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Health Plan Information
Communication exchange has never been so easily accessible and critical to the success of a national health programme. Gain a greater understanding of how effective communications strategies can help promote TB and HIV programmes and further disseminate important health messages to the public. During this course participants will receive training on how to write a professional press release, develop useful promotional tools, conduct media outreach, and discover how to build positive public awareness around an organisation’s work. Learning directly from experts working in mass communications, participants will engage in class exercises, discussions, and real-life simulations that demonstrate how skillful use of the media and communications can propel any health programme to excellence.
Benefits of Attending
Create powerful health-education messages that resonate with the public
Watch how to write a professional press release for public health topics
Increase TB/HIV advocacy abilities for community mobilisation
Discover how to manage a communications crisis
Prepare a communications plan for a health organisation
Confidently navigate the media landscape to identify useful players to promote health initiatives
Organise special events that put the spotlight on your health organisation
Find out how to make use of brochures, newsletters, activity reports, and other promotional tools that build health project awarenessI have to say I was surprised with the press reports last week that there wasn't "rate shock" in California when the California exchange offered preliminary information about their new plans and rates.
At least one prominent health actuarial group had predicted a 30% baseline increase in costs for California's new health insurance exchange plans under the Affordable Care Act (ObamaCare").
As the director of the California exchange put it, "These rates are way below the worst-case gloom-and-doom scenarios we have heard."
But a few days later there is lots more information coming out and it would appear we have a case of apples to oranges to grapefruit. And, we have a pretty good case of rate shock.
First, the exchange officials pointed out that we have to be careful to compare apples to apples when looking at 2013 rates and comparing them to the 2014 exchange rates because the 2014 exchange plans have far more generous benefits.
Yes we do, particularly when the California exchange forces us to give up our apple and buy a more expensive orange.
One of the reasons health insurance in the exchange will cost a lot more in most states is because the new health law outlaws many of the existing plans now being offered and requires only those much richer plans to be sold.
Are people going to get more coverage for their money? Yes. Do they want more coverage if the premium costs for those plans is a lot higher? Likely yes if taxpayers are paying for most of it. If not, clearly they didn't want to pay for it before. Come January, lots of California consumers in the small group and individual market are going to get a letter from their existing insurer telling them their current plan is no longer available and the cost of the new required plans will be a lot more.
Simply, the new law is taking plan design choices away instead of letting the consumer decide what is good for them. Does that matter in California?
As the LA Times reported, "The average premium for individual plans sold through EHealthInsurance in California was $177 per month last year. Covered California said the average premium for the three lowest Silver plans statewide will be $321 a month [+81% over two years], albeit for more comprehensive benefits."
For those insured right now, and the estimated 40% that won't be eligible for a federal premium subsidy, that sure looks like rate shock to me. For the 60% who will get a subsidy, this means the taxpayers are going to have to fork out lots more money.
Then one of the largest insurers in California, Blue Shield, announced that their average rate increase would be 13% under the new law. That sure looks better than the predicted 30% increase for California exchange plans.
But wait, that Blue Shield exchange plan in LA, for example, does not include UCLA Medical Center or Cedars Sinai. In fact, Shield's exchange network includes a total of only 24,000 physicians compared to 66,000 doctors in their full PPO network––only 36% of their usual network docs will be available.
Last week a national player told me there is a nationwide trend growing where the insurer offers a very limited list of providers exclusivity in their exchange plans for deeper payment discounts in the 30% range––the narrow network plan would be the health plan's only offering in the exchange. The tactic was described to me as a "quasi Medicaid strategy for the exchanges."
Health insurers have long struggled to keep premiums low by offering their customers lower benefit options at renewal. Apparently, with that option limited under the new health law, insurers are now sometimes opting to keep premiums lower by limiting provider options.
Let's be clear, "narrow network" plans that contract with fewer lower cost providers are a legitimate cost containment strategy. But Shield is only offering the narrow network in the exchange. While some health plans will sell their regular broader network outside the exchange, consumers can only get the federal premium subsidy inside the exchange. Looks like oranges to grapefruit to me.
The California exchange touted its announcement saying, "This is a home run for consumers in every region of California."
Let's see what California's individual and small group market consumers have to say once they start getting those renewal letters and go to the provider directory to see which doctors and hospitals they can go to.
An aside: I have to give LA Times reporter Chad Terhune lots of credit for staying with this story. During the past few days, he has written three articles (see links above). The first generally summarized the California Exchange press conference, the second dug a little deeper, and the third really got to the heart of the matter. In the end, LA readers got the whole story.
Health Information Exchange (HIE) is challenging. As I've written about previously, several state HIEs have failed or are failing.
There are Federal HIE goals, State Medicaid goals, private sector goals, and many varied sources of funding. Each stakeholder has their own self interest.
The Harvard Program for Health Care Negotiation and Conflict Resolution teaches about the "Walk in Woods", moving from self interest, to enlarged interests, to enlightened interests, to aligned interests.
On September 19, the HIT Council and the HIT/HIE Advisory Committee of Massachusetts stakeholders took such a walk to review a straw man plan that aligns all the interests and optimizes available budgets.
Here's the idea.
There's an ONC-approved State Health Information Exchange plan. There's a State Medicaid plan. There are many existing regional health information exchanges in Massachusetts.
We created a Venn diagram of all these projects and identified their points of intersection.
Then, we developed objective criteria for what could be done now, what needs minor policy/technical work and what needs substantial additional work.
The end result was a phased plan making 2012 the year of connectivity to support push transactions, 2013 the year of databases to support analytics/population health and 2014 the year of the pull transaction.
We then worked on reconciling sources of funds.
There are two state programs with substantial federal matching grants - the Medicaid Management Information System (MMIS) and HITECH funds for State Medicaid Health Plans. Every dollar from state resources that is invested in these programs yields $10 of spending. A very wise use of state funds would be to leverage every dollar using federal matching programs. Since 100% of hospitals in Massachusetts receive Medicaid funds, Federal matching programs for Medicaid improvements are ideal for building the "information highway" to connect stakeholders as well as for state public health gateways to receive syndromic surveillance, reportable lab, and immunization data required by meaningful use.
However, what if we build the highway, but no one uses it? It's important to connect EHRs by overcoming technical and resource barriers. Our workgroups will devise a plan to create a grant or procurement program that leverages ONC HIE funds to accelerate EHR to HIE connectivity.
With senders, receivers, and a pipe connecting the stakeholders, we have a clear HIE plan.
With aligned federal, state and private resources, we can define the timelines and we've developed Gantt charts for all our FY12 projects.
To guide the projects, we'll have 3 "functionality" workgroups
Finance and Sustainability Workgroup,
Technology and Implementation Workgroup
Legal & Policy Workgroup
and 2 "engagement" workgroups
Provider engagement & Adoption Workgroup
Consumer and Public Engagement Workgroup
With clear goals that align the interests of all parties, a budget that optimizes every source of funds, and a multi-stakeholder Advisory Committee with community-wide participation in workgroups, we have the foundation to move forward.
As we proceed with a sense of urgency, our rallying cry to all stakeholders is "focus on making the HIE happen, not on the impediments and barriers that we'll encounter along the way."
On March 22, ONC issued important privacy and security guidance to State Designated Entities. It addresses concerns from State leaders and other stakeholders that health information exchange efforts have been hampered and slowed by the lack of consistent approaches to core privacy and security issues. The Program Information Notice (PIN) provides clear national guidance.
It covers eight Core Domains
1. Individual access
2. Correction
3. Openness and transparency
4. Individual choice
5. Collection, use and disclosure limitation
6. Data quality and integrity
7. Safeguards
8. Accountability
Here's a summary of the highlights:
Access and Correction
Where HIE entities store, assemble or aggregate individually identifiable health information (IIHI), such as longitudinal patient records with data from multiple providers, HIE entities should make concrete plans to give patients electronic access to their compiled IIHI and develop clearly defined processes (1) for individuals to request corrections to their IIHI and (2) to resolve disputes about information accuracy and document when requests are denied.
Openness and transparency
Where HIE entities store, assemble or aggregate IIHI, individuals should have the ability to request and review documentation to determine who has accessed their information or to whom it has been disclosed.
Individual Choice
Push Model
Where HIE entities serve solely as information conduits for directed exchange of IIHI and do not access IIHI or use IIHI beyond what is required to encrypt and route it, patient choice is not required beyond existing law. Such sharing of IIHI from one health care provider directly to another is currently within patient expectations.
Pull Model
Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. Both opt-in and opt-out models can be acceptable means of obtaining patient choice provided that choice is meaningful
Use and Disclosure Limitation
In principle, a health care provider should only access the minimum amount of information needed for treatment of the patient.
Data quality and integrity
Where HIE entities store, assemble or aggregate IIHI, they should implement strategies and approaches to ensure the data exchanged are complete and accurate and that patients are correctly matched with their data.
Safeguards
HIE entities should conduct a thorough assessment of risks and vulnerabilities.
Accountability
HIE entities should ensure appropriate monitoring mechanisms are in place to report and mitigate non-adherence to policies and breaches.
In my view, these are very reasonable principles. The use of "shall" and "should" in these guidelines is important to note. Shall means your must and should means it's a good idea to try. Should is used for more aspirational goals that need additional technology, standards, and policies.
Massachusetts goes live with its statewide HIE this Fall, so it was very helpful that no new regulations are required by the PIN for Push transport models. The new guidance is completely aligned with the Strategic and Operating Plan we already have in process to replace existing paper-based workflows with electronic workflows leveraging current consent models.
Health Plan Information
Communication exchange has never been so easily accessible and critical to the success of a national health programme. Gain a greater understanding of how effective communications strategies can help promote TB and HIV programmes and further disseminate important health messages to the public. During this course participants will receive training on how to write a professional press release, develop useful promotional tools, conduct media outreach, and discover how to build positive public awareness around an organisation’s work. Learning directly from experts working in mass communications, participants will engage in class exercises, discussions, and real-life simulations that demonstrate how skillful use of the media and communications can propel any health programme to excellence.
Benefits of Attending
Create powerful health-education messages that resonate with the public
Watch how to write a professional press release for public health topics
Increase TB/HIV advocacy abilities for community mobilisation
Discover how to manage a communications crisis
Prepare a communications plan for a health organisation
Confidently navigate the media landscape to identify useful players to promote health initiatives
Organise special events that put the spotlight on your health organisation
Find out how to make use of brochures, newsletters, activity reports, and other promotional tools that build health project awarenessI have to say I was surprised with the press reports last week that there wasn't "rate shock" in California when the California exchange offered preliminary information about their new plans and rates.
At least one prominent health actuarial group had predicted a 30% baseline increase in costs for California's new health insurance exchange plans under the Affordable Care Act (ObamaCare").
As the director of the California exchange put it, "These rates are way below the worst-case gloom-and-doom scenarios we have heard."
But a few days later there is lots more information coming out and it would appear we have a case of apples to oranges to grapefruit. And, we have a pretty good case of rate shock.
First, the exchange officials pointed out that we have to be careful to compare apples to apples when looking at 2013 rates and comparing them to the 2014 exchange rates because the 2014 exchange plans have far more generous benefits.
Yes we do, particularly when the California exchange forces us to give up our apple and buy a more expensive orange.
One of the reasons health insurance in the exchange will cost a lot more in most states is because the new health law outlaws many of the existing plans now being offered and requires only those much richer plans to be sold.
Are people going to get more coverage for their money? Yes. Do they want more coverage if the premium costs for those plans is a lot higher? Likely yes if taxpayers are paying for most of it. If not, clearly they didn't want to pay for it before. Come January, lots of California consumers in the small group and individual market are going to get a letter from their existing insurer telling them their current plan is no longer available and the cost of the new required plans will be a lot more.
Simply, the new law is taking plan design choices away instead of letting the consumer decide what is good for them. Does that matter in California?
As the LA Times reported, "The average premium for individual plans sold through EHealthInsurance in California was $177 per month last year. Covered California said the average premium for the three lowest Silver plans statewide will be $321 a month [+81% over two years], albeit for more comprehensive benefits."
For those insured right now, and the estimated 40% that won't be eligible for a federal premium subsidy, that sure looks like rate shock to me. For the 60% who will get a subsidy, this means the taxpayers are going to have to fork out lots more money.
Then one of the largest insurers in California, Blue Shield, announced that their average rate increase would be 13% under the new law. That sure looks better than the predicted 30% increase for California exchange plans.
But wait, that Blue Shield exchange plan in LA, for example, does not include UCLA Medical Center or Cedars Sinai. In fact, Shield's exchange network includes a total of only 24,000 physicians compared to 66,000 doctors in their full PPO network––only 36% of their usual network docs will be available.
Last week a national player told me there is a nationwide trend growing where the insurer offers a very limited list of providers exclusivity in their exchange plans for deeper payment discounts in the 30% range––the narrow network plan would be the health plan's only offering in the exchange. The tactic was described to me as a "quasi Medicaid strategy for the exchanges."
Health insurers have long struggled to keep premiums low by offering their customers lower benefit options at renewal. Apparently, with that option limited under the new health law, insurers are now sometimes opting to keep premiums lower by limiting provider options.
Let's be clear, "narrow network" plans that contract with fewer lower cost providers are a legitimate cost containment strategy. But Shield is only offering the narrow network in the exchange. While some health plans will sell their regular broader network outside the exchange, consumers can only get the federal premium subsidy inside the exchange. Looks like oranges to grapefruit to me.
The California exchange touted its announcement saying, "This is a home run for consumers in every region of California."
Let's see what California's individual and small group market consumers have to say once they start getting those renewal letters and go to the provider directory to see which doctors and hospitals they can go to.
An aside: I have to give LA Times reporter Chad Terhune lots of credit for staying with this story. During the past few days, he has written three articles (see links above). The first generally summarized the California Exchange press conference, the second dug a little deeper, and the third really got to the heart of the matter. In the end, LA readers got the whole story.
Health Information Exchange (HIE) is challenging. As I've written about previously, several state HIEs have failed or are failing.
There are Federal HIE goals, State Medicaid goals, private sector goals, and many varied sources of funding. Each stakeholder has their own self interest.
The Harvard Program for Health Care Negotiation and Conflict Resolution teaches about the "Walk in Woods", moving from self interest, to enlarged interests, to enlightened interests, to aligned interests.
On September 19, the HIT Council and the HIT/HIE Advisory Committee of Massachusetts stakeholders took such a walk to review a straw man plan that aligns all the interests and optimizes available budgets.
Here's the idea.
There's an ONC-approved State Health Information Exchange plan. There's a State Medicaid plan. There are many existing regional health information exchanges in Massachusetts.
We created a Venn diagram of all these projects and identified their points of intersection.
Then, we developed objective criteria for what could be done now, what needs minor policy/technical work and what needs substantial additional work.
The end result was a phased plan making 2012 the year of connectivity to support push transactions, 2013 the year of databases to support analytics/population health and 2014 the year of the pull transaction.
We then worked on reconciling sources of funds.
There are two state programs with substantial federal matching grants - the Medicaid Management Information System (MMIS) and HITECH funds for State Medicaid Health Plans. Every dollar from state resources that is invested in these programs yields $10 of spending. A very wise use of state funds would be to leverage every dollar using federal matching programs. Since 100% of hospitals in Massachusetts receive Medicaid funds, Federal matching programs for Medicaid improvements are ideal for building the "information highway" to connect stakeholders as well as for state public health gateways to receive syndromic surveillance, reportable lab, and immunization data required by meaningful use.
However, what if we build the highway, but no one uses it? It's important to connect EHRs by overcoming technical and resource barriers. Our workgroups will devise a plan to create a grant or procurement program that leverages ONC HIE funds to accelerate EHR to HIE connectivity.
With senders, receivers, and a pipe connecting the stakeholders, we have a clear HIE plan.
With aligned federal, state and private resources, we can define the timelines and we've developed Gantt charts for all our FY12 projects.
To guide the projects, we'll have 3 "functionality" workgroups
Finance and Sustainability Workgroup,
Technology and Implementation Workgroup
Legal & Policy Workgroup
and 2 "engagement" workgroups
Provider engagement & Adoption Workgroup
Consumer and Public Engagement Workgroup
With clear goals that align the interests of all parties, a budget that optimizes every source of funds, and a multi-stakeholder Advisory Committee with community-wide participation in workgroups, we have the foundation to move forward.
As we proceed with a sense of urgency, our rallying cry to all stakeholders is "focus on making the HIE happen, not on the impediments and barriers that we'll encounter along the way."
On March 22, ONC issued important privacy and security guidance to State Designated Entities. It addresses concerns from State leaders and other stakeholders that health information exchange efforts have been hampered and slowed by the lack of consistent approaches to core privacy and security issues. The Program Information Notice (PIN) provides clear national guidance.
It covers eight Core Domains
1. Individual access
2. Correction
3. Openness and transparency
4. Individual choice
5. Collection, use and disclosure limitation
6. Data quality and integrity
7. Safeguards
8. Accountability
Here's a summary of the highlights:
Access and Correction
Where HIE entities store, assemble or aggregate individually identifiable health information (IIHI), such as longitudinal patient records with data from multiple providers, HIE entities should make concrete plans to give patients electronic access to their compiled IIHI and develop clearly defined processes (1) for individuals to request corrections to their IIHI and (2) to resolve disputes about information accuracy and document when requests are denied.
Openness and transparency
Where HIE entities store, assemble or aggregate IIHI, individuals should have the ability to request and review documentation to determine who has accessed their information or to whom it has been disclosed.
Individual Choice
Push Model
Where HIE entities serve solely as information conduits for directed exchange of IIHI and do not access IIHI or use IIHI beyond what is required to encrypt and route it, patient choice is not required beyond existing law. Such sharing of IIHI from one health care provider directly to another is currently within patient expectations.
Pull Model
Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. Both opt-in and opt-out models can be acceptable means of obtaining patient choice provided that choice is meaningful
Use and Disclosure Limitation
In principle, a health care provider should only access the minimum amount of information needed for treatment of the patient.
Data quality and integrity
Where HIE entities store, assemble or aggregate IIHI, they should implement strategies and approaches to ensure the data exchanged are complete and accurate and that patients are correctly matched with their data.
Safeguards
HIE entities should conduct a thorough assessment of risks and vulnerabilities.
Accountability
HIE entities should ensure appropriate monitoring mechanisms are in place to report and mitigate non-adherence to policies and breaches.
In my view, these are very reasonable principles. The use of "shall" and "should" in these guidelines is important to note. Shall means your must and should means it's a good idea to try. Should is used for more aspirational goals that need additional technology, standards, and policies.
Massachusetts goes live with its statewide HIE this Fall, so it was very helpful that no new regulations are required by the PIN for Push transport models. The new guidance is completely aligned with the Strategic and Operating Plan we already have in process to replace existing paper-based workflows with electronic workflows leveraging current consent models.
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