Among the Patient Protection and Affordable Care Act’s provisions are additions to the Public Health Service Act that focus on improving health care quality. As discussed in a previous post PHSA Secs. 2715 and 2717 require the federal government to develop uniform standards for plans' benefit summaries and explanations of coverage and guidelines for health insurers to report on their quality of care initiatives and programs.
The Agency for Healthcare Research and Quality, in the U.S. Department of Health and Human Services, has been addressing health care and health insurer quality issues since 1995 with its Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, a public-private initiative to develop standardized surveys of patients' experiences. The AHRQ’s stated mission is to “foster health care research that helps the American health care system provide access to high-quality, cost effective services; be accountable and responsive to consumers and purchasers; and improve health status and quality of life.”
Most recently, the AHRQ published a Notice of Request for Measures to determine how well health plans and health providers address health plan enrollees' health literacy needs and how well they communicate with health plan enrollees.
The intent of the planned survey, the AHRQ says, is “to gain patients' perspective on how well health and health plan information is communicated to them by healthcare professionals and health plans.” Health plans, medical providers, and others may use the results of the survey to determine the quality of the health information they provide and the best methods to deliver that information to plan enrollees and to patients.
The issues that the measures would assess could include, for example, clarity and simplicity of provided health information related to preventive services (for example, risks and benefits of the service, explanation of screening results); health problems/concerns (such as information on how to stay healthy or prevent illness); treatment choices, instructions, or goals including pros and cons of each option; medications (for example, reason to take the prescribed medications, instructions on how to take the medications, and possible side effects); and care management/disease management.
Another subject that may be assessed is the quality of services that support delivery of health information, such as language access, including availability in other languages and timeliness of customer service and interpreter services and of forms and patient education materials, the quality and accessibility of member services, nurse advice lines, and health plan information on coverage, benefits, and billing information, health plan system navigation and health plan environment (language access and assistance in completing medical paperwork or forms, signage).
Since the CAHPS program started in 1995 it has expanded to include surveys and reports on individual medical services providers, group medical practices, kidney dialysis centers, nursing homes and hospitals. Most recently, AHRQ determined that the CAHPS should develop a survey to obtain the consumers' perspective on the quality of health information (another element of health reform).
Federal law gives the AHRQ the power to conduct and support research and distribute information on health care and on delivery systems including on the following elements: quality, effectiveness, efficiency, appropriateness and value of health care services; quality measurement and improvement; outcomes, cost, cost-effectiveness, use of health care services and access to such services; and health statistics, surveys, and database development.
So, in terms of health care quality assessment and improvement, one federal agency at least already is well established and moving forward to aid in health reform. Check out the AHRQ’s Website
Monday, August 23, 2010
Friday, August 20, 2010
Many states lack power to enforce health reform laws
Earlier this week, the Department of Health and Human Services (HHS) awarded states $46 million, in the first round of grants, to help them crack down on unreasonable health insurance premium hikes. Five states—Alaska, Georgia, Iowa, Minnesota, and Wyoming—did not apply for a grant under this HHS program.
The problem. Why is this money needed? There are gaps in states’ authority to regulate insurance rates as well as to enforce federal health reform’s consumer protections. In fact, currently, only 26 states and the District of Columbia have the authority to reject a proposed increase that is excessive, lacks justification or otherwise exceeds state standards. Even worse, many of the states that have the power to crack down on unreasonable premium increases lack resources to exercise it meaningfully.
Uses for grant money. States expect to use the HHS grants in one or more different ways, including:
The problem. Why is this money needed? There are gaps in states’ authority to regulate insurance rates as well as to enforce federal health reform’s consumer protections. In fact, currently, only 26 states and the District of Columbia have the authority to reject a proposed increase that is excessive, lacks justification or otherwise exceeds state standards. Even worse, many of the states that have the power to crack down on unreasonable premium increases lack resources to exercise it meaningfully.
Uses for grant money. States expect to use the HHS grants in one or more different ways, including:
- Seeking additional legislative authority: 15 states and the District of Columbia will pursue additional legislative authority to create a more robust program for reviewing or requiring advanced approval of proposed health insurance premium increases to ensure that they are reasonable;
- Expanding the scope of health insurance premium review: 21 states and the District of Columbia will expand the scope of their current health insurance review, for example, by reviewing and requiring pre-approval of rate increases for additional health insurance products in their state;
- Improving the health insurance premium review process: All 46 state grantees will require insurance companies to report more extensive information through a new, standardized process to better evaluate proposed premium increases and increase transparency across the marketplace;
- Making more information publicly available: 42 states and the District of Columbia will increase the transparency of the health insurance premium review process and provide easy-to-understand, consumer friendly information to the public about changes to their premiums; and
- Developing and upgrading technology: All state grantees will develop and upgrade existing technology to streamline data sharing and put information in the hands of consumers more quickly.
Wednesday, August 18, 2010
Most large employers revising their health plans for 2011
Most (53%) large American employers plan to make changes to their health programs for next year, in light of health reform and expected large cost increases, according to a survey by the National Business Group on Health. The rest are either (1) scaling back planned changes, (2) making no changes, or (3) unsure of what they intend to do.
Among the employers who are making specific health plan changes to comply with the new health reform law, the survey said that 70 percent indicated they will remove lifetime dollar limits on overall benefits while 37 percent reported they will make changes to annual or lifetime limits on specific benefits. About one in four (26%) will remove annual dollar limits on overall benefits while 13 percent will remove pre-existing condition exclusions for children.
"While the health reform law has forced employers to evaluate their health care benefit strategies and decide whether to comply with the law or lose grandfathered status, they haven't lost sight of the fact that controlling rising costs remains one of, if not, their highest priority. They have to foot the bill, not the government," said Helen Darling, president of the National Business Group on Health. "In fact, with cost increases expected to accelerate next year, many of the plan design changes employers are making are being done to help curb those increases, as they have to do every year."
Other findings. Among other things, the survey found that more employers plan to increase the percentage employees contribute to the premium next year, while more employers plan to raise out-of-pocket maximums next year compared with 36% this year.
With the health reform law making Medicare Part D benefits richer via the closing of the “doughnut hole," five percent of employers plan to drop retiree health coverage in 2011 while 60 percent are considering doing so in the future.
For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
Among the employers who are making specific health plan changes to comply with the new health reform law, the survey said that 70 percent indicated they will remove lifetime dollar limits on overall benefits while 37 percent reported they will make changes to annual or lifetime limits on specific benefits. About one in four (26%) will remove annual dollar limits on overall benefits while 13 percent will remove pre-existing condition exclusions for children.
"While the health reform law has forced employers to evaluate their health care benefit strategies and decide whether to comply with the law or lose grandfathered status, they haven't lost sight of the fact that controlling rising costs remains one of, if not, their highest priority. They have to foot the bill, not the government," said Helen Darling, president of the National Business Group on Health. "In fact, with cost increases expected to accelerate next year, many of the plan design changes employers are making are being done to help curb those increases, as they have to do every year."
Other findings. Among other things, the survey found that more employers plan to increase the percentage employees contribute to the premium next year, while more employers plan to raise out-of-pocket maximums next year compared with 36% this year.
With the health reform law making Medicare Part D benefits richer via the closing of the “doughnut hole," five percent of employers plan to drop retiree health coverage in 2011 while 60 percent are considering doing so in the future.
For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
