The NYT reported on February 24 about increased heart attacks after job loss. Numerous studies have reported on stress, depression, and job loss increaseing heart attack risk. The latest study in 2009 led by Sarah A. Burgard, a professor of sociology and epidemiology at the University of Michigan, found that “persistent perceived job insecurity” was itself a powerful predictor of poor health and might even be more damaging than actual job loss. We recently posted a blog on behavioral health prevention. We have a series of behavioral health prevention articles on our website that address several areas of behavioral health prevention. I suspect that although the new mental health parity rules just release will dramatically increase healthcare costs one benefit may be increased behavioral health prevention of other medical illnesses such as heart disease. We at BHM can help develop cost-effective management programs using detailed data analysis to improve cost effective care. I will be posting more articles on this topic as reducing health care costs while maintaining quality is a national debate.
Never events are medical events that are serious, largely preventable, and of concern to both the public and health care providers. The National Quality Forum has identified a list of 28 events such as surgery on the wrong patient, and hospital acquired injuries which are currently identified as never events, but proponents would like to add more events to this list.
The payment policies for never events as set forth by Minnesota, and followed by more and more states recently states that providers will not be reimbursed for procedures and treatments needed as the result of a preventable serious medical event. These events as reported by the CDC account for 2.4 million extra hospital days per year and $9.3 billion dollars in excess charges.
Payers which are adopting these policies include Aetna, CMS, and Blue Cross and Blue Shield, Medicaid (in some states such as VA, and PA). Payers insist that the purpose of these policies is not to save money, but to raise awareness and accountability within hospitals, and help medical establishments prevent serious errors. Increasingly medical “Never Events” are being worked into hospital contracts as they come up for renewal, but not everyone is on board with the adoption of these policies.
Some providers are worried about events which may occur even after they have put significant safe guards in place such as suicide and falls. Others are concerned about payment determination wondering how it will be determined which services are related to “Never Events” and which are not. Patient advocates are also up in arms since if the insurer fails to pay and the hospital disputes the charges the patient may still be responsible. Whatever the outcome of these disputes, “Never Events” policies are catching on and Managed Care Organizations as well as providers should become familiar with these events and the related payment policies going into the future. BHM can help in designing quality improvement programs to decrease the risk of Never Events.
The Paul Wellstone Mental Health and Addiction Equity Act went into effect on or before Oct. 3, 2009. For more detailed information please see the BHM white paper “Mental Health Parity Preparedness: opportunity for managed care organizations”.
Below is a timeline for Federal Mental Health Parity:
1.?The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act (WDA) was passed on Oct. 3, 2008 ?This act was passed as a component of the Troubled Asset Relief Program (TARP) signed by President George W. Bush ? .
2. The law was initially slated to go into effect on Oct. 3, 2009.
3. Congress deferred the effective date to Jan. 2010 for plans which would have otherwise been covered in 2009 .
4. On Jan. 29th 2009 the IRS (Treasury), Labor, and Health & Human Services, released the interim final guidelines for this act. ?The new “rules” go into effect on July 1st 2010.
The law was 13 pages but the rules are 154 pages. There are going to be many very significant changes when these rules go int effect. This will create both challenges as well as opportunities for both healthcare providers as well as healthcare insurers. BHM’s Mike Forrester will be presenting a number of target webinars to assist organizations in reducing the risk and maximizing the potential of this new legislation.
Until you are able to join Mike Forrester at one of his webinars below are a few tips to begin the preparation:
Keys for Parity Preparation • Review organization history of health care coverage patterns
• Evaluate integration of physical and behavioral health within your current organization • Procure relationships with outside vendors if in-house care is not possible
• Carefully reevaluate your plans provider network • Evaluate potential changes in the following areas:
- Removal of limits
- Change in co-payments
- Change in insurance
- Covered diagnosis
- Pharmacy Benefits
A new study found that being happy, enthusiastic and positive can decrease risk of cardiovascular diseases. Previous studies had found that depression, anger and hostility are important risk factors contributing to heart attack and stroke. We have a series of articles that discuss behavioral health prevention and medical diseases.
According to the study published in the European Heart Journal, people who have high levels of anxiety and depression are at the highest risk of experiencing heart disorders. The article reports that happy individuals are at a 22 percent lower risk of developing the condition as they are less stressed and are able to move on from upsetting experiences. Scientists believe happiness can also reduce the risk of heart disease through reducing a number of critical hormones.
While the study was not able to prove happiness is protective, scientists stressed that individuals should enjoy themselves in order to lower their risk of heart disease. “Essentially spending a few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health and may improve your physical health as well,” said lead researcher Karina W. Davidson.
NAMCP has partnered with us to write a five-part series on how behavioral health can prevent or reduce risk from a number of medical illnesses. The mission of the NAMCP is to enhance the ability of practicing physicians and other health care professionals through accredited continuing medical education programs, research and communication, to succeed in managed care environments and integrated delivery systems.
- The NAMCP was founded in 1991 to serve the interests and needs of physicians working in any form of managed health care. NAMCP is a non-profit association run by physicians for physicians.
- Since physicians affect 85% of the expense side in health care, they should take a proactive role in developing the best delivery system for patients in managed health care, thereby increasing quality, reducing costs and improving practice performance and clinical outcomes.
- Physician-directed managed health care is important for all providers and patients. Today’s health care expenses exceed one trillion dollars; we believe physicians and patients should be educated about all aspects of managed health care in order to control costs and deliver high quality health care. New terms such as disease management and demand management will benefit patients if both physicians and patients understand and participate with these systems in a proactive manner. For any system to work, we must have educated patients as well as physicians, in order to make appropriate decisions in an examination room
I read with interest a recent article about airlines loss of business travelers over the past few years. Last year business travel was down 60%. They expect business travel to be up this year. The article went on to say that the industry does not expect to get back any more than half the business it lost because of technology advances. We recently assisted a managed care company to become URAC accredited in 3 areas over a short period of time. This would have in the past involved lots of travel and on-site meetings. We did all of it with just one face to face meeting (excluding a mock survey and the actual URAC survey). All the rest of the preparation was done via web conferencing. This reduced the cost by at least half. Not only was it very cost-effective but the technology lead to superior results, possible because of the way you can focus participants using web-based technology. If your organization needs high quality cost-effective health care consulting services please contact us for a free consultation.
The Wall Street Journal reported today about the very controversal Wellpoint rate hike in CA. It appears that everyone is jumping on the evil health insurance band wagon. We have discussed that even if health status and health cost per person in america was stable that the current recession will drive up healthcare costs. As employees loss their jobs, they and their family do some quick math. What are my monthly known medical expenses and what is the current cost of COBRA. Families that have high health care cost in relation to the premiums they will be charged for COBRA keep their insurance where as those that have low or no real healthcare cost ( ie the healthy population) chose to take the risk of a major medical event while uninsured. This has a double impact on health insurers, decreased revenue due to lost members( layed off employees) and increased expense ( health insurance companies biggest expense is their members health care cost). In response to this I suspect we will see large increases in health insurance premiums over the next few years. The WSJ went on to say that the recently proposed health insurance reform will led to very similar rate hikes. Any type of healthcare reform has to take very seriously the unintended consequences.
I am often asked what is the best accreditation organization. Typically I am asked this question by a client that has just engaged our services and after they have chosen an accreditation entity. I asked our expert accreditation consultant, Rachel Walker, SVP of BHM’s accreditation and QI Division to help out. She wrote two articles in our February newsletter that I thing are helpful. Please see our newsletter for more details.
When it comes to spending your “accreditation dollars” it can be a jungle out there. Not only are there a variety of accreditations, but also a vast choice in entities which provide them. Find out what to consider before spending your money on accreditation according to BHM’s accreditation expert Rachel Walker. Learn important keys to identifying the accreditation entity which will not only support your organization in reaching goals and objectives, but also be more beneficial to your organization when taking into consideration the “big picture”.
Learn the essential keys to accreditation due diligence. This article will feature concrete questions which should be part of any organizations due diligence process, along with expert advice from BHM’s accreditation expert Rachel S. Walker, RN, B-C, CHCQM.
We published the above headline in our February Newsletter. Since we published the newsletter a number of large insurers have released their quarterly results. See article on Aetna Healthcare.
As we pointed out, health insurance companies are getting both downward pressure due to loss of members. That unfortunately does not tell the whole story. Layed off workers that are healthy do not elect cobra. Layed off workers that have significant medical problems elect to pay for their insurance through cobra. This creates a self-selection. Insurance companies are feeling the pinch of lower revenue and increased care cost per member they are insuring. Insurance companies can react in a number of ways.
1. Increase premiums
2. Increase scrutiny of medical services they are paying. This will result in increased denials of care.
3. Try to remove high cost groups or members
We at BHM believe that most insurers will do a bit of all three methods to improve profits but because of the current economic environment we believe that increased denials maybe the method of choice. In future blogs I will be addressing what insurance companies can do to help reduce the cost of care in a strategic way. We will also address what providers of care as well as consumers can do to prepare for these changes and possible increase in insurance denials.