Arthur Douglas Insurance Services

 

 

 
Supreme Court Schedules Week of Health Care Arguments

 

The Sacramento Bee, By Jesse J. Holland -

 

December 20, 2011: WASHINGTON — The Supreme Court announced Monday that it will use an unprecedented week’s worth of argument time in late March to decide the constitutionality of President Barack Obama’s historic health care overhaul before the 2012 presidential elections.

 

The high court scheduled arguments for March 26th, 27th and 28th over the Patient Protection and Affordable Care Act, which aims to provide health insurance to more than 30 million previously uninsured Americans. The arguments fill the entire court calendar that week with nothing but debate over Obama’s signature domestic health care achievement.

 

With the March dates set, it means a final decision on the massive health care overhaul will likely come before Independence Day in the middle of Obama’s re-election campaign. The new law has been vigorously opposed by all of Obama’s prospective GOP opponents. Republicans have branded the law unconstitutional since before Obama signed it in a March 2010 ceremony.

 

In an extraordinary move, the justices are hearing more than five hours of arguments over the health care overhaul. In the modern era, the last time the court increased that time anywhere near this much was in 2003 for consideration of the McCain-Feingold campaign finance overhaul. That case consumed four hours of argument. The Supreme Court will start the week of arguments that Monday with one hour on whether court action is premature because no one yet has paid a fine for not participating in the overhaul.

 

Federal law generally prohibits challenges to taxes until they are paid. The 4th U.S. Circuit Court of Appeals in Richmond, Va., ruled earlier this year that the penalty for not purchasing insurance will not be paid before federal income tax returns are due in April 2015, therefore it is too early for a court ruling.

 

Tuesday’s arguments will take two hours, with lawyers debating the central issue of whether Congress overstepped its authority by requiring Americans to purchase health insurance starting in 2014 or pay a penalty. The White House says Congress used a “quintessential” power – its constitutional ability to regulate interstate commerce, including the health care industry – when it passed the overhaul. But opponents of the law, and the 11th U.S. Circuit Court of Appeals in Atlanta, say that Congress overstepped its authority when lawmakers passed the individual mandate. A divided Atlanta court panel ruled that Congress cannot require people to “enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.” The Atlanta court is the only one of four appellate courts that found the mandate unconstitutional.

 

Finally, Wednesday’s arguments will be split into two parts, with justices hearing 90 minutes of debate over whether the rest of the law can take effect even if the health insurance mandate is unconstitutional and an extra hour of arguments over whether the law goes too far in coercing states to participate in the health care overhaul by threatening to cutoff federal money.

 

The law’s opponents say the whole thing should fall if the individual mandate falls. The administration counters that most of the law still could function, but says the requirements that insurers cover anyone and not set higher rates for people with pre-existing conditions are inextricably linked with the mandate and shouldn’t remain in place without it.

 

The court also will look at the expansion of the joint federal-state Medicaid program that provides health care to poorer Americans, even though no lower court called that provision into question. Florida and 25 other states argued unsuccessfully in lower courts that the law goes too far in coercing them to participate by threatening a cutoff of federal money. The states contend that the vast Medicaid expansion and the requirement that employers offer health insurance violate the Constitution.

 

 

 
Obama Passes Essential Health Benefits ‘Hot Potato’ to States

 

Bloomberg, By Alex Wayne -

 

December 18, 2011: The Obama administration avoided a potentially brutal lobbying battle over the medical benefits insurers must cover under the U.S. health-care overhaul when it decided last week to hand the decision off to states.

 

The Dec. 16 ruling, coming less than a year before the presidential elections, gives states the power to set coverage levels for the policies uninsured people will buy through regulated marketplaces, called exchanges, starting in 2014. Business groups will argue for a narrow set of benefits to save costs while consumer advocates push for more coverage. The decision shifts the debate to statehouses and away from the White House, and lets President Barack Obama say he’s giving governors and legislatures more flexibility within their own communities to confront rising medical costs and control changes brought about by the 2010 health-care law.

 

“Obama has taken all the grief he can stand over health care,” said Erik Gordon, a business professor at the University of Michigan in Ann Arbor, in an e-mail “He doesn’t want it to give the Republicans any more political ammunition. He is passing the hot potato to the states.” About 24 million people are projected to buy coverage through exchanges by 2019, according to the Congressional Budget Office. Premiums will average $5,800 for individuals and $15,200 for families in 2016.

 

Similar Services

 

Under the new guidelines, state lawmakers must either set coverage levels in line with widely subscribed small- business plans in their communities, or peg them to benefits included in their state employees’ health plan, federal employee plans or the largest commercial managed- care plan in the state.

 

Generally, health plans for small businesses, state employees and federal workers “cover similar services,” including doctors’ visits, hospitalization and outpatient mental health, according to a study conducted by the U.S. Health and Human Services Department ahead of the Dec. 16 announcement.

 

Differences arise in areas such as prescription drugs. While they’re covered as a basic benefit by all government employee plans, only 84 percent of small business plans include them. The others require additional premiums, the study found. Small business plans also don’t tend to cover dental care, acupuncture, bariatric surgery and hearing aids, unless states require it, the study showed. Federal plans cover those services.

 

Business’ Preference

 

“Businesses would rather deal with states, many of whom are far more sympathetic than Washington is to claims that high benefits will bankrupt employers,” the University of Michigan’s Gordon said. “Given the competition for jobs, I expect to see regulatory arbitrage bid down required coverages,” he said. The lack of national standards may allow some states to skimp in areas such as maternity coverage, said Debra Ness, president of the National Partnership for Women & Families in Washington, in a statement.

 

The administration’s ruling is “a grave disappointment” that ignores the health-care law’s direction “to develop a detailed package that would apply uniformly to plans across the nation,” Ness said. States that have delayed implementing the health-care law have one less excuse for not moving forward, said Ethan Rome, executive director of Health Care for America Now, a coalition of labor and civil rights groups that supports the statute.

 

Balancing Priorities

 

“This shifts the battle over essential benefits to state capitals, where the insurance lobby is strongest and where it will advocate for inadequate benefits that won’t meet the needs of people,” Rome said. “State regulators need to have a transparent process in making these important decisions and should stand up for consumers.”

 

Neil Trautwein, a vice president at the National Retail Federation, heads a coalition of business groups and insurers lobbying for a narrow coverage package. He says both the federal and state governments need “to develop a rule that balances state-selected and reasonably comprehensive benefits with affordability for employers and Individuals,” no matter which state is involved. Rules that do otherwise “will make health coverage more expensive for employers and individuals to purchase and make jobs more difficult for employers to create,” he said.

 

Guaranteed Coverage

 

Many states already set minimum benefit levels in regulating insurers. Idaho, for instance, mandates insurers to cover just 13 types of health services while Rhode Island requires coverage of 69, according to the Council on Affordable Health Insurance, an industry group. The health law, though, created insurance exchanges as a way to guarantee coverage for those who don’t have it now and for people who find it hard to be accepted by a health plan because of pre-existing medical conditions.

 

The federally mandated exchanges are central to the law’s goal to expand coverage to as much as 95 percent of Americans. The law, though, left open many questions involving how thye would be set up and run, opening the way for the Obama administration to control that through regulatory guidelines.

 

The decision not to impose national standards is in line with other moves by the administration this year as it develops rules to expand coverage to a projected 32 million people.

 

More State Options

 

Regulations released by the U.S. Deparment of Health and Human Services in July gave states wide latitude to design and run the markets. The administration also offered conditional certification for states that make good-faith efforts to establish exchanges but aren’t able to meet a 2013 deadline.

 

HHS also issued several directives it said were aimed at giving states more options to design their own Medicaid programs. States and the federal government run Medicaid, with the U.S. approving changes in eligibility standards by granting waivers from national law. The program is among the biggest expenses for states and also a prominent vehicle to expand coverage to the uninsured under the law.

 

A February letter from the U.S. to states raised the prospect of dropping some adults with incomes exceeding 133 percent of the federal poverty level from the program to close budget shortages.

 

Still, foes of the 2010 health-care law say the moves don’t go far enough.
The law itself is the issue, not how it is regulated, said Senator Orrin Hatch of Utah, the senior Republican on the Finance Committee, suggesting that it will remain a key campaign issue in the presidential elections no matter what the Obama administration does to dim protests on specific issues.

 

“The framework proposed by the administration takes away the right of individuals to chose the health care plan that best fits their needs,” Hatch said after the administration announced states would set benefit rules.

 

 

 
What’s up, doc fix?

 

POLITICO Pro, By Joanne Kenen -

 

December 14, 2011: It’s that time of year again — the dreaded congressional quest for billions of dollars for the “doc fix.” Which is a bit of a misnomer, as it isn’t the docs who are broken. Though if they were to actually get a 27 percent pay cut slated for Jan. 1, they could soon be broke. It’s a foregone conclusion that Congress will avert such a deep cut — although it could take them into early next year to figure out how to undo it, and for how long.

 

Doc fix is Washington shorthand for the Sustainable Growth Formula, a mouthful of a payment plan wrapped into a 1997 budget law. It was supposed to be a so-smart way of linking physicians costs, Medicare enrollment and the GDP. Only it didn’t work. And everyone knows it. The irony is that this annual scramble still occurs even though pretty much everyone in Washington — Democrats, Republicans, politicians, policymakers and the medical establishment itself — have concluded that the SGR system is broken beyond repair and should be replaced.

 

Not only does the price tag cause a severe bout of budgetary indigestion, the payment system itself perpetuates much of what’s wrong with fee for service medicine. Doctors are paid for how much they do, not how well they do it. And to a certain extent, cutting physician payments for specific services only encourages them to offer more services. Health policy researchers don’t agree on exactly how much they boost services to maintain income, or which medical specialties do the most, but the bottom line is clear: More tests. More imaging. Two doctors appointments where one used to suffice.

 

Until 2002, payments under the SGR formula rose modestly and doctors were happy, or at least not egregiously unhappy. Then, in 2002, doctors got an honest to goodness 4.8 percent Medicare fee cut under the formula. But when more (and deeper) cuts were called for in later years, doctors revolted. Congress balked. From then on, it got worse. Each year, Congress put off, canceled out, or shrank the pay cut. Doctors’ fees grew a bit, or occasionally were frozen. That didn’t solve the problem. It just made it bigger.

 

A few years ago, the cost of fixing SGR was around $50 billion. Now, the full cost of all those delayed cuts amounts to around $300 billion over 10 years. Double that in another five. And that 27 percent doesn’t even include the 2 percent across-the-board Medicare provider cuts that will be triggered starting in 2013 under last summer’s debt deal. The supercommittee failed to avert them by finding another way to save $1.2 trillion over 10 years. And numbers like that can create an access problem, as more doctors could stop taking Medicare patients or cut back on the number of elderly and disabled people they see.

 

The frantic year-end search for a solution inevitably makes it harder for Congress to wrap up whatever big tax or spending or omnibus bill that stands between it and that flight home for the holidays. This year, of course, it’s the payroll tax bill — and, to the extent that it’s all part of the year-end brinksmanship, the final omnibus spending bill. The House has put in a variety of SGR pay-fors in its payroll tax bill, including cutting some health care law insurance subsidy and prevention funds, as well as some hospital outpatient payments.

 

The Senate is toying with using war savings from the reduced U.S. role in Iraq and Afghanistan — or as Sen. Jon Kyl (R-Ariz.) put it, using one batch of “Monopoly” money to pay for another. Neither chamber likes the other’s approach, and as of now, the SGR exit strategy may well be to punt until January — letting bills from about a half-million physicians who treat Medicare patients pile up, unprocessed and unpaid, until Congress acts. And when Congress does act, it could be another “accounting charade,” said Tom Miller, a health policy expert at the American Enterprise Institute. Robbing hospital Peter, for instance, to pay physician Paul (or Paula) shifts costs and ignites lobbying food fights. But it doesn’t save the system money or change the health care inflation dynamics. “The system … has failed to restrain volume growth and, in fact, may have exacerbated it,” the Medicare Payment Advisory Commission wrote to Congress earlier this year, recommending yet again that the formula be jettisoned. A decade of stopgap fixes “are undermining the credibility of Medicare because they engender uncertainty and anger among physicians and other health professionals, which may be causing anxiety among beneficiaries,” MedPAC added.

 

Doctors’ groups, naturally, hate not just the frequent near-death experience with pay cuts, but the uncertainty that individual doctors face each year. It becomes that much harder for them to know their income, their practice, whether they will participate in Medicare and on what terms. To come up with a new payment system, the American Medical Association favors a five-year transition fee scale that allows time to test new approaches to delivering health care, some of which are already being developed as part of the health care reform law. “During this time a variety of new payment models designed to enhance care coordination and quality while reducing costs can be tested and would form the basis for a new Medicare physician payment system,” AMA President Dr. Peter Carmel wrote recently. But the congressional focus on short-term “doc fixes” blunts the momentum for long-term change. “If you are always doing a fire drill, and finding a perpetual one-year patch, it keeps you from confronting the larger mega-reform that’s needed,” said AEI’s Miller.

 

An example of a more free market-oriented approach, Miller said, could be to let doctors bill a patient more than Medicare pays, with protections for lower income elderly. Another approach, said Princeton health care economist Uwe Reinhardt, would be to adapt what some European countries do — set a budget based on the patient population, not fees tied to specific services. If money ran low — say, in November — patients could still get medical care, but doctors would get a bit less for the final weeks of the year. “That’s a far more intelligent way” than haggling over fees and ceding control over volume, said Reinhardt, who thinks it may take years to see meaningful savings from new coordinated care models. “But what has led me to despair is of all possible approaches, we always seem to pick the least intelligent.”

 

The AMA and other physician groups have warned for years that more and more physicians will stop treating Medicare beneficiaries. An AMA survey last year found one in five doctors overall, and nearly one-third of primary care doctors, say they are already limiting Medicare patients. While not everyone believes in the infallibility of an online AMA survey, the message is taken seriously. A few years ago, some policymakers saw the predictions of doctors fleeing Medicare as a physician form of crying wolf. But now, with a 27 percent cut and a $300 billion hole, the perception is that the wolf is at the health care system’s door.

 

 

 
Six California Entities Are ‘Pioneer” Accountable Care Organizations

 

California Healthline -

 

December 20, 2011: On Monday, six California entities were among 32 health care organizations nationwide that were selected to participate in the “Pioneer” accountable care organization initiative, Kaiser Health News/Washington Post reports (Torres, Kaiser Health News/Washington Post, 12/19).

 

Background

 

The Pioneer ACO program is designed to reward early adopters of coordinated care models, the AP/San Francisco Chronicle reports (AP/San Francisco Chronicle, 12/19). HHS received about 80 applications for the program. The complete list of organizations selected for the Pioneer program is available on CMS’ website.

 

According to an HHS release, the program aims to foster collaboration among primary care physicians, hospitals and other health care professionals to improve care for Medicare patients. The department estimates that it could save up to $1.1 billion over five years.

 

Specifically, the initiative will test the effectiveness of innovative payment models and how they help organizations improve care quality, reduce costs and coordinate services with private payers (Kaiser Health News/Washington Post, 12/19). The first performance period will begin on Jan. 1.

 

Selected Organizations

 

The organizations selected for the program span 18 states and care for approximately 860,000 Medicare beneficiaries (Sanger-Katz, National Journal, 12/19).

 

They all have made progress toward or already are functioning as ACOs and will serve as a guide for the groups expected to apply for a larger Medicare Shared Savings Program that is set to launch next year (Kaiser Health News/Washington Post, 12/19).

 

Acting CMS Administrator Marilyn Tavenner said the program will help health care organizations experiment with ways to achieve better care and lower spending. She said, “We know that health care providers are at different stages in their work to improve care and reduce costs,” adding, “That’s why we’ve developed a menu of options for Medicare to meet doctors, hospitals and other health care providers where they are, and begin the conversation of how to enhance the care they are offering to people with Medicare.”

 

HHS Secretary Kathleen Sebelius added that “[p]ioneer ACOs are leaders in our work to provide better care and reduce health care costs” (HHS release, 12/19).

 

California Organizations

 

The six California organizations selected to take part in the Pioneer ACO initiative are:

 

• Brown & Toland Physicians, based in San Francisco;

 

• HealthCare Partners Medical Group, which serves Los Angeles and Orange counties;

 

• Heritage California ACO, which serves southern, central and coastal California;

 

• Monarch HealthCare, based in Orange County;

 

• PrimeCare Medical Network, which serves Riverside and San Bernardino counties; and

 

• Sharp HealthCare System, based in San Diego (California Association of Physician Groups release, 12/19).

 

 

 
California Nabs $118M To Bolster Pre-Existing Condition Insurance

 

California Healthline -

 

December 20, 2011: California will receive an extra $118 million in federal funding to help expand coverage in the state’s Pre-Existing Condition Insurance Plan, the Sacramento Bee reports (Smith, Sacramento Bee, 12/20).

 

Background

 

PCIP provides coverage to individuals with pre-existing conditions until 2014, when the federal health reform law mandates that private insurers accept all applicants regardless of pre-existing conditions.

 

To qualify for coverage in PCIP, an applicant must be a U.S. citizen or documented resident, have lacked medical coverage in the past six months and have a medical condition that could warrant denial of coverage (California Healthline, 10/28).

 

How the Funding Affects PCIP

 

The new funds bring the total federal contribution to California’s PCIP to $347 million. According to officials at the state Managed Risk Medical Insurance Board, which runs PCIP, the funds were needed to expand the program and keep up with the costs of claims. Monthly costs per member have risen more than threefold from what was initially estimated.

 

Sarah Smith — a spokesperson for MRMIB — said that PCIP enrollment at the end of November was 5,972. If California had not received the additional funds, enrollment would have been capped at 6,800 through December 2013 (Sacramento Bee, 12/20).

 

 

 
2.5M young adults gain coverage

 

Associated Press, By Ricardo Alonso-Zaldivar -

 

December 14, 2011: WASHINGTON (AP) — The number of young adults lacking medical coverage has shrunk by 2.5 million since the new health care overhaul law took effect, according to a new analysis the Obama administration is to release Wednesday.

 

That drop is 2½ times as large as the drop indicated by previous government and private estimates from earlier this year, which showed about 1 million Americans ages 19-25 had gained coverage.

 

Administration officials said they now have more data. They say they’re also slicing the numbers more precisely than the government usually does, trying to pinpoint the impact of a popular provision in an otherwise politically divisive law. Under the health overhaul, children can remain on their parents’ health insurance plans until they turn 26, and families have flocked to sign up young adults making the transition to work in a challenging economic environment. But the fate of President Barack Obama’s signature domestic accomplishment remains uncertain, with the Supreme Court scheduled to hear a constitutional challenge next year, and Republican presidential candidates vowing to repeal it.

 

“The increase in coverage among 19- to 25-year-olds can be directly attributed to the Affordable Care Act’s new dependent coverage provision,” said a draft report from the Health and Human Services Department. “Initial gains from this policy have continued to grow as … students graduate from high school and college.” A copy of the report was obtained by The Associated Press. HHS Secretary Kathleen Sebelius is scheduled to release the findings Wednesday.

 

The health care law’s main push to cover the uninsured doesn’t come until 2014. But the young adults’ provision took effect last fall. Most workplace health plans started carrying it out Jan. 1. Using unpublished quarterly statistics from the government’s ongoing National Health Interview Survey, analysts in Sebelius’ policy office determined that nearly 36 percent of those age 19-25 were uninsured in the third calendar quarter of 2010, before the law’s provision took effect. That translates to more than 10.5 million people. By the second calendar quarter of 2011, the proportion of uninsured young adults had dropped to a little over 27 percent, or about 8 million people.

 

The difference — nearly 2.5 million getting coverage — can only be the result of the health care law, administration officials said, because the number covered by public programs like Medicaid went down slightly. Overall, nearly 30 million Americans are between the ages of 19 to 25. For those who are little older, ages 26-35, the uninsured rate went up during the same period.

 

“From September 2010 to June 2011, coverage rose only among those adults affect by the policy,” said the HHS report. The National Center for Health Statistics has documented a broadly similar trend in its official publications, only it’s not nearly as dramatic.

 

Administration officials said those statistics do not focus on the change from calendar quarter to calendar quarter, as does the report by Sebelius’ staff. Instead, they pool data over longer time periods. That has the effect of diluting the perceived impact of the law, administration officials said.

 

Traditionally, young adults were more likely to be uninsured than any other age group. Some are making the switch from school to work. Others are holding down low-wage jobs that don’t usually come with health care. And some — termed the “invincibles” — pass up job-based health insurance because they don’t think they’ll use it and would rather get extra money in their paychecks.

 

Other early coverage expansions in the health care law have not worked as well, including a special program for people with health problems who got turned away by private insurers. Many applicants found the premiums unaffordable. Young adults are a less expensive group to cover than people who are middle-aged, and many companies have spread the extra premiums among their workers. Benefits consultant Delloite LLP has projected additional health plan costs in the range of 1 percent to 2 percent for covering young adults.

 

 

 
‘Freeing’ Data May Be Tricky in California

 

California Healthline Sacramento Bureau, BY David Gorn -

 

December 15, 2011: Mark Smith is a believer. The president and CEO of the California HealthCare Foundation launched a recent forum in Sacramento on the national “Free the Data” movement with an unusual comparison he called the “Harrah’s analogy.”

 

Casinos, he said, hold one of the keys to health care reform. “It turns out that when you get what they call a loyalty card [from a casino] to buy those chips, the main reason they do that is to acquire data so they can not only predict your behavior but alter it,” Smith said.

 

A casino doesn’t necessarily want a first-time customer to lose money right away, he said, because that customer becomes unhappy and won’t come back. “So if you’re a first-time customer and you’re down 150 bucks, someone in the casino will slide up to you and ask you how you’re doing,” Smith said. “And maybe get you a comp meal or a drink.” The casino intervenes before customers reach the decision point to leave. “Which just goes to show,” Smith said, “that the people who run casinos are much smarter than the people who do health care.”

 

Health care could benefit from similar customer-focused systems. The key to those systems, Smith said, is the free flow of information. “The whole notion that by combining real-time access to data, they can not only know what you will do, but it could be designed and executed in a way that could alter the future. That’s something that the casinos and retailers now take for granted as part of doing business … and we’re 10, 15 years behind them.”

 

Smith’s remarks came during a recent forum that aimed to explore the value of making public health care data more easily available. One of the event co-sponsors was CHCF, which publishes California Healthline. According to Smith and others at the forum, one of the first big steps toward shoring up the information technology gap might be to take the federal effort down to the state level — and spread data, for free, across California.

 

‘Data Revolution’

 

Todd Park, chief technology officer at HHS, calls himself the “entrepreneur-in-residence.” He said he’s more interested in getting other people’s projects going, rather than just directing department efforts. “Most of the smart people in the world don’t work for you,” Park said. “We want to make health care data available to other smart people in the world, and it accomplishes our mission in a way we never could have imagined. It’s sort of a data revolution. And it dwarfs what we could do by ourselves.” The idea is simple, he said. There is a vast stream of public information — not private patient information, he was careful to say — that could contribute to improving public health efforts across the country. The only limiting factor to access, he said, often is how the data are formatted. Park’s department has been busy converting public health information from PDFs into XML feeds or Excel spreadsheets. The model of information distribution, Park said, is the National Oceanic and Atmospheric Administration, which runs the National Weather Service. “It collects virtually all weather data, and it not only collected it, but also distributed it for free. And it led to a whole set of innovations,” Park said. “Weather apps, weather insurance, the Weather Channel. It’s a great example of how open data leads to innovation that NOAA by itself couldn’t do.”

 

The first release of federal data came with GPS — global positioning system — data during the Reagan administration. “So this is our third effort to run this play,” Park said. “We’re actually liberating billions of data from HHS, and putting it out in the public domain. The objective is to catalyze an ecosystem of innovation.”

 

The conversion of all of those documents to machine-readable files is actually not so difficult, Park said. About 90% of his department’s work on this project is spent to make sure innovators know the data are available.

 

Park offered examples of how innovators might transform health data into practical applications. “Like for instance, there are 1,100 different metrics of obesity rates, so you can use that information to develop a program to create community access to healthy food,” he said.

 

Ozioma is one example of an app that turned that information into “a virtual health research department, an Apple Genius bar but for health,” Park said. Some pharmacies use the app to help people narrow down their medical information searches. “And Bing [Microsoft's search engine] has ingested Hospital Compare data,” he said, “so when you search for provider information, it pulls up patient satisfaction information and a comparison to the state average, and it pushes all of that to you in the moment it was the most useful.”

 

Freeing Data in California

 

What is happening on the federal level also could occur at state agencies, Park said. “More and more states are getting interested in this. A lot of the most exciting data is with state agencies,” Park said. “So it’s not an HHS initiative anymore, it’s an American initiative.” Panelist Toby Ewing, a consultant with the state Senate Governance and Finance Committee, said there are clearly huge potential benefits to free-flowing data, but California’s Department of Health Care Services is a different animal from the federal HHS. This state has a few different stripes, Ewing said.

 

For instance, privacy rules in California are different, Ewing said. “Now, most of those rules we make, many of them we made a long time ago, so we need to figure out what’s possible now with our technological advances. How do we make sure we can release the data?” Park said he ran into similar concerns on the federal level, and that’s why he advises staying far away from personal health information. “I would proceed cautiously on that front, because we’ve been doing nothing that comes even remotely close to privacy,” Park said. “One thing that might work in that case, though, is people having their own personal data, then they don’t get angry about sharing it, if they’re the ones sharing it.”

 

Andy Krackov of the Lucile Packard Foundation for Children’s Health said if the federal government can be successful releasing already public information, California can do it, too. As a tech leader, it’s unusual for California to be following behind federal efforts, he said. However, Krackov noted, “There may be policies at the state level that might keep us from talking to each other.” According to Park, the benefits are so potentially great that state agencies should at least try. “It’s a hot, cool thing, leveraging the power of data,” Park said. “We will invent our way out of health care issues and problems.” Park made one final analogy to sum up the importance of full flow of data in real time. “It’s like looking at a speedometer on the highway, and it tells you how fast someone else traveled on this road three years ago,” he said. “That just doesn’t work. You can send preliminary data, the initial claims, and not final resolution claims. We have to move in that direction. Otherwise, we will be getting that three-year-old speedometer info, and it’s just not useful to us.”

 

 

 
How Can California Make Most of Telehealth Law?

 

California Healthline -

 

December 19, 2011: For the second half of the 20th century, California was a leader on several fronts of health care’s evolution. California innovations and maturations in integrated delivery, managed care, stem cell research and electronic health records often set the agenda for national trends.

 

Now California is poised to do it again with a 21st century innovation — telehealth.

 

New state legislation (AB 415) passed this fall has the potential to move two-way audio-visual technology out of the realm of wonky oddity and into the mainstream, according to some industry experts.

 

Timing for the California Telehealth Advancement Act may be good for a variety of reasons, including:

 

• A pervasive shortage of physicians and other health care providers, especially in rural areas, makes telehealth more palatable — even appealing — to formerly skeptical providers and public;

 

• Telehealth’s coming of age as major health care reforms take effect may increase the technology’s value in the long run; and

 

• Telehealth has the potential to save millions of dollars in health care delivery in both public and private forums.

 

For California — which is struggling with cutbacks in Medicare and Medi-Cal, the state’s Medicaid program — and for the private sector, which is battling rising costs in a floundering economy, new technology may help calm troubled financial waters. But a new law alone probably will not be enough to move telehealth quickly and efficiently into the medical mainstream.