Tara Kulash, St. Louis Post-Dispatch, Author at �鶹Ů�� Health News

Missouri Pulls Out Stops, But Lags Better-Funded Illinois Effort

Tara Kulash, St. Louis Post-Dispatch — Tue, 11 Mar 2014 09:00:41 +0000

Free food and music are notorious for attracting young people; at least that’s the hope of Missouri insurance enrollment counselors.

Before the March 31 deadline under the Affordable Care Act, groups are beefing up their campaigns to bring last-minute customers to the federal health insurance marketplace—especially young people.

Cover Missouri — a coalition of 400 organizations led by the Missouri Foundation for Health — has 130 enrollment events statewide this month. The St. Louis Effort for Aids, for example, planned the Rock Enroll event last Saturday.

Four bands played while attendees munched on Don Carlos tacos. Upstairs, five certified application counselors helped consumers apply for health insurance online and select a plan.

Nancy Kelley, event coordinator, said she hoped to attract “young invincibles,” people younger than 35 who typically believe they don’t need insurance.

For Hilary Albers, 27, the food and music were “definitely not the allure. The allure was the navigator.” Albers walked away with an insurance plan.

For many others, the event was about supporting friends who were performing music. Some said they were already insured. Others said they plan to use the marketplace to shop for coverage. By the end of the event, 10 people had enrolled in health insurance.

Ryan Barker, vice president of health policy at the foundation, said that social media has been an important tool. One Facebook chat event for Cover Missouri had as many as 300 people in the conversation at once.

Kelley said she pulled off the Rock Enroll fair with a $1,100 budget. But without any help from the state and limited funding from the federal government, it’s been an uphill battle. Missouri’s Republican-controlled state Legislature declined to participate in the implementation of the law.

By the end of January, more than 54,000 Missourians had signed up for a private plan through the marketplace, short of the 73,160 projected by the U.S. Department of Health and Human Services. By the end of this month, that target will be 118,000.

Cover Missouri had its own goal: sign up 200,000 on Medicaid and private plans. After the federal website suffered two months of glitches, though, Barker said he thinks 130,000 might be more realistic.

Things look very different in Illinois, which has had money and support to get out its message. The state backed the Affordable Care Act and by agreeing to participate in a partnership exchange with the federal government, got $35 million for marketing and outreach. That has gone into the Get Covered Illinois campaign.

Gov. Pat Quinn, a Democrat, even declared March 1-8 Get Covered Illinois Week, and Soldier Field in Chicago lit up in orange to honor the campaign logo’s color.

“It’s a way of attracting attention and reminding people of something really serious, which is their health,” said Jennifer Koehler, executive director of Get Covered.

By the end of January, Illinois was virtually on par with the federal government’s target for the state. The goal was 88,660 enrollments on the marketplace, and Illinois reached 88,602.

Sabrina Miller, spokeswoman for Get Covered Illinois, said she is “absolutely encouraged” by the enrollment numbers and believes Illinois can reach the final target of 143,000 by March 31.

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Patient Coordination Would Get Boost If Medicare Changes How It Pays Docs

Tara Kulash, St. Louis Post-Dispatch — Tue, 04 Feb 2014 13:51:22 +0000

Expectations are high this year that Congress will finally reach an agreement to overhaul the way Medicare pays doctors for services, scrapping a method that’s been the target of criticism for more than a decade.

If that happens, experts say, Medicare beneficiaries will see changes in how health care is provided, with an increased emphasis on coordinated care and preventive services.

“We’re optimistic that there are a lot of opportunities in this to help make people healthier, more satisfied with their care and bring down costs,” said Dr. Joseph Craft III, a cardiologist at Mercy Clinic Heart and Vascular and president of the St. Louis Metropolitan Medical Society.

The current Medicare payment formula, enacted in 1997 as part of a budget deficit reduction measure, was designed to curb federal health spending by linking physician payments to an economic growth target.

Known as the sustainable growth rate, or SGR, the formula initially meant modest Medicare payment increases to doctors. That abruptly changed in 2002, when Medicare cut reimbursements by nearly 5 percent. Doctors protested, and Congress responded by delaying the cuts, over and over, ever since. The postponements, however, have just increased the size, and price, of the needed fix.

Under the current system, the majority of Medicare beneficiaries receive fee-for-service care. This means physicians are reimbursed a set amount for each service they provide. This method, critics say, provides financial incentives for doctors to offer more services than necessary.

The fixes working their way through three key congressional committees, while they differ, are designed to provide doctors with incentives to model their services based on value instead of volume, said Dr. Stanley Birge, an associate professor of medicine at Washington University in St. Louis.

“By value we mean the quality of the service, plus the cost efficiency of providing that service,” he said. “That represents, of course, a huge change.”

Instead of each doctor billing for each service, health care providers would be encouraged to form medical groups that coordinate their services and offer bundled bills. For example, it’s cheaper to pay a single fee to a hospital for surgery than to pay the surgeon, anesthesiologist and overhead costs separately.

The advantage to this approach is that physicians will be encouraged to communicate better about their shared patients’ care, which will likely decrease duplicated services and misdiagnoses.

The Patient Protection and Affordable Care Act, signed into law in 2010, pushes heavily for bundled payments instead of fee-for-service. The ACA cannot take full credit, though, for the proposed changes. St. Louis doctors say they’ve been moving in this direction all along.

“It’s already happened, and it’s continuing to happen,” Craft said.

Better Coordination

Many physicians already noticed, and were concerned by, the industry’s focus on quantity over quality — and its contribution to rising health care costs.

In response, doctors groups began moving toward better coordination of services, trying to better manage patient care, Craft said. Accountable care organizations, made up of doctors, hospitals and other providers, follow a patient’s medical life, instead of just a few appointments.

And many physicians — often without reimbursement — lined up medications, physical therapy appointments and more for their patients. They invested in electronic health records for data sharing.

“There was no reimbursement,” Birge said, “so therefore, no way to compensate a physician for spending an hour or two on the phone coordinating the care of the patient that was just discharged from the hospital.”

One retired couple, Herbert and Maria Damron, have continued to visit their St. Louis doctors since they moved to the Lake of the Ozarks more than 15 years ago. Like most Medicare beneficiaries, they are fee-for-service patients.

Both agreed their doctors at Mercy Hospital St. Louis have provided excellent coordinated care.

Maria Damron, 70, said when she had a surgery coming up, her cardiologist was notified and requested to perform a stress test first. Afterward, he called her at home “and was so thrilled — on a Friday, late in the day — and said, ‘You did better than last year.’ That’s coordinating patients to the max. And when a doctor calls you back, you have a good relationship.”

Not all physicians have made efforts to participate in coordinated care. Some profit handsomely on a fee-for-service model. A Jan. 18 article in , for example, spotlighted how dermatologists on average make almost half a million a year by billing separately for tests, labs, and each and every mole removed.

Others, Craft said, are afraid of investing in expensive equipment, such as electronic health records, without knowing for sure whether they will save costs in the long-term.

But doctors groups, including many specialists, are supportive of the SGR repeal.

If it isn’t replaced, many medical providers would endure a huge cut to their pay and staff budgets if Congress failed to avert the scheduled cut due later this year. Because of the repeated deferrals by Congress, cuts in Medicare reimbursements could exceed 20 percent if no action is taken, according to the .

“We’re gonna see a cut in our Medicare reimbursement. It keeps climbing every year, and this really would be a disaster,” Birge said.

Access To Care

Some Medicare physicians have threatened to quit the program if there’s no repeal of SGR.

But Birge said that issue is overblown. The reason doctors stop accepting Medicare, he said, is because they stop accepting insurance altogether.

Each insurance provider has a different set of rules for paperwork, and in an area like St. Louis with several providers, “you need an army of accountants and secretaries to fill out all these forms, and it’s extremely costly,” he said.

Birge pointed to an analysis by the Kaiser Family Foundation that found 96 percent of Medicare beneficiaries say they have good access to doctors.

But Craft, the medical society president, said that’s not what he’s observed in his organization. While most doctors won’t leave the Medicare program, he said, many will cap the number of Medicare patients they’re willing to see.

Once the SGR is replaced, changes will be gradual.

Cristina Boccuti, a Medicare policy analyst at the Kaiser Family Foundation, said after an SGR replacement program is agreed on, alternative payment models need to be tested in different areas of the country.

Socioeconomically disadvantaged patients should be included in the testing, she said, because “these are the patients where it’s crucial that they have access to the care that they need.”

Birge, who specializes in geriatric medicine, said that patients could expect better quality care under the new program.

“The physician really takes ownership of the patient, not just while they’re in the office, but they assume ownership of that patient before the hospital, during the hospital and after the hospital.”

How the standards of quality are set has yet to be determined.

While physicians groups such as the American Medical Association have been working for more than a decade to help define quality care metrics, the systems for analyzing and reporting quality care remain relatively untested, Craft said.

Two committees in the House and one in the Senate are discussing a final bill to present to Congress. The legislators have until the end of March to reach a consensus before Medicare cuts would kick in.

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P.R. For Obamacare Stalls In Illinois, Missouri

Tara Kulash, St. Louis Post-Dispatch — Mon, 11 Nov 2013 13:55:30 +0000

This story was produced in partnership with the

Marketing campaigns to promote the new health insurance exchanges hit a speed bump the size of a boulder last month.

The problem-plagued launch of healthcare.gov on Oct. 1 made it all but impossible for most people to sign up for insurance on the exchanges.

And despite assurances by the administration of President Barack Obama that all would be fixed by the end of November, criticism about the site has turned into broad complaints about the Affordable Care Act.

For organizations tasked with promoting the insurance exchanges, the website debacle has forced them to rethink and readjust.

They’re now faced with a double challenge. Not only must they encourage people to sign up for coverage, they also have to rebuild trust.

and , two campaigns focused on promoting the Affordable Care Act, have stayed active on social media and also promoted resources and informational meetings on their websites.

But both campaigns, which separately use St. Louis public relations and marketing firm FleishmanHillard, were forced to put their mass media efforts on hold.

Daily Strategizing

Get Covered Illinois, Illinois’ $35 million campaign, placed full-page ads in Illinois daily newspapers on Oct. 1. But before placing additional ads, the campaign team had to rethink its strategy, said Kelly Sullivan, chief communications officer for the Illinois marketplace.

She said Get Covered Illinois plans to launch an educational campaign within the next couple of weeks that will focus on getting residents informed about their options under the Affordable Care Act.

If HealthCare.gov is completely fixed by the end of November, then the radio, TV, print and digital advertisements targeting Illinoisans to enroll will begin in December. If the site still isn’t running smoothly, Get Covered Illinois will continue its educational campaign.

“It’s a daily calibration to synch our message with the operational realities of the day,” Sullivan said.

On the Missouri side, private nonprofit organization Missouri Foundation for Health also postponed a mass media launch for its Cover Missouri campaign, including radio ads, Internet banners and YouTube pre-rolls (the short ads that appear before the video you wanted to see).

In the meantime, the foundation launched its Facebook ads last week, as well as a search engine optimization that helps users find the Cover Missouri website easier when they use sites such as Google or Bing.

Ryan Barker, vice president of health policy at the foundation, said he wants people to find the Cover Missouri website because Missourians need to be informed before they enroll.

“A lot of consumers don’t want to come and do this all in one day anyway,” he said. “We’re making the best of it and saying let’s spend this time getting consumers ready for enrollment.”

But changing the schedule can be tricky. Barker said he doesn’t want to target his audience during the holidays, because most Missourians likely will be distracted.

“We don’t necessarily want to be spending our limited resources during Thanksgiving and all the Black Friday ads,” he said.

Stepping In Without The State

With no support from the state, the Missouri Foundation for Health has taken the majority of responsibility for advocating health reform in Missouri. The foundation spent $1.8 million of its own budget to fund the state’s largest Affordable Care Act campaign and another $5 million on certified application counselors, people trained to help consumers use the insurance marketplace.

Other organizations and professionals have joined the movement, too, and the Cover Missouri Coalition has reached 300 members. Since August, the foundation and FleishmanHillard have distributed more than a million pieces of Cover Missouri materials to coalition members to hand out to the community.

Barker admits the campaign could use more money, but he is hopeful of reaching as many Missourians as possible.

“I think we’re doing the best we can,” he said. “I think we’re being pretty effective in educating; I think we’ll see in the next six months. It’s a rough start. The website issues are not helping us any.”

Plus, the federal government altered other timelines, too. Originally, consumers had to be enrolled for insurance by Feb. 15 next year to avoid a fine, but that was extended to March 31 — the end of the enrollment period.

Barker said the Cover Missouri campaign was rescheduled to accommodate the Feb. 15 deadline and then rescheduled again once the deadline was pushed back.

And the federal government was supposed to begin a round of advertisements for the marketplace in October but has yet to launch them. Barker wanted to avoid overlapping the campaigns, but there may be no way around it now. He said he’s not concerned, though, because the federal advertisements will mostly target St. Louis and Kansas City, while the Cover Missouri campaign is more spread out and targets rural areas.

Buying ‘A Little More Patience’?

In Illinois, Sullivan said the campaign focuses on what it can control. The partnership with the federal site is problematic, but GetCoveredIllinois.gov can still provide resources to residents.

“It’s more about, are we making progress continuously? Because we always saw this as a multiple-year endeavor,” she said.

Barker and Sullivan each said they have not changed the strategy of their campaigns to defend healthcare.gov’s image. Residents in both states, they said, have been receptive to accepting information and education while waiting to enroll.

“I don’t know how long this good will is going to last,” Barker said. “That’s the big question, and things are getting better on a daily basis.”

As of Tuesday, federal officials announced the healthcare.gov application process could handle up to 17,000 users at a time with few issues.

Tim Burt, an advertising expert in St. Louis, said consumers’ concerns with the troubled online exchanges shouldn’t be ignored in the marketing efforts. Both Illinois and Missouri campaigns, he said, should address those issues and keep consumers updated on fixes.

“People are a lot more likely to give you a pass,” he said. “You’re gonna buy a little more patience with them.”

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