Essential Health Benefits: Are We Ready in Wisconsin - Milwaukee?

ALL Hands on Deck, WE CAN Action Plan for Preparedness

May 28, 2013

MILWAUKEE -- The Patient Protection and Affordable Care Act (PPACA), insurance plans offered THROUGH the Federally-Assisted Exchanges is ran on behalf of the state and is that "state's exchange".  The Federally-Assisted Exchange is the default if a state fails to select either a "State Exchange" (state-ran) or Partnership Exchange" (state and federally ran).  

Wisconsin is a Federally-Assisted Exchange.

Therefore, Wisconsinites' implementation will be conducted by the federal Housing and Human services department.   The insurance plans will call for coverage of the individual and small group markets and the exchange services are required to cover health benefits and services under the "Essential Health Benefits/EHB".  The Wisconsin exchange plans must  be comprehensive and affordable through "required Benchmarks" by the first quarter of 2012.  Since Governor Scott Walker chose to not participate and legislation was not put in place timely, the state of Wisconsin is lacking with mandated benchmarks not as could be.  How will individuals, families and businesses know what THE ARRAY of plans should offer?  This is a question going forward that is crucial for address.

What will the Essential Health Benefits/EHB include?   The EHB plans are:

• Basic Health plan
• Medicaid Expansion
• Catastrophic
• Bronze
• Silver
• Gold
• Platinum

The EHB plans must include the following 10 categories.  They are:

1. Ambulatory Patient Services
2. Emergency Services
3. Hospitalization
4. Maternity and Newborn
5. Mental Health and substance use disorder services; including behavioral health treatment
6. Prescription Drugs 
7. Rehabilitative and Habilitative services and devices
8. Laboratory services
9. Preventative and Wellness services and Chronic disease management
10. Pediatric Services - including oral and vision care

Preparedness - Decision making knowledge for the customer/beneficiaries is a huge challenge but it is durable. 

We do not know if the challenge will be less or more for the federal Health and Human service department.  We do know, we are at the half way point for 2013 (6 months before FULL implementation) and 4 months from October 1, 2013 - selection of Insurance.

Challenge of Preparedness

Sixty-eight (68) million Americans are expected to enroll in plans subject to Essential Health Benefits/EHB.

The challenge of informing over 5 million Wisconsinites increased with the divisiveness during the Presidential Election and posturing by Governor Walker and others at the level of state legislators.  

With this expanded coverage (PPACA) mandated and expected October 1, 2013 and January 1, 2014, our initial findings of the basic information known about the PPACA by our state senators and state representatives  is just too lacking to feel that Wisconsin, especially urban populations such as  Milwaukee and rural way is out of the cross-hairs of HARM'S way.

What can we do?

Milwaukee Professionals Association LLC has taken the slogan:  Premier "For-profit" Affordable Health Care LLC supporter with an Action plan initiative.  

The Action Plan initiative is called:  All Hands on Deck, WE CAN.

On August 2-4, 2013, in the city of Milwaukee, MPA LLC will host the 2013 Affordable Health Care Extravaganza Inside Summit and Outside Fair. 

Stay tuned June 1, 2013.

Health Care Delivery is an ALL HANDS on DECK, WE CAN Opportunity - Access and Engagement Reform is key

May 27, 2013

WISCONSIN - Wisconsin is a Federally-Assisted Exchange state due to a by-design scheme that was centered around the expected Republican win of the presidency of the United States.  Just as that thought failed so miserably, Wisconsinites/Milwaukeeans are now left with some consequences that lack benchmark basics mandated by the Affordable Health Care law.  They were intentionally left-out by Governor Scott Walker, Insurance Commissioner Ted Nickle, and Health and Human Secretary Dennis Smith.

Wisconsinites must remember how these three (3) elected and appointed individuals for the state government failed to provide due process, honor Oath of Office for political reasons; and, have not addressed the health care variables and how it will short- and long-term create barriers.

URBAN Health Care

Reform that include "patient-centered" health care that improves health require all to be communicating and strategic planning on the same ideas and agreeing on the same policies.  That includes customer/patient, health providers, health practitioners, insurance carriers, pharmaceutical companies, others supporters for service delivery and Medicare/Medicaid.

An innovative and value-way to help ensure long-term cost-containment through IMPROVED HEALTH CARE is a major key.

Chronic Population health care must look first-continuum-last, what is best for the customer-beneficiaries with cost-cutting but not simply financial versus clinical (do not shift cost to the federal budgeting to avoid due diligence to work through the process with the entire population with education, technology and patient-behavior involvement at the census tract-neighborhood level).  

One of the opportunities is in the Virtual PACE (Program of All-Inclusive Care for the Elderly) Memorandum of Understanding project in Wisconsin.

Milwaukee Professionals Association LLC is looking at Wisconsin state government - legislators, Joint Committee on Finance and WI Health and Human Services Department - Memorandum of Understanding (MOU) regarding A Federal-State Partnership to Test a Capitated Integration Model for Medicare-Medicaid Enrollees (Demonstration to Integrate Care for Dual Eligible Beneficiaries).  

Briefings at the 2013 Affordable Health Care Extravaganza, August 2-4, 2013 in Milwaukee will include Dual Eligible beneficiaries and the MOU/Memorandum of Understanding with CMS/Center of Medicare and Medicaid Services.

The event is a "WOW" EVENT with an INSIDE Strategic Summit and an OUTSIDE Fair for show and tell vendor show of health providers, health practitioners, health academic sites, health pharmaceutical organizations and health insurances.

DEFINING MARKETS - CONSUMER REPORTS . ORG Videos HEALTH

MPA LLC AFFORDABLE HEALTH CARE seeks to empower the PEOPLE so that they are accepting their role and responsibility in providing GOOD-BEST health care for themselves.  Creating a Neighborhood-Census tract blueprint with a DEFINED Index unique to URBAN Milwaukee POPULATION Health Care.  It is an ALL HANDS on DECK, WE CAN Initiative.

It is  the STAKEHOLDER'S job to:

• Know your health compass and barometer for ACCESS to health care.
• Know what is in the marketplace to help you navigate the competitive field of health care providers, practitioners and insurers.
• Know your legislators like your primary doctor.
• Know what type of Health Care Exchange your state has.  Wisconsin is Federally-Assisted.
• Know your Health Care Plan - adequacy and affordability.

IT IS the MARKETPLACE PROVIDERS' job to:

• Provide ACCESS.
• Provide Evidence-based benefits.
• Provide POPULATION health care.
• Provide health care that is affordable.
• Provide Quality and Competitive health care.
• Provide "education and technology" attainment.
• Provide Transparency and Best Practice for Cost Containment.

This is a video by Consumer Reports that will help you focus on and share care of self, a loved one, friend, colleague and neighbor.  CLICK

VIDEO:  Oversold Cancer Screening

Oversold cancer screenings

Screenings for several cancers, including prostate, ovarian and lung cancer, are overused. For many people the risks outweigh the benefits. However pap smears, mammograms and colon cancer screening are worth it for people in certain age groups.

 

HEALTH INSURANCE COMPANIES
Incomplete list
Click to Enlarge photo

Meet National Community Pharmacists Association - NCPA

Pharmacist - The Medicine Shoppe - Lewiston, ME

May 20, 2013
MILWAUKEE - (MPA LLC) - We must REACH-OUT daily and find those with similar engagement and like-mind.  Today, we recognize the National Community Pharmacists Association/NCPA for their independent community focus.

NCPA's Mission

• We are dedicated to the continuing growth and prosperity of independent community pharmacy in the United States.
• We are the national pharmacy association representing the professional and proprietary interests of independent community pharmacists and will vigorously promote and defend those interests.
• We are committed to high-quality pharmacist care and to restoring, maintaining, and promoting the health and well-being of the public we serve.
• We believe in the inherent virtues of the American free enterprise system and will do all we can to ensure the ability of independent community pharmacists to compete in a free and fair marketplace.
• We value the right to petition the appropriate legislative and regulatory bodies to serve the needs of those we represent.
• We will utilize our resources to achieve these ends in an ethical and socially responsible manner. 

 State Medicaid Managed Care

Although many states are considering shifting their Medicaid populations into managed care, NCPA cautions that such a dramatic shift is not necessarily a "cure-all" and that in some cases, could result in reduced beneficiary access to services and disruptions in care.

Resources

• Profile Medicaid Managed Care/Kaiser Family Foundation 2010
• Fact Sheet Re: Lewin's Medicaid Pharmacy Managed Care
• Florida Medicaid waiver
• Modernizing Louisiana's Medicaid Pharmacy Program

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MEET THE SOLO HEALTH STATION - A convenient tool for information sharing and self-management of Health

May 20, 2013
Tools for Monitoring health is a series for sharing information.

Today, we are highlighting SOLO HEALTH - their IT/Information Technology kiosk for monitoring the vision, blood pressure and weight.  You can get the results instantaneously after brief test or through email or text.

CLICK below.

Take a look and listen.

Using all AGE GROUPS to advance the Whole

Using all AGE GROUPS to advance the whole

URBAN POPULATION Health Care is essential for empowerment of Neighborhood and Census Tract stakeholders. 

With the advent of implementation of the Affordable Health Care, beginning October 1, 2013, being prepared is optimal for successful use by Milwaukeeans.

The population of Milwaukee is over a half-million with a distribution breakdown (2010 Census) of:

• 30% - 25 to 44 years
• 29% - Under 18 years
• 18% - 45 to 64 years
• 12% - 18 to 24 years
• 11% - 65 or older

Education

Given some pre-requisites in the marketplace, i.e., African American and other People of Color have high chronic health concerns; a benchmark and our REAL INCENTIVE, to ensure that All Hands on Deck, WE CAN will be introduced and vigorously pursued to get each person old enough to hear, talk and reason, to help his/her health.  That means for the next 3-5 years (during the embryonic stage of Affordable Health Care implementation),  individuals are tied to a population score card.  The public will be saturated with information on chronic illnesses common to Milwaukee - how they affect quality of life - morbidity and mortality, how they uptick cost, and how best to treat them.

Today's TECHNOLOGY - Smart Phones and Health Coaching

Social Networking, Apps use, Apps development, implementation of technology throughout the 97 square miles of Milwaukee is critical.  Having access to the internet is crucial to Milwaukeeans becoming health-wise and daily engaged in state-of-the-art use of Smart Phones, various health Apps, imaging Apps, computers - desktop, laptop, tablet, regular use of electronic health records, electronic health reporting and capacity alerts.   

Mary Glass, Chair/CEO,  said, "The high value of intervention and prevention should be everybody's goal.  It starts with 'in-the-womb' care-giving."

Academic and Practicum Training

Training of Milwaukeeans is the priority for framing a culture that will help garner the unified push for necessary health care of over a half-million people.

We constantly hear about the shortage of individuals, health practitioners, to address the present and growing concerns of professional health care.  Glass said, "We see this as a huge opportunity for the recruitment, enrollment, internship, fellowship, scholarship, apprenticeship and Case Learning of the many who are looking for careers, looking to service the population and looking to make the economic landscape more sustainable."

"We seek national and international health providers, pharmaceuticals, health practitioners and insurance carriers to join us in this historic URBAN model".

FYI READ & FEEDBACK - Patient-Centered Medical Homes: Where We Are and What We Know

Melinda Abrams
The Commonwealth Fund
mka@cmwf.org
Alliance for Health Reform Briefing
May 3, 2013
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Melinda K. Abrams, vice president at The Commonwealth Fund, directs the Patient-Centered Coordinated Care program. Since coming to the Fund in 1997, Ms. Abrams has worked on the Fund's Task Force on Academic Health Centers, Commission on Women's Health, and most recently, the Child Development and Preventive Care programs. She played a lead role in conceptualizing and launching the Fund's Assuring Better Child Health and Development (ABCD) initiative, which awarded grants to state Medicaid programs to encourage innovation in the financing and delivery of preventive and developmental services provided to low-income, young children. Ms. Abrams sits on a number of national committees, including the Board of Managers of TransforMED, the PCMH Advisory Committee for the National Committee for Quality Assurance, and two Medical Home Expert Panels for the Agency for Healthcare Research and Quality (AHRQ). In addition, she is a peer-reviewer for the Annals of Family Medicine. Ms. Abrams holds a B.A. in history from Cornell University and an M.S. in health policy and management from the Harvard School of Public Health
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For your information and PARTICIPATION in our Survey, we have added a RECENT briefing given by Melinda Abrams, The Commonwealth Fund.

There are 7 pages.
CLICK  "Patient-Centered Medical Homes:  Where We are and What We Know"
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SURVEY

We would like to hear what you think about the information shared in this briefing about "Home Medical services".  To comment, CLICK

BACK STORY READ - Accountable Care Organizations: The End of Innovation in Medicine?

Scott Gottlieb, M.D., a practicing physician, has served in various capacities at the Food and Drug Administration, including senior adviser for medical technology; director of medical policy development; and, most recently, deputy commissioner for medical and scientific affairs. Dr. Gottlieb has also served as a senior policy adviser at the Centers for Medicare & Medicaid Services. 

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Scott Gottlieb | Health Policy Outlook

February 16, 2011 

No. 3, February 2011

The Obama administration is pinning its hopes for controlling Medicare costs on accountable care organizations (ACOs)--a system in which groups of doctors are given responsibility for a large population of patients, with a share of the doctors' reimbursement dependent on their ability to reduce spending and improve clinical outcomes. 

The Department of Health and Human Services is expected to release regulations governing the framework for ACOs by the end of February. ACOs are supposed to offer incentives for doctors to improve the coordination of care. While this idea is not inherently wrong, the Obama team relies heavily on hospitals to develop these new organizations. Yet historically, most of the significant innovation in health care delivery has developed in for-profit companies, often started by entrepreneurs, and has aimed to move patient care away from costly hospital settings and into less expensive outpatient settings. But entrepreneurs are now exiting the health care services space because the Obama plan tilts the marketplace so heavily against their endeavors. The Obama team is forced to rely on hospitals as much by default as by design, but many hospitals are unlikely to succeed at running ACOs.
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BACK STORY READ is to allow YOU an opportunity to review some background information about the creation/design of the Affordable Health Care process.  We will utilize processes shared for the Sponsor Partner design 2013-2016.
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 CLICK
Key points in Outlook:
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Health Care Law Reform - NEIGHBORHOOD and CENSUS TRACT Businesses

MILWAUKEE (MPA-ACA) -- Milwaukee Professionals Association LLC is hosting the 2013 Affordable Health Care Extravaganza, August 2-4, 2013.  

The special event will focus on INFRASTRUCTURE at the Neighborhood and Census Tract level.  In fact, the national and International partners and invitees are asked to partner for 3-5 years for stabilization and serious investment in the infrastructure of URBAN Milwaukee model for short- and long-term care with a goal for market share that provide improved health and cost containment for all.

A specific focus on Neighborhood/Census Tract small businesses - hidden talent and vetted businesses will cover employer-participation with 1-50 employees.

Wisconsin is a Federally-Assisted Exchange state.

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Creating Options

We will address avenues that promote small businesses 1-50 to participant in:

• affordable insurance in the marketplace
• tax credits
• shared responsibility
• bundling
  

To hear a video on Health Care and Business on C-Span, go to

VIEW

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SIGN-UP Mailing list - Affordable Health Care Extravaganza Fair, August 2-4, 2013.

Sarah Kliff - Health Reporter - Washington Post

SARAH KLIFF covers health policy for the Washington Post. Sarah joined the Post in August 2011 from Politico, where she authored Politico Pulse, a daily health policy tipsheet. Prior to Politico, Sarah was a staff writer at Newsweek covering national politics. Her writing has appeared in National Geographic, the BBC, Humanities Magazine and St. Louis Magazine. She is the recipient of fellowships from the Kaiser Family Foundation and University of Southern California Annenberg School of Journalism.
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We will feature of ten articles of Sarah on Health Care.

Obamacare could lower premiums in New York, new study finds

Posted by Sarah Kliff on May 6, 2013 at 9:12 am

There’s pretty widespread acknowledgement that, under Obamacare, many in the individual market will see premiums go up. Health and Human Services Secretary Kathleen Sebelius has acknowledged this, as have other top Democrats.

This is what happens when insurance plans are required to cover Americans with potentially costly, pre-existing conditions: More sick people, who require additional care, gain coverage. While some will see their premiums decrease (older Americans, for example, due to limits on age rating), states are already seeing significant premium increases.

That’s the case in most of the country — but not in New York State. There, the state is actually expecting some big changes likely to lower health premiums, according to a new analysis prepared for the New York Health Benefits Exchange.
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