Proposed State Health Plan amendment: Health homes
West Virginia’s Medicaid program is considering adopting health homes as a means to control the cost of Medicaid members who have one or more chronic illnesses. Under this approach a team of doctors, nurse practitioners, nurses, social workers and other professionals would develop with the input from the patient an individualize plan for how the patient can control his or her chronic illness rather than just treating the symptoms of the disease. You can read the draft state plan amendment here. Medicaid is planning to submit this state plan amendment to the federal government for approval. If approved, West Virginia would get 90 percent federal money to establish health homes across the state. View the draft.
What happened? How, why, when did W.Va. pack on the pounds?
Talented Charleston Gazette writers Kate Long and Doug Imbrogno teamed up to produce this article and slideshow photographically demonstrating the way we were in West Virginia and what happened when we started packing on the pounds because of too many calories and too little exercise. It's worth watching here.
Report Shows Health Care Reform Options Make Sense Cents in West Virginia
According to a new actuarial report, West Virginia can save millions if any or all of these health care reforms are adopted:
- adopt electronic prescribing (by 2014, $42 million/yr saved)
- adopt health information technology (by 2014, $300 million/yr saved)
- establish medical homes (By 2014, $170 million/yr saved)
- expand Medicaid (By 2014, $590 million/yr saved)
- expand Medicaid plus both individual and employer mandate (By 2014, $2.2 billion/yr saved)
WVAHC helped to commission this actuarial study, three years in the making, with funding from the Sisters of St. Joseph’s Charitable Foundation, the West Virginia Chamber of Commerce, Mountain State Blue Cross Blue Shield, and the West Virginia Medical Association. The medical and pharmaceutical claims of nearly 865,000 West Virginians were anonymously analyzed in the production of the report. Mountain State Blue Cross Blue Shield, Medicaid, PEIA, The Health Plan, and Coventry voluntarily agreed to pool their claims data. The West Virginia Health Care Authority constructed an actuarial model based on this claims data. National health care economists have called this level of cooperation as “unprecedented and impressive.”
One Two Punch: Unemployment Means Uninsured
Last month the United States Census Bureau released their estimates for the number of uninsured West Virginians. Unfortunately, their estimates only included 2008 data. Many more West Virginians became uninsured during 2009 with the economic downturn. As people lost their jobs, they also lost their employer sponsored health insurance. Families USA issued a report on October 20, 2009 finding that the number of working aged, West Virginians who became uninsured in 2009 increased by 16,900. That is an increase of 2 percent, the 16th highest increase in the country. Read the Report
Poll: West Virginians Favor Comprehensive Health Care Reform
West Virginians favor comprehensive health care reform according to a poll of 403 likely West Virginia voters. West Virginians’ Campaign for a Healthy Future conducted the poll and found the following results:
- By a two to one margin West Virginians favor increasing the cigarette tax from the current 55¢ per pack to $1.
- By almost two to one margin voters favor requiring chain restaurants to post on their menu the number of calories in the food they sell.
- Very few voters had heard about patient-centered medical homes (a team approach providing primary care that enhances patient education and care coordination). But when voters understood the concept, they overwhelming approved.
- Voters also strongly supported expanding Medicaid to cover low-income parents.
Finally, voters are most concerned about the cost of health care. A plurality thought that reducing cost was the most important reform with covering the uninsured a close second. Almost one in five West Virginians had put off seeing a doctor because of cost during the last year.
Fat, Fatter, Fattest: West Virginia is a Leader
explosion of obesity in the states can be graphically seen in these
charts. Every state has seen a dramatic increase in
obesity rates. Unfortunately, West Virginia has been, and continues
to be, a leader in percentage of the population that is obese. It’s
time that the legislature takes action to provide consumers with
information at the time of purchase the numbers of calories in the
food that chain restaurants sell.
View the Charts
Cover the Kids
To learn why covering children under Medicaid and the State Children’s Health Insurance Program (SCHIP) is so important and to find out what other states are doing to cover all children, read the following two reports from the Kaiser Foundation.The Illinois program is the most expansive effort in the country for covering all children. While it would be difficult to duplicate Illinois’s program here, it’s time West Virginia covers as many children as possible.
Prescription Drug Trends
This is a Kaiser Family Foundation Report on Prescription Drug Trends. Prescription drugs are vital to preventing and treating illness and helping to avoid more costly medical problems. Rising costs and implementation of the new Medicare drug benefit have highlighted the need for a better understanding of the pharmaceutical market and for new approaches to address rising costs.
Families USA Counts Deaths Due to Lack of Coverage
Families USA has generated the first-ever state-level estimates of the number of deaths due to lack of health insurance. Their estimates are based on both the Institute of Medicine and The Urban Institute methodologies applied to state-level data. In 2006, there were nearly 1,043,000 people between the ages of 25 and 64 living in West Virginia. Of those, 16.5 percent were uninsured.2 Uninsured West Virginians are sicker and die sooner than their insured counterparts. Read the details here.
Miliken Institute Finds West Virginia Chronically Ill
The Milken Institute found that West Virginia had the highest incidents of seven chronic illnesses in the country. These seven illnesses listed in order of number of cases in West Virginia are: pulmonary conditions, hypertension, mental disorders, heart disease, diabetes, cancer and stroke. These conditions shorten lives, reduce quality of life, and have a significant and negative impact on businesses. While West Virginia spends $2.3 billion on treating these seven illnesses, it cost businesses $8.1 billion in lost productivity from these illnesses. The West Virginia data can be found here.
Get the Junk Out of Our Schools
The prestigious Institute of Medicine issued an April 2007 report that calls on schools to ban trans fat and limit calories, fat, sugar and sodium in foods sold in schools. Additionally, the report calls on schools to ban soft drinks sold during school time.
Who Has the Best? U.S.?
Many Americans believe that we have the best health care system in the world. The Commonwealth Fund, a national health care research organization, studied the health care systems of six different countries: Austria, Canada, Germany, New Zealand, England and the United States. The report examined Quality of Care, including right care, safe care, coordinated care, and patient-center care, as well as access, efficiency, equity, and long, healthy and productive lives. Despite spending almost double the average of these five other countries, the United States was rated last or second to last on all but one of these criteria. Canada didn’t do much better. They were rated fifth out of the six countries. England was the first rate country, followed by Germany, with Australia and New Zealand tied for third place. You can read the entire Mirror, Mirror on the Wall report, or click on a chart that summaries the report.
Because most health care dollars are spent in the last few months of life, we all need to be certain that we get only the care we need and the care we want. Each of us should have a living will and medical power of attorney. A living will tells your doctor what life-prolonging interventions you want to be used if you are terminally ill or in a persistent vegetative state. A medical power of attorney gives someone whom you select the right to make medical decisions for you if you become unable to do so. The West Virginia Center for End-of-Life Care has all the forms and information you need to make a living will and medical power of attorney or you can download the forms here:
Who Spends the Most for Health?
Expenditures for health care are concentrated in relatively small number of patients according to a Health Affairs article. Concentration of Health Care Expenses Revisted found that the sickest one percent of individuals use 27 percent of health care expenses. The top 5 percent use 55% of all health carte dollars. By contrast the healthiest 50 percent of the population only uses 3% of health care expenses. Any effort to control health care inflation has to concentrate on the sickest individuals and to prevent others from becoming this sick. No public policy or amount of education that is aimed at the healthiest 50% of the population will have any meaningful impact on overall health care expenses.
340B Drug Pricing Program Sites
West Virginia’s federally qualified health clinics -- or FQHCs -- are mostly rural clinics that accept all patients regardless of their ability to pay. They provide quality primary care, and have access to what is called 340B prescription drugs. These brand name drugs are priced 50 to 60 percent below the average wholesale price and 10 percent below Canadian drug prices. West Virginian’s federally qualified clinics are well suited to provide the state’s residents with quality, low cost primary care. We should actively encourage their use. A list of the West Virginia clinics that dispense 340B drugs can be found here.