Monday, October 31, 2011

HHS Announces Refined Survey Standards to More Constitently Measure Care Disparities

The U.S. Department of Health and Human Services (HHS) released final standards to more consistently measure race, ethnicity, sex, primary language, and disability status, thereby improving the ability to highlight disparities in health status and target interventions to reduce these disparities.

“It is our job to get a better understanding of why disparities occur and how to eliminate them. Improving the breadth and quality of our data collection and analysis on key areas, like race, ethnicity, sex, primary language and disability status, is critical to better understanding who we are serving,” said HHS Secretary Sebelius. "Today, through these new standards, we are providing a new set of powerful tools to help us achieve our vision of a nation free of disparities in health and health care.”

The Affordable Care Act requires new standards for the collection and reporting of health care information based on race, ethnicity, sex, and primary language. Making data standards consistent will help identify the significant health differences that often exist between and within ethnic groups, particularly among Asian, Hispanic/Latino and Pacific Islander populations.

For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 per 100, 000) and Puerto Ricans (204 deaths per 100, 000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100, 000). However, this information would have remained unknown if only the umbrella terms of “Hispanic” or “Latino” had been used.

By adding Mexican American and Chicano/a, Puerto Rican, Cuban, and other Hispanic Latino/a or Spanish origin as explicit categories required on all HHS-sponsored health surveys, we can better capture the individual ethnic group challenges that are often found within minority populations. This specificity allows for better measurement and tracking of health differences in these populations and target interventions appropriately.

The new data collection requirements also will improve researchers' ability to consistently monitor more dimensions of health disparities among people with disabilities. Collection of all data will take place under HHS’ longstanding, strict commitment to protecting privacy.

“Many racial and ethnic minorities, people with limited English proficiency, people with disabilities, and other populations face unique health challenges, often have reduced access to health care and often pay the price with poorer health,” said Garth Graham, M.D., MPH, HHS deputy assistant secretary for minority health. “Today we are implementing an important provision of the Affordable Care Act that reinforces our commitment to reducing these health disparities. These new standards will help us carry forward the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and our work to address disparities in people with disabilities as well.”

The standards, effective upon publication today, apply to health surveys sponsored by HHS where respondents either self-report information or a knowledgeable person responds for all members of a household. The standards will be used in all new surveys and at the time of revision to current surveys.

For more information on the final data standards, visit

Source: HHS News Release

NLM Honors Winners of Software Development Challenge

Five innovative software applications that help researchers, health professionals, and the general public in their quest for medical and scientific information are the winners of the National Library of Medicine's first software development challenge.

The winning applications can help people learn about anatomy, help researchers find gene information in research literature, and help people sift through large amounts of scientific and medical information.

The library's software development challenge, Show off Your Apps: Innovative Uses of NLM Information, solicited applications that used the library’s data to develop innovative ways for people to obtain and share scientific and medical information. Entrants could create a new app, or submit an existing one. An independent panel of judges chose five winners and five honorable mentions.

The National Library of Medicine (NLM), part of the National Institutes of Health, is the world’s largest medical library and itself a pioneer and innovator in the use of technology to improve access to biomedical and health information. NLM provides a wide variety of information online by developing groundbreaking databases and software tools that enable people to explore medical literature, clinical trials, historical images, DNA sequences and much more.

"NLM was a leader in open data long before that term was coined," says U.S. Department of Health and Human Services (HHS) Chief Technology Officer Todd Park. "Challenges like this one bring the library’s rich data sources to the attention of new groups of innovators."
"By making our data available for others to use, we spark more innovation and give taxpayers a bigger dividend on their investment," says Donald A.B. Lindberg, M.D., director of the NLM, which is celebrating its 175th anniversary this year.

Click here to view the winners of the Challenge.

Click here for more information about the Software Development Challenge.

Source: NIH News Release

Monday, October 24, 2011

CMS Proposes Regulatory Reduction Rules

On October 18, the Centers for Medicare & Medicaid Services (CMS) took steps to reduce unnecessary, obsolete, or burdensome regulations on American hospitals and healthcare providers. These steps would help achieve the key goal of President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and would save nearly $1.1 billion across the health care system in the first year for a total of over $5 billion over 5 years.

CMS proposed two sets of regulatory reforms and finalized a third. All are designed to improve transparency and help providers operate more efficiently by reducing their regulatory burden. One set proposes updates to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). The second set addresses regulatory requirements for a broader range of health care providers and suppliers who are regulated under Medicare and Medicaid. CMS also finalized a third rule reducing regulatory burden for ambulatory surgical centers (ASCs).

CMS estimates that annual savings to hospitals from the proposed revisions to the Conditions of Participation could exceed $900 million in its first year as hospitals increasingly use this new flexibility. The Medicare Regulatory Reform rule could save up to $200 million in the first year. The final rule for ASCs could generate an extra $50 million in savings per year.

Taken together, these three rules would reduce hospital and other healthcare provider costs by nearly $1.1 billion the first year. These cost savings would come directly from reduced regulatory burdens, and are not accompanied by reimbursement reductions. As such, all of these savings would be available to help providers improve the quality of care they provide to Medicare beneficiaries and all Americans.

Click here to view the news release.

Source: CMS News Release

CMS Launches Innovation Advisors Program

The Centers for Medicare & Medicaid Services (CMS) announced that it was accepting applications for a new Innovation Advisors program to help health professionals deepen skills that will drive improvements to patient care and reduce costs. These health care improvements will benefit people enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Made possible by the Affordable Care Act, this initiative will be managed by the Center for Medicare and Medicaid Innovation (Innovation Center).

“We seek to support and expand the number of health care leaders with the knowledge and the vision to find innovative ways to improve care for patients and use our healthcare dollars more wisely,” said CMS Administrator Don Berwick, M.D. “The CMS Innovation Center is an ideal host for this network of experts. It will support their work on efforts that can strengthen public-private partnerships and ensure patients can spend more time with their doctor and get higher-quality care and lower costs.”

Under the new program, there will be up to 200 Innovation Advisors, including clinicians, allied health professionals, health administrators and others. They will attend in-person meetings as well as remote sessions to expand their skills and knowledge, and apply what they learn in their organizations and areas.

After an initial, intensive orientation phase, Innovation Advisors will work with the Innovation Center to test new models of care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States.

Innovation Advisors will be expected to commit up to 10 hours per week to the Innovation Advisor Program during the initial six months of the program, with part of that time devoted to seminars and instruction. The rest of that time will be devoted to implementing the improvement project they propose in their initial application. The Innovation Advisors who are selected will meet regularly to exchange insights, report on successes and discuss common challenges.

This initiative is just one of a number of efforts made possible by the Affordable Care Act to help bring better health and better health care not just to Medicare beneficiaries, but also to all Americans, while helping use healthcare dollars more wisely. Already, more than 5,000 organizations have joined the Partnership for Patients and pledged to reduce hospital-acquired conditions and improve transitions in care. The Bundled Payments for Care Improvement initiative will give providers flexibility to work together to coordinate care for patients over the course of a single episode of an illness. The Comprehensive Primary Care Initiative will allow CMS and other payers, such as employer-based health plans, to align strategies designed to strengthen primary care services delivered to Medicare beneficiaries.

Applications for the Innovation Advisors program are due on November 15, 2011. Applications will be reviewed and Innovation Advisors will be notified of their selection by mid-December 2011.

More information, including a fact sheet, frequently asked questions, application and terms and conditions can be found at:

Source: CMS News Release

HHS Releases New Program to Help Providers Give Better Care to Medicare Patients

People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care under a final regulation issued today by the Department of Health and Human Services (HHS).

Created by the Affordable Care Act, these final rules on Accountable Care Organizations add to the menu of options for providers looking to better coordinate care for patients and will make it easier for providers to deliver high quality care and use health care dollars more wisely.
The initiatives announced are just two of several efforts made possible by the Affordable Care Act to help bring better health, better care and lower costs not just to Medicare beneficiaries, but to all Americans. For example, the Bundled Payments for Care Improvement Initiative and Comprehensive Primary Care Initiative offer alternatives to coordinate and improve health care.

“Today we have taken another step to improve health care for people with Medicare,” said HHS Secretary Kathleen Sebelius. “We are excited to give doctors, hospitals and other providers the flexibility and support they need to work together and focus on making sure patients get the care they need.”

“This model of delivering care may not be right for everyone, but it provides new incentives for doctors, hospitals, and other health care providers to work together in new ways,” said Secretary Sebelius.

The two initiatives launched – the Medicare Shared Savings Program and the Advance Payment model – will help providers form Accountable Care Organizations and reflect the significant input provided by stakeholders as well as lessons learned by innovators in care coordination in the private sector.

The Medicare Shared Savings Program will provide incentives for participating health care providers who agree to work together and become accountable for coordinating care for patients. Providers who band together through this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. The higher the quality of care providers deliver, the more shared savings the providers may keep.

The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.

“As a physician I understand the complexities of caring for a patient who may have multiple providers,” said Donald M. Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS). “This opportunity to coordinate care among providers could greatly improve the quality of care Medicare beneficiaries receive.”

Both the Medicare Shared Savings Program and Advance Payment model create incentives for health care providers to work together to treat an individual patient across care settings – including doctors’ offices, hospitals, and long-term care facilities.

Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. Rather, a determination of whether an Accountable Care Organization was responsible for coordinating care for a beneficiary will be based on whether that person received most of their primary care services from the organization.

“We listened very carefully to the more than 1,300 comments we received on the proposed rule released this spring, and this final rule includes a number of improvements suggested by those comments that will strengthen the program,” Dr. Berwick said. “For example, the final rule will increase the incentives and streamline the Shared Savings Program, extending the benefits of the new program to a broader range of beneficiaries.”

Other changes from the proposed rule include making the one-sided model truly one-sided, expanding participation to Rural Health Clinics and Federally Qualified Health Centers and organizations where specialists provide primary care, and providing a flexible starting date in 2012. Federal savings from this initiative could be up to $940 million over four years.

To aid organizations interested in becoming Accountable Care Organizations, CMS offers a number of learning opportunities for providers, including the third Accelerated Development Learning Session on November 17-18 in Baltimore. This free session will offer providers the opportunity to learn more about this option for providing care. For more information, visit

People with Medicare have received information about what an Accountable Care Organization could mean for them in the annual issue of “Medicare & You” and if their current health care provider is participating in an Accountable Care Organization, they will receive additional information from their provider.

The Shared Savings Program final rule can be found at: (See Final Rule on Shared Savings Program: Accountable Care Organizations)

The Advanced Payment solicitation is posted at:

For more information, fact sheets are posted at: and

The joint CMS and Department of Health and Human Services Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program can be found at: (See Request for Public Comment on Final Waivers in Connection with the Shared Savings Program).

The Antitrust Policy Statement is posted at: and

The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), is posted at:,,id=248490,00.html.

Source: HHS News Release

Medical Office Survey on Patient Safety Culture Comparative Database & Toolkit Available

AHRQ’s Medical Office Survey on Patient Safety Culture is a tool for medical offices to use to assess clinician and staff opinions about the culture of patient safety in their medical offices.
The database is a central repository for survey data from medical offices, health care systems, or survey vendors that have administered the AHRQ medical office survey instrument. It will produce comparative results among users to help medical offices identify strengths and opportunities for improvement in their patient safety culture.

Select for more information.

Source: AHRQ News Release

EHR Decision Support Tool Saved Physicians Time, Errors in Retrieving Clinical Information

A decision support tool generated by an electronic health record (EHR) that collects clinical information on ambulatory diabetes care saved primary care physicians more than 4 minutes compared to the conventional method of searching on multiple EHR screens, an AHRQ-funded study has found. Writing in the September/October 2011 issue of the Annals of Family Medicine, researchers at the University of Missouri family medicine department created an EHR-generated diabetes “dashboard” with the technology company Cerner. The dashboard collects important diabetes clinical data on one page and mirrors the information sought by national organizations to benchmark high-quality diabetes care. Physicians using the dashboard located the 10 data elements within 1.3 minutes, compared to 5.5 minutes among physicians searching multiple EHR screens. Physicians who used the dashboard correctly identified the data requested 100 percent of the time, compared to 94 percent for physicians using the conventional method.

Select for the article.

Source: AHRQ News Release

EHR Use Results in Higher Quality Care, AHRQ-Funded Study Finds

Patients who are treated by physicians using electronic health records (EHRs) were significantly more likely to receive care that corresponds to accepted treatment standards and get better care than patients treated by physicians who rely on paper records, a new AHRQ-funded study concludes. The study, published in the September 1 issue of the New England Journal of Medicine, examined physician practices in the Cleveland, OH, area that treated more than 27,000 adults with diabetes. Regardless of insurance mix, practices using EHRs showed higher achievement of care and outcome standards and greater improvement in diabetes care. Nearly half (43.7 percent) of the patients at EHR practice sites had diabetes outcomes that met at least four of the five standards, compared to 15.7 percent of patients at paper-based practice sites. Annual improvements in meeting care standards and quality outcomes were faster in practices with EHRs than paper-based practices. Select to access the article.

Source: AHRQ News Release

AHRQ Launches Initiative to Encourage Better Communication Between Clinicians and Patients

The U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) announced a new initiative with the Ad Council to encourage clinicians and patients to engage in open communication to ensure safer care and better outcomes.

AHRQ has long supported patients getting more involved in their health care, and this effort builds on previous public education campaigns with the Ad Council that encouraged patients to ask questions. In the new campaign, clinicians are reminded that a “simple question can reveal as much medical information as a medical test.”

The campaign also includes a series of videos featuring actual patients and clinicians who discuss why asking questions and sharing information is so important. Other elements of the campaign include an interactive tool that lets patients create a personalized list of questions based on their health condition; a new brochure that helps patients be more prepared before, during and after their appointment; and upcoming ads about the campaign for clinicians that will appear in a variety of print and online journals, including the New England Journal of Medicine, the Journal of the American Medical Association, and others.

Select for more information on the new initiative.

Source: AHRQ News Release

Tuesday, October 18, 2011

New CMS Proposed Rules Designed to Cut Red Tape

New proposed rules released by the Centers for Medicare & Medicaid Services (CMS) would reduce unnecessary, obsolete, or burdensome regulations and save hospitals and healthcare providers nearly $1.1 billion each year and over $5 billion over 5 years. The new proposals regarding the rules for hospitals that treat Medicare and Medicaid patients were developed in response to President Obama’s call on all Federal agencies to eliminate burdensome and unnecessary regulations.

“The President and I have challenged agencies to hunt down burdensome regulations,” said Vice President Joe Biden. “Today’s steps will remove outdated, duplicative, unnecessary burdens on hospitals - saving money and improving care.”

“President Obama has been clear: it’s time to cut the red tape,” said HHS Secretary Kathleen Sebelius. “Our new proposals eliminate unnecessary and obsolete standards and free up resources so hospitals and doctors can focus on treating patients.”

CMS proposed two sets of regulatory reforms and finalized a third. All are designed to improve transparency and help providers operate more efficiently by reducing their regulatory burden.

One set proposes to update the rules for hospitals that treat Medicare and Medicaid patients -- the Medicare Conditions of Participation. As an example, the proposed reforms would consolidate patient care plans and eliminate outdated requirements for hospital management. This could save hospitals over $900 million per year and perhaps grow to much more over time as hospitals increasingly use this new flexibility.

The second set of reforms address regulatory requirements for providers other than hospitals and could save up to $200 million in the first year. The rule would identify and begin to eliminate duplicative, overlapping, outdated, and conflicting regulatory requirements for healthcare providers and suppliers such as end-stage renal disease facilities and durable medical equipment suppliers. Examples of these reforms include updating obsolete e-prescribing technical requirements to meet current standards and eliminating other out-of-date and overly prescriptive requirements for healthcare providers.

CMS is also finalizing a third rule that reduces regulatory burden for ambulatory surgical centers (ASCs), which is expected to save ASCs $50 million per year. This rule makes common-sense changes to the requirements ASCs must follow in order to meet Medicare and Medicaid health and safety standards.

These regulatory reforms are just one part of a wide-ranging effort by the Obama Administration to improve the quality of health care and lower costs for all Americans, using important new tools provided by the Affordable Care Act. These efforts include the National Quality Strategy and the Partnership for Patients. These initiatives aim to reform the health care delivery system and bring together both private and public sector partners to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings. CMS intends to invest up to $1 billion to help drive these changes through the Partnership for Patients initiative. And beginning in FY 2013, for the first time, the Hospital Value-Based Purchasing program authorized by the Affordable Care Act will pay hospitals’ inpatient acute care services based partially on care quality, not just the quantity of the services they provide.

To view the proposed and final rules, please visit:

Both proposals invite the public, including doctors, hospitals, patient advocates, and other stakeholders, to comment. To submit a comment, visit, enter the ID number CMS-9070-P or CMS-3244-P, and click on “Submit a Comment.”

For additional information on these and other Conditions of Participation, visit

For additional information on the Department of Health and Human Services overall Plan for Retrospective Review of Existing Rules, visit

Source: HHS News Release

Monday, October 17, 2011

Health Care Reform Presents Opportunities for Performance Improvement

A recent article Becker's Hospital Review says that providers will need to find ways to reduce costs - particularly in Medicare and Medicaid - while maintaining or improving quality.

William C. Mohlenbrock, MD, FACS, discusses "three specific initiatives to improve quality and control costs [in the healthcare reform law]: the Medicare Shared Savings Program, which establishes Medicare accountable care organizations; the Bundled Payments for Care Initiative, which expands CMS' Acute Care Episodes; and Consumer Operated and Oriented Plans."

Source: Becker's Hospital Review

Friday, October 14, 2011

Journal of Hospital Medicine Shows Link Between Accreditation, Quality

New research published in the October issue of the “Journal of Hospital Medicine” shows that hospitals accredited by The Joint Commission outperformed non-accredited hospitals on nationally standardized quality measures of acute myocardial infarction (AMI), heart failure, and pneumonia and that the performance gap between Joint Commission accredited and non-accredited hospitals increased over the years of the study.

The study, “Hospital Performance Trends on National Quality Measures" is the first to show the association between Joint Commission accreditation status and performance improvement over a five-year reporting period.

Source: TJC News Release

HHS announces record number of National Health Service Corps members

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the number of participants in the National Health Service Corps (NHSC) has nearly tripled because of investments in the National Health Service Corps through the Affordable Care Act, the American Recovery and Reinvestment Act and annual appropriations. The NHSC has awarded nearly $900 million in scholarships and loan repayment to health care professionals to help expand the country’s primary care workforce and meet the health care needs of communities across the country.

“Thanks to the National Health Service Corps, more Americans can see a doctor and get the health care they need,” said HHS Secretary Sebelius. “The investments we made are improving health and creating access to care, fueling economic activity nationwide.”

Analysts: Debt Reduction Talks Stalling Hospital Expansion

Wall Street panelists at the Center for Studying Health System Change's (HSC) recent "Wall Street Comes to Washington" Conference say that expansions and construction of new hospitals aren't happening because of investor fears and over potential cuts that may be made by Congress to reduce the national debt.

"I think right now the biggest hurdle is planning," said Fitch Ratings analyst Jeff Schaub. "There are so many things that are unknown. And the planning cycle at acute care providers is five years, 10 years they’re looking out and there’s a big black hole starting 2013, 2014 and extending through 2017. So capital decisions that need to be made now, organizational decisions, affiliation decisions that really need to be made now are being made with a certain amount of contingency. Very often when I meet with hospitals they’re talking about...five, six, maybe even 20 different alternative views of the future and trying to quantify and make decisions among that entire array of possible outcomes."

Citigroup analyst Gary Taylor said that facilities that should be being built right now are probably not because investors do not know if how or if Congress will cost shift Medicare and Medicaid cuts to publicly-traded hospitals. “Since this debt ceiling debate took over and we’ve made commitments to reduce entitlement spending etcetera, publicly traded hospital stocks are down probably 40 percent on average, [and] nursing home stocks are down 70 and 80 percent on average,” Taylor said according to a report in CQHealthbeat (subscription required). “The collective wisdom of the market right now is that investing in . . . certain types of health care providers is extraordinarily risky because of the policy changes, primary reimbursement cuts, that are going to potentially come out of Congress.”

Source: CQ Healthbeat (subscription required); HSC Conference Transcript

ONC/FHA Call For Participants in HIMSS 2012 Interoperability Showcase

Is your organization successfully using nationally recognized standards to securely share patient data with other organizations? Demonstrate your successes within the Office of the National Coordinator for Health IT (ONC) and Federal Health Architecture (FHA) area in the HIMSS 2012 Interoperability Showcase!

ONC and FHA are looking to highlight cutting-edge interoperable health information exchange at HIMSS 2012, with a focus on ONC-related initiatives, including:

Nationwide Health Information Network
Direct Project
State HIE Programs
S&I Framework
SHARP Program
Regional Extension Centers
Beacon Communities

All nominated demonstrations must include interoperable health information exchange among at least three end user organizations. End users include healthcare organizations (hospitals, clinics, state or federal agencies, etc.) and health information exchanges, not health IT vendors or IT service providers. All demonstrations must be live. No canned demonstrations or static presentations will be considered.

A panel of ONC staff will evaluate all nominations and determine which nominated demonstrations will be included within the ONC/FHA area of the Interoperability Showcase. Only nominations directly related to ONC programs will be considered. Nominations are due October 26th at 5:00 p.m. ET, and the determination of who will be included will be made by November 2nd.

Complete information is here:
Source: ONC/FHA News Release

Friday, October 7, 2011

HSPH Study: Lower Quality, High Cost Hospitals Treat More Poor, Minorities

Hospitals with the lowest scores on certain quality and cost measures treat more than twice as many minority and poor patients as hospitals with the highest scores, according to a Harvard School of Public Health study published in Health Affairs.

The study compared quality and cost measures at roughly 3,200 hospitals with the proportion of minority and Medicaid patients the hospitals served. "As the United States embarks on efforts to improve hospital care using value-based purchasing principles, we will need to help hospitals improve quality and efficiency simultaneously and to monitor the results of their efforts, so that we do not inadvertently worsen disparities in care," the study concludes.

Maulik Joshi, president of the Health Research & Educational Trust and senior vice president of research for the AHA, said the AHA "is committed to sharing with hospitals tools and strategies that can help eliminate disparities in care. As noted by today's study and others in Health Affairs, there are many community-based influences on health and health care. We need to address the many factors that impact community health, such as access to preventive and follow-up care, and work with all stakeholders to ensure improved care for patients and communities."

Source: AHA News Release

Wednesday, October 5, 2011

Blue Cross Blue Shield Association Unveils Action Plan To Improve Healthcare Quality; Rein In Costs

The Blue Cross and Blue Shield Association (BCBSA) released a comprehensive, interconnected action plan that fundamentally transforms the healthcare system, moving it away from a fee-for-service model to a patient-centered model. The action plan, Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America, provides specific recommendations to improve healthcare quality and tackle rising costs and is based on the experience of BCBSA's 39 Plans in all 50 states and federal territories, in every market and every zip code. An independent economic analysis of the recommendations shows that, if adopted, this action plan will achieve more than $300 billion in federal savings over the next 10 years.

"We believe that the healthcare system needs to fundamentally change so that people get the best, most affordable care possible. We need to put the patient back in the center of healthcare and this is going to take a significant collaborative effort between both public and private sectors," said Scott P. Serota, president and CEO of BCBSA. "It's time to stop the finger pointing and start working together to make our system the best for patients. In Building Tomorrow's Healthcare System, we make specific recommendations for what the government should do and show how Blue companies nationwide have been working with doctors, hospitals, consumers and policymakers to transform the healthcare system."

The proposal lays out specific, actionable steps the government should take in four key areas:
1.Reward Safety: National and local leadership along with new provider incentives are needed to eliminate preventable medical errors, infections and complications that harm hundreds of thousands of people each year and cost billions of dollars.
2.Do What Works: The incentives in our system must be changed to advance the best possible care and reward quality outcomes, instead of paying for more services that are ineffective or redundant and add unnecessary costs to the system.
3.Reinforce Front-Line Care: A higher value must be placed on primary care and on ensuring there is an adequate workforce of professionals to deliver necessary, timely and coordinated care that results in better outcomes and lower costs.
4.Inspire Healthy Living: With 75 percent of today's healthcare dollar spent on the treatment of chronic illnesses — many of which are preventable — consumers must be empowered and encouraged to make better choices, live healthier lives and better manage their health.

If adopted, the recommendations would save $319 billion over the next decade according to an economic analysis by Ken Thorpe, Ph.D., Robert W. Woodruff Professor and Chair Department of Health Policy & Management Rollins School of Public Health, Emory University.

"The BCBSA proposal reflects a clear understanding of the transformational approach needed to reform our prevention and healthcare delivery system," said Thorpe. "Building evidence-based approaches to coordinate care for Medicare and Medicaid patients that will improve the quality and reduce healthcare spending is a discussion we need to have. Rather than simply shifting federal costs to seniors, the states, or elsewhere, these proposals have the potential to reduce total healthcare spending."

The proposal contains several examples of Blue Cross and Blue Shield initiatives underway across the country that can work as models for improving care and reducing costs. One example is the Michigan Health and Hospital Association's Keystone: ICU Program, which has dramatically reduced central line-associated bloodstream infection rates and ventilator-assisted pneumonia rates in ICU patients. More than 70 Michigan hospitals participate in this program and over a six-year period the initiative has saved 1,830 lives, eliminated an estimated 140,700 avoidable hospital days for patients, and saved more than $300 million.

"This action plan recommends changes that will bring about real improvement for our fragmented healthcare system," said Daniel Loepp, president and CEO, Blue Cross Blue Shield of Michigan. "In Michigan, and in local communities across the country, the Blues are seeing first hand the difference that these types of programs can make for patients. That is why we're encouraging the government to work with the private sector to expand on efforts that improve the quality and affordability of care."

To read Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America, please visit

Source: BCBSA Press Release

Monday, October 3, 2011

Medicare "Plan Finder" Available

In advance of the new, earlier annual enrollment period, people with Medicare can begin reviewing plan benefit and cost information on Saturday, October 1st, 2011. The Centers for Medicare & Medicaid Services (CMS) will launch access to its popular web-based Medicare Plan Finder that allows beneficiaries, their families, trusted representatives, and senior program advocates to look at all local drug and health plan options that are available for the 2012 benefit year.

“With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year,” said CMS Administrator Donald M. Berwick, M.D. “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.”

The annual enrollment period begins earlier this year, on October 15th, and runs through December 7th. People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage begins without interruption on January 1, 2012.

This year, as beneficiaries look over their available plan options, they will see better value in the Medicare Advantage (Part C) and Prescription Drug (Part D) plan benefits. All beneficiaries will have access to Medicare-covered preventive services at zero cost-sharing, including an Annual Wellness Visit. Those in the Part D coverage gap, or donut hole, will continue to receive 50 percent discounts on covered brand name drugs thanks to the Affordable Care Act. On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans expect enrollment to increase by 10 percent. Average premiums for Part D prescription drug plans will also decrease to $30 in 2012, about 76 cents less compared to the average 2011 premium. The premium amount is based on bids submitted by Part D plans for the 2012 plan year. Benefits in 2012 remain consistent with those offered in 2011.

People can use the Plan Finder – available at –by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas. If the zip code search shows multiple counties it will prompt users to select one county to continue the search. For 2010, the Plan Finder was the most popular tool on, with more than 280 million page views. Also available online is Medicare’s Formulary Finder, which allows beneficiaries to insert their prescribed medications and zip code to see a display of plans offered locally that cover their drugs.

Due to provisions in the Affordable Care Act, Medicare will begin to financially reward Medicare Advantage plans which achieve high quality ratings. Part D plans will also continue to receive quality ratings. Beginning October 12, the Medicare Plan Finder will include each plan’s quality star rating for 2012. For the first time this year, people who use the Plan Finder will also see a gold star icon designating the top rated 5-star plans, and will continue to see warnings for those plans who consistently are poor performers. “We encourage all Medicare beneficiaries enrolled in private plans to know their plan’s overall star rating and to consider enrolling in plans with high ratings,” said Jonathan Blum, CMS Deputy Administrator and Director, Center for Medicare. When comparing plans, beneficiaries should consider the plan’s quality in addition to its costs, coverage, and other conveniences. On October 15, people with Medicare will be able to make informed decisions when they select their plan for the coming year.

More information is available at, a new web-based portal brought to you by the U.S. Department of Health & Human Services.

Source: CMS News Release