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Managed Care

Bridges to Excellence: Rewarding Quality Across the Healthcare System
The Bridges to Excellence coalition is a not-for-profit organization created to encourage significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, effective, efficient, and patient-centered care. BTE was initially implemented in Cincinnati, and has spread to other communities throughout the country.

Medicare Fee-for-Service Provider Resource Center
CMS wants to ensure providers, physicians, health care practitioners, and suppliers have quick access to accurate Medicare program information. In keeping with this goal, the provider/supplier-specific pages are a one-stop resource focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers.

The significant number of Americans without health insurance coverage is the source of growing debate. While the numbers of uninsured children has declined due to renewed government efforts over recent years, the number of uninsured adults has reached nearly 44 million, according to government estimates. Fewer individuals are being covered by employer-based plans,and lack of access by minority populations remains a challenge. Tighter state and federal budgets have advocates for the uninsured increasingly concerned. Locally, how lower-income and indigent patients can afford the high cost of prescription drugs is a growing issue, as is the proliferation of dental care needs among this group.

Consumer demand for choice in the managed care marketplace continues, spurring new products, such as “tiered” plans and “defined benefit” offerings in Cincinnati and elsewhere. The choice is coming with a price tag, as health plans grapple with how to balance choice with affordability. Attention to managed care profitability is raising some eyebrows, as health insurers announce large profits. Yet in a period of rising premiums, with little on the horizon in the way of solutions, some have begun to question the ability of managed care to hold down costs in the same manner as in years past. Linking increased reimbursement to patient outcomes is gaining ground; a few such partnerships are in place locally.

Premium increases are a major concern of business leaders as 2002 cost upswings were the highest in a decade. These increases are particularly difficult for smaller businesses to absorb. Employers are passing more costs on to employees, in the form of higher co-pays, “tiered” benefit offerings and the like. Employers are also exploring options that “define” benefits and shift more decision-making about how funds are utilized to the employee. Employers are paying increasing attention to improving outcomes and patient safety.

Providers of care and advocates for area Medicaid recipients watched closely this past year the budget wrangling as state legislatures here and across the nation looked to cuts in Medicaid spending as a means to balance serious budget shortfalls. The recent economic downturn has resulted in a surge of new Medicaid enrollees. In Ohio, the Governor is attempting to shift public dollars from costly nursing home care to services provided in the home and community. Programs in recent years to get more children covered have generally achieved some success.

For the first time ever, everyone with Medicare, regardless of income, health status, or prescription drug usage, will have access to prescription drug coverage. This new coverage became available January 1, 2006. Please visit Medicare.gov for more information.