Hospitals are spending billions of dollars to achieve meaningful use of electronic medical records, but if patients don't use the new technology, hospitals may not reap the federal stimulus payments that await.
That's the conclusion of a report -- Putting Patients into Meaningful Use – from PwC's Health Research Institute, which found that 14% of 1,000 consumers surveyed last fall said they get their medical records electronically from their physicians, and 30% of patients said they didn't know why they would need to.
Bruce Henderson, director and national leader of the EHR-HIE Practice at PwC says hospitals need to build in patient input earlier in the process to comply with Stage 2 of meaningful use requirements.
"Successful use of electronic health information will ultimately be measured in better patient outcomes, higher quality and reduced costs," Henderson said. "Health systems need to have both patients and physicians actively using the health information to make care decisions, and they aren't there yet."
Henderson said providers must first understand what healthcare consumers want before they can be sold on the benefits of EMR. "Then, they need to build new, technology-enabled healthcare delivery processes around patient preferences and convenience, which means changing how clinicians work," he said.
The PwC survey of 1,000 healthcare consumers found that:
Half of patients said they call their physician's office or hospital for a paper record, and 11% said they don't know how to get their health record.
Of those who access their medical record electronically, 34% share the information with primary care physicians and specialists.
While basic information about prescriptions and appointments are readily available to consumers who have electronic access to medical records, 55% can't access lab results or physician visit notes.
Only 13% of consumers said they'd been asked by providers what they think about EMRs, even though 56% said they'd be willing to talk about what they'd like in an EMR and how they'd like to use it.
When asked how they would like EMR to be used, 66% of consumers said for physicians to follow-up on their condition, 59% said for scheduling follow-up appointments, and 53% said to learn about treatment options.
35% of consumers said they would like their physician to use the information to monitor treatment compliance, and 34% said they would like their physician to monitor their health condition, such as blood pressure, remotely via a device that automatically sends information.
Approximately one-quarter of respondents would like to share electronic health information with family members to better understand family medical history.
13% of health leaders have an interactive patient portal in place, while
66% have a physician portal in place
HHS' Stage 2 proposed standards for meaningful use may require hospitals to offer 80% of patients with the ability to access to view and download their health information via a Web-based portal within 36 hours of discharge. Doctors and other providers must have at least 20% of their patient populations electronically accessing their health information, including access to diagnostic test results. Providers must meet these minimum requirements by October 2012 to qualify for additional stimulus money.
While 90% of more than 300 provider executives surveyed by PwC in the spring of 2010 said they expected to achieve meaningful use standards before the penalties kick in, their confidence is waning slightly as new realities set in and health organizations rethink their work plans to devote more attention on engaging external stakeholders. By the fall of 2010, 82% of the executives said they will meet the timetable.
Henderson said there are significant social, educational, and access barriers that providers are trying to overcome – including a gap in expectations between what patients and physicians want, and conflicting views about turnaround time. PwC's cited one hospital's internal research that found that physicians thought 45 days was a reasonable timeframe for making test results available electronically, while patients expected this information within 30 minutes.
"A patient's medical record and the health information within it should not be a history lesson. Those days are over," Henderson said. "To be meaningful, health information needs to be relevant, actionable, integrated into care and treatment decisions and available in real-time."
PwC's survey also found progress. Nearly one-third of health systems said they are now adding patient input into their meaningful use initiatives, up from 19% last spring. Approximately 50% of health systems are providing assistance to physicians who need support tools for using EMR in their clinical work.
The National Board of Medical Examiners has agreed to provide "reasonable testing accommodations" and remove other barriers for people with disabilities who want to take the U.S. Medical Licensing Examination, the Department of Justice has announced.
The agreement disclosed this week settles an Americans with Disabilities Act complaint that was lodged against the private, nonprofit NBME by Frederick Romberg, a Yale Medical School student with dyslexia who was twice denied "reasonable testing accommodations" to take the exam. With the settlement, Romberg will be given double the standard testing time and a separate testing area to take the USMLE.
"In the past, demands for unnecessary or redundant documentation, burdensome and expensive repeated professional evaluations, or irrelevant evaluative testing unrelated to the ability to demonstrate one's knowledge or skills on an examination prevented individuals with appropriately documented disabilities from pursuing their chosen professions." said Thomas E. Perez, assistant attorney general for DOJ's Civil Rights Division. "By entering into this agreement, NBME is doing its part to ensure that people with a reading disability like Mr. Romberg will have the opportunity to take the USMLE with the reasonable testing accommodations they need to demonstrate their knowledge and ability."
Under the agreement, the NBME will:
· Only request documentation about (a) the existence of a physical or mental impairment; (b) whether the applicant's impairment substantially limits one or more major life activities within the meaning of the ADA; and (c) whether and how the impairment limits the applicant's ability to take the USMLE under standard conditions;
· Consider the recommendations of qualified professionals who have personally observed the applicant in a clinical setting and recommended accommodations based upon their clinical judgment that the individual is substantially limited in one or more major life activities within the meaning of the ADA and needs the requested test accommodations in order to demonstrate his or her ability and achievement level; such recommendations are to be based on generally accepted diagnostic criteria and supported by reasonable documentation.
Consider all evidence indicating whether a person's ability to read is substantially limited within the meaning of the ADA, including the extent to which it is restricted as to the conditions, manner or duration as compared to the reading ability of most people.
DOJ pressed for the settlement under Title III of the ADA which prohibits discrimination against people with disabilities by private testing entities that administer examinations related to professional licensing.
In response to the settlement with Justic, NBME issued this statement:
"The NBME was first contacted by the Department of Justice regarding Mr. Romberg in October 2010. We explained to the Department of Justice the reasons for our decision on Mr. Romberg?s request for testing accommodations. Through the Department of Justice, NBME was provided additional documentation relating to Mr. Romberg, and NBME and the Department of Justice subsequently reached an amicable resolution that addressed the concerns of each party. The NBME will continue to provide testing accommodations to candidates in accordance with the requirements of the Americans with Disabilities Act. Our accommodation process is rigorous but fair, and properly reflects the important role that the USMLE plays in the licensure process for physicians. We appreciate having the opportunity to work with the Department of Justice toward a mutually satisfactory outcome."
Maryland-based Cignet Health has been slapped with a $4.3 million fine for its refusal to provide patients with copies of their health records, and for willfully failing to cooperate with the federal government's attempts to resolve the complaint, the Department of Health and Human Services announced Tuesday.
HHS's Office for Civil Rights said the fine is the first such "civil money penalty" imposed for violations of the Privacy Rule of the Health Insurance Portability and Accountability Act.
Calls to Mitchellville, MD-based Cignet on Tuesday afternoon were not immediately returned.
HHS's Office of Civil Rights said Cignet violated 41 patients' rights by denying them access to their medical records when requested between September 2008 and October 2009. The patients complained to OCR alleging that Cignet was violating the HIPAA rule that requires "covered entities" to provide patients with copies of their medical records within 30 days -- and no later than 60 days -- of the request, HHS said.
The civil money penalty for the violations was $1.3 million.
During the investigations, however, Cignet allegedly ignored OCR's demands to produce the records. A federal court issued a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet gave the medical records to OCR, allegedly with no efforts to resolve the complaints through "informal means." OCR alleged that Cignet also failed to cooperate with the investigation from March 17, 2009, to April 7, 2010, indicating "Cignet's willful neglect to comply with the Privacy Rule." The failure to cooperate with OCR added $3 million to the civil money payment, HHS said.
"Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA's requirements," said OCR Director Georgina Verdugo. "The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules."
The civil money penalty is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Steward Health Care System, the physician-led operator of eight acute care hospitals in the Boston area, has expressed an "interest" in taking over Jackson Health System, Miami's financially troubled safety net hospital, in a deal that -- if completed -- would be valued at about $1.1 billion.
In a non-binding letter sent Monday to John Copeland, chairman of the Public Health Trust, which oversees JHS, Steward Healthcare CEO/ChairmanRalph de la Torre, MD, said he "envisions a transaction" under which SHC would assume JHC's approximately $500 million in outstanding debts, and invest another $600 million in capital and infrastructure improvements.
"Not only will this investment allow JHS to modernize its facilities and equipment, it will have the added benefit of creating economic activity that will mean thousands of additional jobs for the people of Miami-Dade County," de la Torre said in the letter.
"The combination of infused capital and cash to fund debt will yield an investment by SHC of over $1 billion. This investment will be further augmented by any cash SHC needs to invest to fund losses on operations during the 'turn around' phase of our involvement. (We estimate that the current 'run rate' of these losses is $190 million to $200 million per year.)" de la Torre said in the letter.
JHS and PHT did not immediately respond to requests for comment on the letter.
SHC asked the PHT for an "exclusive" 60-day due diligence period, at the end of which SHC will produce a proposal. If PHT and Miami-Dade County officials approve the proposal, they would be given a 30-day "go shop" period for other interested buyers to review the SHC proposal and make their own bid. If another buyer is selected, SHC would be reimbursed for expenses associated with the due diligence.
"Timing is of the essence," SHC said in its outline of the proposal. "We believe that any delay in this timeline imperils JHS and with it our ability to significantly impact operations. We therefore ask that the PHT provide us any feedback regarding the acceptability of these terms by March 1, 2011."
SHC said it was also willing to fund a "parallel" study by an organization that PHT/JHS chose to "explore the feasibility of JHS remaining an independent organization and still being able to fulfill its mission."
SHC was created by the New York private equity firm Cerberus Capital Management to run the six-hospital Caritas Christi hospital chain in Massachusetts, which was acquired last year in a deal valued at $895 million.
Most U.S. healthcare providers would never photograph patients and post the pictures on the Internet. Doing so, they understand, would violate patient confidentiality, and would merit substantial fines for breaching the federal Health Insurance Portability and Accountability Act.
Yet, some U.S. physicians, nurses, medical students, and other providers who volunteer their medical skills in developing nations have posted pictures of their patients on Facebook and other social media Web sites. That doesn't violate HIPAA because it's beyond U.S. borders, but it is a breach of ethics, University of College of Medicine researchers write in a Journal of Medical Internet Researchstudy. The researchers want providers to respect privacy rights for all patients, regardless of where they're treated and where they live.
"A medical student would not take a picture of a patient in clinic here and post it on Facebook," said Erik Black, an assistant professor of pediatrics with the UF College of Medicine and a lead author of the paper. "But there is a disconnect on these trips. We are not respecting these people as individuals. If we are not going to respect them in the same way we respect patients in the United States, why are we even going?"
UF researchers examined the Facebook profile pages of 1,023 medical students and residents, finding no breaches of patients' privacy in the United States. However, they found 12 photos of patient care in developing countries.
Every year, students from all health fields work in clinics in medically underserved nations, such as the Dominican Republic, Haiti, and Ecuador. It's a chance to get hands-on experience in a patient-care setting and help people who sometimes travel days for care.
HIPAA doesn't apply to patients outside of the United States, says Lindsay Thompson, MD, an assistant professor of pediatrics in the College of Medicine, and a lead author of the report. If a nation has privacy laws in place, doctors must follow them when practicing there.
In addition, Thompson says, doctors are ethically bound to follow the laws of the state or country where they practice. "We in the medical profession have to be held to a different standard. Our actions, however altruistic they are, could have some unintended consequences," Thompson said.
Ruben Ayala, MD, a primary care physician and medical officer with Operation Smile, which provides corrective facial and oral surgery for children in developing nations, said his organization has strict guidelines for using pictures of its patients.
"Anything we put on the Web site or anything we put out in mailings or videos, all of that done only after we double- and triple-check that we have permission from the patients or their parents to do so. Not everybody is eager to tell their story," Ayala says.
"A few years ago we modified our informed consent. In a lot of these countries there isn't a culture of informed consent. These patients, we realized, there is always a chance that because they are poor or don't have access they would think that if they don't say 'yes,' they won't get the surgery. We have to make sure they understand that if they say 'yes' to any pictures that will not increase the changes of their child having surgery, and if they say 'no' that does not decrease the chances of their child having surgery," Ayala says.
Physicians and other medical professionals from the United States who volunteer for Operation Smile must sign a code of conduct that forbids posting pictures of patients. Ayala says that on the rare occasion when they learn that a picture has been posted inappropriate, Operation Smile contacts the healthcare provider and asks them to remove the post. "Most times the reaction will be 'Oh I'm sorry. I didn't realize,'" he says. "I don't know where the disconnect comes from because these are practitioners who would never do this in the United States."
In many cases, medical students and doctors may not realize the differing patient privacy laws in other countries or that that these laws could be even stricter than those in the U.S.
"A lot of people consider this an ethical gray area," said Reed Van Deusen, MD, an assistant professor of internal medicine and pediatrics at the University of Pittsburgh, who was not involved with the study. "It is pretty complicated, but I agree with their basic tenet that trainees, and physicians in general, should not be posting pictures of patients, whether they are in this country or not. I think it is going to take a bit of a culture change to get everyone else on the same page."
Terry Kind, MD, a director of pediatric medical student education at the Children's National Medical Center at George Washington University, in Washington, DC, said medical school faculty must teach students about issues like these, namely by modeling professional behavior themselves.
"(Social media) is here and not going away," Kind said. "There are opportunities for use, but there is risk. The nature of the widespread dissemination is people forget to have that internal check on professionalism."
U.S. patients who agree to be photographed sign consent forms. Black says even getting consent from patients in developing countries poses an ethical challenge, because patients may feel they have to sign the form to receive medical care. Also, because the Internet is borderless, posting pictures to social networking sites could have repercussions for some patients, particularly if the images were taken in countries where being treated by an American doctor is frowned upon.
Even posting photos to a "private" page is not really ensuring patient privacy because, in some cases, the person posting the photo could be sharing it with 1,000 "friends," Black said.
"We are not telling people not to do anything," Black said. "We are telling them to think about it. Use your moral and ethical compass. What if this was your child?"
Maybe hospital executives have too much on their plates already. There may be too many pressing issues to contemplate – such as understanding the impact of the dizzyingly complicated healthcare reforms, installing electronic medical records, or even keeping the doors open and the lights on.
Whatever the reason, the 2011 HealthLeaders Media Industry Survey found that over the past year, recruiting and retaining physicians dropped from the No. 2 “top priority” to No. 7. Did something happen in the last 12 months that relieved the nation’s chronic physician shortage? Did the U.S. demographic get younger, slimmer, more physically fit?
Well, no; the need for physicians is as strong as ever, but the need to focus on recruitment and retention has softened somewhat. The top priorities that ranked above physician recruiting and retention in 2011 are, in order, cost reduction, quality/patient safety, reimbursement, patient experience/patient satisfaction, developing an accountable care organization, and care coordination.
Despite the shifting priorities, hospital leaders do not appear to be in denial about the physician shortage. Only 29% are positive about the supply of primary and specialty care physicians over the next three years, while about 40% see supply as having a negative impact. And yet, 67% of hospital leaders rank their current physician staff as “strong” or “very strong,” which is down from 78% last year. Meanwhile, 9% of leaders describe their physician staff as “weak” or “very weak,” not much better than last year’s 10%.
So leaders need to decide as they walk past every 10th physician, should physician recruitment—with an eye on quality—be a higher priority?
The College of Healthcare Information Management Executives (CHIME) has recommended that the federal government push back the deadline for Stage 2 implementation of meaningful use until the impact of Stage 1 on hospitals can be more accurately evaluated.
"Absent such as assessment, we greatly fear that the (Health Information Technology Policy Committee's) proposals for Stage 2 may be unduly ambitious, even unattainable, for many eligible hospitals and eligible professionals," CHIME President/CEO Richard A. Correll and Lynn Vogel, MD, chair of the CHIME board, said in the Feb. 18 letter to Joshua Seidman at Health and Human Services' Office of the National Coordinator for Health Information Technology.
The CHIME leaders said that seeking public comment about Stage 2 implementation before a proper assessment of Stage 1 "is a big like putting the cart before the horse."
CHIME recommended not moving to Stage 2 until about 30% of eligible hospitals and providers have been able to demonstrate competency with stage 1 meaningful use.
"We believe this approach would strike a reasonable balance between the desire to push EHR adoption and MU as quickly as possible and the recognition that unreasonable expectations could end up discouraging EHR adoption if providers conclude that it will be essentially impossible for them to qualify for incentives," CHIME wrote.
CHIME also suggested that Medicare allow hospitals and providers to "skip a year" if they are not fully prepared to move to the next stage. "CHIME sees no value to imposing some artificial deadline on the movement to stage 2 and urges ONC and CMS to take all the time needed to produce clear and understandable policies. We consider this better than rushing the rulemaking process only to have to repeatedly issue frequently asked questions (and answers) and other policy clarifications and explanations to address provider and EHR vendor confusion and uncertainty," CHIME said in the letter.
The average per capita cost of healthcare services covered by commercial health plans and Medicare programs rose 6.06% in 2010, matching the lowest growth rates in four years, and continuing seven consecutive months of cost growth deceleration, according to the Standard & Poor's Healthcare Economic Indices.
A further S&P breakdown shows that – even with its older, sicker population and higher utilization, Medicare’s growth in per capita costs – at 3.27% in 2010 – was less than half the rate of cost growth for commercial plans, which saw an increase of 7.75% for the year.
David M. Blitzer, chairman of the Index Committee at Standard & Poor’s, said the slower rate of growth in Medicare, doesn’t necessarily mean the federal government does a better job delivering healthcare. “The federal government does a better job than the private sector of legislating prices,” Blitzer said. “It’s a combination of the Medicare fee caps that are set by the government, even after they’re moderated from time to time by Congress. And, almost inevitably, there is cost shifting. I don’t think that Medicare is necessarily doing a better job of cost containment, but they are doing a different job of writing down the price list.”
The S&P monthly estimate for the 12-month period ending in December showed that medical inflation slowed 0.21% when compared with the 6.27% growth reported for the 12-month period ending in November 2010. The rate of growth has fallen 2.68 percentage points since May 2010, Blitzer says.
“The December year-end report shows that the trend of slowing annual growth rates in healthcarecosts that started in early/mid-2010 continued through the end of 2010,” Blitzer says. “The Composite Index posted a new recent low in the annual growth rate (+6.06% in December), a level last seen nearly four years ago during the summer of 2007.”
Healthcare cost increases continue well above the rate of inflation in the larger economy, which grew 1.6% for the 12-month period ending in December as measured by the Consumer Price Index. Most of that growth was fueled by rising food and energy costs, the Bureau of Labor Statistics reports.
Blitzer says some of the reduced rate of growth in healthcare costs may be attributed to the recession and the slow recovery. “What we are seeing and what we are still benefitting from is that until very recently general inflation in the economy was slowing down,” he says. “Looking at trend over the last 12 months we are still benefitting of what has been a deceleration in inflation that goes back to the beginning of the financial crisis. We may also be seeing some moderation in terms of employment trends. Less growth in employment in physicians’ offices and hospitals will slow down expenditure numbers too.”
Whatever the reason, Blitzer says the new healthcare reforms are not a factor. “There is nothing we are seeing that we can either credit or blame on the healthcare reforms. It’s too early in the process,” he says. “While I’m sure one side would love to say costs are rising more slowly because of healthcare reform and the other side would like to say healthcare reform is going to ruin us, we can’t answer that question either way.”
The December S&P indices found that:
Claim costs associated with hospital and professional services for patients covered under commercial health plans rose 7.75% over the year ending in December, down from 7.79% for the year ending in November, and 8.19% for the year ending in October, but well above the historical low of +6% annual growth rate posted in September 2005.
Medicare claim costs for the same services rose 3.27% over the year ending in December -- the lowest annual growth rate for Medicare claims in the six-year history of the S&P indices. In the year ending November 2010, Medicare claims costs rose 3.74%.
The S&P indices estimate the per capita change in revenues accrued each month by hospital and professional services facilities for services provided to patients covered under traditional Medicare and commercial health insurance programs. The annual growth rates are determined by calculating a percent change of the 12-month moving averages of the monthly index levels versus the same month of the prior year.
“The year 2010 was highlighted by a trend of deceleration in annual growth rates for all three headline indices – the Composite, the Medicare and the Commercial Indices. Especially since May 2010, most of the indices annual growth rates have declined month-to-month,” Blitzer says. “The S&P Healthcare Economic Hospital and Professional Services Indices also show a similar moderation in the rate of increase of annual growth rates, posting +5.60% and +6.34% rates for December 2010, respectively, versus May 2010 prints of +7.99% and +9.33%, respectively.”
At least eight physicians, eight nurses, four physical therapists, and several healthcare company owners and executives were among the 111 people in nine cities who were charged Thursday in separate Medicare fraud investigations that federal investigators say were responsible for at least $225 million in false billings.
More than 700 law enforcement officials executed 16 search warrants in the round ups – the largest one-day sweep of its kind. Led by the federal Medicare Fraud Strike Force, law enforcement officials made arrests in Miami, Brooklyn, Houston, Los Angeles, Baton Rouge, Tampa, Detroit, Dallas, and Chicago, the Department of Justice and Health and Human Services said in a joint announcement.
"With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country, we have safeguarded precious taxpayer dollars, and we have helped to protect our nation's most essential healthcare programs, Medicare and Medicaid," Attorney General Eric Holder said at a news conference Thursday afternoon announcing the sweep.
Also Thursday, DOJ and HHS announced the expansion of the Medicare Fraud Strike Force to Dallas and Chicago.
"Over the last two years our joint efforts have more than quadrupled the number of anti-fraud Strike Force teams operating in fraud hot spots around the country from two to nine -- with the latest additions Chicago and Dallas -- bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars," HHS Secretary Kathleen Sebelius said. "Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers. From 2008-2010, every dollar the Federal Government spent under its Health Care Fraud and Abuse Control programs averaged a return on investment of $6.80."
The 111 people charged on Thursday are accused of various healthcare fraud-related crimes, including conspiracy to defraud Medicare, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.
Prosecutors said the defendants participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. Indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks to supply beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare. Collectively, the doctors, nurses, healthcare company owners, executives and others are accused of submitting more than $225 million in fraudulent billing, DOJ said.
·In Miami, 32 defendants, including two doctors and eight nurses, were charged in various fraud schemes involving a total of $55 million in false billings for home health care, durable medical equipment and prescription drugs.
·In Detroit, 21 defendants, including three doctors, three physical therapists and one occupational therapist, were charged in schemes to defraud Medicare of more than $23 million, in cases involving false claims for home health care, nerve conduction tests, psychotherapy, physical therapy and podiatry.
·In Brooklyn, NY, 10 people, including three doctors and one physical therapist, were charged with fraud schemes involving $90 million in false billings for physical therapy, proctology services and nerve conduction tests.
·In Tampa, 10 people were charged in connection with schemes involving more than $5 million related to false claims for physical therapy, durable medical equipment and pharmaceuticals.
·In Houston, nine people were charged in schemes involving $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care and chiropractor services.
·In Dallas, seven people were indicted for conspiring to submit $2.8 million in false billing to Medicare related to durable medical equipment and home healthcare.
·In Los Angeles, five people were charged in schemes to defraud Medicare of more than $28 million, involving false claims for durable medical equipment and home health care.
·In Baton Rouge, six people were charged for a durable medical equipment fraud scheme involving more than $9 million in false claims.
·In Chicago, charges were filed against 11 people in businesses that have billed Medicare more than $6 million for home health, diagnostic testing and prescription drugs.
Since their inception in March 2007, Strike Force operations in nine districts have charged more than 990 people who collectively have falsely billed Medicare for more than $2.3 billion.
Six states and a consortium of New England states will split $241 million in federal “Early Innovator” grants for developing health insurance exchanges for small businesses and individuals that could serve as national models when the programs launch in 2014, the Department of Health and Human Services announced Thursday.
“Early Innovator states will play a critical role in developing a consumer-friendly marketplace where insurers must compete to deliver the best deal,” said HHS Secretary Kathleen Sebelius. “These grants ensure that consumers in every state will be able to easily navigate their way through health insurance options.”
Starting in 2014, health insurance exchanges are supposed to provide one-stop shopping to help individuals and small employers find affordable private health plans. HHS said Early Innovator states will develop the building blocks for Exchange IT systems, providing models for how Exchange IT systems can be created. This will help other states build their Exchanges quickly using the models and building blocks created by the Early Innovator states, without having to start from scratch.
The Early Innovator states are:
Kansas: Kansas Insurance Department, $31,537,465
Maryland: Maryland Deptartment of Health and Mental Hygiene, $6,227,454
Multi-State Consortia: University of Massachusetts Medical School, $35,591,333
New York: New York Department of Health, $27,431,432
Oklahoma: Oklahoma Health Care Authority, $54,582,269
Oregon: Oregon Health Authority, $48,096,307
Wisconsin: Wisconsin Department of Health Services, $37,757,266
The innovator states represent different parts of the country, and different exchange governance structures and information systems, to ensure that a wide range of IT models are developed, and every state will benefit, HHS said.
“Everyone wins,” said Don Berwick, MD, administrator of the Centers for Medicare & Medicaid. “This grant program means that states don’t have to waste money reinventing the wheel, and consumers get the best of the best.”
