Improving Health Care, Controlling Costs – Rutgers Launches New Initiative

One key factor sets Robert Wood Johnson Partners apart from other attempts at reform – the Accountable Care Organization has the power of a major research university behind it

Monday, October 7, 2013

By Andrea Alexander

Credit: Nick Romanenko

Nurse Donna Bonavitacola assists as Alfred Tallia examines Barbara Carcich.

'This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care. This was not possible before. Now we have all the pieces under one roof.' – Alfred Tallia

 

Meet the some of the collaborators and researchers behind Robert Wood Johnson Partners:

 

Lynn Clemow, a clinical associate professor in the RWJMS Department of Family Medicine and Community Health, coordinates a program to place graduate students from the Department of Psychology and the Graduate School of Applied and Professional Psychology at the Monument Square primary care practice. The graduate students work with patients to quit smoking, take their medicine and on more traditional mental health issues. "Mental health services are a nightmare of poor reimbursement and poor access,'' Clemow said. "This cuts through the stigma of seeking out services and having to call an 800 number, talk to a clerk about your issues and get a list of providers, many of whom arent taking patients or on the plan anymore, Clemow said. About 15 percent of patients recommended for mental health services outside the office make an appointment, but closer to 90 percent of patients do in an integrated system, she said. "Depressed people don't take as good care of themselves, they don't take their medications because they don't seem to have the energy to do that, Clemow said. "If you treat the depression, everything works better.''

 

Xiaomu Zhou, an assistant professor in the School of Communication and Information, wants to study how access to information through the patient portal can improve communication between patients and doctors. "I want to understand how information technology can be designed to provide more information access to patients, facilitate communication and lead to better health outcomes,'' Zhou said.

 

Professors Kang Li and Susan Albin, in the School of Engineering, will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. "The availability of services from a patient care coordinator could reduce patients frustration obtaining care, fulfill doctors’ plans for how best to help the patient, and reduce the cost burden on the whole community with fewer emergency room visits and hospital admissions,'' said Albin, a professor in the Department of Industrial and Systems Engineering.

One Rutgers, A World of Discovery

The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In an online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond.

– The Editors

During nearly three decades as a primary care physician, Alfred Tallia has identified a daunting list of flaws with the nation’s health care.

Specialists rarely coordinate care for patients with chronic illnesses such as diabetes and high blood pressure – which can lead to repetitive, expensive tests.

In most doctors’ offices, no one is responsible for developing plans with patients to lose weight, exercise and change their diet – or for following up with those patients to help them meet their goals.

But Tallia, chair of the Department of Family Medicine and Community Health at Robert Wood Johnson Medical School – now part of Rutgers – is getting ready to launch a solution he believes will deliver more effective care at a lower cost.  

“The idea of improving quality and controlling costs, that is something here to stay,’’ Tallia said. “We can’t keep spending 18 percent or more of the Gross Domestic Product on health care, not cover everybody and have disappointing outcomes. That is what we have now.’’

Tallia is spearheading the creation of an Accountable Care Organization, called Robert Wood Johnson Partners, that will coordinate treatment among doctors, other health professionals, and hospitals through better use of electronic health records. The project also involves restructuring doctors’ offices to improve communication with patients, and directly involve them in developing plans to benefit their health.

Although similar efforts have been rolled out around the country since health care reform became law in 2010, one key factor sets Tallia’s work apart :

Robert Wood Johnson Partners has the power of a major research university behind it.

Tallia and others in the medical school – in partnership with Robert Wood Johnson University Hospital and Health System – are teaming up with researchers across different disciplines at Rutgers to find the best ways to improve care and curtail costs. This includes the School of Engineering, the Department of Psychology, and the School of Communication and Information.

Credit: Nick Romanenko

Physician Alfred Tallia at Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square.

 

“The reason for Robert Wood Johnson Medical School and Rutgers to be involved is to answer the many outstanding questions about how a system should work,’’ Tallia said.  “We are in the best position not only to deliver care, but to also do the research to make it better.’’

For example, a professor in the School of Communication and Information plans to study the use of a patient portal, an online information hub that would allow patients to access test results and other health information. The technology will also allow patients to schedule appointments, request or renew prescriptions, pay bills and ask questions about their care.

Graduate students from the Department of Psychology in the School of Arts and Sciences and the Graduate School of Applied and Professional Psychology will work in a primary care practice to help patients quit smoking, improve eating habits and address other behavioral health issues.

And professors in the School of Engineering will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. The person in this position would be dedicated to helping patients adhere to plans for their health – which could involve communicating with pharmacies to make sure prescriptions are filled, keeping tabs on exercise plans and coordinating appointments.

“Part of what the engineering department is going to do is help us make our care more efficient so we can spend more time on things that really matter,’’ said Elizabeth C. Clark, an assistant professor in the RWJMS Department of Family Medicine and Community Health.

“If doctors are spending less time doing paperwork they will have more time to spend with patients,’’ Clark said.

The medical schools, nursing, pharmacy, and other professional programs at Rutgers can also build on lessons learned to train a team-based workforce suited to meet the health care needs of the future, Tallia said.

Brian L. Strom, the incoming chancellor of Rutgers Biomedical and Health Sciences who is also a primary care physician, echoed concerns about the health care system and called Tallia a “national leader in this area.’’

“As a nation, we need to move away from an episode-based disease management system,’’ Strom said.

“This will require a multidisciplinary approach to population health, and a multidisciplinary approach to evaluating the new models of care that emerge, like the ACO planned by Dr. Tallia. Rutgers, with its depth and breadth across health and non-health fields, is enormously well positioned to be a leader in this field."

A Timeline for Providing Care

Robert Wood Johnson Partners is seeking approval to start treating Medicare patients early next year. The Affordable Care Act encourages the creation of such Accountable Care Organizations for Medicare patients, but most have been developed around hospital systems.

Rutgers would be one of the first academic institutions to launch such an organization, Tallia said.

Tallia is also talking to some of the state’s major health insurance companies including Horizon Blue Cross Blue Shield and Aetna to expand into a statewide organization next year called Rutgers Health Partners.

In the meantime, the Robert Wood Johnson Partners would be modeled on the restructuring of Rutgers Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square in New Brunswick. The primary care practice, which is part of the Robert Wood Johnson Medical School, has been organized into a “patient-centered medical home,” where medical providers share information and work with patients to closely coordinate care.

Nearly 30 additional primary care practices have signed contracts to participate in the upcoming rollout of Robert Wood Johnson Partners.

The partnership would also include the 500 specialists in the Rutgers Robert Wood Johnson Medical Group along with clinicians on staff at Robert Wood Johnson University Hospital and the other hospitals within Robert Wood Johnson Health System.

Medicare and insurance companies offer financial incentives for such reform efforts that meet benchmarks for improving care while moderating costs. Participating doctors, hospitals, and other providers would receive a share of the savings. And in Robert Wood Johnson Partners, patients may also share in the benefit.

A Difference Patients Will Notice 

What this will mean for patients is seamless care, much like the experience Lou and Barbara Carcich have with the doctors at Monument Square, where some of the changes have already been introduced. When Barbara Carcich went for a follow up visit after a hospital stay, the doctor had all the information about her illness and treatment at his fingertips.

“I didn’t have to go through the whole thing again: why I went in, what happened,’’ said Carcich, of Somerset. “You know the information you usually have to retell, it was all there. My doctors in the hospital communicated and all care was coordinated with Dr. Tallia and his nursing team at Monument Square."

And Lou Carcich finds it reassuring that Tallia and his cardiologist receive the results of his blood work simultaneously. “I feel very confident and comfortable knowing that I have two doctors working for me who are both on the same page," he said.

What the Somerset couple doesn’t see is the coordination behind the scenes. Tallia and the cardiologist both have access to Lou Carcich’s electronic medical records. If there is an issue Tallia wants the cardiologist to look into, he can make a note in the record for the cardiologist.

Tallia and other members of his team are looking forward to forming new partnerships with faculty from other academic units and research institutes at Rutgers – including the College of Nursing, the School of Social Work, the Edward J. Bloustein School of Planning and Public Policy, Rutgers Center for State Health Policy and all the units of the new Rutgers Biomedical and Health Sciences – as Robert Wood Johnson Partners moves ahead.

“This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care,’’ Tallia said. “This was not possible before. Now we have all the pieces under one roof.’’

http://news.rutgers.edu/feature/improving-health-care-controlling-costs-%E2%80%93-rutgers-launches-new-initiative/20131006#.UlKy71CsiSp

Humana and CVS/pharmacy Announce Partnership to Educate Customers about Health Coverage Options under the Affordable Care Act

Humana representatives will be available in more than 500 CVS/pharmacy locations over the next six months to address health coverage questions from individuals and their families

LOUISVILLE, Ky. & WOONSOCKET, R.I., Oct 04, 2013 (BUSINESS WIRE) -- Humana Inc. HUM -0.04% , one of the nation's leading health and well-being companies, and CVS/pharmacy, America's leading retail pharmacy, today announced a strategic retail partnership designed to educate individuals and their families about their health care coverage options under the Affordable Care Act (ACA).

Humana representatives will be present at CVS/pharmacy's Project Health events starting this month. Humana will also be holding in-store events at CVS/pharmacy locations to educate individuals and their families about health care coverage options under the ACA.

-- CVS/pharmacy's Project Health - Project Health is a CVS/pharmacy wellness program designed to improve access to health care and deliver preventive services. Humana representatives will be present to answer questions about health coverage under ACA at 80 CVS/pharmacy Project Health weekly events in states such as Florida, Georgia, Illinois, Michigan, and Texas during the months of October and November.

-- Health Coverage Information - Humana representatives will also be in more than 500 CVS/pharmacy stores located in 12 of the 14 states* where Humana is offering individual health insurance as a Qualified Health Plan on Federal and state individual market public exchanges. Representatives will answer questions that individuals and their families may have about their health coverage options. Representatives will be in CVS stores select Wednesdays, between the hours of 2 p.m. and 6 p.m., throughout the six-month open enrollment period for the Health Insurance Marketplace, which started Tuesday, Oct. 1.

"Humana's partnership with CVS/pharmacy reflects our proven and ongoing commitment to educate individuals and their families at the places they go when they have questions about their health," said Roy A. Beveridge, MD, Humana's Chief Medical Officer. "We're working to ensure people develop a better understanding of how their health coverage can help them make better, and healthier, decisions."

"Providing information about new health insurance coverage opportunities is in keeping with our purpose of helping people on their path to better health," said Helena Foulkes, Executive Vice President and Chief Health Care Strategy and Marketing Officer for CVS Caremark. "We are pleased to combine our innovative suite of services and our new and existing relationships with organizations such as Humana to help patients understand and have access to information about insurance options in their community."

Humana and CVS/pharmacy will also provide educational brochures and other materials that will be available to individuals and their families.

People can visit www.HCR411.com in order to find the closest CVS/pharmacy store that has a Humana representative. Individuals can view a listing of the stores that have Humana representatives, as well as the dates and times they'll be in-store by typing in their zip code.

For the past several months, Humana has focused its efforts on educating people about the impact of health care reform. The company unveiled the website "Health Care For You," which can be accessed at www.humana.com/HealthcareForYou. The site is designed to help educate individuals on their health care coverage options via a character-driven experience focused on baby boomers, families with children and young independents.

Humana also recently announced a partnership with the YMCA of the USA (Y-USA),whereby the company is sponsoring health and wellness community events and health care reform educational seminars - led by Humana representatives - at select YMCA locations throughout the six-month open enrollment period for Health Insurance Marketplaces.

*CVS/pharmacy does not have stores in Utah and Colorado, where Humana is on exchange.

About Humana

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

More information regarding Humana is available to investors via the Investor Relations page of the company's web site at www.humana.com, including copies of:

-- Annual reports to stockholders;

-- Securities and Exchange Commission filings;

-- Most recent investor conference presentations;

-- Quarterly earnings news releases;

-- Replays of most recent earnings release conference calls;

-- Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors);

-- Corporate Governance information.

About CVS/pharmacy

CVS/pharmacy, the retail division of CVS Caremark Corporation CVS +0.04% , is America's leading retail pharmacy with more than 7,500 CVS/pharmacy and Longs Drug stores. CVS/pharmacy is reinventing pharmacy to help people on their path to better health by providing the most accessible and personalized expertise, both in its stores and online at CVS.com. General information about CVS/pharmacy and CVS Caremark is available at http://info.cvscaremark.com.

Photos/Multimedia Gallery Available: http://www.businesswire.com/multimedia/home/20131004005543/en/

SOURCE: Humana Inc.

http://www.marketwatch.com/story/humana-and-cvspharmacy-announce-partnership-to-educate-customers-about-health-coverage-options-under-the-affordable-care-act-2013-10-04?reflink=MW_news_stmp

Scott & White, Baylor Health Care become one through merger

YNN: Scott & White, Baylor Health Care become one through merger
Play now

Long a staple in Central Texas’ healthcare landscape, Scott & White Hospital announced Thursday it will merge with Baylor Health Care, another major player in the area.

Company officials say the deal will result in Baylor Scott & White and will provide a cheaper and more efficient service for patients.

"We are going to lower the cost of the practice of medicine,” Drayton McLane Jr., Chairman of Scott & White’s Board of Trustees said. “We think this is going to put us in leadership in the Southwest."

Officials say the discussions to form the new Baylor Scott and White healthcare system started two years ago. The systems' parallel missions were the selling point.

"We saw the similarities,” McLane said. “Both organizations are based on Christian healing. Both organizations are physician-centric."

Leaders from both systems also say the implementation of the Affordable Care Act played a role in the merger. They knew change was coming, and they wanted to meet the new health care standards.

"We knew pretty much where it was going, so it made sense two years ago when we didn't know anything about what we know today," Dr. Robert Pryor, president of Baylor Scott & White said.

They hope to reduce health care costs by focusing on reducing the time patients stay in the hospital and they want to make sure everyone who needs health care gets it.

"Twenty-seven percent of the people that live in Texas are uninsured. Though it's unacceptable we have to get a health plan system that makes health care affordable and everyone can have access to it," SO AND SO said.

The new healthcare system will have 43 hospitals across Central and North Texas.

http://austin.ynn.com/content/news/295587/scott---white--baylor-health-care-become-one-through-merger

Meaningful Use Payments To Continue Despite Gov't Shutdown

Meaningful use incentive payments will continue despite a federal government shutdown, according to National Coordinator for Health IT Farzad Mostashari, MedPage Today's "The Gupta Guide" reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments (Pittman, "The Gupta Guide," MedPage Today, 10/3).

Background on Shutdown

The shutdown came after lawmakers on Monday failed to advance legislation to continue funding the federal government.

Only four of the 184 employees at the Office of the National Coordinator for Health IT were retained during the shutdown to work on the "orderly phase-down and suspension of operations."

Meanwhile, HHS furloughed 52% of its workforce, or about 40,512 employees (iHealthBeat, 10/1).

Meaningful Use Payments Continue

In a tweet on Thursday, Mostashari wrote that CMS "continues to process mandatory payments to docs and hospitals."

He added that meaningful use incentive payments "do not come from annual appropriations" and that CMS "continue[s] to receive attestations."

Thursday was the last day that physicians and eligible professionals could start the attestation process to qualify for Stage 1 meaningful use program incentive payments in 2013 ("The Gupta Guide," MedPage Today, 10/3).

Meanwhile, the federal government shutdown led to the postponement of a House committee hearing on FDA's health IT regulatory strategy that was scheduled for Thursday, Modern Healthcare's "Vital Signs" reports.

Among those scheduled to testify at a hearing of the House Energy and Commerce Committee's Health Subcommittee were:

• Jeffrey Shuren, director of the FDA Center for Devices and Radiological Health; and
• Janet Woodcock, director of the FDA Center for Drug Evaluation and Research.

They were slated to discuss the FDA Safety Innovation Act (Conn, "Vital Signs," Modern Healthcare, 10/3).

The act authorized the creation of the FDASIA work group, which was tasked with developing a report that proposes strategies and recommendations for a risk-based regulatory framework for mobile health applications and other health IT tools (iHealthBeat, 8/8).

http://www.ihealthbeat.org/articles/2013/10/4/meaningful-use-payments-to-continue-despite-govt-shutdown

Aetna's Dental Medical Integration Program May Help Lower Costs and Result in Better Health

-- Medical claims costs lowered by an average of 17 percent among members in the program --

HARTFORD, Conn.--(BUSINESS WIRE)--October 04, 2013-- 

Aetna (NYSE: AET) today announced results of an analysis of the Dental Medical Integration (DMI) program. Program outcomes show that good dental health may reduce medical costs and improve overall health. To date, DMI program members who visited the dentist have:

   -- Lowered their medical claim costs by an average of 17 percent,
 
   -- Improved diabetes control by 45 percent,
 
   -- Used 42 percent less major and basic dental services, and 
 
   -- Required 3.5 percent fewer hospital admissions year-over-year compared to 
      a 5.4 percent increase for non-members.

"The mission of our DMI program is to keep our members healthy and reduce their cost of health care," said Mary Lee Conicella, DMD and Chief Dental Officer for Aetna. "We've proactively reached over 1.5 million members since the program began. The results show that members with coordinated dental and medical care are healthier."

The DMI program launched in 2007. It was the result of research Aetna completed with Columbia University College of Dental Medicine that found:

   -- Members who received preventive dental treatment while pregnant had 25 
      percent lower pre-term delivery rates and 34 percent fewer incidents of 
      low birth weight, and 
 
   -- Members with diabetes or cardiovascular disease who received dental care 
      had an average of 27 percent lower risk scores.

The DMI program uses technology to automatically identify members with diabetes, cardiovascular disease, or who are pregnant. Members with those medical conditions who have not recently seen the dentist receive education by mail and phone on the importance of regular dental care. Aetna dental coordinators are available to help DMI members choose a dentist and schedule an appointment. DMI members qualify for enhanced dental benefits such as an extra cleaning and periodontal services covered at 100 percent to help prevent more serious and costly issues. The enhanced dental benefits are not subject to deductible or coinsurance and do not count toward annual plan maximums. There is no added cost to members or plan sponsors for the DMI program.

http://online.wsj.com/article/PR-CO-20131004-905325.html?mod=googlenews_wsj

Miami Beach’s ‘Rock Doc’ held before trial on Medicare fraud charges

BY JAY WEAVER

JWEAVER@MIAMIHERALD.COM

Miami Beach’s “Rock Doc” won’t be getting out of jail anytime soon.

Christopher Gregory Wayne, an osteopathic physician charged with ripping off Medicare, will have to stay in a Miami federal detention center until his trial, a magistrate judge ruled Thursday.

Wayne, 53, arrested Monday, pleaded not guilty to a dozen charges of submitting bogus bills for physical therapy treatments, such as massages and electrical stimulations, at his former Miami clinic.

But at his bail hearing, federal prosecutor Eric Morales argued that Wayne filed almost $5 million in false claims for those treatments in 2007-09 and was paid $1.7 million by the taxpayer-funded Medicare program. He said Wayne, whose patients dubbed him the “Rock Doc” because of his punk-style hairdo, submitted bills for 500 daily physical therapy sessions on average in 2008 — a mathematical impossibility.

Some patients told the federal grand jury that his therapy services were a “joke,” the prosecutor said, adding that the treatments were sometimes provided by Wayne’s unlicensed “office girls.”

Morales told Magistrate Judge Barry Garber that Wayne faced between 6 1/2 and 8 years in prison, making him a likely risk of flight. He also pointed out that the physician filed for bankruptcy, his Miami Beach home was mortgaged to the hilt and that he traveled out of the country in recent years.

Wayne’s criminal defense attorney Michael Grieco countered his client was only charged with $230 in actual Medicare fraud — not millions. He also noted that Wayne has lived in Miami Beach for more than 20 years and has family in Arkansas and Illinois. And, he pointed out, the federal probation office recommended that Wayne get a personal surety bond before trial.

“He’s not going anywhere,” Grieco said.

But Garber, the magistrate, sided with the prosecutor, saying “he might well flee this jurisdiction.”

Wayne, who has sported punkish hair along with chains, bangles and leather bracelets in the past, has been in the public eye before as a focus of a Wall Street Journal profile in December 2010.

According to the profile, he had used his Pine Tree Island home as a production studio for Playboy photo spreads and had posed with celebrities such as Paris Hilton and Aerosmith’s Steven Tyler.

The Miami indictment charges him with 12 counts of Medicare fraud by submitting “false claims” for therapeutic treatments, such as a 15-minute massages ($25), electrical stimulations ($20) and ultrasounds ($15).

The indictment accuses him of “falsely and fraudulently representing that these treatments and services were medically necessary and had been provided to Medicare beneficiaries” between December 2007 and August 2009.

The indictment further alleges that he disbursed the Medicare payments to himself and others.

Wayne once operated a lucrative medical practice in Miami’s Design District.

But Medicare administrators grew suspicious of Wayne’s voluminous billing activity for physical therapy services and began heavily scrutinizing his bills in 2009. That increased oversight forced him to sell his business.

Wayne, who obtained his osteopathic license in 1990, worked for a pain clinic, Park Place Medical Group, in Fort Lauderdale in 2010-11, according to state records.

But he got into trouble dispensing pain killers and other prescription drugs. In September 2012, the state Department of Health banned him from owning, operating or working in a pain management clinic and from dispensing prescription drugs, such as Oxycodone, Xanax and Flexeril.

His Facebook page says Wayne, who received his osteopathic degree from Nova Southeastern University, is now working in the emergency room at Larkin Community Hospital in South Miami. He was arrested there Monday by agents with the FBI and Department of Health and Human Services-Office of Inspector General.

Wayne also says he worked at Regional General Hospital in Williston, and as a family physician in Hialeah Gardens.

http://www.miamiherald.com/2013/10/03/3667271/miami-beachs-rock-doc-held-before.html

Read more here: http://www.miamiherald.com/2013/10/03/3667271/miami-beachs-rock-doc-held-before.html#storylink=cpy

Google agrees to sign BAA as means to HIPAA compliance

Google removes a barrier to Google Apps adoption by offering to sign BAA for organizations that need to comply with HIPAA. 

In September 2013, Google offered for the first time to sign a HIPAA Business Associate Agreement (BAA) available for Google Apps. That's good news for organizations unwilling to deploy Google Apps without such an agreement. It is also a smart competitive move, as it matches Microsoft, which offers to sign a BAA for Office365.

HIPAA: The basics

For those who may be unfamiliar, HIPAA (Health Insurance Portability and Accountability Act), refers to a set of laws passed in the United States in 1996. The laws seek to limit access to individually identifiable healthcare information to those that "need to know". HIPAA holds healthcare industry professionals accountable for the privacy of patient information.

Effective HIPAA compliance implementations resemble effective security systems: they're designed with the aim of protecting individually identifiable health information (IIHI). Such information is broadly referred to as "protected health information", or PHI. This information includes an individual's name, address, and any information related to the individual's health or payment records. A Business Associate Agreement (BAA) provides written assurances that an organization's partners will also seek to secure an individual's PHI.

Google Apps BAA

Google's BAA agreement covers three Google Apps services (Gmail, Calendar, and Drive), along with the Google Apps Vault service, which archives user data from the other three services. To sign up, an Administrator for the Google Apps domain must answer three questions online. From the website:

1. Are you a Covered Entity (or Business Associate of a Covered Entity) under HIPAA?
2. Will you be using Google Apps in connection with Protect Health Information?
3. Are you authorized to request and agree to a Business Associate Agreement with Google for your Google Apps domain?

After responding, the Administrator will be taken to the BAA document for signature. As of September 27, 2013, Google is using Adobe's Echosign to obtain digital signatures.

Read before signing

The BAA terms state "...other Google services or third party Marketplace Apps should not be used in connections with PHI. This agreement requires that you disable all Additional services in the Admin console." (Emphasis is mine.)

An organization signing the BAA would not be able to use the domain covered by this agreement for additional useful Google services, such as Google+, Google Groups, or Google Sites. As the terms state, you must disable all Additional services: you may use Gmail, Calendar, Drive and Google Vault. The terms also appear to prohibit the use of Marketplace Apps in conjunction with PHI. (It is unclear whether the terms also prohibit the use of apps intended to secure and protect PHI, such as zSentry. zSentry offers to sign a BAA, and is a third-party app, which may be connected through the Marketplace.)

Implement thoughtfully

If your organization needs HIPAA compliant email, calendars and document storage, then sign the BAA and move forward with the migration. Your organization can adopt Gmail, Calendar, and Drive, confident that IIHI and PHI in those apps will be protected by the BAA.

If your organization is already using Google Apps, review your usage carefully before signing the BAA. If you've already implemented measures to ensure HIPAA compliance, the availability of a BAA may not change anything for your organization. For example, you might already prohibit the use of PHI in Gmail, Calendar and Drive. You might already use tools to audit and verify compliance, such as CloudLock.

Documents don't ensure security

Google's willingness to sign a BAA for organizations that need to comply with HIPAA is helpful and certainly welcomed. It may remove a barrier to adoption for some organizations. But healthcare professionals need to remember that HIPAA compliance, like all IT security, involves complex systems comprised of people, policies, and practices. (For example, you still need effective password policies, security measures such as 2-step authentication, and appropriate user permission settings.)

Signing a BAA doesn't ensure your entire organization is HIPAA compliant: the BAA is just one piece of a complex system needed to protect IIHI and PHI.

http://www.techrepublic.com/blog/google-in-the-enterprise/google-agrees-to-sign-baa-as-means-to-hipaa-compliance/

No Bond For Cancer Doctor Charged With Fraud

DETROIT (WWJ) – An Oakland County doctor accused of intentionally misdiagnosing patients and ordering unnecessary treatments will remain in jail until trial.

Dr. Farid Fata asked a federal judge Wednesday to lower his bond from $9 million to $500,000.

But Judge Paul Borman instead ruled there would be no bond.

WWJ Legal Analyst Charlie Langton was in the court room when the decision was made.

“The judge cited that the doctor was a likely flight risk, that he has significant ties to Lebanon — he owns a house there, he recently visited there, and he’s got substantial family in Lebanon,” Langton reported. “Also, the doctor has the means to flee, having received nearly $169 million for Medicare.”

Prosecutors say they’re still not sure if they’ve found all his money.

Outside the courthouse, about a dozen people protested against Fata’s possible release. One sign read, “Without fail Fata will jump bail.”

Fata is charged with committing fraud to enrich himself through health insurance programs. The government says some patients were repeatedly exposed to powerful drugs despite having no cancer. Fata denies it.

Liz Lupo, whose mother was a patient of Dr. Fata, talked to reporters at the courthouse.

“I’m thrilled; we couldn’t have had a better outcome,” Lupo said. “I’m not a vengeful person. I’m not one of the people saying he should have chemo treatments like he gave his patients … But something has to be done.”

Fata faces 10 years in prison and deportation if convicted.

A trial date was set for Feb. 4.

http://detroit.cbslocal.com/2013/10/02/no-bond-for-cancer-doctor-charged-with-fraud/

Health Alliance bypassed for Medicare Advantage contracts

Thousands of retired state workers in the Springfield area would lose coverage from Health Alliance Medical Plans based on contract decisions announced by the state this week, but those retirees would be able to keep their Springfield Clinic doctors.

“Those members would still have a medical home at Springfield Clinic,” Mark Kuhn, chief administrative officer at the Springfield-based multi-specialty group, said Wednesday.

The Illinois Department of Central Management Services on Tuesday announced the selection of four contracts for Medicare Advantage plans that will serve 123,000 retirees statewide, most of them 65 or older.

Urbana-based Health Alliance was among the bidders but wasn’t selected for what could end as 10-year contracts worth a total of almost $4.2 billion.

The company is considering whether to appeal the decision within administrative channels, according to Health Alliance senior vice president Jane Hayes.

Health Alliance was “surprised and disappointed” by the state’s decision, she said. “We’re looking at our options.”              

Health Alliance serves 15,000 Medicare-eligible state retirees affected by the new contracts. Several thousand of those retirees live in the Springfield area, and many of them use Springfield Clinic doctors through different contracts with the state.

Kuhn said those retirees will be able to continue with Springfield Clinic doctors because the clinic is part of the Humana and Aetna networks offered by companies that won contracts this week for coverage that begins Jan. 1.

The plans include a health-maintenance organization plan from Aetna Life Insurance Co., an HMO plan from Humana Health Plan, an HMO plan offered by Humana Benefit Plan, and a preferred-provider plan offered by UnitedHealthcare.

Currently, Medicare-eligible state retirees have about 80 percent of their health-care costs paid by the federal Medicare program. The remaining 20 percent is covered by one of the health insurance plans offered to active workers.

Offering this type of Medicare supplement coverage through standard insurance plans is costly, according to CMS officials who have said the state could save more than $100 million annually by switching these retirees to Medicare Advantage plans.

With Medicare Advantage, Medicare benefits are provided by a private insurance company rather than the federal government. The insurer receives a stipend from the federal government for providing the benefits.

Health Alliance’s exclusion from the state’s new Medicare Advantage contracts appears to be a more significant issue for patients in the Champaign-Urbana area. That’s because about 6,000 retirees in that area who receive their care through the Carle health system may have to change doctors.

The Carle doctors aren’t included in any of the Medicare Advantage networks of the companies awarded contracts, Hayes said.

Health Alliance’s Medicare plans have been rated among the top in the state by the National Committee for Quality Assurance, she said.

Read more: http://www.sj-r.com/breaking/x452546743/Health-Alliance-bypassed-for-Medicare-Advantage-contracts#ixzz2gflBWYfj

Aetna Inc : Innovation Health Approved to Offer Health Insurance Plans in Virginia

10/03/2013 | 08:33am US/Eastern

Innovation Health Insurance Company and Innovation Health Plan Inc. ("Innovation Health"), the result of a partnership between Aetna and Inova, have received approval from the Virginia Bureau of Insurance to begin offering health insurance and HMO plans to employer groups of two or more members.
Aetna and Inova announced their collaboration and the formation of Innovation Health in May 2012, joining forces in a new way to deliver and finance more affordable, quality health care for employers and residents in Northern Virginia.
"We're excited to bring Innovation Health products to the Northern Virginia marketplace. Our goal when we formed Innovation Health was to demonstrate that an insurance company and a health care system, working together, can dramatically improve the quality and delivery of patient care while also reducing the costs associated with that care," said Tom Grote, Aetna's president for Virginia, Maryland and Washington, D.C. "With these approvals, we're ready to take the next step."
Innovation Health will offer fully insured and self-insured group products beginning with effective dates of Oct. 1, 2013. Plans will be available to businesses whose employees primarily are located in Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City, Fredericksburg City, Loudoun, Manassas City, Manassas Park City, Prince William, Spotsylvania and Stafford. Innovation Health plans also will be offered to individuals both on and off Virginia's health care exchange. For more information, see www.innovation-health.com.
"These plans offer superior health care advantages, including clinical integration and a unique payer/provider collaboration," said Knox Singleton, CEO of Inova. "Coupled with a comprehensive network of community physicians, emphasis upon preventive care and, when required, treatment at the right facility at the right time, Northern Virginia consumers will enjoy lower costs and greater patient satisfaction."
The partnership combines long-standing local, regional and national experience to deliver sustainable solutions for high-quality, affordable health care. Innovation Health leverages Aetna and Inova services and technology to promote wellness and improve patient outcomes.
Inova serves more than 2 million people each year from throughout and beyond the Washington, D.C. metropolitan area. Aetna provides health benefits to more than 600,000 members in Virginia.
About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
About Inova
Inova is a not-for-profit health care system based in Northern Virginia that consists of hospitals and other health services, including emergency- and urgent-care centers, home care, nursing homes, mental health and blood donor services, and wellness classes. Governed by a voluntary board of community members, Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research.