New 'Obamacare' exchanges could miss enrollment deadline - GAO

By David Morgan and Caroline Humer

(Reuters) - New health insurance exchanges being set up by the federal government in more than 30 states under President Barack Obama's 2010 healthcare overhaul could miss an October 1 deadline for open enrollment, a government report said on Wednesday.

The launch of the exchanges, or marketplaces, which are expected to provide federally subsidized health coverage for 7 million people in 2014 and 22 million by 2016, could determine whether Obama's signature domestic policy achievement succeeds. The administration will operate exchanges in 34 states, while the remainder operate their own markets.

The report by the nonpartisan Government Accountability Office (GAO) said U.S. officials have missed deadlines and remain behind schedule on key parts including those that involve consumer eligibility for federal subsidies, the certification of health plans to be sold on the exchanges and the hiring and training of special "navigators" to guide people through the enrollment process.

GAO found that states have also failed to complete many of the tasks assigned for implementation and that the administration has conducted only initial testing of the computerized system that will link the exchanges with states and federal agencies including the Internal Revenue Service.

A separate GAO report found that the exchanges for small businesses that are also being created under the Patient Protection and Affordable Care Act are behind schedule, with about 44 percent of the key activities targeted for completion by March 31.

But in both cases, the government watchdog agency said much progress had been made in completing major tasks necessary for implementation, including establishing the regulatory framework for reform.

The Department of Health and Human Services (HHS) has also completed contingency plans and is prepared to carry out additional exchange functions that individual states may prove unable to assume, according to GAO.

"Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined," the GAO report concluded.

While interim deadlines that have been missed up to now may not affect implementation, the agency added, "additional missed deadlines closer to the start of enrollment could do so."

'NOT READY FOR PRIME TIME'

Federal officials, led by U.S. Health and Human Services Secretary Kathleen Sebelius, have vowed repeatedly that the federal exchanges set up under the healthcare law, also known as "Obamacare," will be ready on time in states that have chosen not to implement their own marketplaces, often because of political opposition from Republican governors and legislators.

The administration reiterated that stance in response to the report, telling the GAO authors that "HHS is extremely confident that on October 1 the (federal) marketplace will open on schedule and millions of Americans will have access to affordable quality health insurance."

Republicans, who want the law repealed and have blocked new federal funding for the implementation effort, said the GAO report confirmed a picture of an administration ill-prepared for implementation more than three years after Obama signed healthcare reform into law.

"This law isn't ready for prime time, and come October, millions of Americans and small businesses are going to be the ones suffering the consequences," said Senator Orrin Hatch, top Republican on the Senate Finance Committee.

The GAO report underscores the changing complexities that confront the federal government and individual states as the Patient Protection and Affordable Care Act edges toward full implementation on January 1.

In addition to the federal exchanges addressed by GAO, several states that had planned to operate their own exchanges have turned to Washington for support in the past two months.

After HHS allowed states to split responsibility for the individual and small business exchanges, Utah decided that it would hand the individual exchange to the federal government. Idaho and New Mexico, whose efforts had been stalled until earlier this spring by their state legislatures, have also decided to use federal technology to get their exchanges going.

(Reporting by David Morgan in Washington and Caroline Humer and Sharon Begley in New York; editing by Paul Simao and Matthew Lewis)

http://news.yahoo.com/obamacare-exchanges-could-miss-enrollment-deadline-gao-142233728.html

3 patient engagement lessons

June 12, 2013 | Anthony Brino, Associate Editor

Patient engagement is a term Jan Oldenburg, Aetna’s VP of patient and provider engagement in accountable care, didn’t first hear until 2009. But she remembers the concept gradually coming to the fore in the mid-1990s and the early 2000s, as her former employer, Kaiser Permanente, launched a personal health record, and as the importance of active chronic disease management became more apparent.

Fast-forward to 2009, and the HITECH Act-created 17 Beacon Communities set out to experiment with digital health tools and patient engagement in a variety of urban and rural settings, focusing on patients with co-morbidities.

With those experiments wrapping up after three years, the Office of the National Coordinator and the providers and health organizations that worked in those communities have a fair understanding of what can work, and what might not, for using a patient engagement as a route to better care and lower costs. Clinicians and program mangers from two of those Beacons and the ONC shared lessons-learned at the HIMSS Government Health IT Conference.

Bring the right technology to the right patients – and docs

Nancy Maloney, a clinical operations manager with the Western New York Beacon Community, worked with a 40-organization team that was trying to coordinate care for patients in some of the poorest areas of the country, in the eight counties around greater Buffalo. Although the Beacon had some notable successes, such as with nutrition programs, a web-based medication adherence program ended up not working out.

“We started a medication adherence program that we thought was fabulous: web-based, written at a fifth grade level, videos for how to use a glucometer,” Maloney said.

Many of the patients, though, were not computer literate, not confident using the web or didn’t have adequate access. Another problem the Beacon encountered, Maloney said, was with doctors. The web-based medication service wasn’t accessible from EHRs, so physicians would have to use a separate web app for patient medication instructions – another step in the work flow that, however minimal, created extra tasks for already time-strained doctors.

Likewise in rural central Pennsylvania’s Keystone Beacon Community, Geisinger Health System community engagement manager Teresa Younkin ran into the limits of consumer health technology.

Younkin and Geisiner went to health fairs with laptops and wireless cards to try to help show mostly senior patients how to find reputable health information on the internet. “We couldn’t get anybody to touch it,” Younkin said.

“If I come to you with some kind of IT tool, I cannot dictate to you how it’s going to work in your community.”

Use ‘beer and pretzel language’

“Patient-centered outcomes.” “Patient engagement.” “Population health.” What do those terms mean to the typical Beacon Community patient or the typical American patient – say, someone with multiple chronic conditions, like diabetes, asthma and heart disease?

Not much necessarily. And possibly the word population may actually trigger fears of rationing or bring to mind an elitist bureaucracy, because patients want to be treated as individuals, as Aetna’s Oldenburg said.

Geisinger and the Keystone Beacon Community, learned firsthand the importance of clinicians – doctors or nurses – having conversations with patients about chronic disease management, and doing so in “beer and pretzel language,” said Younkin.

One huge for opportunity in patient engagement is for clinicians – and also community organizations partnering with providers – to explain things like nutrition, metabolism and exercise and counsel patients on their habits.

In this and other cases, Younkin said, the phone call – midway between email and in-person visits – may be preferable for some patients, especially those who may be more comfortable talking frankly over the phone as opposed to in-person.

Clinicians entering the realm of health coach may be huge challenge, too, particularly for patients that may never have learned basic nutrition science. But if the nation is going to curb the diabetes epidemic, providers are going to have to contribute to health education and engagement. (And as Aetna’s Oldenburg noted, some are already doing this, such as by hosting farmers markets and healthy cooking demonstrations.)

For HIE authorization, avoid registration overload

A key foundation of accountable care (and care coordination in general) is information exchange, which under HIPAA requires patient consent.

Health systems and HIEs have experimented with opt-in or opt-out consents – framing the choice as either being able to sign up or being automatically signed up unless otherwise opting out. But one variable that may not have been widely considered is how and when the consent is offered.

Doreen Salek, director of case management at the Keystone Beacon Community and an RN at Geisinger, ended up testing a few methods of obtaining consent. She found that universal authorizations at registration, selling the form and cold calling didn’t work.

What did work was using a trusted care team member to explain what the consent form actually meant – that a patient’s information will follow them the next time they seek or need healthcare.

http://www.govhealthit.com/news/three-patient-engagement-lessons