Ohio Health Policy Review

Allen County Board of Health decides to close its Child Health Clinic

On Friday May 8th, the Allen County Board of Health voted 6 to 1, with one member abstaining, to close its Child Health Clinic at the end of May (Source: "Health board decides to close children's clinic," The Lima News, May 9, 2008).  Its clinic currently serves 575 chilrden. 

Those supporting this decision cited two reasons for closing the clinic.  One reason is the diminishing need for its safety net services.  The Board reports that there is enough capacity between local physicians and the Allen County Health Partners, a federally qualified health center, to meet the needs of these children.  According to Allen County Health Commissioner, David Rosebrock, "It's a little different situation out there, and the safety net we've been providing we don't feel is necessary any longer. That decision can be revisited if we find there are continuing problems."

The second reason is financial.  The clinic had been using grant money from the Ohio Department of Health to help support the direct care it provided.  However, changes in ODH rules now only allow the money to be used for non-direct care, such as social work visits.  This change in grant rules requires the Health Board to find $100,000 in additional funds to run the clinic.

Board member Wilfred Ellis vehemently opposed the decision.  Among his objections, Ellis stated, "when you have patients with social issues, who miss appointments because they have other situations, the time allotted to address these situations may not be able to be managed by practices. A lot of practices just don't have the time to do that."

The Ohio 21st Century Transportation Priorities Task Force announces regional meetings

The Ohio 21st Century Transportation Priorities Task Force is bringing all Ohioans to the table to explore the broad spectrum of transportation issues facing the state. The Task Force is seeking input from citizens, businesses, and other through a series of regional meetings.  The purpose of these meetings is to gain input on priorities and policy options as the state balances the movement of people and freight, promotes safety and reduces congestion, creates jobs and encourages responsible growth, helps to build sustainable communities, and links all modes of transportation - connecting highways to rail, aviation, water ports, and transit. 

People interested in health care issues related to transportation may want to attend on of these sessions or provide input in other ways.

The Task Force has a website for additional information on its work and to allow for input electronically.

The regional meeting times, dates, and location are below.  All meetings are from 4 to 8 p.m.  There may be additional meetings added later.

Southwest Ohio - May 21st  Miami Valley Regional Planning Commission 1100 W. Third Street  Dayton, OH  45407

Southeast Ohio - June 4th  Walter Hall Room 135, Ohio University, Athens, Ohio 45701

Northwest Ohio - June 10th, Nitschke Hall, University of Toledo, Toledo, Ohio 43606-3390

Eastern Ohio -  June 11th, Shannon Hall, Ohio University Eastern Campus 45425 National Road, St. Clairsville, OH  43950

Central Ohio -  June 12th, Ohio Building at the Ohio Expo Center and State Fairgrounds, 717 E. 17th Ave, Columbus, OH 43211

Northeast Ohio - June 19th  Independence Civic Center, 6800 Brecksville Road, Independence, OH 44131

Parents sue to block rule eliminating Medicaid funding for specialized autistic services

The Ohio Legal Rights Services filed a lawsuit against the Ohio Department of Job and Family Services and the Ohio Department of Mental Health in District Court in Columbus (Source: "Parents sue for autistic services," The Columbus Dispatch, May 9, 2008).  This lawsuit, filed on behalf of some parents with children who have autism, seeks to block implementation of a rule that is to take effect on July 1st.  This rule would eliminate Medicaid funding for specialized autism services that their children had been receiving through the Step by Step Academy in Worthington, Ohio.

According to the Department of Job and Family Services, the Step by Step Academy accounted for half of the $5.3 million spent last year on autism treatment, while only serving 4 percent of all children with autism served under Medicaid.

Survey finds health care opinion leaders see need for fundamental change to health care system

The Commonwealth Fund and Modren Health Care magazine released their 14th annual survey of health care opinion leaders (Source: "Health Care Opinion Leaders' Views on Health Care Delivery System Reform," The Commonwealth Fund, April 2008).  This year's survey includes responses from 211 individuals.

One survey question asked about the amount of change needed to achieve signficant gains in quality and efficiency care.  Among the respondents, 89 percent called for fundamental change and 8 percent for modest reform, while no one responded that no changes are needed.

Another question asked about how important five different policy options are to improving health care delivery.  Strengthening the primary care system and encouraging care coordination were both rated as important or very important by 90 percent of the respondents.  The rating of the other three policy options as important or very important was 88 percent for promoting care mangement for high cost/complex patients, 82 percent for integration of providers and organizatinos, and 67 percent for promoting health information exchange.  Eighty (80) percent of the responded agreed that government funding support for health information technology infrastructure development is a high or very high priority.

The survey also found strong support for payment reform.  For instance, 84 percent of respondents gave strong or very strong rating for providing supplemental payments to primary care providers and for incentives to avoid uncessary hospitalizations and rehospitalizations.  In addition, 71 percent favored giving additional payments to certified medical homes.

Adequacy of Ohio's 9-1-1 system questioned

ColoComm Research LLC will be releasing a report next week that details its findings on the adequacy of the nation's 9-1-1 system, including the situation in Ohio (Source: "Ohio 9-1-1 System Facing Critical Funding Challenges Cited in National Report on Health of Country's 9-1-1 System," Press Release, The Earth Times, May 8, 2008).  On May 14th, Ohio State Representatives Larry Flowers and Steve Driehauss, along with county officials and members of the 9-1-1 Industry Alliance will discuss the importance of these findings for Ohio.

According to preliminary information on the report's findings, a critical lack of funding in Ohio threatens the state's ability to complete its Phase II wireless initiative.  Ohio's wireless initiative's purpose is to make sure that Ohio's 9-1-1 capacity can pinpoint the exact location of any wireless caller.

Representative Flowers, a supporter of continued funding for this effort, states that “The health of Ohio’s 9-1-1 system is already marginal and without funding experts say it will be terminal.  Currently, if you call 9-1-1 from a cell phone, the technology needed to find you may not be in place. If funding is not secured, how many Ohioans are being put at risk"

Representatives Flowers and Driehauss have introduced House Bill 550 to continue funding for this initiative and extend the Sunset provision for the project by an additional three years.  Without this extension, the funding source for this effort will expire at the end of 2008.

Intel developing technologies to promote health for older people

Intel is seeking to develop technologies that could enhance the health and well being of an aging population (Source, "Intel developing ways to monitor health," The Columbus Dispatch, May 6, 2008).  Through its Digital Health Group, Intel is researching and developing tools, many of which are for in-home use, to improve prevention and detection of health problems.

Among its work are projects aimed for people with Parkinson or Alzheimer's conditions. One such tool remotely monitors tremors of Parkinson patients for physicians.  Another tool seeks to help Alzheimer's patients communicate more effectively.  At the same time, Intel is developing a sensor that the company hopes will detect neurological problems that could lead to falls, which are a leading cause of hospitalization for older people.

New study examines efforts of emergency rooms to redirect non-emergency patients to other care settings and to try and establish medical homes

A new analysis of 12 communities under the Studying Health System Change Project examines how hospitals are responding to the pressure of non-emergency use of emergency rooms (Source: "Safety Net Emergency Departments: Creating Safety Valves for Non-Urgent Care," Center for Studying Health System Change, May 7, 2008).  Cleveland is one of the twelve cities studies under this project.

The report finds that many low income people, whether uninsured or on Medicaid, turn the emergency rooms because they lack timely access to care in other settings, even for follow up appointments   Therefore, these patients show up for routine and urgent care at emergency rooms. 

The study reports that most hospitals, especially safety net hospitals, are working to redirect these patients to other, more appropriate and less costly care settings.  However, these efforts are meeting with varied results.

The authors conclude that "a combination of approaches could help stem ED use for non-urgent care, including expansion of community health centers, community clinics and hospital clinics and strategies to improve their accessibility. Alignment of hours of operation and available services among existing providers could increase people's care options at lower costs. Since transportation is a significant barrier for some, bringing services to low-income neighborhoods through mobile vans and school-based services could improve access in a cost-effective way."

Individual insurance may be better for people who come into poor health than small group insurance

A new analysis by Mark Pauly and Robert Lieberthal examines the relationship between type of health insurance coverage and the risk of becoming uninsured (Source: How risky is individual insurance?" Health Affiars Web Exclusive, May 6, 2008 - available for free access to two weeks only).  The authors find that people with median health status have a higher risk of becoming uninsured if they are individually uninsured and the lowest risk if they are insured through large group insurance.

On the other hand, the authors report that individuals who start out healthy and then develop fair or poor heatlh do better in keeping their health insurance when covered through the individual market than people covered on the small group market.  The risk of being uninsured in the next renewal period was 44 percent for those on the small group market, a rate almost twice as high as for those covered through the individual market.

According to the authors, "high risks pay more if they seek individual coverage after they have
become high risks, but individual coverage provides better protection (compared to group insurance) against high premiums for already individually insured peoplewho become high risk."

The analysis cites two main reasons for this finding.  One reason is that the individual market is supposed to employ guaranteed renewability at class average rates.  This feature means that a downward change in health status is not to specially affect the premium rate at renewal.  The second reason is that a downward change in health status often leads to a loss of employment.  If the person's health insurance is tied to their employment, this loss of employment results in a loss of health insurance.

As the authors conclude, "group insurance has a tear in its net of protection; it leaves a person who becomes a high risk more vulnerable to dropping or losing any and all coverage than does individual insurance."

McKesson buys Ohio health technology firm

McKesson Incorporated announced on May 2, 2008 that its connectivity services business unit, RelayHealth, acquired Ohio-based HTP.  HTP currently provides transaction processing services for Ohio's Medicaid program.  It also is provides the platform and infrastructure for the Utah Health Information Network.  According to HTP's President and CEO Ray Shealy, ""HTP's mission has been to deliver efficient and secure automation of financial, clinical and administrative processes. Joining forces with RelayHealth enables us to leverage our technologies to make a positive impact on healthcare operations."

Understanding Indiana's high deductible plan-based Medicaid expansion

One year ago Indiana embarked on its effort to create a Medicaid expansion based on high deductible health plans and health power accounts, called the Healthy Indiana Plan (HIP).  After intense negotiations with the Centers for Medicare and Medicaid Services (CMS), Indiana launched this expansion in December 2007.

On the May 1, 2008 Health Affairs Blog, Mitchell Roob and Seema Verma discuss their work in creating this health reform strategy (Source: Indiana: "Health Care Reform Admist Colliding Values," Health Affairs Blog, May 1, 2008).  Indiana's plan has funding to cover up to 120,000 people.  In its first three months 30,000 people had applied for coverage under the program.

Roob and Verma's  discussion identifies the following six key lessons from their experience:

1.  Inaction is not a market solution

2.  Choose reforms that help those who need it, but also increase personal responsibility and utilize market incentives

3.  Be fiscally responsible

4.  Reach out across party lines and to multiple constituencies

5.  Compromise and cut deals

6.  With the exception of compromise, don't take any of the above lessons too seriously

They conclude their discussion by stating, "The unique structure of the plan holds the promise of redesigning the Medicaid program as we know it today. For the first time, HIP brings recipients and the State together in a market based partnership to use resources judiciously, and to promote provider competition resulting in improved transparency, quality and value for all Hoosiers."