHealthCareSource.com

We all hear “Presidents Day” and think “Washington and Lincoln.” Banks and post offices are closed and for some, another well deserved federal holiday. But that’s just habit.
This year, we might do well to remember another group of presidents–those who have done their best to establish a better health care system for the nation. Every president for the past 75 years has been part of the struggle, yet we still have a system that not only bankrupts individual citizens without regard, it decimates state budgets and paralyzes the federal government from making substantive improvements to the nation’s economy.

While Lyndon Johnson gets much of the credit for getting Medicare and Medicaid passed into law, the true hero of Medicare was John F. Kennedy, who worked, negotiated, and hammered out a solution that would help Americans – and actually found a way to get it approved by Congress.

Medicare has worked fairly well for fifty years—but at the time, the same doubts were voiced that we are hearing today—the bill’s imperfections were too great. At a rally in New York to support health care for the elderly, Kennedy confronted the question: “We’ve got great unfinished business in this country,” he said, “and while this bill does not solve our problems in this area, I do not believe it is a valid argument to say ‘This bill isn’t going to do the job.’ It will not, but it will do part of it.”

The comprehensive health care reform we need today is even more critical than when Kennedy spoke those words in 1962. No, it may not be entirely accomplished by the plans now being discussed in Congress. Yes, it’s imperfect, but the cost of doing nothing is unacceptable. Turning our backs now, when we have a solid plan that insures over 90 percent of Americans; that bends the health care cost curve; that brings down premiums and that strengthens Medicare for seniors, is simply irresponsible. This plan is the closest we’ve ever come to true reform.

There’s no need to give up. Let’s call upon Congress to deliver a bill to the President in recognition of President’s Day. Moreover, for all the presidents before him who have fought tirelessly to get Americans a health care system that will move us one step closer to handling this country’s “unfinished business.”

What do you thing has been the most significant achievement in reforming health care up until now, and which President do you think gets the most credit?”