During his successful presidential campaign, candidate Barack Obama famously said federal leaders needed to use a scalpel—rather than a hatchet—to make budget cuts.
Now, less than two months into the Obama administration, the Illinois Democrat has set aside an instrument usually found on ER for one that stars on Ax Men. In the president's first budget proposal, Obama took aim at Medicare Advantage overpayments. That's not a surprise.
Obama and the Democrats are not fans of the Republican-backed program that costs about 14% more on average than Medicare fee-for-service beneficiaries.
However, by using a chainsaw on Medicare Advantage, the president is also slashing payments to a subset of plans called special needs plans (SNPs). SNPs were created under the Medicare Modernization Act of 2003 as a way to bring managed care to seriously chronically ill beneficiaries who are institutionalized, dually eligible, and suffer from severe and disabling chronic conditions. Congress has since established specific chronic condition SNPs that focus on such high-cost ailments as end-stage renal disease, chronic heart failure, dementia, cancer, HIV/AIDS, stroke, and chronic lung diseases.
SNPs are under the Medicare Advantage umbrella because the plans feature private entities (health insurers and disease management companies) that provide care coordination for chronically ill Medicare beneficiaries. One of the largest providers of SNPs is XLHealth, a disease management company based in Baltimore. XLHealth's Care Improvement Plus offers SNPs to chronically ill beneficiaries with diabetes, heart failure, chronic obstructive pulmonary disease, and end-stage renal disease.
Once a vendor that delivered DM services, XLHealth now offers SNPs exclusively. With experience in the Medicare population, XLHealth entered the SNP space because the company believed it had the system capabilities and understood how to care for chronically ill people, says Paul Serini, executive vice president at XLHealth.
Through its SNP programs, XLHealth combines its technology platform called XLCare, which aggregates data obtained through claims, pharmacy, face-to-face interactions, nurse calls, and visits with social workers, nurses, and doctors, with its regular outreach that helps care for beneficiaries medically, socially, and emotionally.
Now, after three years of providing SNPs, XLHealth faces an uncertain future under Obama's budget plan. Serini says company officials have spoken with CMS and Congress about the need to not lump SNPs in with Medicare Advantage cuts because reducing payments to Medicare fee-for-service levels would harm SNPs.
Serini says XLHealth isn't opposed to getting paid at the same level as fee-for-service providers, but CMS needs to rework the payment system so those providing services to chronically ill patients receive the right reimbursement. Currently, providers and insurers are underpaid by 12% to 18% for seriously chronically ill beneficiaries, says Serini.
The Medicare Trust Fund faces bankruptcy within the next 10 years given the wave of chronic care and baby boomers. For this reason, policymakers shouldn't cut programs that help chronically ill Medicare beneficiaries, but should test myriad solutions to see which work best.
The XL executive says one possible solution is Medicare-managed care—such as SNPs—which is a perfect fit for chronically ill patients. He believes this because Medicare managed care coordinates care across multiple providers, offers care management support, stabilizes medications for patients moving in and out of the hospital, and does transitional care planning between hospitals and nursing homes. All of these programs create a medical home for chronically ill patients, says Serini.
"We do think that managed care, managed Medicare in particular, when applied to the frail and chronically ill, is probably the best way to manage the costs of the chronically ill in the Medicare system," says Serini.
SNPs have not been around long enough to tell us whether managed Medicare programs can lower costs and improve patient health status in the long run. By cutting payments to SNPs, which will lead to insurers leaving the program, the president is in effect decimating programs that could ultimately be the best way to care for the highest-cost beneficiaries.
As President Obama looks for programs to cut, he needs to take his own advice and pick up the scalpel.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
In picking Nancy-Ann DeParle to champion an overhaul of the nation's health system, President Obama selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy, and respect on both sides of the political aisle. But he also chose to overlook DeParle's business ties to companies that have a direct stake in the healthcare debate.
Newly appointed Health Resources Services Administration Administrator Mary Wakefield says her background as a registered nurse will be as valuable to her new job as her years of experience and expertise in the healthcare policy arena.
"The frontline experience is as important as anything. Clinicians have had that up-close-and-personal experience with the problems that these vulnerable and underserved people face," Wakefield says in an interview with HealthLeaders Media. "When you bring in a healthcare provider into many of these administrative positions, you've got individuals who've got a sense of what it is like to operate inside the healthcare delivery system. Having clinicians in key positions gives them a finger on the pulse, brings them a little bit closer to the issues, and adds color and perspective to how programs can be deployed, how they can touch people's lives, and what differences they do or don't make."
Wakefield starts at HRSA on March 10. Since 2001, she has served as associate dean for rural health and director of the Center for Rural Health at the School of Medicine and Health Sciences, University of North Dakota, in Grand Forks. Before that, she was director of the Center for Health Policy, Research, and Ethics at George Mason University in Fairfax, VA. Before that, she worked in Congress in the 1980s and early 1990s as chief of staff for North Dakota Democratic Sens. Quentin Burdick and Kent Conrad. She is an expert on issues like patient safety, rural health, and Medicare payment policy, and has served on several federal health policy advisory commissions.
At HRSA, an agency under HHS, Wakefield will lead an organization with 1,400 employees in six bureaus and 13 offices, and an annual budget of about $6.85 billion—90% of which is doled out to provide grants that directly affect about 23 million people in urban and rural areas in every state and territory. HRSA grants are targeted to improve healthcare access, quality, and outcomes to vulnerable populations that include the poor, uninsured, people with HIV/AIDS, pregnant women, and mothers and children. The agency also oversees healthcare centers across the country.
Tim Size, executive director of the Rural Wisconsin Health Cooperative, says the Obama administration could not have picked a stronger advocate for rural health than Wakefield. Size says her selection has sent a clear signal to the public healthcare advocacy community that the new administration is serious about improving healthcare access and quality for poor and uninsured people. "If you named three people who are among the most respected in rural health in America, she'd be on that list," Size says. "She won't be there to represent a political ideology as much as to try to deal with the historic challenges that HRSA faces around disparities in rural and urban health."
Size says a nurse is exactly what HRSA needs. "Nurses, especially senior nurses, think very systemically. They are probably the one profession that is trained intuitively to break through silos," he says. "She will very much be working on how to help clinics continue to fulfill their mission, and also on how they relate to the rest of the system and how we maximize those relationships."
Wakefield made it clear that she does not regard herself as merely a functionary for the Obama administration. "Front and center I work for the president and I'll be taking my directions from his healthcare team. It's there that I'll be getting much direction," she says. "But in addition, I was brought to this by some of the expertise that I have. This is really about working for, on behalf of, and in sync with the vision that will be articulated by the administration. I have every intention of complementing that with the expertise that I will bring not just managing an agency but knowing something about many of the programs that are operationalized through that agency."
Wakefield says she expects her priorities at HRSA will include ensuring that the $2.5 billion in stimulus money that flows through HRSA goes toward its intended targets, which are improving the healthcare infrastructure and training healthcare professionals. She says she also expects to examine HRSA programs and their relationship with the health reform proposals that President Obama is bringing forward.
Wakefield says HRSA's role has become more critical with the collapse of the economy as more people lose their jobs and their health insurance. She says HRSA can greatly impact rural healthcare by promoting programs like the National Health Service Corps, which places physicians and other healthcare providers in underserved rural and urban areas.
She says she anticipates looking at the Office of Rural Health Policy, which is located in HRSA, to promote programs that encourage collaboration between rural and urban hospitals. "There are different program levers that can be pulled to try to meet the simple workforce needs and help support safety net infrastructure in urban and rural underserved areas," she says.
Wakefield was asked what message the Obama administration was sending to rural healthcare advocates and observers by picking her.
"What this communicates to me is that rural is not left behind. Rural is part and parcel of the focus of programs that are so important to individuals and programs that reach directly into the heart of communities," she says. "They are saying rural is part of that too."
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
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With companies tightening their budgets, inexpensive social media may well be the next marketing frontier. But as with any new trend, there are enormous opportunities—and large pitfalls that marketers should be aware of. This article identifies the possible Twitter landmines so marketers can fast-track their company's exploration of this vast new frontier.
Many patients today are also savvy consumers. They want the best and they're willing to shop around to find it. So, what's a hospital to do to capture market share and attention? In the midst of renovations and an increasingly competitive market, the Reading Hospital and Medical Center in West Reading, PA, decided the best way to satisfy the needs of today's patient was to provide a five-star experience.
The facility wanted to secure the patients it had while also attracting a higher payer mix. So a multidisciplinary team comprised of the marketing department, nurses, providers, housekeeping, and volunteer services was put together to work alongside the construction team to develop the patient-centric elements the facility needed.
"We called ourselves the five-star amenities team because we knew we wanted to create a five-star experience for our patients," says Diane Gallagher, assistant director of marketing for Reading Hospital and Medical Center.
The team and hospital decided that it needed to provide patients with the ultimate in clinical service by providing things like private rooms, premier facilities, amenity packages, and a concierge service. "And of course from a marketing perspective we needed to package and to help promote it," says Gallagher.
Though the team brainstormed creative concepts, they ultimately decided to feature a simple, solitary image that would convey a high-level of care. "When you think of [the jeweler Tiffany & Co], consumers tend to think of a level of excellence," says Gallagher. "That's why we decided to feature a sterling, Tiffany-like baby rattle."
Using a multi-integrated approach, the campaign featured the baby rattle as the primary and consistent focus of the imagery with the tagline "You're expecting the best. We Deliver."
"Everything we did that came out of that five-star committee started to take on the look and feel of that Tiffany rattle," says Ann Valuch, director of marketing for Reading Hospital and Medical Center.
Since the campaign launched, the newly-renovated Reading Hospital Beginnings Maternity Center has seen sterling results. Over 3,600 babies have been delivered—an increase of more than 300 deliveries from the previous year—and the facility has seen a high payer mix. Press Ganey satisfaction scores rose from 82%—99%.
Kandace McLaughlin Doyle is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kdoyle@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
Although it might not at first seem obvious, the fact is that there are a lot of parallels between the marketing department and the human resources department. What do marketing and HR have in common? Marketing is responsible for communicating to all customers. And employees and prospective employees, both within the purview of HR, are, after all, customers.
Some hospitals get this, taking full advantage of the expertise and talent available in both departments to deliver a strong message to these important customers.
At Hamilton Health Care System in Dalton, GA, for example, marketing and HR work together on recruitment efforts, internal communications, employee satisfaction, service excellence, and more.
I interviewed Jason Hopkins, director of human resources at Hamilton, for a recent article in HealthLeaders magazine (See Your Friends in HR). He says that when HR "goes rogue," it makes the organization look disorganized and undermines the brand image. "It's not a matter of being territorial," he says. "A collaborative effort just seems to make more efficient sense, rather than an adversarial approach."
Keith Jennings, who worked with Hopkins before becoming an independent marketing consultant, says the approach benefits both departments—and the organization as a whole. In particular, he said, it can help with recruitment efforts.
In a follow-up interview, Jennings expanded on that theme. Hospitals should start by asking these questions, he says:
Why is there a shortage of healthcare workers?
What's driving this shortage?
Is this shortage affecting patient care?
Why should a nurse or doctor choose your hospital over their other choices?
What makes you so special?
And once with you, why should they stick around?
How do you make a difference in their lives and those they serve?
"These are marketing issues," Jennings says. "What hospitals need to do is honestly and sincerely answer those questions with their staff. Not for them."
And, as always, the message has to come from the top. (Or, in this case, the questions must come from the top.)
"There's something powerful in hearing a CEO say, ‘Sure, we're short staffed. Sure, things could be better. But it doesn't change the fact that what you do for us is important. What you do matters. And we need you to help us earn our customers' trust and confidence. So, how can we do that?'
"Strong hospitals have leaders who connect their staff's capabilities to a meaningful purpose," Jennings says. "Weak hospitals suffer from the confusion of a lack of purpose. That's when you have thousands of staff venting their frustrations at home and in the community."
One of my favorite expressions—which I've repeated to the point that I'm in danger of over-using it—is that your brand walks on two feet. When HR, marketing, the c-suite, and your work force work together, you can put a little extra spring in your hospital's step.