8-31-19: “State Embarks on Mission to Transform Health Care,” Steve Lohr, The New York Times, B1, B8:

North Carolina is testing out an approach to keep people healthy and out of the hospital and save money on health care spending.

The approach uses accountable care organizations, social determinants of health, and links payments to total costs of care for patient populations and quality measurements not to hospital stays or surgical procedures. Primary care clinics and their physicians and nurses are expected to play a larger role in managing care and stand to gain financially. The North Carolina project uses a payment model based on outcomes and is likely to increase the share of total health care dollars that go to primary care physicians as opposed to specialists, hospitals and other places – to 10 to 13 percent from 6 to 8 percent over several years.

The new payment model pushes primary care to do more in a systematic way such as asking patients detailed screening questions about depression, alcohol consumption, food, and housing.

North Carolina plans to spend $650 million of state and federal funds for pilot projects to address health related risks in a person’s daily life – social determinants of health – like access to food, housing, and transportation

A primary care clinic at the front of the North Carolina project, Ardmore Family Practice in Winston-Salem, with 5,300 patients will be grouped with a few others into an accountable care organization. These groups have shared training and technology programs and have the patient populations whose health outcomes will determine reimbursement in the new model. Dr. Amy Sapp, a physician in the clinic, describes her work as “firsthand longitudinal health care” – taking care of people over years knowing them, their families, their living circumstances, and their life changes. On annual wellness visits, doctors now spend more time with patients and received extra $20 in addition to the clinic’s standard charge of about $150.

A hospital group, a housing non-profit and university researchers identified 41 families with children who made frequent hospital visits for asthma. They visited the homes; identified potential asthma triggers like mold, dusty carpeting and poor ventilation; and made recommendations and repairs. Afterward, asthma-related hospital costs for those clients dropped by more than 50 percent.

In addition, North Carolina is building technology to enable better linking of community groups, doctors, and insurers. A free online service, NCCARE360 with state wide coverage planned by end of 2020 will connect public health departments and doctors and hospitals which can make online referrals to service organizations and people in need.

Further, the insurer, Blue Cross, will share claims information with health care providers and doctors and hospitals will share clinical data for data analysis software that flags patients most in need of care or counseling.

North Carolina did not expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health.

8-13-19: “Provident Hospital May Get a New Facility,” subtitle “$240M Building Would Be Smaller With 42 Beds, 70 Outpatient Rooms,” Lisa Schencker, Chicago Tribune, Section 2, page 1, 2:

A national trend indicates more procedures are being done on an outpatient basis and hospitals compete for patients.

Cook County Health plans to build a new facility to be located just west of its current facility, Provident Hospital, pending approval by the Illinois state Health Facilities and Services Review Board. The State board is scheduled to consider the application at its October 22 meeting.

The new building will be 22% smaller than the current one and have fewer beds for medical/surgical patients, dropping from 79 beds to 42 and have 70 outpatient exam rooms. Provident is licensed for up yo 85 beds but on a typical day only about 15 to 20 of those are full. The new facility will offer more services such as MRI imaging, bariatrics, orthopedics, dental and sports medicine. Its emergency department will be able to deliver more comprehensive care.

Most of Cook County Health’s patients are on Medicaid, Medicare, or uninsured. The project is part of Cook County Health’s strategic plan to upgrade facilities to provide state of the art care and attract new, privately insured patients. Private insurance companies tend to reimburse hospitals for care at higher rates than Medicaid, a state and federally funded health insurance program for the poor and disabled,

Provident Hospital opened in 1891 as an African American hospital and the country’s first open-heart surgery was performed there by an African American doctor, Dr. Daniel Hale Williams. Provident also had the first nursing school for black women in Chicago.

6-28-19: “The Lessons of Washington State’s Milestone Health Care Bill,” subtitle “A ‘Public Option’Lacks Big Savings,” Sarah Kliff, The New York Times, A19:

“The whole debate was about the rate mechanism“

Per Washington State’s Governor Jay Inslee his state created the country’s first ‘public option’ – a government health plan that would compete with private insurance. New Mexico and Colorado are exploring whether they can also introduce state-level, public health coverage open to all residents.

The Washington public option signed into law was watered down for passage. It started as a very aggressive effort to push down prices to Medicare level and ended quite a bit more modest per Larry Levitt, senior vice president for health reform at Kaiser Family Foundation. Washington state estimates that individual market premiums will fall 5% to 10% when the new public plan begins. David Frockt, the state senator who sponsored the bill said the bill is important but also relatively modest.

According to Jennifer Hanscom, executive director of the Washington State Medical Association, they were trying to be in every conversation because “rate setting doesn’t work for us – let’s consider some tother options. As soon as it was put in the bill, that’s where our opposition started to solidify.” Legislators were put into a bind because the whole point of public option was to reduce premiums by cutting health care prices. If they cut too much they risked revolt. Doctors and hospitals could snub the new plan, declining to participate in the network.

“The whole debate was about the rate mechanism” per Mr. Frockt, “with the original bill, with Medicare rates, there was strong opposition from all quarters. The insurers, the hospitals, the doctors, everybody.” Mr. Frockt and his colleagues raised the fees for the public option up to 160% of Medicare rates. In addition, instead of the state starting their own insurance company the state decided to contract with private insurers to run the day-to-day operation of the new plan.

Hospitals and doctors will get to decide whether to participate in the new plan which pays loser prices than private competitors. Participation is currently voluntary though state officials stated they will consider revising that if they are not able to build a strong network of health care providers

According to Mr. Frockt,”This is a core debate in the Democratic Party: Do we build on the current system, or do we move to a universal system and how do we get there?” In addition, he said “I think the rate-setting issue is going to be vital. It’s what this is all about.”