Colorado Chosen by CMS to Develop Dual Eligible Integrated Care Model

The new CMS Innovation Center, in cooperation with the Federal Coordinated Health Care Office, announced recently that it is partnering with fifteen states across the U.S. in an effort to design new approaches to better coordinate care for dual eligibile patients (i.e., those patients eligible for both Medicare and Medicaid). 

Colorado and fourteen other states were each awarded up to $1 million to develop a model describing how the state would structure a patient-centered approach to coordinate care across primary, acute, behavioral health, and long-term supports and services for dual eligible individuals.  This initiative is funded by the Affordable Care Act.

CMS has explained that the goal of this demonstration program is to identify delivery system and payment coordination models that eliminate duplication of services, expand access to care, and lower costs for dual eligibles.   After federal review of the proposals, CMS will work with states to implement the plans that hold the most promise, eventually testing them and replicating them in other states.

For more information on this new initiative, see the CMS Innovation Center's announcement or CMS's website and press release.

Supreme Court Hears Pharma Data-Mining Dispute

Tomorrow the United States Supreme Court will hear oral arguments regarding states' authority to limit uses by pharmaceutical companies of physician prescription records for marketing.  We discussed this issue in November on a blog post when the Vermont data-mining restrictions were found unconstitutional as a violation of free speech.  For more on this battle headed to the Supreme Court, see this article in the New York Times.

Vermont Data Mining Law Found Unconstitutional

The Second Circuit Court of Appeals decided yesterday that the Vermont law restricting pharmaceutical companies’ uses of information about the drugs that physician prescribe is unconstitutional as a violation of free speech. This ruling is a particularly interesting development because Maine and New Hampshire laws prohibiting data mining have both been upheld by the First Circuit Court of Appeals in the last several years. All of these laws involve limiting the type of information that pharmacies can give to pharmaceutical and health information companies, as those companies use the prescribing pattern information for marketing purposes.

In 2007, Vermont enacted a law to increase transparency in prescription drug information and pricing.   The law limited companies’ access to prescriber data for marketing purposes unless the prescribing physician consents by notifying the state licensing board.  Later in 2007, three health information companies, Verispan, LLC, Wolters Kluwer Health, and IMS Health Inc., filed a lawsuit against the State of Vermont to declare portions of its “Prescription Restraint” law unconstitutional, claiming the law violates the First Amendment by improperly restricting commercial speech. In 2009, a federal district court judge in Vermont held that the law was constitutional, rejecting the health information companies’ challenge.

In yesterday’s ruling, however, the Second Circuit struck down the Vermont law in a 2-1 decision, finding that the law is a restriction on commercial free speech in violation of the First Amendment. In the majority opinion, the court determined that “[Vermont] has not demonstrated that its interests in protecting public health and containing health care costs could not be as well served by a more limited restriction on speech.” Vermont officials have stated that the state is considering appealing this ruling to the U.S. Supreme Court.

This decision follows two previous rulings—the first in November 2008 and the second in August 2010—by the First Circuit Court of Appeals upholding similar laws in New Hampshire and Maine, respectively.  Interestingly, Vermont’s data mining law was modeled after the New Hampshire law. Given the Second Circuit’s ruling this week, however, there is now a circuit split between the First Circuit and Second Circuit on these data mining restrictions, making it increasingly difficult for companies to navigate compliance with the different restrictions in each state. This is especially true given that many other state legislatures currently have similar data mining laws pending. Although last year the U.S. Supreme Court refused to grant cert to the First Circuit Court of Appeals decision upholding the New Hampshire law, the Second Circuit’s decision this week on the Vermont law has created a divergence in the Circuit Courts’ decisions, making this issue particularly suited for U.S. Supreme Court review.

CMS Introduces Innovation Center

The Centers for Medicare and Medicaid Services ("CMS") announced today the creation of its Center for Medicare and Medicaid Innovation (the "Innovation Center").  The Innovation Center was established in the health care reform law, the Patient Protection and Affordable Care Act.  CMS explains that the purpose of the Innovation Center is "to explore new approaches to the way we pay for and deliver care to patients so that we have better results both in terms of the quality of care and the affordability of coverage."  At first, the Innovation Center will focus on the following three key areas: (1) improving care for patients, making it more efficient, effective and safer; (2) developing new models of care to ensure health care providers work together to coordinate care for patients; and (3) fighting public health problems such as obesity and smoking at the community level.

CMS has also unveiled a website in conjunction with the Innovation Center.  CMS describes the website as not only a way to obtain information from CMS about various innovative approaches to health care, but also as a way in which people from a variety of backgrounds can share their knowledge with one another.  At the moment, the website contains little information, but we expect it will expand considerably over the coming months.  For a link to the Innovation Center's blog, click here.

A Big Day in Health Care Reform

Today marks six months from the date that the Patient Protection and Affordable Care Act was enacted.  Several key provisions of the law become effective today, September 23, 2010, including:

  • Expansion of coverage for dependents up to 26 years old. 
  • Elimination of annual or lifetime dollar limits to the amount of money spent on health care services.
  • Prohibition of denials of coverage to children under 19 years old for preexisting conditions.
  • Coverage for all preventative services with no co-pays.
  • Free preventative care (for all new plans).

These changes take effect immediately for any new policies bought after today.  For those with existing policies, however, the changes will take effect either during the next open enrollment period (for employer-based plans) or at the time a policy is renewed (for individually-purchased plans).  

To read more about these changes, CNN has posted this article and the government's new health care reform website has posted this article.

 

CDPHE Awarded $300,000 For Public Health Improvement

In an effort to strengthen the nation's public health infrastructure, the Centers for Disease Control and Prevention has awarded $42.5 million in funding to public health groups as part of the National Public Health Improvement Program.  Funding is courtesy of the Prevention and Public Health Fund created by the Affordable Care Act.  The only award in Colorado went to the Colorado State Department of Public Health and Environment ("CDPHE"), which received $300,000 to develop a "performance management" program for evaluating the effectiveness of the agency.  All award recipients must designate or hire someone to oversee the performance management program and participate in a national network of performance improvement professionals. 

Colorado Begins to Implement National Health Care Reform

Colorado Governor Bill Ritter has begun implementing health care reform in Colorado.  By executive order, he has created a new task force called the Interagency Health Reform Implementing Board to oversee this process and has appointed his health care policy expert, Lorez Meinhold, to the newly created position of Director of Health Reform Implementation.  On a roll, he also has signed four bills into law that his press release states are designed to "enhance the state's nationally recognized health reform initiatives." 

Health Care and Education Affordability Reconciliation Act of 2010

Here's the text of the 153 page House Bill called the Heath Care Education and Affordability Reconciliation Act of 2010.  We'll be reading it too and posting our thoughts on how it affects you and your business.

House Passes Health Care Reform

No longer a question of will it pass, here are links to a variety of articles discussing this issue:

Wall Street Journal

New York Times

Los Angeles Times

Denver Post

National Public Radio

BBC

Survey Says . . . Patient Data Not Protected

According to a new survey of healthcare IT practitioners, healthcare organizations are not adequately protecting confidential patient information.  Sixty-one percent of those surveyed said that their organizations do not have the resources to fully comply with the federal privacy regulations.  The survey results aren't entirely surprising considering the fact that organizations are struggling to comply with HITECH and make the transition to EHR.  What is surprising, however, is that 70% of the respondents believe that senior management does not consider patient privacy a priority.  The OCR has quite clearly stated that it intends to increase enforcement and not making protection of patient privacy a priority could be a costly decision.