Page 10 - Delaware Medical Journal - November 2017
P. 10
PRESIDENT’S PAGE
by Sachin Jain, MD, CEO of CareMore, a medical group that specializes in a proactive model of senior care. Dr. Jain said, “Let’s face it, chronic care management is not rocket science. It’s measuring lab values. It’s engaging your patients. It’s ensuring medication adherence...It’s supporting them in doing the right behaviors, and that 3
In a planned ceremony only one hour after
signed House Joint Resolution 7. This resolution grants authority to DHSS to establish a health care spending benchmark rate that is linked to the economic growth of the state.
The second meeting of this summit series was held on Friday, September 22 at the Medical Society of Delaware Conference Center and focused on provider and hospital leadership. One of the speakers was Retired Brigadier General Norvell V. Coots, MD, President and CEO of Holy Cross Health and Maryland Region of Trinity Health. He discussed the Maryland Medicare waiver. Basically, this program equalizes Medicare and commercial payer reimbursement
rates to hospitals. In doing so, Medicare reimbursement rates increased. However, this also comes with stipulations. The hospitals have to meet quality metrics and reduce overall health care spending growth.
Recently, “under a new CMS waiver approval, Maryland hospitals and doctors can enter care-coordination partnerships and share savings stemming from more Dempsey Stallings, Vice President of Policy at the Maryland Hospital Association. Such partnerships could trigger federal anti- kickback laws, but the approved plan waives participants’ liability starting July 1. Sixteen hospitals will participate in the Care Redesign Program and more will be able to 4
The third in this summit series was held
on September 25, 2017, and focused on the legal and regulatory aspects of establishing the benchmark. Stuart Altman, Ph.D.,
and retired Massachusetts State Senator Richard Moore followed Secretary Walker in presenting how Massachusetts went about establishing a benchmark. While Massachusetts has not managed to decrease (it remains one of the top two highest spenders in the country), it now ranks as the second healthiest state in the country per America’s Health Rankings. “This report analyzes a comprehensive set of behaviors, community and environment policy, clinical care, and outcomes data to provide a holistic 5 As stated earlier, Delaware ranked 31st in this survey. However, Secretary Walker’s presentation states that Delaware has a population which is “older” and “sicker” than the average state. Also, the State of Delaware covers health insurance for a larger proportion of the population (State Employee Health Plan and Medicaid) compared with other states.
At the time of this writing, there are two more Health Care Benchmark Summits pending. The fourth will concentrate
on data analytics and total-cost-of-care methodology. The last will focus on governance and authority. MSD will continue to be present to represent the physicians of Delaware in these discussions.
MSD is aware that the physician community has concerns over value-based payments. Physicians partaking in quality programs have become disillusioned with some payers who are failing to provide actionable data
in a timely manner to meet quality metrics, while others have put in great time and expense to meet quality goals only to learn that it was not good enough for gain share. As physicians, we need to be at the table to make sure the data feeding quality metric assessments is accurate, meaningful to
patients, not out of the physician’s control, and improves health care outcomes. A physician participating in this process does not want his time with patients further condensed just to click extra keys or the mouse so that an already cumbersome EMR can collect this data.
The benchmarking process is sure to
be further complicated by America’s uncertain future with regards to health care when the next repeal and replace bill will come forward and what it would mean for Medicaid funding.
MSD appreciates the opportunity given
Prayus Tailor, M.D.
President, Medical Society of Delaware
REFERENCES
1. Odom-Walker K. Driving change with
the health care spending benchmark. Presentation at: Health Care Spending Benchmark Summit; September 7, 2017; Wilmington, Del.
2. Delaware.gov: The Official Website of
the First State. Governor Carney Signs Legislation to Limit Growth in Health Care Spending; September 7, 2017. Available at: http://news.delaware.gov/2017/09/07/ benchmark.
3. Emanuel E. The impact of rising health care costs and options for Delaware. Presentation at: Health Care Spending Benchmark Summit; September 7, 2017; Wilmington, Del.
4. Dickson V. CMS approves Maryland waiver to encourage care coordination. Modern Healthcare. July 27, 2017. Available at: http://www.modernhealthcare.com/ article/20170727/news/170729911
5. United health Foundation. America’s Health Rankings Annual Report 2016. Available at: http://assets.americashealthrankings.org/ app/uploads/ahr16-complete-v2.pdf
330
Del Med J | November 2017 | Vol. 89 | No. 11
