Tag Archives: Group Health Cooperative

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Washington state moves to address epidemic of prescription painkiller overdose deaths – BMJ

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A feature article on efforts in Washington state to address the epidemic of prescription painkiller overdose deaths by LocalHealthGuide editor Michael McCarthy appears this week in the BMJ, the journal of the British Medical Society.

Containing the opioid overdose epidemic

In the late 1990s, Washington State began to relax its rules regulating the prescription of opioids. Shortly thereafter, overdose deaths began to climb.

“We saw the deaths increase within a year,” says Gary Franklin, medical director for the Washington Department of Labor and Industries, which administers compensation for job related injuries and illnesses for more than 3.2 million workers in the state.

“These were productive people who were working the day they came into the system with a back sprain or whatever, and three years later they were dead from an accidental overdose of opioids,” Franklin says. “I had never seen anything so sad.” . . .

Read the full article on the BMJ website.

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Group Health opens new expanded 24/7 urgent care facility in Tacoma, Oct. 8th

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Beginning October 8th, Group Health members in the Tacoma area will now have access to new expanded 24/7 urgent-care facility at the Group Health Tacoma Medical Center’s on 209 Martin Luther King Jr. Way in Tacoma.

The expanded facility will have 19 care rooms—12 exam rooms, four observation rooms, three cardiac beds, and a triage room—all open 24-hours.

The current urgent service, housed in the first floor, has seen approximately 24,000 Group Health member visits a year. With the new expansion, Group Health can now accommodate more than double that amount.

The facility is for patients with non-life threatening emergencies, such as:

  • lacerations or severe cuts
  • conjunctivitis (pink eye)
  • ear infection
  • possible broken bones or sprains
  • sudden abdominal pain.

Members wanting to know more about urgent care can go to the Group Health website.Group Health also offers its members access to a 24/7 Consulting Nurse Hotline to help members evaluate the situation and find the right care: 1-800-297-6877 for all areas in Washington state and Idaho, 206-901-2244 in the Seattle area.

If it’s a life-threatening emergency, Group Health recommends that members call 911.

This December, Group Health is opening a new Puyallup Medical Center complete with a green roof, the latest in new technology, and access to walking paths to encourage our members and staff to live a healthy and active life. For more on the project go to

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Group Health Cooperative plans layoffs and cuts – Seattle Times

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Group Health Cooperative must cut $250 million over the next 16 months through layoffs, better cost control and some reorganization at the top, Seattle Times health reporter Carol Ostrom reports in today’s issue of the paper.

Ostrom writes:

Group Health, which insures about 600,000 people in Washington and has annual revenues of $3.5 billion, is aiming to climb back up to a 3 percent operating margin, Armstrong said in a Friday memo to staff, first reported by the Puget Sound Business Journal. The memo noted there had been three years of sharp declines in finances.

“This cannot continue,” Armstrong wrote. “We are better than this, and I am not going to let us have another year like this one.”

To learn more read Ostrom’s article: Group Health announces layoffs, cuts.

 

 

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Group Health study finds “shared decision making” may reduce medical procedures

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Osteoarthritis of the knee

By Ankita Rao

While policymakers debate whether doctors should be paid by the number of services they provide or the outcomes of their treatment, shared decision could have an impact on the ground by reducing demand for medical procedures.

A new Health Affairs report about decision aids, materials given to patients to help educate them about treatment options, shows that they can help hold down costs.

“The decision aids discuss all the available treatment options equally,” said Dr. David Arterburn, an author of the study released Tuesday and investigator at Group Health Cooperative, a non-profit health system in Seattle

For example, in the aids for joint disorders, he said, “Losing weight and increasing physical activity are discussed in detail, as are anti-inflammatory medications, other over the counter medications, and prescription medications for treating osteoarthritis.”

Decision aids can be used for a variety of medical issues, from cardiovascular health to hip replacements. They are delivered in the form of DVDs or printed guides, and are usually provided before a patient visits a specialist.

Researchers conducted randomized trials in Washington state with patients who suffered from knee and hip osteoarthritis, the most common joint disorders in the U.S. They sent aids to 332 patients with hip osteoarthritis and 978 to patients with knee osteoarthritis. The treatments and outcomes were then tracked and compared to a control group that did not receive the aids.

After six months, researchers found that among patients with knee problems who received aids, 38 percent fewer chose to have elective knee replacement surgery than the control group.

Among patients with hip problems, 26 percent fewer opted for hip replacement surgery.

Patients who received aids also had slightly fewer visits to primary care and specialty care doctors.

Overall treatment costs were lower among patients who received aids. For those with hip osteoarthritis, the average total cost of treatment was $13,489 after the use of decision aids, compared to $16,557 for the control group. In the knee osteoarthritis groups those with aids spent $8,041 compared to $10,040 in the control group.

Many states see promise in the shared decision model, and are taking early steps to encourage its use.  Minnesota, for example, outlines the need for a physician to discuss health care options in a shared decision making process in its rules for medical homes.

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An approach to contain health care spending–viewpoint from Scott Armstrong, Group Health CEO

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By Scott Armstrong, president and CEO Group Health Cooperative

For more than 200 years, the New England Journal of Medicine has been an important source of information for physicians about advances in medical research, developments in clinical practices, and ideas about what it means to deliver great care to patients.

So it’s a great honor to be a coauthor of an article titled “A Systematic Approach to Containing Health Care Spending” that appears in the August 2 issue of the NEJM.

Other contributors include Stuart Altman and David Cutler, professors at Brandeis and Harvard, respectively, who are nationally recognized experts on health care economic policy; Peter Orszag, former Director of the Office of Management and Budget and a current member of the Institute of Medicine; and Don Berwick, who served as head of the Centers Medicine and Medicare Services until late last year.

The article was prompted by the increasingly dire impact of health care spending on our national economy. A recent report from the Congressional Budget Office estimated that in 25 years, health care will account for 25 percent of all spending in this country and consume 40 percent of the federal budget.

This level of spending will drive the budget deficit beyond the breaking point, cripple the government’s ability to invest in education and infrastructure, and squeeze income for middle class families.

Clearly, we can’t let this happen.

In response, the authors of “A Systematic Approach to Containing Health Care Spending” have proposed 11 specific and actionable policy changes that we believe will help contain the rising cost and control the expanding volume of medical services.

The proposals include establishing global payment rates for all health care providers within a state. This would be achieved through a process in which rates are negotiated by public payers (such as state Medicaid programs), private insurers, and providers, working with an independent council that also includes businesses, consumers, and economists.

Through this process, hospitals would no longer be able to shift costs from public programs to private insurers or raise prices as they acquire physician groups and expand their local market power.

We’ve also proposed that there be a faster transition from the current fee-for-service payment structure to “bundled” payments where physicians are paid a fixed amount to treat patients with specific conditions, such as cardiac or orthopedic care.

We believe that within 10 years, Medicare and Medicaid should pay for at least 75 percent of all care through bundled payments or other alternatives to fee-for-service.

A third suggestion is to require health care providers to be open and transparent about their prices and to publicly report comparative information on quality.

This would allow patients, employers, and other purchasers of health care services to choose care based on a better understanding of cost and value, something that is virtually impossible today.

Taken together, these three changes—along with eight others included in the article—would have a dramatic impact on the cost and quality of care in this country.

How do we know they will work? One reason is that many of the suggestions in “A Systematic Approach to Containing Health Care Spending” are modeled on steps we are already taking at Group Health.

For example, because of how we pay our physicians and other staff in the group practice, we have invested in primary care and prevention, rather than expensive, profit-generating treatments. And we already receive bundled payments for our 70,000 Medicare patients. As a result, we’ve reduced unnecessary hospitalization rates and emergency care, which is helping us control costs and improve health.

Today, we’re working with Providence Health Care in Spokane, Virginia Mason in Seattle, the Franciscan Health System, in Tacoma, and The Everett Clinic in Snohomish County to expand value-based payment beyond our own medical group.

This will allow us to share innovations that we know lead to better health and lower costs as we create partnerships that are designed to improve coordination, efficiency, and quality.

Of course no matter how persuasive or convincing it is, it will take more than a single article in the New England Journal of Medicine to steer health care in this country toward a more sustainable path. Medicine is a complicated industry. Change is slow and difficult.

But it is very gratifying to see many of the ideas and changes we’ve been pioneering at Group Health reflected in the proposals and suggestions put forward by such a large group of respected health care leaders. More than 20 men and women from across the country contributed to “A Systematic Approach to Containing Health Care Spending.” Most are academics and policy makers. I am one of just a few who lead organizations that actually provide care to patients.

This is an exciting affirmation of the value of the work we’re doing at Group Health to find innovative ways to deliver care that is both more effective and more affordable.

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Group Health teams up with Providence Health & Services

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By Harris Meyer

In an unusual partnership, a nonprofit health plan that employs its own doctors is joining with a major Catholic hospital system in the Pacific Northwest to provide more efficient health care services to members of all health plans in the Spokane area.

Seattle-based Group Health Cooperative and the 32-hospital Providence Health & Services announced Wednesday they have formed a joint venture to offer a single delivery network in Spokane to all health plans and employers that want to contract with them.

The goal is to expand Group Health’s patient-centered medical home model to the broader community and reduce preventable hospital readmissions and other wasteful services.

The medical home model features primary care physicians leading a team of nurse practitioners and other professionals in providing for all the patients’ health care needs.

Physicians, hospitals, insurers and employers across the country are teaming up to try to control medical costs and improve quality of care through new models called accountable care organizations (ACOs).

The Spokane collaboration resembles an ACO in that the partners will share responsibility for meeting cost and quality goals for insured patient groups. But it’s unique because a health plan’s staff physicians are involved.

While many joint ventures between hospitals and health plans failed in the 1980s and 1990s, they have a better chance of succeeding now because the players are more realistic about the need to control costs, said Peter Kongstvedt, a McLean, Va.-based health care consultant.

The new company will meld Group Health’s 119 primary care and specialty doctors and other professionals in 16 locations with Providence Medical Group’s 276 doctors and professionals, Providence Sacred Heart Medical Center & Children’s Hospital, and Holy Family Hospital into a single network. It will comprise nearly 40 percent of all doctors and advanced practitioners in Spokane.

This is the first time Group Health, a consumer-governed, staff-physician model HMO founded in 1947, with 660,000 members in Washington and Idaho, will make its physicians and clinics available to commercial subscribers of other health plans.   

Providence officials hope the joint venture will enable their hospital system — Spokane’s largest, with 65 percent of the market — to position itself for an expected shift from fee-for-service payment to global payment for managing patients’ health. Both public and private insurers are moving in that direction.

“This is part of Providence’s effort to move away from fee for service to payment for value and outcomes,” said Mike Wilson, head of the eastern region for Providence, which operates in five states in the Northwest.

Like other hospital systems, Providence bought many outpatient physician practices in Spokane over the past several years and is working to organize those doctors into a seamless delivery system with its hospitals.

Group Health, with its long experience in working with physicians, is expected to help with that.

“Our experience is having an exceptional acute care system, and what Group Health brings is a strong historic program of managing care well in the outpatient world,” Wilson said.

Kelly Stanford, Group Health’s vice president for business development in Spokane, said “a couple” of health plans already have expressed interest in contracting with the new network.

Kongstvedt said the partnership could bring benefits to both sides. “It makes sense for Providence to look to Group Health to organize its doctors and manage issues of productivity and cost,” he said. “That’s something Group Health knows how to do, and that large hospital systems really underestimate.”

Group Health officials acknowledge that while the medical home approach in its staff-run, primary-care-oriented clinics has produced lower costs and higher patient satisfaction, the organization has struggled to achieve the same results working with independent doctors outside its clinics.

“What we’re trying to do [in this joint venture] is extend our model of care and achieve the same really good health and cost outcomes among the community of providers that aren’t necessarily working for Group Health,” said Mike Foley, a Group Health spokesman.

Providence has been Group Health’s main hospital partner. But Wilson says physician leaders from both organizations now will meet to design a more integrated system of care across primary, specialty, hospital, and post-hospital care. Providence physicians will switch to the same electronic health record system, Epic, used by Group Health, and Providence hospitals will follow soon after, he says.

Robb Miller, executive director of Compassion & Choices of Washington, a group that works with patients on end-of-life options including physician aid in dying (which is legal in Washington), said he hopes Group Health will take steps to protect patient choice in the new network, given that Providence doctors are required to follow Catholic religious directives governing reproductive and end-of-life care. Stanford said Group Health had not discussed that issue with Providence.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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The cost of overtreatment: What care is necessary?

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By Barbara Trehearne, PhD, RN
Vice President Clinical Excellence, Quality, and Nursing Practice
Group Health Cooperative 

With health care reform moving forward following the U.S Supreme Court decision to uphold the Affordable Health Care Act earlier this month, several issues immediately jump out as key areas ripe for improvement.

One important issue is overtreatment.

Overtreatment is a huge driver of soaring health care costs, and I and a panel of experts will participate in a panel discussion on that challenge and others before the health care system on July 30 at Seattle CityClub.

It’s estimated anywhere from one-fifth to nearly one-third of all tests and treatments are unnecessary. Turning around what is at times thought of as defensive medicine must be tackled and soon, not only to rein in health care costs but to deliver appropriate and high quality care that is evidenced based: More is not always better in healthcare.

Take high-end imaging, such as MRIs and CT scans. Sometimes they are critical diagnostic tools, but in other instances they are unnecessary, and give no better guidance for treatment than less expensive diagnostic methods.

Group Health’s own experience may hold some answers about guiding the use of high-end imaging.

We’ve done work at Group Health to help clinicians with better support tools when it is appropriate. We’ll do monitoring of a practice to give feedback to see if they’re using imaging in its more effective way.

Most of the physicians getting this feedback say it helps them to really look at their own practices and find opportunities for improvement.

Of course, the Group Health integrated model of care, which pays medical professionals a salary, is very different from the vast majority of the health care industry’s current “fee-for-service” model that pays providers for every office visit and tests such as MRIs.

Another area we’ll delve into at the CityClub panel is the notion of who in the healthcare system is able to satisfy and provide healthcare needs.

For example, we know nurse practitioners (NP) can and do satisfy many of our health care needs in areas such as primary care including pediatrics.

It’s an idea that must be discussed throughout the health care system in this country. Over 25 years ago and consistent with today’s estimates, the Office of Technology concluded NPs could safely and effectively provide 75 percent of general primary care. NPs consult when needed in the same way family practice physicians do.

We must help people understand the care that is safely provided by advanced nurse practitioners (APNs) which include NPs, Certified Nurse Anesthetists and Certified Nurse Midwives.

These APNs consistently receive high satisfaction scores from patients. Twenty-five plus years of research demonstrates cost effective, high quality, safe care delivered by APNs. Multiple studies on NP practice confirm the clinical outcomes they achieve are comparable to their physician colleagues.

In fact, the health system must start talking about the role of all nurses on many levels, include other opportunities to use nurses in more effective ways. That includes case managers, nurse navigators, and nurse led clinics.

Nurse navigators have been a focus of research at Group Health to examine how they might improve care across multiple settings and providers. Navigating the health care system is complex, confusing, and intimidating. Nurses are often central to care for complex patients and are best positions to assure care is coordinated and consistent.

Another issue to be discussed by the CityClub panel will be whether there is an overuse of care for end-of-life patients. There must be more widespread understanding of end-of-life issues, because too many gravely ill, very elderly patients still are ending up in ICUs for expensive, painful and futile care when their wishes are otherwise.

In 2009 GHC, began making shared decision aids available to patients with various conditions. Providers can discuss patient options for various procedures with the help of videos, booklets and other online material.

There is very strong evidence that use of these tools increases patient knowledge and allows them to be more engaged in decisions about care. One promising front in this area is using videos for patients and their families to help understand all the issues involved in end of life care.

We need to continue to support clinicians in their very careful assessment of benefits, harms, and costs of treatments and tests and to also determine how value is necessary to reducing cost while maintaining quality.

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The cost of overtreatment: What care is necessary? — CityClub panel July 30

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As part of its four-part series looking at the high cost of healthcare, Seattle’s CityClub is will host a panel discussion July 30th on the cost of overtreatment, its causes and strategies to reduce unnecessary testing and treatments.

Overtreatment is a large contributor to runaway health care costs. It’s estimated that anywhere from one-fifth to nearly one-third of the tests and treatments we get are unnecessary. Are doctors practicing “defensive medicine” by opting for more testing?

The health care industry’s current “fee-for-service” model pays doctors for every office visit, test, and procedure. How do we discourage unnecessary treatments that often accompany this fee-for-service model?

How is the decision about a course of treatment made? Who is trained to help patients make these decisions?

Who is the best practitioner to provide care? Can nurse practitioners satisfy most of our health care needs?

Is there an overuse of care for end-of-life patients and, if there is, how can we address it?

Panel:

  • Douglas Conrad, Professor, University of Washington School of Public Health
  • Jay Fathi, President & CEO, Coordinated Care
  • Brian Knowles, Executive Director, Bailey-Boushay House
  • Barbara Trehearne, VP of Clinical Excellence, Quality, and Nursing Practice, Group Health Cooperative 

Moderator:

  • Joanne Silberner, Contributor, Public Radio, Artist in Residence, University of Washington

Location:

Washington Athletic Club | 1325 Sixth Avenue, Seattle, WA 98101

Registration:

11:30 a.m. – 12:00 p.m.

Luncheon & Program:

12:00 p.m. – 1:30 p.m.

Luncheon Prices:

CityClub Members – $35 | Guests & Co-Promoters – $40 | General Public – $45

Coffee & Dessert Prices:

CityClub Members – $12 | Guests & Co-Promoters – $15 | General Public – $18

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Whatever the Supreme Court decides, we’re all in this together – Viewpoint

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By Dr. Eric B. Larson, MD, MPH
Vice President for Research, Group Health Cooperative
Executive Director & Senior Investigator, Group Health Research Institute

Last week’s U.S. Supreme Court arguments about the Affordable Care Act created uncertainty over health reform’s immediate future. But the debate about the “individual mandate”—the law’s requirement that everyone get health coverage—strengthened my conviction: To solve our health care system’s cost, quality, and access problems, we must ultimately bring all Americans into that system.

Group Health has embraced the idea that “we’re all in this together” since the Cooperative was established in 1947. Our founders understood the basic principle of insurance: No one can predict when illness or injury may strike, so everyone (young, old, sick, or well) needs to participate to ensure that coverage and care are available and affordable for anyone who needs it. They knew that some would need more care than others. But over time, the population would spread the risk, and everyone would get their fair share from the system.

Group Health didn’t even raise rates with age until the 1980s, when the market forced the issue. Without this change, Group Health would have attracted so many old and sick people that everyone’s rates would have become unaffordable.

Group Health has always stood for universal health coverage—not only because it’s the “right thing”, but also because it’s the most cost-efficient way to provide quality care. 

The same dynamic is behind the individual mandate. When healthy people opt out—because they choose to “take their chances” or can’t afford coverage—the system loses resources needed to pay for those who are sick.

The sick may include those few unlucky, uninsured youths who suddenly need treatment for a broken arm, appendicitis, or that rare, unfathomable case of cancer. Or it may be people with existing illnesses who have been denied coverage. The uninsured often get care through emergency rooms, which are required by law to take all comers.

And ultimately, we all pay for their care through higher taxes and increasing insurance premiums. The new law attempts to deal with this problem by expanding coverage through Medicaid and state health-benefit exchanges for individuals and small businesses.

Group Health has always stood for universal health coverage—not only because it’s the “right thing”, but also because it’s the most cost-efficient way to provide quality care. That’s the challenge our country faces today. Ensuring coverage only for subgroups—say, folks over 65, or the employed—just doesn’t work.

As journalist John Cassidy wrote in The New Yorker last week, “Opting out of the health care market is about as realistic as opting out of dying.”

Weeks may pass before the Supreme Court rules. Meanwhile, leading experts continue to call for reforms to the current fee-for-service payment system—a key driver of rising costs.

One is Stanford’s Victor Fuchs, PhD—our country’s most prominent health economist and author of Who Shall Live, a book that has long defined how economics and social choice effect health.

Last week he told the New York Times: “If we solve our health care spending, practically all of our fiscal problems will go away.” And if we don’t, “almost anything else we do will not solve our fiscal problems.”

Dr. Fuchs is not optimistic that health care can change itself. Rather, it will require “revolutionary” changes that unsettle established interest groups, he believes. But “American history is studded with examples of things that were not politically feasible until they were,” like the emancipation of slaves and a trillion-dollar bailout of the financial industry, he said.

“Major changes in health care policy usually occur because of something outside of health policy—large scale civil unrest, a depression,” he added. One catalyst could be a decision by China to stop buying the American bonds that finance Medicare and Medicaid debt, he explained.

But whether change is triggered by forces inside or outside the broken fee-for-service system that dominates our nation’s health care system, we at Group Health must aspire to demonstrate a successful alternative. Ours is a model born 65 years ago from our founders’ desire “to serve the greatest number”—a mantra that fits health reform today.

As citizens and patients, as health care professionals and researchers, we each have a stake in health care’s future; our place at Group Health gives us a front-row seat to history in the making. More importantly, we have an opportunity to work for positive transformation. Let’s not be spectators, but doers.

Attend 2012 Birnbaum Endowed Lecture on April 30. Dr. Don Berwick, senior fellow at Center for American Progress, and former administrator of Centers for Medicare & Medicaid Services, will describe the important role health professionals play in health care reform. Then Group Health, Geisinger Health System, and HealthPartners leaders will discuss the development of integrated health organizations as learning health care systems.

To learn more:

  • Read Center for American Progress on why establishing insurance coverage for people with pre-existing conditions requires enacting an individual mandate.
This article first appeared in the Group Health Research Insitute’s online Research News webpage.
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CityClub’s 2012 Health Care Series begins April 17th

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CityClub’s 2012 Health Care Series

Seattle’s City Club begins a series of talks on the cost of health care April 17.

The series will feature four expert panels which will talk about why U.S. health care costs so much and what we can do to bring those costs down.

The series will be moderated by Joanne Silberner, NPR’s Health Policy Correspondent for 18 years and Artist in Residence at University of Washington.

Tuesday, April 17, 2012 : Delivery Systems and the Cost of Care

How do we discover the true costs of health care, and how do we gain more transparency in the system? How much do services and procedures really cost? How do uncompensated care and other hidden expenses also drive cost?  How can consumers assess relative costs and quality among different providers? What are the barriers to transparency in the system? What role can hospitals, physicians, insurance companies, health systems and the consumer play in breaking those barriers down? How can understanding the true cost of care ultimately help us reduce it?

Featuring:

  • Scott Bond, President and Chief Executive Officer, Washington State Hospital Association  
  • Rich Maturi, Senior Vice President for Health Care Delivery Systems, Premera 
  • Robert O’Brien, Executive Vice President Health Plan Division, Group Health Cooperative
  • Rick Cooper, Chief Executive Officer, The Everett Clinic 

Where:

Washington Athletic Club | 1325 Sixth Avenue, Seattle, WA 98101

When:

Registration: 11:30 a.m. – noon

Luncheon & Program: noon – 1:30 p.m.

Luncheon Prices:

  • CityClub Members: $35
  • Guests & Co-Promoters: $40
  • General Public: $45
  • Coffee & Dessert Prices -
  • CityClub Members: $12
  • Guests & Co-Promoters: $15
  • General Public: $18
To learn more and register go to CityClub.

June/July 2012 : Appropriate Use of Care

When does cost containment sacrifice quality? How much do testing and technology advance the standard of care, and how much is too much for us to afford? Why are hospitals and medical centers building new stand-alone emergency facilities when that is the most expensive care to provide? Is there an overuse of care for end-of-life patients and, if there is, how can we address it?


August/September 2012 : Health Care Payment Reform

Who actually pays for healthcare – how much of the burden do government, employers, insurance companies and consumers bear, and how has that shifted over the last decade? How do we increase productivity and accountability in the provision of health care? How can we switch from paying for procedures to paying for outcomes? How can we invest more healthcare dollars in prevention?


November/ December 2012 : Access to Affordable Health Care

Why do we have a shortage of general practitioners and nurses? What do we do to cover the growing number of uninsured Americans? Should we use a carrot or a stick to drive down healthcare costs, e.g. should we provide less care for patients who don’t take care of themselves? What reforms are needed to make Medicare and Medicaid sustainable for future generations? What countries are doing this better and what can we learn from them?

 

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Group Health seeks members for Board of Trustees

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Group Health Cooperative, which is a consumer-governed health-care system, is seeking candidates from its membership for four Board of Trustees positions.

Candidates must receive their medical coverage through Group Health in order to be eligible.

The Board of Trustees is an 11-member consumer governing body that sets the strategy, direction, and policy for GHC, a nonprofit enterprise with $3.3 billion in annual revenues.

Individuals with the experience and range of skills necessary to help lead GHC’s consumer-governed health care system are encouraged to apply.

Trustees serve a three-year term.

Applications deadline is Monday, April 9th, 2012, and the election will be held in October.

To apply:

  • For additional information call 206-448-2073 in Seattle, or toll-free 1-800-252-3305, extension 21.

 

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Seattle Business magazine’s 2012 “Leaders in Health Care” picks

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In this year’s list the magazine’s judges included more health-care leaders working outside the Seattle area, including Pullman, Walla Walla and Yakima.

 

 

 

 

 

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Coordinated case management cuts healthcare costs

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By Mary Agnes Carey

Care management programs, which combine information technology, patient-centered nursing and care coordination, have helped Alliance of Community Health Plan (AHCP) members cut costs and improve patient care, the group said in a report released Wednesday.

For example, the Group Health Cooperative in Seattle has reported more than $2.5 million in cost savings during the first seven months of this year for its 8,224 patients in complex case management and 1,831 patients in regular case management.

Tufts Health Plan in Massachusetts and Rhode Island found that every $1 spent on obstetrical case management for women at high risk for preterm delivery saved $4.50, and on-site and telephone review of hospital utilization saved $4.80 per dollar spent.

The group represents 22 not-for-profit, community-based and regional health plans and provider organizations. The ACHP report says the case management techniques the plans have used included helping patients and caregivers manage medical conditions and psychosocial problems more effectively, coordinating care, reducing duplication of services and reducing the need for expensive medical services.

“Complex, chronically ill patients have traditionally been the most expensive and difficult to treat; almost half of all health care spending in the United States goes to only five percent of patients, many of whom have multiple health conditions as well as social, environmental or financial barriers to good health,” AHCP President and CEO Patricia P. Smith notes in the report. ‘

“Such patients often need and benefit from personalized care, tailored to their individual needs; care management nurses, many of whom work in partnership with social workers, nutritionists, pharmacists and other staff, can step in to supplement the care patients are receiving at their physicians’ offices.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Block doctors from asking about guns in the home? Crazy.

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Our Tax Dollars at Work?

By Dr. Rob Nohle
Chief of Pediatrics, Group Health Cooperative

Dr. Rob Nohle

Have you heard about the Florida state Rep. Jason Brodeur who has proposed legislation to block doctors from asking about guns in the home or face a fine up to $5 million or be sent to prison for up to 5 years?

He says he has “heard about a number of cases in which doctors asked about guns” and thinks the topic should be off limits.

His concern is that this is a privacy right and that the information could fall into the hands of the government or insurance companies.

From this pediatrician’s perspective, it’s just crazy and a waste of time, money, and energy. Is there really nothing more important for legislators to do given our country’s current financial state?

The question about guns in the house is one that I do ask families during well visits. The reason is not to make any judgment, but to assess risk and make sure that proper storage is occurring. Just a few weeks ago at our south region pediatric department meeting we discussed proper storage of firearms to get on the same page as a group.

Do you want your child playing in a friend’s home where there are unlocked firearms and access to ammunition? I think most of us make an assumption that things are safe, but is that always valid? I am all for people having choice and the right to have firearms, but only if there is a safe and proper way to store them. I have many fond childhood memories of shooting rifles as a child and learning gun safety from my father and at Boy Scout camp that has taught me a healthy respect for them. I feel very comfortable when my children go over to the home of a friend who owns guns because I’ve asked the question. I feel assured that the guns are locked away in the gun safe, making it impossible for any of the children to access them.

Photo Credit: Matuusz Atroszko

The American Academy of Pediatrics states the following:

  • A gun kept in the home is 43 times more likely to kill someone known to the family than to kill someone in self-defense.
  • A gun kept in the home triples the risk of homicide.
  • The risk of suicide is 5 times more likely if a gun is kept in the home.

If a gun is going to be kept in the home:

  • Always keep the gun unloaded and locked up.
  • Lock and store the bullets in a separate place.
  • Make sure to hide the keys to the locked boxes.

Dr. Rob Nohle is chief of pediatrics at Group Health Cooperative. This article originally appear in his Kids & Health blog. To read more of his articles go to: www.drnohle.org

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View: A new era for access to health insurance

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By Megan Grover
Director, Regulatory Affairs at Group Health Cooperative

The dawn of a new age in health insurance began Thursday when the first requirements of the Patient Protection and Affordable Care Act (PPACA) went into effect, six months after the enactment of the new law.

Since most of the provisions in the reform law do not take effect until 2014, the intention of these new rules is to ensure individuals have adequate health coverage in the short-term, until the PPACA is fully implemented.

Most consumers will see these changes as their plans renew next year.

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Short-term insurance reforms will be implemented upon renewal for all current groups and for all new groups beginning September 23, 2010. Individual and family plans will implement applicable changes on January 1, 2011. Changes include:

  • No plan lifetime limits or lifetime limits for essential benefits
  • Restricted annual limits for essential benefits
  • No costs shares for in network preventive services
  • No pre-existing condition exclusions for new members under age 19
  • Expand dependent coverage to age 26
  • Restrictions on rescissions (retrospective terminations)
  • Coverage for emergency services the same in and out of network
  • Pediatricians allowed as Primary Care Provider
  • Direct access to OB/GYN without authorization or referral
  • Medical Loss Ratio reporting for calendar year 2010
  • Modified Internal Claims and Appeals Process and External Review

Keep in mind, grandfathered plans are exempt from some of these requirements to allow employers and/or individuals to keep the coverage they have (as promised during the debates).

The exemptions vary between group and individual coverage, but one example is the elimination of cost-sharing for preventive services.

Everyone – from health plans to regulatory agencies – has been working diligently to interpret and comply with the new requirements.

Much has already been completed to prepare Group Health products, processes, systems and communications for these changes, and there’s more to come.

It may feel a little uncomfortable right now as reform is realized incrementally over the next few years. But for those of us who have looked forward to the day when better health care access is provided to each and every person, it’s a great, new day.

To learn more:

  • Visit Group Health Cooperatives’ health policy blog In Our View.

Megan Grover is the Director of Regulatory Affairs, within the Public Policy Team at Group Health Cooperative. In this position, Megan is responsible for monitoring regulatory activity, and acting as Group Health’s voice in response to federal regulations. She also serves as a representative for Group Health’s interest in promoting quality healthcare in industry association meetings.

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