What do industry experts think of the healthcare reform

In an article published at HealthcareITNews 4 different experts provided their opinions on what can be anticipated as a result of the healthcare reform. I tend to agree with most of the opinions and therefore highlighted the most significant in my opinion parts. Please see full body of the article enclosed below.

WASHINGTON – With the nation on the edge of its seat June 28, the Supreme Court ruled it constitutional for all Americans to obtain health insurance or face penalties. And with the remaining sections of the ACA staying in place, healthcare reform was deemed to be in full swing, resulting in another victory for the Obama administration.

With that said, we compiled four expert reactions to the Supreme Court's ACA decision.

1. It's a 'historic victory.' New York State Attorney General Eric T. Schneiderman felt the decision was a 'win' for all Americans who will be covered by health insurance. "The law's effects will be significant in our state, where over two million people are uninsured. Over a million uninsured New Yorkers will soon have access to affordable coverage," he said. "This law will continue to provide a spectrum of key consumer protections including keeping young adults on their parents' plans, ending pre-existing condition restrictions, and increasing consumer information about healthcare choices."

2. Healthcare continues to be in a state of change.  "It's about creating a sustainable healthcare industry," said Bruce Johnson, CEO of supply chain management company GHX. "Unlike most industries, healthcare is two-dimensional: delivering high-quality care to save lives while running efficient businesses. At the core, healthcare reform is driven by the need to reduce costs while delivering care of the highest quality." The business of healthcare needs to change, continued Johnson, to deliver cost-efficient and effective business processes. "It's all about quality and access -- and quality can be improved by healthcare businesses working together to standardize and streamline their processes."

3. The decision will impact all healthcare providers. "Those who were waiting to see what would happen with healthcare reform can now expect to see a number of changes to their practice," said Claire Marblestone, attorney at healthcare provider firm Fenton Nelson. "For example, there will be additional funds for rural healthcare providers, incentives to adopt electronic healthcare records, and mandatory adoption of compliance and ethics programs for certain facilities." Furthermore, she added, "The changes to Medicare and Medicaid will have an impact on provider reimbursement."

4. The focus will shift to implementing programs as soon as possible. Bart Stupak, former Michigan congressman, said now that the ruling has been made, "the focus within the executive branch, in the states, and throughout the healthcare industry will be on developing and implementing the programs as quickly as possible." The demand for healthcare is about to explode as baby boomers continue to age. "It will be critical for all parties involved in the healthcare system -- providers, hospitals, insurers, and the government -- to innovate and develop methods for reducing the costs of delivering quality healthcare,"Stupak added, "so the country will be able to afford expansion."

Gluten FREE? - Places to go to in NYC

I found an article posted by CBS New York on some of the best places in NYC that are Gluten FREE. As I explore each one I'll post comments to this post.

I have shared this with a lot of my friends, although I have not been diagnosed with Celiac, giving up gluten was the best things I have done for myself in a long while. I no longer feel tired, my energy level stays evenly high through the day. This results in me being more productive and enjoying my days more. Quality of life increase of sure. 

Suffer from Celiac disease? Going through life gluten-free poses its challenges, especially when cravings for comfort foods like pizza and cupcakes come knocking. Don’t worry – we’ve got you covered. Here’s a look at some of the top GF fare in town. 

Risotteria

Our favorite gluten-gree find in all of New York City may be Risotteria’s breadsticks (credit: Risotteria)

270 Bleecker Street (between 6th & 7th Aves.)
New York, NY 10014

(212) 924 – 6664 

risotteria.com
Reviews & More Info

If you suffer from a gluten intolerance, you’ll find a bit of heaven at Risotteria. From the minute they place the first round of gluten-free breadsticks at the table until you finish the last bite of your gluten-free apple pie at dessert. In between, you can sip on gluten-free beer! The menu targets those with Celiac Disease, and itemizes the options with markers for “gluten free,” “vegetarian,” or “dairy free.” The restaurant specializes in risotto and gluten-free baked goods, which you can order to go. On Tuesdays, order from a special gluten-free pasta menu. Yes, the place sounds too good to be true for those who normally can’t enjoy all of these foods – and the crowds that gather nightly prove the restaurant’s worth. Reservations aren’t accepted, wait time can be lengthy and the place gets crowded fast. But our tip? It’s worth it.

Bistango

(credit: bistangonyc.com)

415 3rd Avenue
New York, NY 10016
 (212) 725-8484 
bistangonyc.com
Reviews & more info
The gluten-free options here are limitless, and the staff is eager to please and ensure a safe and delicious meal for everyone. You’ll probably even meet the owner, Anthony, who often comes out to greet guests and chat about his restaurant. Start the meal off with warm, crusty gluten-free bread that puts most other GF bread to shame. For dinner, you can dine on creamy Spinach & Ricotta Ravioli, flavorful Wild Mushroom & Ricotta Ravioli,  or Cheese Tortellini from the gluten-free menu. For a $2 premium, you can make any pasta item on the menu gluten-free. They also offer two Green’s gluten-free beers, the dark and sweet Endeavor and the light and fresh Quest. During the summer, sip fresh gluten-free white wine sangria. Try the GF homemade cheesecake for dessert.

Keste Pizza & Vino

The pizza from Keste. (photo credit: kestepizzeria.com)

271 Bleecker Street
New York, NY 10014
 (212) 243-1500 
kestepizzeria.com
Reviews & more info
A good pizza can be tough to find – especially when you’re avoiding gluten – but Mondays and Tuesdays are gluten-free days at this West Village spot. Choose from the Mast Nicola, with lardo, Pecorino Romano (a hard, salty cheese), and basil, or sample the Marinara (tomatoes and oregano) or the classic Margherita. All pies come on a cruncy, brick-oven crust that will make you forget it’s gluten-free. The torta caprese, a flourless chocolate almond cake, is moist and dense, completely gluten-free, and a great way to finish off your meal.

S’MAC

(credit: S’mac/Facebook)

345 East 12th St
New York, NY 10003
 (212) 358-7912 
smacnyc.com
Mac’n'cheese is the ultimate comfort food (check out our Best Mac roundup) - but for not always for gluten-free lifestyles. That’s where S’MAC comes into the play. They’ve gone through a lot of effort to make their entire menu available in GF variations, charging a bit more depending on the size of dish you order. For GF mac, they use Brown Rice elbow macaroni, bechamel (no wheat flour), and breadcrumbs made from GF cornflakes.  With all that in mind, dive into their extensive collection of delicious mac flavors, including cheeseburger and cajun.

Lilli And Loo

Getty Images/Clip Art

792 Lexington Avenue
New York, NY 10065
 (212) 421-7800 
lilliandloo.com
Hungry for stick-to-your-bones, Chinese takeout – sans gluten? Check out this Lexington Avenue locale, Lilli and Loo. Their gluten-free menu boasts more than 50 items, including spicy General T’so’s chicken or tofu, which retains the crunch its gluten-filled counterpart is known for. We like the rice noodle pad thai, and the dumplings are delicious with GF soy sauce.

Candle 79

(credit: Candle 79)

154 E 79th St
New York, NY 10021
 (212) 537-7179 
candlecafe.com
Dimly-lit and perfect for date night, this Upper East Side venue boasts a thorough gluten-free menu. Their organic, vegan fare pairs fabulously with a thorough cocktail selection. The atmosphere is welcoming to those without dietary limitations, as well. We’re big fans of Angel’s Nachos ($16.00).

Tu-Lu’s Gluten-Free Bakery

Tu-Lu’s Vanilla Cupcake with Vanilla Buttercream (credit: Tu-Lu’s)

338 East 11th St.
New York, NY 10003
 (212) 777-2227 
tu-lusbakery.com
Time for dessert. Tu-Lu’s made our Best Cupcake list on the quality of its wares alone. It’s a bonus that they’re gluten-free. Tully Lewis attended culinary school at Le Cordon Bleu in Austin, Texas, before making her way up to NYC to continue her studies at NYU. Good thing for us it’s not all academic for her. Her chocolate chip cookies get rave reviews, and of course, we love the vanilla/vanilla cupcake.

Rice To Riches

(credit: ricetoriches.com)

37 Spring Street
New York, N.Y.
 212.274.0008 
ricetoriches.com
In a skinny city where venues like Pinkberry make a business of encouraging visitors to top their non-fat concoctions with healthy additions like fruit and nuts, Nolita’s Rice To Riches offers heaping portions of their trendy take on comfort food while encouraging the overindulgence (the walls are lined with phrases poking fun at thin girls and fitness freaks). It’s a bit pricey, but even the smallest size is big enough for two to share. The staff is knowledgeable about which flavors are gluten-free, and which ones aren’t safe for those with the allergy.

Managed Care News - WellPoint to aquire Amerigroup

A very big change in the delivery of healthcare is here. Healthcare reform makes an impact on all of the aspect of care delivery, from providers to suppliers, to pharmaceutical, to insurance companies. One of the big transactions will take effect in the first quarter of 2013.

WellPoint is acquiring Amerigroup along with some other companies, such as 1-800-Contacts, a Draper, Utah based contact lens retailer. Please see the article published in ModernHealthcare.com below:

WellPoint said it entered a definitive agreement to acquire Amerigroup, a Virginia Beach, Va.-based managed-care company, for about $4.9 billion.

The deal will expand the Indianapolis-based health insurer’s Medicaid managed-care business, including its share of the dual-eligible population. 

“We expect Medicaid spending under managed-care programs to increase by nearly $100 million by the end of 2014,” said WellPoint President and CEO Angela Braly during a conference call. “These opportunities will develop organically in addition to the Medicaideligibility expansion under healthcare reform.”

 

 

 

The combined company will serve about 4.5 million Medicaid beneficiaries, as well as have a Medicaid presence in 19 states. Amerigroup, which said its revenue is expected to double over the next five years, will operate as a wholly owned subsidiary of WellPoint. 

The deal is expected to close in the first quarter of 2013. 

WellPoint said last month that it planned to acquire 1-800-Contacts, a Draper, Utah-based contact lens retailer, for an undisclosed sum.

ACO - Accountable Care Organization - What is it all about

This morning I received my usual set of Healthcare related news. One of the articles published by ModernHealthcare caught my attention.

"CMS announces 89 new ACOs" - as I read about this news, I realized that many of those whose lives are affected by the changes in healthcare delivery do not know what ACO is and how does it change the delivery of healthcare for Medicare Recipients.

From the article I gather that CMS (Center for Medicaid and Medicare services) engaged more ACOs through out the country. See the body of the article below:

As of July 1, 89 new Medicare accountable care organizations (PDF) started to serve Medicare beneficiaries in 40 states and Washington, D.C., the CMS announced Monday.

These new programs bring the total list of ACOs to 154, which includes 32 ACOs in the Pioneer ACO model from the CMS Innovation Center that were announced last December and six physician group practice transition demonstration organizations that began in January 2011. 

“The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” CMS Acting Administrator Marilyn Tavenner said in a statement.

On the official CMS website I found a detailed description of what the ACO is all about and what available programs for are available to get involved if you are a provider, or a Healthcare professional. Please see the explanation below:

Accountable Care Organizations (ACO)

What's an ACO?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it willshare in the savings it achieves for the Medicare program.
Medicare offers several ACO programs:

• Medicare Shared Savings Program—a program that helps a Medicare fee-for-service program providers become an ACO. Apply Now.
• Advance Payment Initiative—a supplementary incentive program for selected participants in the Shared Savings Program.
• Pioneer ACO Model—a program designed for early adopters of coordinated care. No longer accepting applications.Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.

Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.
As a healthcare provider, must I participate in an ACO?
Participating in an ACO is purely voluntary for providers. We realize different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.
What are the rights of my Medicare patients if they see providers who participate in a Medicare ACO?
Fee-for-service Medicare patients who see providers that are participating in a Medicare ACO maintain all their Medicare rights, including the right to choose any doctors and providers that accept Medicare. Whether a provider chooses to participate in an ACO or not, their patients with Medicare may continue to see them.
Where can I learn more about ACOs?
CMS offers different learning opportunities for organizations interested in learning more about ACOs. Visit this page periodically to learn about the latest opportunities.
Included in those opportunities are ACO Accelerated Development Learning Sessions (ADLS). CMS hosted two ADLS this year (June in Minneapolis; September in San Francisco), and will host an additional session in Baltimore on November 17-18. The ADLS help executive leadership teams from existing or emerging ACO entities:

• Understand their current readiness to become an ACO.
• Identify organization-specific goals for achieving the three-part aim of improving care delivery, improving health, and reducing growth in costs through improvement.
• Begin to develop an action plan for establishing essential ACO functions.

For more information about the ADLS and to view resources from previous sessions, visit the ADLS website.
How else is Medicare encouraging coordinated care?
The CMS Innovation Center offers a menu of alternative options, including:

• Comprehensive Primary Care initiative
• Bundled Payments for Care Improvement initiative
• Community Based care Transition Program

We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to join in and begin this work, no matter your organization's stage.

Downloads

• Click here for a chart highlighting some of the key differences between the proposed and final rules. [PDF, 125KB]
• The Affordable Care Act: Helping Providers Help Patients - A Menu of Options for Improving Care [PDF, 73KB]

Patient Health Records access for UnitedHealthcare members

Most of us working in healthcare know that any program, mandate or regulation first being implemented by the CMS (Center for Medicaid and Medicare Services). This is also true for the EHR implementation, followed by PHR (Patient/Personal Health Records). Most of the commercial insurance companies stay on stand by observing the outcomes of the CMS effort and join in later in the process to reinforce and adopt regulation, program or mandate at hand.

Some come forward and adopt innovation faster than others and it is always interesting to see who and how will participate first. Department of Veterans Affairs has always been on the forefront if implementation.

As stated in the article published by Healthcare IT News United Healthcare has launched their own Blue Button program. This program enables plan participants to access and print their PHRs  with just a click of a mouse.

 Although, as per UnitedHealthcare, the PHR have been available for almost 20 years, the importance and availability of it is now emphasized. By placing the Blue Button in a more visible position UnitedHealthcare plans to attract the attention of the users and enables them to download their records in a PDF or text formats as well as printing it out.

UnitedHealthcare members can view, print and download information such as claims data, health screenings and self-entry. An individual's PHR will include critical health information such as previous or current health conditions, vital signs and procedures, and personal information that allow easy sharing of important information.

By March of 2012 the Blue Button program went live on one website for 500,000 people enrolled in Health Plan of Nevada.  By the end of the year it is anticipated for more than 12 million employer-sponsored plan participants to have access. By 2012 nearly 26 million UnitedHealthcare enrollees will be able to access their records.

As per Karl Ulfers, VP of Consumer Solutions at UnitedHealthcare, "The technology encourages people to update their personal health records as well as print them, so they can take their records with them and discuss their health and treatments with their doctors."

Between government and private-sector organizations it is anticipated for as many as 75 million people to have access to their records via the Blue Button.

The full body of the article is quoted below:

MINNETONKA, MN – Taking a cue from the U.S. Department of Veterans Affairs, UnitedHealthcare has launched its own Blue Button program, enabling its plan participants to access and print their personal health records (PHRs) with the click of a mouse.

The Department of Veterans Affairs launched the Blue Button in 2010 to allow simple exchange of a patient’s personal health data in a standard, consistent format. Initially designed for use by veterans, the idea has begun to find footholds in the private sector.

“Blue Button puts patients in charge of their personal health information. It is central to our vision of patient-centered clinical encounters,” said Peter L. Levin, chief technology officer at the Department of Veterans Affairs. “The federal Blue Button initiative is a great example of public-private partnerships and open government. With Blue Button, the government created a framework that offers patients private and secure access to their data, and is a model for the private sector.”

For years, nearly 20 million people who log on to UnitedHealthcare’s health and wellness site (myuhc.com) have had access to a PHR. But officials say the addition of Blue Button to the site will make that access easier, promoting the importance of a PHR and offering users the ability to print their records in either PDF or text formats.

UnitedHealthcare members can view, print and download information such as claims data, health screenings and self-entry. An individual’s PHR will include critical health information such as previous or current health conditions, vital signs and procedures, and personal information that allow easy sharing of important information.

UnitedHealthcare’s support of the Blue Button initiative first began in September 2011, and in March 2012 the Blue Button went live on one website for 500,000 people enrolled in Health Plan of Nevada benefit plans. As the firm expands the use of the technology, more than 12 million employer-sponsored plan participants will have access by the end of the year, and by mid-2013 nearly all 26 million UnitedHealthcare enrollees will be able to access their PHR with the click of the Blue Button, UnitedHealthcare officials say.

“Blue Button is a new, convenient way people can access their health records securely and easily with just a single click,” said Karl Ulfers, vice president, Consumer Solutions at UnitedHealthcare. “This technology encourages people to update their personal health records as well as print them, so they can take their records with them and discuss their health and treatments with their doctors.”

About a half of million veterans and Medicare members, including nonveterans, have already downloaded their records using the Blue Button interface, according to Veterans Affairs CIO Roger Baker.

“By the end of 2012, we think as many as 75 million people will have access to their medical information through Blue Button,” said Baker. “We’re getting a lot of adoption by private-sector organizations.”

Inforgraphic - Do Healthcare professional use Social Media

Very interesting perspective on how healthcare professionals use Social Media Resource. Originally published in Healthcare IT News

Medicaid Expansion - Will your state be In or Out

Healthcare blog at the TheHill.com has published an interesting article - "Fifteen governors reject or leaning against expanded Medicaid program". This brings a very valid point, if the congress passed a law that has an option to opt out for the state how will the overall effort be effected, since we are talking about a federal law implementation. 

As much as I would like to stay out of politics, this is one topic where I simply cannot refrain myself from commenting. The implementation and acceptance of the Medicaid expansion can only work if it is implemented across all of the states, with the affordable option for healthcare insurance be available anywhere in the country. Should a state choose not to participate it may have far beyond reach implications on the migration of the population from one state to another.

At least 15 governors have indicated they will not participate in the expansion of Medicaid under the healthcare law, striking a blow to President Obama’s promise of broader insurance coverage.

Before Thursday’s Supreme Court ruling, states had the option of either increasing their Medicaid rolls or being penalized by the federal government. The high court struck down that offer as unconstitutional.

 

Governors still have a financial incentive to participate in the expansion of coverage for low-income people, since the government will foot most of the bill through 2016. But the decision is also loaded with politics, particularly for Republican governors who are adamantly opposed to “ObamaCare.”

“You can make the political call real quick, but the actual decision is a complicated one,” said Matt Salo of the National Association of Medicaid Directors. “Governors are going to be looking at the numbers and asking: Does this make sense for us?”
Seven states with Republican governors have given a flat “no” to the Medicaid expansion since the Supreme Court ruling, according to reports and press statements.

States that will decline to participate include Florida, where Gov. Rick Scott (R) turned his opposition to the law into a political career, and Louisiana, where Gov. Bobby Jindal (R) has vowed to help elect Mitt Romney as president in order to repeal it.

In eight other states — seven with GOP governors — the Medicaid expansion seems unlikely, given comments from governors and their offices.

Texas Gov. Rick Perry (R) “has no interest in fast-tracking any portion of this bankrupting and overreaching legislation,” spokeswoman Lucy Nashed said in a statement Monday. “We will continue to call for the full repeal of the bill.”

Virginia Gov. Bob McDonnell (R), considered a contender to be Romney’s vice-presidential nominee, said his focus is on November. 

Some consider the expansion as "budget-busting":

“The only way to stop Barack Obama’s budget-busting healthcare takeover is by electing a new president,” McDonnell said in a statement following the court’s decision.

Interestingly enough, a lot of states already working on the Medicaid redesign and expansion even without a Federal mandate. But that doesn't apply to all.

Some states haven't made a decision as of yet, whether they will or won't participate in the expansion of the program.  
New Jersey Gov. Chris Christie (R), also the subject of VP speculation, has not announced what his state will do. His political position is trickier, since he leads a blue state where there is more support for the healthcare law.

In its original form, the Affordable Care Act would have pulled all federal funds for state Medicaid programs that did not expand as the law intended.

Chief Justice John Roberts strongly criticized that approach in his opinion for the majority.
“The financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encouragement’ ” to expand Medicaid, Roberts wrote. “It is a gun to the head.”

Past estimates have found that, as designed, the law’s expansion would have provided healthcare access to an additional 17 million low-income Americans.

“States have a lot to consider,” said Robin Rudowitz with the Kaiser Commission on Medicaid and the Uninsured. “That is a lot of federal money sitting on the table.”

Alan Weil with the National Academy for State Health Policy said states that do not comply could raise the ire of some in Congress.

“If states turn down that offer, it leaves a lot of people uninsured. If we end up in that place, a lot of people in Congress are going to say that is a problem,” he said.

Several Democrats have expressed confidence that the bill’s intention to expand healthcare coverage can still be fulfilled.

Peter Orszag, who led the White House budget office during the healthcare debate and had a major role in shaping the legislation, said states might come around eventually.

He said the law’s coverage expansion would be significantly undercut if a large number of states opt out.

“There may be significant gaps that open up, and that would be unfortunate,” he said, noting that more than half of the coverage expansion was set to come through Medicaid.

But Orszag said there is plenty of precedent for states to expand their Medicaid programs when they don’t have to. About 60 percent of current Medicaid spending goes toward people or benefits that are not mandated by federal law, he said. States decide to provide those optional benefits because the federal government bears most of the cost — and it would cover an even bigger share of the Affordable Care Act’s expansion.

The federal government will cover the entire cost of the expansion for a few years. Its share begins to drop after that, but Orszag said it won’t fall far enough to be a bad deal for states.
“A 90 percent subsidy rate is going to be hard to resist,” Orszag said Monday on a conference call organized by Foreign Affairs magazine.
— Sam Baker, Lydia Nuzum and Gunnar Sidak contributed to this report.

You can find original article along with the list of states that already decided on their participation/non-participation here