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4 posts from May 2015

05/29/2015

Potential Republican Party Responses to King v. Burwell: A Conversation With Tevi Troy (May 28th)

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Shortly before the Supreme Court recesses in early July the Court will rule on David King v. Sylvia Burwell, the case where the plaintiffs argue the Affordable Care Act only allows for tax credit subsidies via state-run exchanges or only those, as the ACA states, "established by the state."  If the court rules in favor of the plaintiff an estimated 5 to 8 million newly insured will lose their coverage absent a subsidy because to date only 16 states plus the District of Columbia have set up state health insurance exchanges or marketplaces.  If this is the Court's ruling how might the Republican-controlled Congress react?   Regardless of the Court's decision the health care reform likely becomes a 2016 presidential campaign issue for the Republican party.  

During this 21-minute discussion, Dr. Tevi Troy outlines possible responses by the Republican controlled Congress to a Court's decision in favor of the plaintiffs, how Republican presidential candidates may shape the race's health care reform debate (moreover if the Court rules in favor of Burwell) and he addresses major aspects of the ACA that remain contentious, i.e., the employer mandate, the Cadillac tax and Medicaid reform.

Dr. Tevi Troy is currently President of the American Health Policy Institute and Adjunct Fellow at 220px-Tevi_David_Troy_HHS_2007the Hudson Institute.  Previously he served as Deputy Secretary at the Department of Health and Human Services under President George W. Bush, as Deputy Assistant and Acting Assistant to the White House Domestic Policy Council, as Policy Director for Senator John Ashcroft and as Senior Domestic Policy Adviser and Domestic Policy Director for the House Policy Committee.  Still previously he was a Researcher at the American Enterprise Institute.  His numerous writings include,"What Jefferson Read, Eisenhower Watched and Obama Tweeted, 200 Years of Popular Culture in the White House," and "Intellectuals and the American Presidency," Philosophers, Jesters or Technicians?"  Dr. Troy earned his Ph.D. in American Civilizations from the University of Texas as Austin.     

Information on Dr. Troy's latest book, ""What Jefferson Read, Eisenhower Watched and Obama Tweeted, 200 Years of Popular Culture in the White House” can be found at: http://www.amazon.com/What-Jefferson-Watched-Obama-Tweeted/dp/1621570398/ref=sr_1_1?ie=UTF8&qid=1437409023&sr=8-1&keywords=what+jefferson+read+ike+watched+and+obama+tweeted.

 

 

05/14/2015

What Is Risk Adjustment and How Is It Accomplished Under MA: A Conversation with Robert Book (May 13th)

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Risk adjustment is a statistical method by which payers can reasonably predict how much a patient's care needs are expected to cost in any given year.  In so called Fee-For-Service Medicare this matter is essentially moot since since providers are simply paid for the reimbursable services they provide their patients.  However, health care payment is rapidly moving towards fixed or pre-arranged reimbursement models.  For example, Medicare Advantage plans are paid a pre-determined or fixed per member per month fee and ACOs are incented to spend less annually than a pre-determined benchmark that amounts to an ACO's patients' historical costs risk adjusted.  Therefore, risk adjustment, or getting risk adjustment right, becomes critically important.  

During this 23 minute discussion Dr. Book explains the theory behind risk adjustment, how it's calculated for Medicare Advantage plans using hierarchical condition categories (HCC) codes and demographic data, the phenomenon known as "up coding," what CMS has done to address the issue and whether predicted costs tend to be lower than actual costs for high cost beneficiaries is a problem.

Dr. Robert Book is a Health Economist and Senior Research Director at the Health Systems  Robert_A_Book_147x220_cl
Innovation Network.   (His paper discussed during this interview was authored via his work with the American Action Forum.)  Dr. Book's work primarily focuses on modeling of the effects of the ACA.   He has also expertise in a wide variety of related issues including Medicare and Medicare Advantage pricing, provider incentives, employer-sponsored insurance, drug regulation and the economics of medical research.  Dr. Book earned his Ph.D. in economics and his MBA at the University of Chicago, an MA in computational and applied mathematics at Rice and his undergraduate in mathematics at Duke.     

Dr. Book's primer on Medicare Advantage risk adjustment is at: http://americanactionforum.org/research/primer-medicare-risk-adjustment.

For a discussion on Medicare Advantage pricing more generally see the May 6, 2013 interview with Dr. Brian Biles.   

05/08/2015

Mt. Sinai's Hospital At Home Demonstration: A Conversation with Dr. Jeffrey Farber (May 7th)

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Beyond hospital care's considerable expense and at times questionable quality, it can be often times unnecessary.  We spend over $900 billion, or one-third of all health care spending, on hospital care annually. Despite these costs the quality of hospital care can be poor if not harmful.  A 2013 study published in the Journal of Patient Safety concluded between 210,000 and 440,000 patients hospitalized annually are fatally harmed. Beyond cost and quality, according to federal Agency for Healthcare Research & Quality (AHRQ) approximately ten percent of all hospital admissions for certain chronic and acute conditions are avoidable.

During this 21 minute discussion Dr. Jeffrey Farber explains the impetus for Mt. Sinai's hospital at home or mobile acute care demonstration.  How it's funded, what patients with what diagnoses are eligible, the range of services they receive, the importance of carefully screening these patients before admission and the demonstration's anticipated results.     

Dr, Jeffrey Farber is an Associate Professor in the Brookdale Department of Geriatrics and Farber photoPalliative Medicine at the Icahn School of Medicine at Mount Sinai, he also serves as the Chief Medical Officer at Mount Sinai Health Partners, as VP of Hospital Services Utilization and as Chief Executive Officer of Mount Sinai Care, Mt. Sinai's Accountable Care Organization.  Dr. Farber completed a residency in Internal Medicine at New York Presbyterian Hospital, Columbia Campus and a fellowship in Geriatric Medicine at Mount Sinai School of Medicine.  His career interests include research in models of care for older adults, as well as clinical documentation and the medical interface with hospital finance.  He is a recipient of a federal Geriatric Academic Career Award and his research has been published in The Annals of Internal Medicine and The Journal of Hospital Medicine.

CMS's summary of Mt. Sinai's Mobile Acute Care Team (MACT) demonstration is at: http://innovation.cms.gov/initiatives/Participant/Health-Care-Innovation-Awards-Round-Two/Icahn-School-Of-Medicine-At-Mount-Sinai.html 

 

05/01/2015

The State of Alzheimer's Funding and Research: A Conversation with Robert Egge (April 30th)

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Alzheimer's Disease accounts for approximately 70% of all dementia diagnoses.  The disease affects over five million Americans or upwards of 35 million worldwide.  Disease burden is currently estimated to grow to 16 million patients in the US by 2050 with projected costs estimated at over $1 trillion.  Patients diagnosed with Alzheimer's survive three to nine years. The disease kills 500,000 deaths annually, making it the 6th leading cause of death.  The risk of the disease is believed to be largely genetic.  There are currently no treatments or medications to stop, reverse or modify its progression - the only major disease with this distinction.  

During this 23 minute discussion Mr. Egge discusses the work of the Alzheimer's Association, the current state of curative research and the development of a blood test to diagnose Alzheimer's before symptoms appear, the adequacy of federal funding to fight the disease, the federally-legislated "National Alzheimer's Plan" and what's being done to improve care for patients currently suffering from Alzheimer's and other forms of dementia.   

Robert Egge is the Chief Public Policy Officer and Executive Vice President of Government Affairs Eggefor the Alzheimer's Association.  Mr. Egge also serves as the Executive Director of the Alzheimer's Association's sister organization, the Alzheimer's Impact Movement.  Prior to joining the Alzheimer's Association Mr. Egge served as Executive Director of the Alzheimer's Study Group.  Prior still he served as a Project Director for the Center for Health Transformation and as Vice President for Government Affairs for the JC Watts Companies.  Mr. Egge's writings have appeared in The New York Times, the Financial Times, in Health Affairs and he has provided testimony to both US House and Senate health care committees.

For more on the work of the Alzheimer's Association go to: www.alz.org.