On March 28, 2012, I had the honor of participating, with HIMSS members from the Central and Southern Ohio chapter and the Northern Ohio chapter, as they hosted their 5th Annual Advocacy Day. Throughout the day, the connection between Ohio’s economic future and the use of technology in healthcare was the focus of discussions with legislators in the Ohio Statehouse and HIMSS advocates.
During these meetings, HIMSS members met with 29 state representatives and 19 state senators and left legislative packets at 55 offices. Governor Kasich also issued a proclamation naming March 28 as Ohio State Health Care Information Day.
I also had the pleasure of learning from a HIMSS member about a unique Affordable Care Organization in the Buckeye State. She told me about the Nationwide Children’s Hospital, which is the largest pediatric accountable care organization in America. This ACO manages the care of 290,000 at-risk children on Medicaid – a concept that is a central part of the new healthcare law.
While discussion around accountable care organizations has centered almost exclusively on the creation of adult ACOs through Medicare, the Patient Protection and Affordable Care Act of 2010 called for funds for Medicaid ACO demonstration projects, including a pediatric ACO demonstration project that started this past Jan. 1.
I learned some of the differences with Medicaid and pediatrics when it comes to ACOs. They include:
Typical Medicare ACOs vs. Medicaid ACOs
- Medicare is one federally managed system; Medicaid is a state-federal operation, which results in differences between states, and is essentially 50 different programs.
- Unlike Medicare, one size does not fit all. Because states operate Medicaid programs in different ways, ACOs at the state level will have to adpat and innovate.
- Access needs to be a more significant focus within a pediatric-based ACO than a Medicare ACO because pediatrics relies on Medicaid as a payer. With Medicaid reimbursements at 76 percent of Medicare rates, many practices are closed to Medicaid patients.
General Population vs. Pediatrics
- Pediatrics offers, perhaps, the biggest opportunity to bend the long-term cost curve in healthcare.
- While the savings may be less immediate, evidence indicates many of the pervasive, and costly, chronic diseases of adulthood can be successfully prevented in childhood, for example, obesity.
- Pediatrics is positioned to provide wellness and care management protocols to more successfully usher/transition children into the adult healthcare system.
Finally, you can find out more here on Medicare and the potential impact on Ohio and the Nation.
I would like to take this opportunity to thank the HIMSS members who were so gracious to me while I attended the Ohio Advocacy day activities. I really enjoyed meeting new HIMSS friends as well as catching up with old ones. I look forward to another successful advocacy day next year in Columbus. In my mind, the HIMSS volunteers are the reason some many state officials know of HIMSS and our mission to lead healthcare transformation through the effective use of health information technology.
And -with all the discussion about ACOs and Medicare, how many of you are aware that ACOs are also receiving reimbursement from the government under the Medicaid program?
