Managed Healthcare Executive - January 2009 - (Page 4)

{ FOR YOUR BENEFIT } Obama and Daschle want your reform wish list Tom Daschle will serve a different role than past HHS secretaries as he drives infrastructure changes BY JULIE MILLER Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@ advanstar.com id you have a Health Care Community Discussion last month? In case you missed the call for action, I’ll ll you in. The Web site change.gov promotes President-elect Obama’s agenda and o ers the public interactive options for submitting input. Last month, the site encouraged anyone who was interested to arrange community discussions and report back to the Obama reform team. Incoming HHS Secretary Tom Daschle promised to attend some of the meetings. If you attended a meeting, I’d love to hear what happened. Send me an email. Several managed care leaders I’ve spoken to lately told me what they want from the new administration’s o cial healthcare reform team. Here’s part of the wish list. Primary care must be reinforced by new physicians entering the eld. If the administration hopes to make good on its promise to cover all children or to cover more people in general, then it better have a strategy to actually deliver care to the newly covered members, lest they be waiting in line. An insurance card or veri cation of eligibility is not care; getting an appointment and seeing a physician in a timely manner is. Expect the pent-up demand to be staggering. Expect the dwindling supply of PCPs to be overworked, overwhelmed and demanding more money, which we don’t have. Design an infrastructure to allow for continuous coverage and streamlined eligibility processes. Churning is the death knell D for outcomes in so many public programs. If politicians want to see a more e cient system, they should look at the cost of churning not just from an administrative perspective, but from an outcomes perspective. Spend a fortune getting everyone’s diabetes under control, then turn them away from coverage for six months, and then bring them back again? Were you really expecting a return on that investment? Those now worse-o patients are yours once again, and you get to start over, thanks to your cumbersome eligibility process that’s meant to save money by keeping your rolls short. Someone needs to measure this alleged savings. Realize that the money has to come from somewhere. Milliman recently noted that employers and private insurers pay a “hidden tax” of $88.8 billion each year because government programs don’t pay adequate reimbursements. In 2006, hospitals earned 23.1% for privately insured patients and a negative 10.8% for Medicare and Medicaid patients. In 1996, those gures were 14.1% for commercial and 0.2% for Medicare and Medicaid, according to Milliman. Follow the money trail, and you’ll nd that those on the receiving end of the cost shift—employers and members—will pull out of the system altogether. And the cost comes right back to the government programs that shifted it in the rst place. Health IT needs funding. Obama promised to spend about $50 billion to get electronic medical records up and running. Less than 12% of hospitals have even the most basic EMRs, and funding is the only thing that’s going to change that. Comparative effectiveness needs a champion. Daschle plans to create a Federal Health Board that would make independent coverage decisions for federal programs, which no doubt will be the coattails other entities will ride on for their decisions, too. Transparency will be the make-or-break point in determining the board’s usefulness. What’s on your wish list? Daschle wants to know. MHE 4 JANUARY 2009 http://www.change.gov

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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