This is the Health Chairs e-bulletin for August 2006.
These are excerpts from the August, 2006 email update on state health policy resources available on the Internet.
The seventh annual Covering Kids & Families Back-to-School Campaign launches August 9. The Robert Wood Johnson Foundation project encourages parents to include enrolling their eligible, uninsured children in Medicaid or SCHIP as an important part of getting them ready for the new school year. See what is happening in your state at http://coveringkidsandfamilies.org/projects/
Resources Online
Children
Who's Covered and Who's Not? The State of Children's Health Insurance: A Primer for State Legislators. The number of uninsured children decreased from 1997 to 2004, from 10.8 million to just over 8.2 million uninsured children. Even with this improvement, over 11 percent of children lack health insurance coverage. Certain groups of children are over-represented in the uninsured population. Poor (below the federal poverty level, or FPL) or near-poor (between 100 percent and 200 percent of the FPL) children, those who are Hispanic or who have a non-U.S. citizen parent, and adolescents are more likely to be uninsured. Read more at http://www.ncsl.org/programs/health/forum/childinsprimer.htm
Premium Assistance Programs
Premium assistance links public funding and private coverage for lower income workers, but they have often been complicated and underused. The National Health Policy Forum has released an issue brief, Premium Assistance in Medicaid and SCHIP: Ace in the Hole or House of Cards? that examines the evolution of the program and policy options for improving it. http://www.nhpf.org/pdfs_ib/IB812_PremiumAssist_07-17-06.pdf
Medicaid
The Deficit Reduction Act (DRA) gives new power to states to redesign their programs, by allowing changes through state plan amendments rather than waivers. But a few states are already raising concerns that the easier process may undercut consultation among state Medicaid agencies and legislatures. The National Health Law Program (NHeLP) has examined state laws to see whether Medicaid changes require modification to statute, legislative approval, or public comment. The paper was produced in April and a number of legislatures were considering changes to their laws to assure continued involvement in shaping the program. Role of State Law in Limiting Medicaid Changes. This 16-page PDF file can be downloaded at http://www.healthlaw.org/library.cfm?fa=download&resourceID=81840&appView=folder&print
CMS has just posted a number of guidances and other information related to the deficit reduction act. The site includes links to the plan amendments from West Virginia, Kentucky and Idaho http://www.cms.hhs.gov/DeficitReductionAct/03_SPA.asp#TopOfPage
It has also issued guidelines on “special needs plans”, a program for the dually eligible—individuals who receive both Medicaid and Medicare. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1911
For more on these and other information about the DRA, go to http://www.cms.hhs.gov/DeficitReductionAct/
Quality and Chronic Conditions
Arizona Governor – and incoming NGA head – Janet Napolitano offered Congress her vision of Medicaid reform, rooted in Arizona’s experiences with home and community based care, Medicaid managed care including for all long term care and dual eligibles, and health information technology: http://aging.senate.gov/public/_files/hr160jn.pdf
The AcademyHealth Meeting in Seattle this June included a daylong colloquium, sponsored by the Commonwealth Fund, on long-term care, featuring two issues:
- Transitions in long-term care settings; and
- Technology and long-term care.
You can download the files, listen to them in MP3 format on your iPod, or look at the agenda, including commissioned papers and resources, at http://www.academyhealth.org/ltc/2006/index.htm
Watson Wyatt Worldwide, a consulting firm, reports that most employee health spending is due to a small portion of covered lives.
“According to the analysis of health benefit plan expenditures, the 4 percent of participants with serious health conditions account for nearly half of health benefit spending in any given year...
“Those who are not as sick — the roughly 25 percent of participants in the early stages of chronic conditions or with acute health episodes — account for 40 percent of spending. In contrast, those who are healthiest — 72 percent of participants — account for just 11 percent of health care spending.”
|
Average health care cost per individual |
Percentage of plan participants |
Percentage of 2004 health care costs |
|
< $1,500 |
72 percent |
11 percent |
|
$1,500-$9,999 |
24 percent |
40 percent |
|
> $10,000 |
4 percent |
49 percent | Source: Watson Wyatt Worldwide analysis of benefit plan expenditures, 2004 http://www.watsonwyatt.com/news/press.asp?ID=15974
Working Family Caregivers are the subject of a new report from the Family Caregivers Alliance. Eight states are considering related legislation: HI, IL, MA, MN, NJ, NY, PA and WA. The report includes describes the implementation of California’s paid leave law, and gives summaries of other state efforts. http://caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1679
Providers and Workforce
Dental workforce shortages lead to shortfalls in dental care. A report on Financing Dental Education: Public Policy Interests, Issues and Strategic Considerations, was produced by NCSL for the federal Health Resources and Services Administration (HRSA). Shortages in faculty, rising levels of debt for graduates, and lack of residency programs for new practitioners are all identified as concerns for policymakers. The report is now on line at http://bhpr.hrsa.gov/healthworkforce/reports/dental/default.htm
Retail Healthcare is coming to a Wal-Mart near you according to a report from the California HealthCare Foundation. http://www.chcf.org/topics/view.cfm?itemid=123218 Not surprisingly, the AMA has proposed guidelines. http://www.ama-assn.org/ama/pub/category/16463.html We’re featuring this issue in the next State Health Notes. http://www.ncsl.org/programs/health/shn/ Legislators may expect to see this issue to heat up next year!
Stuart Guterman, who now is at the Commonwealth Fund, has thought long and hard about how physicians might be induced to provide better quality care. For a good overview of Medicare reimbursement policy, the quality problem, and some approaches to improve coordination and quality, see his recent testimony at http://www.cmwf.org/usr_doc/Stu_Testimony-House_Energy&Commerce_060723.pdf
States may be particularly interested in this testimony as they respond to the CMS call for proposals for Transformation Grants, authorized under the DRA. A total of $150 million over 2007 and 2008 is available to states through competitive grants to improve the efficiency and effectiveness of state Medicaid spending. States must submit applications by September 15, 2006. More information on the grants and how state Medicaid agencies can apply for them is on the CMS Web site at: http://www.cms.hhs.gov/MedicaidTransGrants/.
According to the press release at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1908
Possible approaches states may consider include:
- Reducing patient error rates (electronic health records, clinical decision support tools or e-prescribing programs).
- Improving rates of collection from estates of amounts owed under Medicaid.
- Reducing waste, fraud, and abuse under Medicaid, such as reducing improper payment rates.
- Reducing Medicaid expenditures for covered outpatient drugs, particularly in the categories of greatest drug utilization, by increasing the utilization of generic drugs through education programs and other incentives
- Improving coordination of care through care management programs and other steps to prevent complications and duplicative or unnecessary services
- Implementation of performance-based payment programs to provide rewards and support for high-quality care
- Implementation of programs to promote personal control over services, with greater emphasis on prevention steps
- Improving access to primary and specialty physician care for the uninsured using integrated university-based hospital and clinic systems.
- Implementation of a medication risk management program as part of a drug use review program
Health Information Technology Milestone
Physicians have been slow to adopt electronic health records (EHR) in part because of the high cost—coupled with fear that investments in software will become obsolete. Now, after testing for functionality, interoperability and security, the federally-funded Certification Commission for Healthcare Information Technology (CCHIT) has given a seal of approval to ambulatory electronic health record products from 19 different companies. http://www.cchit.org/media/CCHIT+Announces+First+Certified+Electronic+Health+Record+Products.htm
Other reasons may be behind the slow adoption. Maybe they don’t really provide the value and savings that everyone seems to be touting, or can only do so as part of larger health system changes. That’s the question raised by a recent Health Affairs article. http://content.healthaffairs.org/cgi/content/full/25/4/1079
Public Health
Four for Emergency Preparedness
In the aftermath of Hurricane Katrina, a remarkable coalition came together to improvise medication records from a variety of data sources for residents displace by the storm. The Markle Foundation has just released a report on the project, Lessons from KatrinaHealth, including recommendations on preparing for the upcoming hurricane season by planning for storing patient data securely, creating simple, shareable electronic health information systems, agreeing on a way to authenticate who is accessing the data, making records available to emergency health care responders, and examining existing laws to make sure they don’t hinder delivering post-disaster medical care. http://www.markle.org/downloadable_assets/katrinahealth.final.pdf
The Urban Institute has also released a review of Katrina responses. According to their press release, “Federalism after Hurricane Katrina: How Can Social Programs Respond to a Major Disaster? explores the programs' responses to Hurricane Katrina, describes pre-disaster operations, specifies what made Katrina so hard to handle, and recommends better ways to respond to disaster in the future.” The paper http://www.urban.org/url.cfm?id=311344, is part of the Urban Institute's After Katrina research series (http://www.urban.org/afterkatrina).
The Government Accounting Office has also released its recommendations in the report Disaster Preparedness: Limitations in Federal Evacuation Assistance for Health Facilities Should be Addressed, http://www.gao.gov/new.items/d06826.pdf
And HRSA has partnered with the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities to identify legal and regulatory issues related to state-based Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP), “including emergency declarations; licensing, credentialing, and privileging issues; civil and criminal liability issues; and workers’ compensation.” Read about the project and download the report at http://www.hrsa.gov/esarvhp/legregissues/default.htm
…and Rebuilding
The Louisiana Health Care Redesign Collaborative plans to replace the system destroyed by disaster with a model of quality and effectiveness. Follow them at http://www.dhh.louisiana.gov/offices/?ID=288
Take a Deep Breath…
Asthma Care Quality Improvement: A Resource Guide for State Action and its companion workbook, Asthma Care Quality Improvement: A Workbook for State Action are now available from AHRQ http://www.ahrq.gov/qual/asthmaqual.htm
For pandemic flu information (including the latest allocations to states), more information on HHS pandemic influenza preparedness efforts is online at http://www.pandemicflu.gov/. For NCSL’s information on pandemic influenza preparedness, go to http://www.ncsl.org/statefed/health/FluReport.htm. The distribution of the $325 M FY 2006 Pandemic Influenza State and Local Funding can be found at http://www.pandemicflu.gov/news/allocation.html
Motherhood and Apple Pie?
Home visiting, a practice as old as in-hospital births, is being looked at anew as a way of improving birth outcomes and reducing risks for mothers and children—and lowering costs for the initial investment. This report by the Association of State and Territorial Health Officers (ASTHO) looks at state programs in Georgia, Maine, Montana, Oklahoma and Puerto Rico. http://www.astho.org/pubs/HomeVisitingBriefFinal.pdf
Diagnosis: Illiteracy
A thought-provoking article from the New England Journal of Medicine points out that functional illiteracy is common and can be harmful to a patient’s health if not diagnosed. http://content.nejm.org/cgi/content/full/355/4/339?query=TOC
Disparities
The University of North Carolina Minority Health Project to eliminate health disparities recently offered its annual summer health research conference on line. Two sessions were archived, one on a tobacco cessation project and one on the scientific basis of race-specific medicine. You can access these and other archived webcasts (you may have to register to view the archives) at http://www.minority.unc.edu/resources/webcasts/#medicine
Stem Cell Research
As Congress debated the issue, NPR recently did a round-up of state laws related to stem-cell research based in large part on NCSL’s Genetic Technologies Project which also looks at a number of other issues raised by scientific advances in this area. http://www.ncsl.org/programs/health/genetics.htm, http://www.npr.org/templates/story/story.php?storyId=5569910
There’s more to come. NCSL's Genetic Technologies Project will release two booklets, Stem Cells: A Guide for Policymakers and Genetics: A Snapshot for State Legislatures, at Annual Meeting. Pick up your copy at the NCSL bookstore in Nashville or visit www.ncsl.org/programs/health/genetics.htm after the meeting for ordering information.
The stem cell guide is intended to help policymakers better understand the potential implications of various policy options for stem cell research, and, in doing so, direct them to an alternative that will result in their preferred outcome. The guide provides an introduction to research activities involving stem cells; an overview of federal laws on policies; a detailed description of current state laws and policies; and an analysis of the state stem cell research experience.
The snapshot discusses the role of state in genetics in seven key areas:
- Newborn genetic and metabolic screening;
- Providing access to other genetic services;
- Genetics education;
- Surveillance, data and information systems related genetic information and samples;
- Scientific research;
- Discrimination protections; and
- Privacy protections.
Counter to Conventional Wisdom…
Across the nation, emergency departments (ED) are experiencing crowding. But a new study finds that ED use is lower, not higher, in communities with greater numbers of Hispanics, uninsured and noncitizen residents. Higher use is associated with fewer alternatives and a general preference for EDs according to a new Health Affairs special. http://content.healthaffairs.org/cgi/content/full/hlthaff.25.w324v1/DC1
Several months worth of past Chairs e-bulletins are archived at: http://www.ncsl.org/programs/health/forum/chairs/ebull/index.htm
Have any questions you'd like answered? A topic for which you’d like us to gather resources? Do you have a report of your own you'd like to share with your peers? Drop us a line…(and fill out and fax back the Chairs meeting RSVP below if you haven’t done so yet)
Kala Ladenheim, Ph. D. Program Director Forum for State Health Policy Leadership National Conference of State Legislatures ph: 202-624-3557 fx: 202-737-1069 kala.ladenheim@ncsl.org
Donna Folkemer, Group Director Forum for State Health Policy Leadership National Conference of State Legislatures ph: 202-624-8171 fx: 202-737-1069 Donna.Folkemer@ncsl.org
 Health Chairs Project
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