July 19, 2013
Volume 57, Issue 29

State Gears Up to Enroll Thousands in Exchange
DHS unveils state exchange enrollment outreach strategy

Medicaid Director Brett Davis outlined the state’s plan to enroll about 250,000 people in Medicaid or in an insurance plan offered on the exchange. The Department of Health Services (DHS) plans to create regional enrollment networks that rely heavily on training and mobilizing local resources that will help people gain health care coverage.

"Everyone will have access to insurance," according to Davis. "I’m very concerned about the hand-offs as (they) go from one entity to the next."

Speaking at the July 16 Wisconsin Health Insurance Enrollment Summit in Madison, sponsored by the UW Population Health Institute, Davis said the Department plans to identify partner organizations and determine the education and training needs for each by August 16. DHS will leverage the Milwaukee Enrollment Network efforts that are already in place.

The Department will focus its outreach efforts to those who are currently covered by Medicaid who will be transitioned to the exchange and to those uninsured individuals that will be newly eligible for Medicaid. Notification for those who are now in the Medicaid program who might be impacted by coverage changes will start September 20. There are, according to Davis, 86,000 parents and caretaker relatives and 5,000 childless adults who could potentially be impacted by changes.

WHA President Steve Brenton and Joanne Alig, senior vice president, policy & research, both participated in the July 16 Summit. Brenton moderated a panel that discussed how to best identify and reach out to those who will be newly eligible for Medicaid, or who have been dropped from the program and will be moved to the exchange. Alig participated on a panel where she shared hospital-related enrollment considerations.

The Summit materials are available online at: http://uwphi.pophealth.wisc.edu/programs/health-policy/ebhpp/events/20130716/index.htm.

HHS/CMS to host stakeholder teleconference on Wisconsin exchange

The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) will host the second in a three-part series of teleconferences regarding the health insurance exchange in Wisconsin July 31 at 1 p.m.

This call is intended specifically for stakeholders in Wisconsin where there will be a federally-facilitated exchange. CMS and HHS will give brief updates on the operational execution of the exchange including systems readiness, consumer support and outreach. There will also be a brief question and answer session.

Registration is required. Register at www.cmsregion5HIMWI2.eventbrite.com. Visit the Open Door Forums website for links to registration and information on future calls. For more information on the health insurance exchange, visit http://marketplace.cms.gov.

CMS issues insurance exchange final rule for navigators and assisters

On July 12 the Centers for Medicare & Medicaid Services (CMS) released its final rule implementing the Patient Protection and Affordable Care Act (ACA) provisions regarding consumer assistance programs for the federally facilitated and state partnership insurance exchanges. The rule includes standards for navigators, non-navigator assistance programs and certified application counselors. The rule covers training, conflicts of interest, privacy and security of personal information, nondiscrimination and serving people with limited English proficiency and people with disabilities. CMS is expected to announce the navigator grants for the federally-facilitated exchanges in mid-August.

WHA is pleased that CMS created one final rule governing assister programs giving clarity to many provisions. However, key information such as the timing and processes for training for certified application counselors—a role hospitals may want to play—is yet to be determined. WHA staff is reviewing the rules in detail and will continue to provide more information through the Enrollment Action Council and in The Valued Voice.

OCI says don’t expect exchange insurer information before July 31
Moves forward with state-level navigator/assister regulations

At a meeting July 17, the Wisconsin Office of the Commissioner of Insurance (OCI) announced that information about insurers participating in the exchange won’t be available until at least July 31. In making the announcement, J.P. Wieske, OCI legislative liaison/public information officer, told the audience OCI anticipates releasing the information on their website, but it shouldn’t be expected earlier than the end of July, as OCI is still reviewing all of the filings. Wieske elaborated that OCI expects insurers to participate in all parts of the state, but couldn’t confirm whether there would be multiple plans in every area.

After discussing the outreach OCI has been doing with agents and brokers about exchange enrollment, Wieske also stated that OCI is beginning to plan for events in various communities throughout the state in September, where the OCI Commissioner and staff will provide information to community members and consumers about the insurance exchanges.

Finally, OCI is moving forward in implementing the new requirements for navigators and other assisters that were included in the biennial budget.

Earlier this month, OCI released a scope statement regarding the administrative rules governing navigators, certified application counselors, and other assisters in their roles in helping consumers facilitate coverage in the exchange. OCI staff indicated that the draft rules would be released no sooner than August 15, and that they will be reviewing the final federal rules as they work on the state regulations. WHA will continue to monitor the rule-making process over the next several weeks. OCI is also working on making training available primarily online. Assisters are required to take 16 hours of state-backed training in the first year. The training will include eight hours on Wisconsin insurance, four hours on insurance exchange coverage, and four hours on Medicaid. Training is expected to be available in mid-August.

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WHA Leadership Summit to Focus on Health Care Finance

Finance is a driving and complex force on the health care landscape. At the upcoming WHA Leadership Summit, scheduled September 19 at Country Springs Hotel in Pewaukee, a panel of health care colleagues will discuss their perspectives on the future of health care finance.

The panel discussion will be moderated by Bill Petasnick, vice chair of the Froedtert Health Board of Directors. Panelists will include Weldon Gage, CFO of Children’s Hospital and Health System; Gail Hanson, senior vice president/CFO, Aurora Health Care; and Kelly Arduino, partner with Wipfli LLP.

The panelists will share their outlooks for Medicare, Medicaid, private insurance, pay-for-performance and consumer-driven products, and their impact on organizational strategy and planning. They will also discuss strategic approaches to monitoring and adjusting to changes in the finance environment.

CEOs, CFOs, nurse leaders, physician leaders, department/service line managers, and board members should register today at http://events.SignUp4.com/13LeadershipSummit0919.

A block of rooms is being held at the Country Springs Hotel for the evening of September 18. Reservations can be made in the WHA block by calling 262-547-0201 by August 28.

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High Value Health Care—Wisconsin’s Competitive Advantage: Hospital’s "Good Catches" Prevent Patients’ Readmissions

Over 90 hospitals in Wisconsin are working hard to reduce the frequency of patients returning as an inpatient within 30 days of their original discharge. Along with redesigning the discharge process, many inpatient units have implemented a standard practice of follow-up phone calls. Among hospitals working in the Partners for Patients initiative, this is the most commonly-adopted intervention.

"This is not as easy as it sounds," according to Stephanie Sobczak, improvement advisor for the WHA readmissions initiative. "Sometimes patients stay with a relative, so a home number isn’t the one to call. Patients may not be awake to receive the call, so multiple attempts are necessary. Even how the hospital name shows up on a caller ID display can mean the difference between a patient picking up the call or thinking it may be a telemarketer."

In spite of the challenges, evidence shows that nurses who reach a patient by phone within the first 72 hours post-discharge can prevent a potentially serious situation for the patient.

Linda Boyer, RN at Monroe Clinic calls several patients daily in her role as a care coordinator. Monroe has been working to reduce readmissions for the past three years. Linda’s stories about good catches are great examples of the importance of the follow-up phone call.

"I remember one patient who wasn’t feeling well after he went home," Boyer says. "Based on his symptoms, I encouraged him to go to the emergency room. He was very dehydrated, and after receiving fluids he was able to go home. If his condition had worsened, he very likely would have been admitted."

In another instance, she contacted a patient who was diabetic and required daily dressing changes for an infected toe. During the call, Boyer discovered the patient was not following his care instructions.

"The patient told me he would just have the dressings changed when he saw the surgeon. After finding this out, arrangements were quickly made for the patient to have the dressings changed daily by a nurse," Boyer said. "If we hadn’t spoken to the patient early, the outcome could have been very bad."

Monroe’s work with other community organizations is paying off as well.

"We have found a good partner in our local Aging and Disability Resource Center (ADRC)," Boyer said. "I discovered a patient was going to be unable to keep her appointment with her primary care physician because of being wheelchair bound, and her husband was unable to transport her. I contacted the ADRC and they provided the patient with wheelchair-friendly transportation to her appointment."

Boyer said if she had not worked on care transitions outside of the hospital, that resource may have gone unused.

Monroe Clinic is committed to continuous improvement in care transitions and redesigning services to meet the needs of patients and families in their service area.

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ACO Pioneers Slow Health Cost Increases: Bellin-ThedaCare Saves Money

While the overall results of the Pioneer Accountable Care Organization (ACO) program were mixed, a Wisconsin-based participant will share in several millions of dollars in savings. At the end of the first year, the pioneers produced $140 million in total savings, $76 million of which will be shared among the organizations that saved money.

Bellin-ThedaCare Healthcare Partners was one of 13 organizations that produced enough savings to share some of that money with the Centers for Medicare and Medicaid Services (CMS), according to a report issued July 16 by CMS. Bellin-ThedaCare Healthcare Partners reduced costs by an average of 4.6 percent for its 20,000 Medicare ACO patients. Dr. David Krueger, executive director and medical director for Bellin-ThedaCare Healthcare Partners, was pleased with the results, especially since the quality of care provided increased as the overall cost declined.

"This program is opening the doors to the discussion about volume vs. value and we are moving toward being paid for outcomes, which means we get paid more for providing better care," Krueger said, adding the Pioneer ACO success is leading to discussions with commercial insurance customers about paying for quality rather than quantity.

In addition to reduced costs, patients in the program had reduced hospital admission rates, shorter hospital stays and lower readmission rates.

Allina Health, which is based in Minneapolis and operates River Falls Area Hospital and several clinics in western Wisconsin, did not save money, but still found value in the program. Allina’s health care expense trend rose less than one percent, which is below its historical average.

"We have learned a lot over the first year, and it has helped us to focus our efforts on the triple aim of reducing costs, improving quality and increasing patient experience," said Gloria O’Connell, an Allina spokesperson.

Both groups plan to continue with the program. CMS said that seven Pioneer ACOs that did not produce savings intend to apply to the Medicare Shared Savings Program, while another two are exiting the program.

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July 25 Webinar Focus on ACA’s Employer Shared Responsibility Provisions

WHA members can still register for a WHA July 25 webinar focused on what hospitals need to know as employers themselves about the Affordable Care Act (ACA) and health insurance exchanges. With the recent postponement of some of the ACA provisions specific to employers, you won’t want to miss this webinar. Participants will receive an update on hot topics for employers under the ACA, with a focus on ACA’s "pay or play" or "shared responsibility" provisions, and how they impact strategy and plan design issues.

Hospital HR professionals, CEOs, COOs, and CFOs will benefit most from participation in this WHA members-only forum. There is no cost to participate in this member forum, but pre-registration is required. Register at http://events.SignUp4.com/13HotTopics0725. If you cannot participate in the live webinar, there is an option to request an audio recording.

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August 14 Member Forum Features CMS, DHS and OCI Representatives

On August 14, WHA will be offering another members-only forum focused on the most current information available on the implementation of the health insurance exchange in Wisconsin. During this webinar, Jackie Garner, interim regional director of HHS Regional Office V for the Centers for Medicare and Medicaid Services (CMS), will share the most current information available related to the implementation of the federal exchange in Wisconsin, including timelines, development of the online tool for consumers, information about the federal call centers and other consumer assistance.

In addition, Brett Davis, Medicaid director for the Department of Health Services (DHS), will discuss the transition of Wisconsin Medicaid recipients to the federal exchange, and J.P. Wieske, legislative liaison/public information officer for the Office of the Commissioner of Insurance (OCI), will discuss the most current information available regarding insurers participating in the exchange, as well as information on training and registration for enrollment assisters.

There is no cost to participate in this members-only forum, but pre-registration is required. Register online at http://events.SignUp4.com/13HCExchange0814. If you cannot participate in the live webinar, there is an option to request an audio recording.

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Nominations Sought for 2013 "Country Doctor of the Year"

Does your hospital work with a great country doctor? The kind of physician who still makes house calls? If so, he or she may qualify as the 2013 Country Doctor of the Year. Presented by Staff Care, Inc., a national health care staffing firm based in Irving, Texas, the Country Doctor of the Year Award honors the spirit, skill and dedication of America’s rural medical practitioners.

As part of the award, Staff Care will provide the 2013 Country Doctor of the Year with a temporary physician for two weeks at no charge so the award recipient can take time away from his or her practice, as well as national recognition in publications like USA Today and many others. According to Staff Care President Sean Ebner, rural doctors often cannot find physicians to cover their practices and so have difficulty taking vacations.

Nominations for the 2013 Country Doctor of the Year Award will be accepted for physicians who practice in rural communities and who are engaged in such primary care areas as general practice, family practice, internal medicine, and pediatrics. Anyone can nominate a physician, including friends, patients, co-workers or family members, and all stories or anecdotes about the physician’s practice are welcomed.

Nomination forms can be downloaded from the Country Doctor of the Year Award website at www.countrydoctoraward.com, or you may call Staff Care for a nomination form at (800) 685-2272. Completed nominations must be received no later than October 21, 2013.

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Wisconsin Hospitals Community Benefits – Charity Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $232 million to more than 700 patients each day last year. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Financial assistance helps patient get back on his feet

Daniel Knitter, 49, was trying to turn his life around, but it wasn’t easy without a job or health insurance. He was struggling to manage his diabetes and other health concerns and didn’t know where to turn.

His sister-in-law, a nurse at Wheaton Franciscan Healthcare – Franklin, encouraged him to talk to one of the financial counselors there. That’s when he met Linda Stephens.

"Linda was a blessing," Daniel said. "She helped me apply for Wheaton’s Community Care program, which has paid for 100 percent of my care."

Linda was also able to secure some of Daniel’s medication through the Wheaton Franciscan Healthcare - Foundation for St. Francis and Franklin. With her assistance, Daniel also applied for BadgerCare. He is currently on the state’s waiting list.

Today, Daniel’s diabetes is under control, which he credits in part to the support he’s received from Wheaton Franciscan Healthcare. "Everyone from Linda to the receptionist to the doctor has been kind and caring," he said.

"If Wheaton hadn’t helped me, I would be suffering. I know this is a gift and I don’t take it for granted," he said.

Wheaton Franciscan Healthcare – Franklin


Imagine you joined the military at 18, proudly served 23 years full-time in the Army and National Guard. You always supported yourself, your family and extended a hand to anyone in need. Imagine after retiring, circumstances changed. You became unemployed, were not eligible to receive benefits from the military and you were challenged when you found out that you had a life-threatening medical condition.

You had no idea where to turn, how to take on the burden of the illness and find the medical help you needed. If you are a person who has worked all of your life and are thinking about retiring someday, what would you do if you ended up in this situation?

My best friend Steven is the person in this situation. I can tell you, he was not able to do much. It was too overwhelming. Every time he went to the emergency room or hospital, someone came to get his personal information and upon finding out he had no insurance, gave him a business card and asked him to call the number on it. The bills kept coming. During one hospitalization, a Meriter Patient Finance Coordinator came to speak to Steven. She showed genuine compassion and concern for his health. She spoke to me as a caregiver and told me she had been a caregiver for her parents and understood the stress we both felt. She then gave us forms to fill out for financial assistance through Meriter.

I must also tell you about his experience at the HEALTH (Helping Educate and Link the Homeless) clinic. Thank God Steven found his way there. If not for this clinic, his diagnosis would not have been made until much later. The outreach nurse worked diligently to help Steven get appointments that otherwise may have taken weeks or months. This time would have passed while we learned the ‘uninsured’ world, and his prognosis could have been worse.

Even after medical plans were in place the outreach nurse called to see how Steven was doing. Her care and concern for him as a person, not just a patient, showed through every time we saw her or talked to her. Please know how much her advice helped us.

It is very difficult knowing where to turn when you don’t have medical insurance.

Because of your amazing help, Steven’s medical bills from Meriter have been covered. Although Steven feels guilty and was reluctant to accept this charity given to him, he is thankful to have one thing—just one thing not to worry about.

Thank you for this gift. Steven can continue to fight for his life while being cared for by some of the most compassionate and knowledgeable medical staff ever seen at one of the world class medical facilities.

Meriter Hospital, Madison


Chest pain leads to bill pain

A 39-year-old presented to Upland Hills Health Emergency Department by ambulance with chest pain and shortness of breath. The patient received his bill and was concerned about how he would be able to pay for these emergency services. He was trying to get state or county assistance and did not qualify. He was just starting a new job. Because of this financial hardship, he completed the Upland Hills Health Uncompensated Care application and was granted a discount on his medical services. He is very thankful that Upland Hills offers this for patients that are having a financial hardship.

Upland Hills Health not only provides care for patients, but there were 911 patient encounters assisted through the Upland Hills Uncompensated Care Program in fiscal 2011.

Upland Hills Health, Dodgeville

"They really do work hard to help you."

Serving others is in Peggy McLean’s blood. For 30 years, she provided child care for families in her hometown of Mondovi. After that, she worked at two different local restaurants including a town favorite pizza restaurant. When she walks into the Mayo Clinic Health System clinic in Mondovi, the staff jokingly asks her, "Where’s the pizza?" She’s also quick to joke and laugh about how she can’t get rid of her two adult children who live nearby.

But three years ago, the tables turned, and McLean needed help from others. Years of hard work had caused such agonizing back pain that she needed surgery to fuse some of her vertebra.

"After all the tests and doctor’s visits, the bills got to be too much," McLean says. "I was scared to death, not knowing how I was going to pay the bills. If they hadn’t helped me, I would have never gotten them paid."

When asked if she was interested in applying for the financial assistance program, McLean’s response was, "Yes, please!"

If patients need financial assistance, they can apply for it before or after services are given. In some cases, part or all of a medical bill may be forgiven. If treatment extends from one Mayo Clinic Health System location to another, financial assistance information can be transferred along, too. This was the case for McLean, as she was treated at multiple Mayo Clinic Health System locations. This streamlined process reduces paperwork requirements and anxiety for patients.

McLean completed the necessary paperwork, worked with a financial planner and set up monthly payments that she could afford. "I haven’t met anyone who is grumpy or anything. They really do work hard to help you."

McLean’s health concerns are far from over, as she continues to struggle with a gall bladder issue and a heart condition that developed as a result of having rheumatic fever as a child. However, she remains optimistic. "They really try to help anyone who needs it. They give 100 percent. I have no worries about getting the help I need."

Mayo Clinic Health System – Oakridge

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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