We are delighted to present this guest blog by Suzanne Schlattman, Deputy Director for Community Outreach and Development at the Maryland Citizen’s Health Initiative (MCHI)! MCHI is a long-time grantee of Community Catalyst, and in addition to their great work on outreach and enrollment, they are now also working on a health system transformation project. Maryland has long had a unique system for setting hospital payment rates, and MCHI has focused their project on influencing changes to that system that are underway right now. While MCHI’s specific project is grounded in Maryland’s unique hospital payment model, the creative steps that MCHI has taken to engage consumers and partners in their work could be replicated by other states. Read more to find out exactly what MCHI has done!

A New Frontier in Health Advocacy in Maryland

Maryland is implementing innovative changes to how our hospitals are paid (see below for more details).  At MCHI, we believe that consumer involvement will be essential to achieving the goals motivating these changes, which include lower costs and better quality care.  But it is also somewhat uncharted territory for MCHI. Traditionally our coalition has mobilized around expanding coverage and concrete campaigns like raising tobacco and alcohol taxes for public health programs. Mobilizing consumer engagement in a campaign for quality was going to take some retooling—so here’s how we are approaching it:

Focus Groups

  • First, we contracted with OpinionWorks, a research and strategy firm located in Annapolis, MD, to host a series of regional focus groups with consumers, especially consumers enrolled in both the Medicaid and Medicare programs who frequently utilize the hospital. We wanted to learn about their impression of Maryland hospitals and introduce new concepts of how their care might change.  We found that consumers are most interested in practicalities like having their prescriptions filled and in-hand before being discharged. Consumers are also interested in learning more about resources at the hospital and in the community that can facilitate better coordinated care, but they also want control over their privacy.

Public Forums

  • Then, we applied what we learned from the focus groups to develop outreach, education and messaging strategies that we are sharing through a series of public forums that began in January and will continue through this summer. We’ve been reaching out to our current coalition partners and other local coalitions and tagging on to existing meetings where possible. This has resulted in greater participation and allowed us to build relationships with new partners, like Local Health Improvement Coalitions, who are more active at the local level. We’ve sensed some resistance to using our customary regional approach and we’ve responded by adjusting our strategy and planning more local forums—using more of a hospital-by-hospital approach. What we have learned from these forums is that patients, providers and community-based organizations are eager to be engaged and want a clear call to action and follow-up steps for ongoing collaboration.

Faith-based work

  • Meanwhile, our staff looked to models where hospitals have successfully engaged local communities to improve care delivery and coordination. The most impressive model we found was the Congregational Health Network in Memphis, TN where the local hospital entered into a covenant with local faith leaders to organize and align resources in the health care system and the faith community. We think this would be a great model in Maryland and are sharing this as a possible “next step” with local leaders at the public forums. There has been a tremendous response and already significant progress on this front. We hope to support the launch of at least one pilot project at a Maryland hospital by the end of this year.

This is new and exciting territory for our organization. While we are blazing the trail hand-in-hand with local providers, hospitals and advocates, we are also eager to learn from other states that are now approaching these same ideas and challenges!

Background on Maryland’s Unique All-Payer Hospital System

What would your state’s health care system look like if you could tell Medicare—and all other payers—what to pay for each hospital service?

Well, that’s what we have in Maryland. Thanks to a waiver from CMS (the Centers for Medicare and Medicaid Services), this arrangement has been serving us very well for nearly 40 years. Our independent Health Services Cost Review Commission monitors hospital rates and performance and establishes consistent rates used by all hospitals and all payers across the state. Not only has this resulted in better transparency and more consistent quality from hospital to hospital, but our per capita costs have been lower and rising more slowly than the national average since receiving the waiver.

In other words, this waiver has been a major “win” for consumers and hospitals alike. The terms of the new waiver call for some pretty ambitious goals around reducing avoidable hospital admissions and readmissions while also applying some pretty tight financial parameters under global budgeting, which rewards hospitals for improving the health of the population in an area rather than simply paying for a volume of services.  Maryland is blazing a new trail in healthcare, and MCHI has jumped into the fray to make sure that the consumer voice is heard!

Suzanne Schlattman, Deputy Director for Community Outreach and Development,
Maryland Citizen’s Health Initiative 

Dear Governors,

As you continue budget conversations with your state legislature, state consumer health advocates urge you to protect health insurance coverage programs that help consumers achieve financial stability and good health.

Clearly, we have not recovered from the Great Recession and state economies remain fragile—as do the many consumers who rely on public programs to help them achieve financial stability. As states are crunching numbers and making trade offs, we urge you to take the long view. Protect coverage gains and ensure ongoing access to health care for consumers in your state.

Don’t go back on coverage.

After five years of the Affordable Care Act (ACA), 16.4 million consumers now have access to health coverage, many for the first time. Through the ACA we’ve opened the door to good health and we cannot backslide on coverage. Dismantling the progress we’ve made in insuring consumers to balance state budgets is costly. Without an insurance option, many consumers—many of whom are our most vulnerable community members—forgo coverage and delay care. These delays in care lead to more complex and costly health conditions.

Protect the people Medicaid helps the most.

Medicaid is the coverage program that provides access to health care no matter the age when we are most vulnerable. The faces of Medicaid range from the working parent to the retired grandmother—from the pregnant mother and her child to an individual with a disability. Medicaid plays a vital role in securing health access during difficult moments in our lives. The faces of Medicaid are hardworking parents and their children, expectant mothers, our seniors, and individuals with disabilities striving to live independent lives. They are our friends, our neighbors and our family. Numerous studies have shown us that an investment in Medicaid pays dividends to our future. Just this spring, a working paper published by the National Bureau of Economic Research finds a correlation between Medicaid eligibility in children and increased earnings for those children as adults. And in turn, we know the devastating impact of scaling back eligibility for benefits. A study commissioned by CT Health Foundation finds that potential cuts to Medicaid in their state will lead to an average increase of $1,900 per year in health care costs for families. Between 7,000 and 10,000 parents will likely become uninsured and child coverage rates will likely drop—because parent and child health insurance coverage go hand in hand.

Elevate your voice to Washington.

We understand there is pressure to cut health programs in your state. We support a greater focus on making our health programs more efficient, producing high quality care that reduces cost. These health system transformations are percolating across the country—but they need time to expand and lead to best practices around quality and value for consumers.

In this time of economic uncertainty governors should raise their voices to Washington in support of federal funding for programs like Medicaid and CHIP, as Governor Hogan of Maryland just did. Congress is currently debating whether or not to continue the Children’s Health Insurance Program (CHIP), a long-standing health insurance program for children. Governors across the country must stand united on ensuring that this successful program continues to provide needed child-specific coverage to our children and bring needed federal funds into the states.

Finally, Governors must add their voice to the conversation about Medicaid structure on the federal level. The Republican proposal to restructure Medicaid into a block grant program would lead to severe funding cuts to state budgets, forcing states to eliminate Medicaid coverage for millions of our working families, seniors, and people with disabilities.

We all must work together to preserve the lowest uninsured rate in 40 years. This is not the time to move backward on coverage—this is the time to reimagine the health care system with coverage for all as its foundation.

Sincerely,

State Consumer Health Advocates Everywhere

Five years ago today, the Affordable Care Act (ACA) became the law of the land. Since then, more than 16.4 million people have gained access to health care coverage, many for the first time.Chalkbaord image with balloons and listed reasons to love the ACA

The passage of the ACA was a monumental achievement for individuals and organizations across the country. Here at Community Catalyst, we continue to be incredibly proud of all our state partners who have worked tirelessly to implement the law in their own states and as part of a national effort. 

Consumer health advocates have made the law work by:

  • Setting up State Marketplaces or working with federal policymakers to improve the Federal Marketplace. 
  • Training thousands of in-person assisters who sit down with consumers and help them understand not only how to enroll in health care coverage but what it means to have coverage.
  • Ensuring that individuals who are dually eligible for Medicare and Medicaid have high-quality care that is coordinated and comprehensive.
  • Closing the coverage gap in 28 states (plus the District of Columbia) so everyone can benefit from the full intent of the ACA.
  • Releasing nationwide information about drug and device manufacturer payments to doctors and teaching hospitals, beginning a new era of sunshine and transparency. The information, which is made public under a provision of the Affordable Care Act, shows the millions of ways that drug and device manufacturers try to influence doctors using gifts, free meals, free travel and other payments of some value.

We know there is much more to do, but the ACA is a really strong start toward creating a system where everyone can receive and afford high quality care. Repeated efforts to repeal the law as a whole or take it apart piece by piece have not been successful. However the threats are not over, and we are committed to protecting the law and working to improve it every step along the way. We cannot return to the days when young adults could not stay on their parents’ plans, when women were charged more for their care than men, and when insurers could deny people coverage because of a pre-existing condition.

Today is a day to celebrate what our partners have achieved and, more importantly, what consumers have gained. Happy 5th Birthday ACA!

A few recent headlines suggest that red states stopped making progress on closing the coverage gap. These headlines fit neatly into the “Republicans block ObamaCare” storyline that dominates other aspects of ACA implementation, but they don’t accurately describe the coverage gap debate.

Regardless of your party affiliation, the benefits of closing the coverage gap are hard to ignore. Within the past few weeks, new studies of states that already accepted the federal dollars confirmed that closing the coverage gap not only provides health security to millions of low-income Americans, it frees up money in state budgets and creates new jobs.

Since when are Democrats the only ones interested in reducing state spending and boosting employment? They’re not. That’s why poll after poll shows that closing the coverage gap has strong public support, even among conservative voters. And it’s why 15 Republican Governors have come out in support of closing the coverage gap since 2012.

Now, let’s be real: it’s usually harder to get an expansion bill through a Republican-dominated legislature than it is to gain support of a Republican governor (though this isn’t always the case - sorry, Maine!). Indeed, a few plans developed by Republican governors recently hit roadblocks in their statehouses. Unlike governors who heed to statewide support, many Republican legislative leaders’ districts are so conservative that their biggest fear is getting Eric Cantored – making them vulnerable to Tea Party demands.

Despite the disproportionate Tea Party influence in many statehouses, at least six Republican-dominated legislatures are actively working to build a compromise to close the coverage gap this year. This progress is often driven by establishment Republicans who are fed up with their party being hijacked by the far-right.

Download the map here. 

That’s not even the complete picture. The last six months saw a rash of high-profile Republican leaders reversing their earlier opposition to closing the coverage gap. For example, Governor Bentley (R-AL) recently indicated that he’s open to exploring a waiver to close the coverage gap, as did Governor McCrory (R-NC). Governor Otter (R-ID) has implored his state to find a solution to the gap, as has Governor Mead (R-WY). And the Republican-dominated legislature in Kansas held hearings this week to discuss the benefits of closing the coverage gap.

It’s too early to tell in which states these bills will survive the legislative process and make it into law. If all six of the most promising states closed the coverage gap this year, nearly 2 million more people would have access to affordable health care by 2016. While we certainly wish it would happen faster, it’s safe to say that red states are making slow but steady progress toward closing the coverage gap.

The evidence confirming that closing the coverage gap is good for working families and state budgets continues to pile up. In addition to the recent good news from Kentucky, two recent reports detailing the outcomes from closing the gap in four other states are showing savings when states accept federal dollars to close the Medicaid coverage gap.  We hope these findings inspire state lawmakers – whose top priority is balancing the budget – to champion closing the coverage gap on behalf of both their constituents and their budgets.

The two  studies – the first on Kentucky and Arkansas and the second on Connecticut, Washington and New Mexico – illustrate several positive budget impacts from closing the gap:

  • State savings from enhanced federal matching. Previously, states had to pay 30 to 50 percent of the cost of covering high-need Medicaid beneficiaries. With expansion, some of these beneficiaries are now covered by 100 percent federal funding. Arkansas saved $17.5 million in 2014 by accessing these federal dollars, while Kentucky is poised to save more than $38 million in 2014 and 2015.
  • Savings in state-based health programs. By shifting the cost from state dollars to federal dollars, all five states experienced savings in behavioral and public health programs, while four states quantified savings for in-patient care for incarcerated individuals.
  • State and local savings in uncompensated care costs. State and local governments generally fund 40 percent of uncompensated care costs (UCC). Closing the gap allowed some states and localities to significantly reduce these costs – $17.2 million in Arkansas and $13.8 million in Kentucky for 2015. Additionally, a recent news report about New Jersey cites a $150 million reduction in UCC spending for 2015.
  • Long-term state savings and revenues attributable to closing the gap. While all states cited positive short term effects to the state budget from closing the gap, Washington and Kentucky are reporting a longer-term budgetary impact. Washington will produce a $79 million net savings in 2014 as well as net Medicaid savings each fiscal year from 2013-2021 (even when federal matching drops to 90 percent). Likewise, closing the gap generates a $919.1 million positive economic impact in Kentucky from now until 2021.

Although each state and budget is unique, these studies provide compelling and consistent evidence that closing the gap saves states money. We hope the 22 states who have not yet closed their coverage gaps will take note: they can boost state budgets and provide health security to working families.