How Long Does Obama Have To Fix Healthcare.gov?

 

By Julie Appleby

KHN Staff Writer

OCT 21, 2013

“They've got a few weeks.

But if federal officials can’t get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents’ calls to delay implementation, say analysts.”

That is only 3 weeks from today   October 22, 2013.  According to sources, there are over 3 million lines of ‘code’ to review and correct as necessary.

If the administration solves the problems before the end of October, “this would just be a blip on the radar,” said Dan Mendelson of consulting firm Avalere Health in Washington.

If problems cannot be resolved that quickly, Mendelson said “there are other options for getting people enrolled,” noting that Medicare beneficiaries signed up for coverage for decades without using computers.

 

 

The president also mentioned those options Monday, saying consumers could sign up by telephone, in person with trained assisters or by downloading an application and mailing it in. (28 pages)

But those options are not ideal, mainly because millions of applications would have to be manually checked across several federal agencies.

“That would take significantly longer than if it was automated,”

Some analysts suggest that if problems persist into late November or December, that the Obama administration will need to consider extending the open enrollment period.

Such a decision, however, would have political and financial ramifications.

These events have created a political and administrative bonfire. It impacts financial planning by insurance companies, and to say the least…..the object for affordable care, the patients themselves. Unfortunately patients are left for last, covered in dust, smoke and mirrors.

Because the health law is primarily aimed at low to moderate income people – and their household cash flow is often drained by holiday gift spending and replenished by February tax refunds -- getting the exchange working by November isn’t critical, said Brian Haile, senior vice president of healthcare policy at Jackson Hewitt tax service.

“If you’re trying to sell something you need to do it at a period during which you don’t have competing consumption,” said Haile. “After Nov. 1 … foremost on their minds is not, ‘Am I going to buy insurance?’ but ‘What am I going to put under the tree?’ ”

Jay Hancock, Anna Gorman and Philip Galewitz contributed.

Health Beneficiary Exchange: How is Social Media Involved?

 

#navigator #hbx

The recent roll out of the Health Benefit Exchange has not gone exactly as planned.

The latest on the Health Benefit Exchange snafu : HHS maintains a ‘blog” as part of their “Digital Strategy” web pages.

In a post published Sunday on the HHS "Digital Strategy" blog, the Obama administration said it has formed a team of IT experts from the public and private sectors to help resolve the technical glitches that have plagued the Affordable Care Act's federally run health insurance exchange website

Although the Navigator program envisioned by HHS to educate and assist patients in navigating health benefit exchanges, there are several problems. The Navigator program is not fully implemented and difficult to find and/or contact.

Much of the affordable care act is targetted at young people, those who are on social media platforms including Google +, Facebook, and Twitter as well as many others, Pinterest, Myspace, and a host of other sites.

It makes sense that social media can be used with better comunication than all other media. Mobile provides ubiquitous messaging with apps for all of the above social media sites.

Illinois is one of the first to harness social media to broadcast their ‘message’.

llinois Social Media Experts Seek To Help Frustrated Exchange Users

Chicago marketing agency FleishmanHillard has deployed a small team of social media experts to monitor and respond to online comments about glitches associated with the federally run health insurance exchange under the Affordable Care Act, the AP/Washington Post reports (AP/Washington Post, 10/18)

Since the Oct. 1 start of the open enrollment period, many consumers have experienced technical glitches on HealthCare.gov  that have hindered their attempts to enroll in coverage (iHealthBeat, 10/15).

Since the website opened for enrollment Oct. 1, consumers and health insurers have continued to report application delays and errors with HealthCare.gov that extend beyond the high visitor traffic and software issues that HHS officials initially identified as the causes of the problems

In Illinois, the federally run Get Covered Illinois website teaches state residents about their insurance options before sending them to HealthCare.gov.

According to FleishmanHillard, the agency has put on hold all paid advertisements.

Instead, social media experts now are engaging with discouraged consumers and posting new information and advice on Twitter, as well as other social media websites.

The team also is using Facebook to post updates about HealthCare.gov.

Meg Poulelis -- a social media expert working for the outreach campaign -- said, "We're making sure we're listening [to consumers] and we're supportive and we're there for them when they're having difficulties."

Dave Kerpen -- social medial strategist with New York-based Likeable Media -- said, "Given people's frustrations with the federal website, Get Covered Illinois has to be able to respond promptly with great care to their customers."

Several other avenues will be email, and networking with influential bloggers.

However, a word of caution….some social media users have ulterior motives and may offer highly biased views if they oppose the Affordable Care Act, or are out to market self-interest views.

 

Dr. Manny: America, stop turning to social media for information on Obama Care

Dr. Alvarez notes that many politically inclined ObamaCare enrollment continues, the folks in charge of informing Americans about health care are politically biased individuals who don’t necessarily care about or understand health care issues, but rather simply want to promote a progressive agenda of a socialized America.

For all the questions you can’t find answers to about Health Benefit Exchanges #hbx or #navigator may help to begin.

The Obama Code

 

Few people don’t know about the run up and hype about the national  HealthCare.gov launch as a pre-mature birth.  HealthCare.Gov is now being rushed to the NICU (neo-natal intensive care unit).

Obamologists are running some quick diagnostics on the new baby, to determine if it’s a hardware or software problem. 

Early indicators are that despite President Obama’s announcements,this will not be a quick recovery from a birth with an Apgar score of less than 4.  At that level any prognosis is guarded.

It’s all  in the code…..or is it the hardware, servers, and networks? Experts are being rushed in to replace and/or augment government contractors from the space, and military industry.  Outside experts not familiar with, or having no desire to file for a government contract and it’s byzantine contracting process have been sought to fix another government fiasco. Will this be through a bidding process or just another government contract over-run with which we are all too familiar?  After all isn’t software for health the same as for rockets, space-craft and running the IRS?

The Health and Human Services Department, which administers the site, said Sunday it has recruited "some of the best and brightest" technology experts from inside and outside the government to resolve the defects.

Internet users have been unable to create accounts, received confusing error messages and had to endure pages loading slowly or failing to respond in a timely way.  President Obama considers those problems "unacceptable. Thank you Mr President, so do the rest of us.

When and if Mr.Obama’s aides read the ACA he is in for some even bigger surprises. After enrollees enter the door and enroll in whatever plan they chose, there will be even bigger surprises. Some will enter the system, chose a provider (maybe an MD, or a PA or NP).  Some will find surprisingly high premiums and a sticker shock of 10,000 dollar deductibles as a trade-off for lower premiums.

For Example:

 

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Betrayals, Lies, and Deception

 

As I was sitting down this Sunday morning to think about my next blog posting, my twitter feeds, facebook and Google + lighted up my smartphones, tablets and desktop PC.

A life-long friend, David Fox sent me an email about Dan Bongino who is a candidate for the Congressional seat (2nd district), Maryland about Obamacare which he sent to his former employer.

Mr. President,

In one of your famous Obamacare speeches you stated, "If you like your plan, you can keep your plan."
Well, as evidenced by the letter below, which my wife and I just received, you lied. We did "like" our plan.  But we were informed in this letter that our plan will no longer exist and we will be forced to purchase a new plan, from a website which doesn't work, for a higher monthly premium, for services we don't want.
Now, I know I am not one of your connected cronies and insiders, who were all given waivers from this disastrous piece of legislation. I was just one of your Secret Service agents who put my life on the line for you every day. I was still praying that given our middle-class existence, operating a small-business in Maryland, that your "fundamental transformation" of America would have stayed out of our home. Apparently that is not the case as my public battle against your disastrous presidency has just become very personal.
Regards,

Dan Bongino

Letter from Blue Shield

 

Technorati Tags: health insurance,obamacare,affordable care act,bongino,obama,maryland congress

Sebelius will be a no-show at Obamacare hearing

 

The title of this blog post says it all, and confirms the disdain HHS show for providers, patients, pharma, insurance companies, hospitals and Congress.

The  Affordable Care Act assigns authority and responsibility to HHS for the implementation and mandates of the Affordable Care Act. Kathleen Sebelius is the personification of HHS as her appointed title indicates. She was confirmed by Congress several years ago, prior to passage of the Affordable Care Act.

Health and Human Services Secretary Kathleen Sebelius will not testify at a congressional hearing Thursday into breakdowns in the rollout of the federal Affordable Care Act, drawing more heat from House Republicans.

An HHS official confirmed Saturday that the secretary would not attend, citing a conflict in her schedule.

"We are in close communication with the committee and have expressed our desire to be responsive to their request,” the official said.

 

The hearing, before the House Energy and Commerce Committee, was scheduled this week to address glitches in the Obamacare website. Chairman Fred Upton, R-Mich., ripped Sebelius when initial reports indicated she would not attend.

Sebelius states that she is too busy to attend due to prior commitments.  Is this cowardice, or merely indicating  her lack of  priority for the Affordable Care Act?

Health experts, including consultants are overly analytical attempting to prove or disprove the merits of the ACA with tables, graphs and diagrams outlining ObamaCare, how much it will cost and how much it will save, and how many more souls will now have health insurance.

They ignore the common sense question….why is there much opposition to the law?

And as more deadlines approach for mandates the opposition grows. The nuts and bolts which account for success or failure are whirring and grinding.  Is it because it was planned in committee rooms and in the planning process key experts who did not follow the Democratic vision were excluded from the process early on. Isn’t this why the Republicans could not or would not vote for the ACA. Is this what led up to the Budget Stalemate and the Debt Ceiling Crisis?

Failure does not have to be the end of the Affordable Care Act, however the early phases should set off loud alarm bells at HHS and in Congress.  Mr Obama has two choices….to fall on his sword and ask both parties to reconnoiter and rethink Health Reform either by amending the law or have it repealed.

The Affordable Care Crisis

 

Opposition to the current roll-out of the Affordable Care Act has grown and has come center-stage. Proponents of the new law seem to have taken a less visible role, and public opinion has gradually drifted to changing the mandate deadlines. From a practical stand point the health benefit exchanges do not seem to be entirely ready, and have generated confusion and more anxiety.  The Dept. of HHS hyped the HBX and raised unrealistic expectations.  It became more of a marketing ploy than a real value proposition.

It is time to back off and take a breath to re-evaluate the goals and what must be implemented to assure a smooth and successful health reform .  It may require major revisions during the next 24 months.   The compressed time schedule from 2010 when the law was passed until 2013 is really a very short time to transition a huge industry. Much of it evolves only if all the steps take place in an orderly fashion. It is a bit of a domino game and a false step or missed opportunity may crash the project entirely. 

Health care has not and will not been reformed by the Affordable Care Act.

Another indicator of the error in thinking, HHS failed to realize that health will still operate in an open marketplace, save for those at the bottom tier who will have to rely on a legacy medi-caid system, an antiquated poverty level, and a maze of federal-state-county eligibility system.

In the current system counties calculate benefits based upon maintance costs, also legacy and badly out of date poverty level figures. For one thing poverty levels are determined for the nation at large. Poverty level in California is far different from Poverty levels in the midwest or Arkansas as one example.  In fact poverty levels vary greatly in each state, such as a state with wide disparity  in income zones.One size will not fit all and nothing has been mentioned regarding specifics of how the medi-caid system will be modified to adapt to ObamaCare.

Obamacare and the Federal Poverty Level

Who gets help from Medicaid (AHCCCS in Arizona) and who gets help with their health insurance premiums under Obamacare?  It all depends on a person’s, or a family’s income in relation to the federal poverty level.

An individual or a family will get help with their health insurance premiums if their income is between 133% and 400% of the federal poverty level (FPL).

In addition to getting help with health insurance premiums, some people will get help with co-pays that are part of their health insurance plan. Individuals or families making less than 200% of the federal poverty level (but higher than 133%) will get this help if they enroll in a Silver plan. (I guess I need to explain the coverage levels next.)

Here is a chart that shows the FPL changes based on the number of people in a family.

The Beginning or The End to the Affordable Care Act

 

By now perhaps 20 million or more Americans have tried to log into the National Health Benefit Exchange, or one of the State-run portals.

There is probably no way to tell exactly since the analytics are not working for the site. However Google could probably tell us. (Maybe HHS should have contracted with  them.

These are not glitches,” said an insurance executive who has participated in many conference calls on the federal exchange. Like many people interviewed for this article, the executive spoke on the condition of anonymity, saying he did not wish to alienate the federal officials with whom he works. “The extent of the problems is pretty enormous. At the end of our calls, people say, ‘It’s awful, just awful.' ”

The reluctance for many states to join the national HBX effort is outlined by the following.

Interviews with two dozen contractors, current and former government officials, insurance executives and consumer advocates, as well as an examination of confidential administration documents, point to a series of missteps — financial, technical and managerial — that led to the troubles.

Politics made things worse. To avoid giving ammunition to Republicans opposed to the project, the administration put off issuing several major rules until after last November’s elections. The Republican-controlled House blocked funds. More than 30 states refused to set up their own exchanges, requiring the federal government to vastly expand its project in unexpected ways.

Deadline after deadline was missed. The biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring, according to people familiar with the process. As late as the last week of September, officials were still changing features of the Web site, HealthCare.gov, and debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.

 

From the Start, Signs of Trouble at Health Portal

Dr. Donald M. Berwick, the administrator of the federal Centers for Medicare and Medicaid Services in 2010 and 2011, said the time and budgetary pressures were a constant worry. “The staff was heroic and dedicated, but we did not have enough money, and we all knew that,” he said in an interview on Friday.

There are opposing opinions as to how long it will require to unravel another Gordion knot.  Some say weeks and others say several months.

How much will it cost? Like every government project it will most likely come in over budget, which can also be said about the entire Affordable Care Act.

And while I compare apples to oranges, at  $150 million USD a pop for a state of the art F35 stealth fighter, that will sound like a Walmart special, as compared to Obamacare.  

And like Health Benefit Exchanges, there is a web site dedicated to the F35 Raptor .

Twinkies and Ding Dongs Democrats or Republicans

 

Republicans, or Democrats.  Who is the Twinkie and who is the Ding Dong?

Depending upon whom you ask the PPACA is the best thing since the advent of the Twinkie. And although PPACA passed congress we are not certain how it will survive. It will survive as the Twinkie and the Ding Dong are surviving despite skeptics and outright hostility from some quarters.

What about some bi-partisan support and remediation by Republicans and Democrats, alike?

Physician medical groups seem the happiest of all segments of medicine.

Don Crane, the CEO of CAPG (California Association of Physician Groups) in the December issue of their newsletter had this to say in 2010.

“As we watched the election results, it became clear that the Accountable Care Act (ACA) is, in fact, established policy. Regardless of our political views, we now have a more accurate picture of what the future holds for physician groups. At last we can put long-term planning back on the table and base our decisions on fact instead of speculation. That is good new”

Don Crane sees the big picture overall as he eloquently and accurately states,

“The most urgent issues facing our country are the deficit and the federal budget,

and both will have a huge impact on the healthcare community. The sustained

growth rate (SGR) provider payment measurement, which dates back to 1997 when

spending costs were increasing much more slowly, will probably get another

“patch.” That isn’t enough. What it needs is a genuine and lasting “fix” that includes

incentives for coordinated care, primary care and Accountable Care Organizations

(ACOs). We will continue to press for those kinds of improvements to the ACA. Another critical issue associated with the ACA is the expansion of healthcare coverage to 32 million million uninsured. It will be costly, and implementation may be difficult. In California, however, voter-approved Proposition 30 provides additional taxes which should prevent serious cuts to Medi-Cal.”

Don Crane summarized well in the newsletter,

“I expect to see an acceleration of the mergers and acquisitions trend, with well managed physician groups among the most sought-after entities. CAPG physician groups and others practicing in our accountable care model know how to provide better care at lower costs. They know how to measure and improve clinical quality. They know how to establish effective management. Those who also understand how to adapt and innovate in a new environment will be among the success stories of the next decade”

Managers love to manage, and the bigger the group they manage the greater their esteem. It’s a little bit like government.

Physician medical groups will adopt quickly to ACA and even possibly to the ACO concept. Small medical practices, individual solo practices will struggle with much more, setting up an organization. Much of the transition has to do with infrastructure and professional management.

HHS says that ACOs will create great cost saving measures, and improve quality of care. Both claims will require some hard evidence. These early claims are based upon already formed large medical group systems (already in place) with very early statistical evidence for a short time period.

Engaging small systems will require careful and prudent management. In a sense this is a new enterprise model, subject to all of the vagaries of all startups. Management costs, health information technology, and capital requirements could tip the balance into insolvency very quickly.

The incentives offered by HHS for adoption of EHR are misleading and do not allow for continuing maintenance, nor software updates. It is well known that EHR hardware and software maintenance costs over the long run far exceed the capital expenditure to purchase a system.

Of course all of this was before “Sequestration” precipitated by the debt crisis. There is much uncertainty as to how this will be implemented for Medicare plans.

 

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We Are Behind, or are We ?

It would seem that healthcare is changing rapidly. But has it and is it really ?  The Department of Health and Human Services, Medicare and the Affordable Care Act have mounted a huge and expensive campaign using hype, and a lot of money to convince potential patients that all will be well (or maybe better) with government guidance, incentives, mandates, and a ‘battle plan’ for revolutionizing health care. This was accomplished with preconceived ideas and a partisan plan developed behind closed doors.

Is it so?

Michael L. Millenson reminds us that we are behind. Demanding Medical Excellence came out in October, 1997. What progress has been made since then, and where we have fallen short? He addresses that question in a short article, “The Long Wait for Medical Excellence,”

“I set out to review this topic and found his excellent observations in The Health Care Blog, featuring “Still Demanding Medical Excellence”.

Written at a time  (1997), well before the Institute of Medicine’s (IOM) scathing analysis of dangers in the health system Millenson points out;” the 1998 report on errors from the IOM estimated that 44,000 to 98,000 patients die each year in hospitals from preventable mistakes. The Agency for Healthcare Research and Quality (AHRQ), using a different methodology, recently estimated the number to be 97,000. Put it all together and this is what you’ve got: for the past decade (or, maybe, for several decades), 100,000 Americans (or maybe upwards of 200,000 Americans) have lost their lives each year in hospitals through preventable medical mistakes. Add it up: a million preventable deaths? Two million? Plus preventable injuries? Pick your time frame and your toll.”

In a 2010 Health Affairs blog, “Why We Still Kill Patients,” I bluntly blamed the lack of progress on a combination of errors’ invisible consequences, professional inertia and the income hospitals quietly reap from substandard care. I believe that new standards of transparency, in addition to government and private sector financial incentives, are making care safer.”

All is not lost, just that progress has been very slow as compared to product recalls for defective devices, infectious disease outbreaks. and more.  Perhaps processes and system are more difficult to change. One cannot recall a process without bringing the system to a dead halt.

Now consider that all of the above is about hospital care. Now, consider that 15 years after the IOM error report there is no reliable estimate at all of the death and injury toll in the outpatient environment. Why? And why no outrage?

 

Commentary and Opinions are invited and encouraged. Guest bloggers are also welcome to contribute here.  Send requests to gmlevinmd@gmail.com

 

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Government Shutdown vs. Health vs. Debt Ceiling

 

The present stalemate in Washington reflects how ridiculous it is for anyone to think that government can really “run’ health care.  Does the world’s economy really depend upon making the right decision regarding the American Health Care system, or how it will effect the American Debt Ceiling. How much grandstanding is taking place in D.C. ?  What is true?  That depends upon which side of the aisle you live in.

It may be a good thing that we have become more of a paperless society, because the sheer weight of what might have been printed regarding the affordable care act (not to speak of the law itself) would tip the spinning globe off it’s orbital axis.

The real issue now before us in regard to the Affordable Care Act is how to amend it and maintain it’s worthy, lofty and principled goal to provide good health care to all. No one can even define what ‘good health care’ means.  Let alone to fund it.

The law was passed, and Speaker Pelosi said we would not know what was in it until it passed.  So be it. Neither Pelosi, Obama, Reid, and others knew how this law could or would play out.

The beginning is not promising as we have seen with several delays and one of the principle components, the health benefit exchange portals being  broken and incomplete.  Despite input from credible business, and healthcare sources the reaction of the administration is both defensive, and arrogant.

The segment of the industry that seems to complain the least is the insurance companies, for they have gained the most, and lost the least. Even with the mandate that they must allocate 85% or more of their income to direct patient care, insurers have other means of restricting their cost and maintaining profitability hidden away in increased deductibles, and larger copays as well as raised premiums.The government claimed that health spending is out of control, and the only means to correct it is for them to ‘regulate’ it more.  The truth is that most of the increase in cost has been fueled by regulations in all areas of healthcare.

Haste does make waste and it is time to call a time-out and halt further mandate deadlines.  During this period an assessment needs to be made in regard to repairing what is already in place.

The real uncertainties of the Affordable Care Act, in addition to the funding impact, now include whether it will be fully implemented at all.  The final word is not yet out. (this despite Democrats clearly pointing out it is the law of the land).Clearly there are many Americans, democratic and republican opposed to it’s present form. Any law popular or not must face the test of logic, and rational thought. Pipe dreams do not fit in this category.

Do we need to sacrifice 40 million people to be without health care? Certainly not, while a means can be had to insure almost all Americans with a sound business model.

The current form of Obama care is fraught with chaos, and an attempt to manage, manipulate and coerce different health segments with economic sanctions and reward. The problem is that a sanction to one segment is a reward to another, and rewards to one segment may be a sanction to another.  Each segment may have competing interests.  The result of this Gordian knot is the unpredictability of what secondary effects will occur, as has been shown during the run up to the employer and the individual mandates, and it’s effect on employment by small businesses.

The verbal assurances by the Obama administration of lowered insurance premiums are in doubt as real figures begin to emerge.  There is great fluctuation in premium estimates on a state wide basis. This seems to fly in the face of a National Health Care System.

While many of the previously uninsured will receive an “insurance card” there is real expert opinion that it may not be worth the paper it is printed on.  Like many patients with Media-Cal’s blue and white “BIC” for many it will be worthless or even worse, a liability.  Many providers will not deal with programs that require inordinate bureaucratic burden for inadequate reimbursement.

In a recent non scientific sidewalk study by FOXNEWS there were many who thought Obama care was not the same as the Affordable Care Act.  Some even thought that Obama care was better than the Affordable Care Act.

Leading the Charge in Wireless Health

 

Who and what is leading the growth of wireless technology in health care? You would be surprised.

According to Leslie Saxon MD in a special to CNN, Technologic advances don’t happen in isolation. There are many different elements— cultural and technologic — that must come together to turn an innovation into a scalable business product, and then, possibly—but rarely—a cultural phenomenon.

When it comes to digital health products, the prevailing attitude among physicians is still deep suspicion. While many people look at physicians as the drivers of change in digital health, I am in the minority of innovators in this field. There are some physicians who are on the vanguard of talking about it, but only a few are actual innovators. Many of the advances will come from non-healthcare innovators–the “pull through” demand will come from the public who recognize the benefits of new technology to help them become healthier and smarter about their lives.

Read on: Digital Health Space

Technorati Tags: wifi,wireless,wireless health,mobile apps,mhealth,Leslie Saxon MD,patient driven,digital health products #hitsm #hcsm

Paul E. Zimmerman.com: Don't Buy Health Insurance, Don't Pay The Fine, Do Enjoy Yourself

Paul E. Zimmerman.com: Don't Buy Health Insurance, Don't Pay The Fine, Do Enjoy Yourself

Arriving Track 1 on the Affordable Care Act

 

Where you stand depends on where you sit

Please stand back to avoid being ‘sucked’ under the train. Wait until the train has come to a complete stop before boarding or exiting (that may take some time)

Take some time to read the entire blog post from Phil Levy, the author of “Not running a hospital”

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