IHA Daily Briefing: Dec. 6

IHA Presents to Hospital Transformation Committee
IHA Cook County Reception Dec. 12
State, National Marketplace Open Enrollment Lagging
HHS Announces Senior Advisor for Drug Pricing Reform
Briefly Noted

IHA Presents to Hospital Transformation Committee
IHA President & CEO A.J. Wilhelmi and Senior Vice President Patrick Gallagher on Wednesday gave an extensive presentation on preliminary policy recommendations for the Medicaid Hospital Transformation Program to the legislative Hospital Transformation Review Committee, which met in Chicago and Springfield.

To develop preliminary recommendations for the allocation of the $263 million in hospital transformation funding established in the assessment redesign legislation, IHA created an 18-member Hospital Transformation Task Force – representing all segments of Illinois hospitals and geographic areas across the state. The IHA Task Force met five times from June to October and developed principles and policy recommendations to serve as a framework for allocating the transformation funding to support hospitals that want to transform their delivery models to meet the healthcare needs of their communities in a financially sustainable manner. The IHA Board of Trustees reviewed and revised the preliminary recommendations in November.

Included in the preliminary recommendations are key transformation principles:

  • Reform is about meeting needs of the community across the continuum of care;
  • Transformation activities should be measured with indicators such as improving access to care in short term and improving health status/quality of life in the long term;
  • Delivery system reform is about the entire system, not just hospitals, and requires carefully thought through partnerships;
  • Reform outcomes must be sustainable with rational payment systems;
  • Accountability must be achieved before funds are delivered; and
  • Adequate time is needed for proper planning.

Wilhelmi and Gallagher also described and explained the preliminary recommendations that focus on four key issues: Distribution of Funding, Priority Participation Criteria, Required Elements for Transformation Proposals, and Financing Parameters.

They noted that some hospitals – due to lack of resources – may need consulting assistance to examine options and prepare proposals and suggested that the State should consider providing consulting services for these hospitals. Wilhelmi also raised the issue of ongoing challenges with Medicaid managed care – including denials, billing and payment delays – that impact the financial viability of some hospitals and create additional challenges to transformation. Wilhelmi also expressed appreciation to Healthcare and Family Services (HFS) Director Patti Bellock and her staff for their efforts to try to address these MCO challenges.

Earlier this week, IHA sent members a detailed overview of the preliminary policy recommendations and will be seeking feedback from members in the coming weeks. The IHA Board will consider that feedback at its meeting in late January, with IHA presenting its final recommendations to the Hospital Transformation Review Committee and HFS in February.

The Review Committee also heard presentations Wednesday from the Association of Safety Net Community Hospitals and SEIU Healthcare. The safety net group proposes that priority funding in the Transformation Program go to Safety Net Hospitals (as defined in state statute), psychiatric hospitals above 50 percent MIUR, Critical Access Hospitals and Children’s Hospitals and that Safety Net Hospitals get credit for prior transformation initiatives. SEIU proposes that the primary purpose of the program should be to reduce health disparities and expand access to care. SEIU proposes to direct program funding to DSH, Safety Net and Critical Access Hospitals, and says transformation projects should expand services and support the workforce and address health inequities.

The Hospital Transformation Review Committee will next meet in January (date to be scheduled).

IHA Cook County Reception Dec. 12
IHA is hosting a reception for hospital leaders and the Cook County Board of Commissioners on Wed., Dec. 12 from 4-6 p.m. at 312 Chicago. Click here for more information and to RSVP.

State, National Marketplace Open Enrollment Lagging
The Centers for Medicare & Medicaid Services released week five data (Nov. 25 – Dec. 1) for the health insurance marketplace open enrollment. During week five, more than 773,000 consumers renewed or purchased health insurance via Healthcare.gov. That figure is lower than week five figures from 2017 (Nov. 26 – Dec. 2), which showed more than 823,000 consumers selecting or renewing coverage.

From Nov. 1 – Dec. 1, nearly 3.2 million consumers selected a new plan or renewed their coverage. That figure is lower than 2017 open enrollment figures for that same timeframe (Nov. 1-Dec. 2), which showed 3.6 million consumers selecting or renewing coverage.

Cumulative 2018 enrollment figures (Nov. 1 – Dec. 1) for Illinois show more than 100,000 Illinoisans purchasing or renewing their coverage via the health insurance marketplace. When compared to cumulative data from 2017 for that same timeframe, Illinois’ health insurance marketplace enrollment is down about 27,000.

Dec. 15 is the last day of open enrollment on the health insurance marketplace. Make sure to visit www.GetCovered.Illinois.gov.

HHS Announces Senior Advisor for Drug Pricing Reform
Today, the Dept. of Health and Human Services (HHS) announced that John O’Brien will serve as Senior Advisor to the Secretary for Drug Pricing Reform. Previously, O’Brien had served as Advisor to the Secretary for health reform and drug pricing, as well as Deputy Assistant Secretary for Health Policy within the Office of the Assistant Secretary for Planning and Evaluation.

Prior to his time at HHS, O’Brien, a pharmacist, was Vice President of Public Policy for CareFirst BlueCross BlueShield. He has also worked at the Centers for Medicare & Medicaid Services, the Notre Dame of Maryland University College of Pharmacy, and various pharmacy and pharmaceutical organizations.

An HHS blog post authored by O’Brien discusses his thoughts on the International Pricing Index (IPI) demonstration project. In support of the project, O’Brien said, “Simply put: The IPI demo doesn’t just seek to end foreign free-riding, it introduces competition and negotiation to Medicare Part B drugs. And it provides drug companies with a valid reason to walk away from the negotiating table when other countries demand low prices subsidized by America’s seniors. The socialist systems to whom drug companies are giving better deals simply do not have monopoly power when compared to the importance of participating in the Medicare program.”

Briefly Noted
Today, the U.S. Senate and House passed a continuing resolution to fund the government until Dec. 21. The stop-gap measure awaiting President Trump’s approval would avert a Dec. 7 partial shutdown and postpone a funding battle over a U.S.-Mexico border wall.