OK-SAFE, Inc. Blog

September 18, 2011

OK-SAFE, Inc. Reporting – 1st Joint Committee Mtg on Federal Healthcare Reform/Exchanges

OK-SAFE, Inc. –  The first meeting of the Oklahoma joint legislative committee formed in spring 2011 to examine the impact of the federal healthcare reform law/exchanges on the state of Oklahoma was held in the House Chambers on Wednesday, Sept. 14, 2011 at the OK Capitol.

Below are the notes taken during this presentation by OK-SAFE, Inc.  Included in these notes are:

  1. The minute markers for the start and stop times for the individual speakers
  2. Some notes on their presentations
  3. Some key transcriptions of the comments by two presenters – Julie Cox-Kain of the OK Dept. of Health on the exchanges, and Buffy Heater of the OK Health Care Authority on the information technology system changes required.

Consider their presentations as confirmations of what OK-SAFE and others have been researching regarding the intent and purpose of healthcare reform and the role the exchanges play:  the creation of a ‘fused’ technology system that contains comprehensive information about all individuals, connected to/interfacing with a developing federal data hub, or federal data ‘cloud’ as it was referred to.

It is confirmation of the Vision 2015 document issued by the Director of National Intelligence – a roadmap for the systemic change of our entire governmental structure.

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Notes on First Joint Committee Meeting on Health Care Reform in Oklahoma

Wednesday, September 14, 2011

9:00 am to 4:00 pm

House Chambers, OK Capitol

Oklahoma City, OK

Link to OK House Video:  http://okhouse.granicus.com/MediaPlayer.php?view_id=2&clip_id=387

Video Minute Markers indicated in [brackets]

 

Key Excerpts:

 

Question by Rep. Nelson to Julie Cox-Kain (OK Dept. of Health)– “One other question I’ve got is, what my understanding is that probably the states’ health care authority would be where an exchange would be housed, but where are other states putting it, is that the best place for an exchange here? If the federal government produces an exchange, would they house it in Washington, would they house it here, where are these things going to be housed?”

 

Answer by Julie Cox-Kain –  “States have an option for governance of an exchange, governance and operation of an exchange, and it can be implemented through a state agency, or you could have a non-profit entity, and you can contract out certain functions of the exchange.  And so, in fact, you could even have a quasi-governmental entity. This has been addressed or mentioned some in the dialogue about how we would govern and operate an exchange. Actually could even have a trust, there are some in existence now, that govern that exchange.  There is a little bit of state flexibility in how we choose to go forward and implement and/or operationalize an exchange.  Again the question about the federal government exchange, there’s very few answers to what the federal government exchange would look like, so it is very hard to make that particular decision without that part of the equation being known.”

 

Buffy Heater (OHCA) presentation – “Now we’re going to talk about the technical aspects of information systems changes. So I think I’ll start off by addressing the question that was brought up earlier in the session about the federal data hub or the federal data exchanges that are being established as part of the ACA through both the exchange set-up as well as for the Medicaid income verification pieces.  So basically, the federal government is creating a data hub, or a data cloud, as it be, in that there will be sources from federal agencies, the IRS, the Social Security Administration, and the Department of Homeland Security, where there will be member level or individual level information that is fed up to this data cloud. 

 

Then there will be queries from the states or from a federal exchange that will be able to be sent up to that federal data hub and a match return, that basically says for this person’s last IRS data here was their modified adjusted gross income. Or validating that that individual’s social security number is as was reported matches, yes indeed, it matches on that individual’s name and date of birth. As well as the Homeland Security is going to verify individual citizenship and identity, if possible. 

 

So the federal data hub is going to require that it is a state level entity that engages in the contractual relationship between the federal government, and so the way the proposed rules that Cindy had mentioned before, right now those proposed rules do limit states in that it is restricted to only state operated  entities that can be able to engage in that federal data hub. I will tell you that the feds are specifically soliciting comment on states that might be looking at having a private entity run and operate their exchanges and how the rules might accommodate that…. the ACA requires a ‘plug’ of sorts to be ready to plug Medicaid into the exchanges….”

(Slide) New CMS IT Guidance – Service Oriented Architecture, Reusable, Interoperable, Scalable, Ease of Use.  Some states are still using legacy mainframe systems.  So federal government required (above list).

(Slide) CMS IT Funding – Enhanced funding available – Medicaid Eligibility Systems (thru 12-15-2015) – 90% match – design, development and implementation.  75% match – ongoing operations. In the past was only 50%.

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Opening Comments by co-chairs Rep. Glen Mulready and Sen. Gary Stanislawski [00:00:00 to 00:22:00]

 

I)                    Julie Cox-Kain, Chief Operating Officer, OK State Dept. of Health

[Minute Marker 00:22:01 to 00:53:26]

Topic – “Present State of Health Outcomes and Health Care in Oklahoma”

 

Slides:       (NOTE: Missing one slide on an OK health stat)

  1. OK has excess death and mortality & overall health rankings
    1. Chart of Determinants of health and their contribution to premature death.  Environmental, social circumstances (stressful), healthcare 10%.  Insurance reform addresses access to health care, genetic disposition, behaviors.
    2. United Health Foundation rankings for Oklahoma 2010 – showed selected health measures: cardio vascular disease, tobacco use (25%) 48th in nation, access to care measures, leads to other outcomes we’d like to track in our state.  (Prevalence of obesity in our state), preventable hospitalizations, i.e. people aren’t controlling their conditions very well; infant mortality rate (significantly higher than other states); immunization coverage, lack of health insurance; primary care physicians availability.  Overall health ranking is 46.
    3. United Health Foundation Rankings Oklahoma 2010. We track fruits and vegetables consumption.  Only 14% of our population gets 5 fruits and vegetables/day.  Other stats on people’s behaviors. How are you feeling?  19% of our population responded that they don’t feel very well.
  2. Leading causes of death in Oklahoma.
    1. Total Mortality Rate per 100,000 Population  – 2005-2007.  Source: State of our State Health Report.  Some counties earned an “F” due to chronic conditions and behaviors.
    2. Leading Causes of Death in Oklahoma – heart disease, cancer, chronic obstruction/pulmonary
    3. Heart Disease Rates – Oklahoma is in the bottom for heart disease rates. (Burden of disease.)
    4. Leading risk factors for Heart Disease: Physical inactivity, overweight and obesity, high blood pressure, smoking, high cholesterol, diabetes.
    5. Cancer Rates per 100,000 Population 2007.  OK has one of the worst rates of cancer death
  3. Cancer Death Rate per 100,000
  4. Leading Cancer Types in Oklahoma – Lung disease, etc.
  5. Risk Factors for Lung Cancer
    1. Chronic Obstructive Pulmonary Disease in US 1999-2006.  Oklahoma has high rate of burden.
  6. Chronic Lower Resp. Disease Death Rate per 100,000 Popl 2005-2007
  7. Risk Factor for COPD in OK
  8. Stroke Rates – U.S. Map
  9. Stroke Death Rate per 100,000 Population in OK
  10. Risk Factors for Stroke Death – High blood pressure, etc
  11. Hospital Cost Associated with Top Four Cause of Death in OK 2009 Heart Disease $2.1 B,
  12. Infant Mortality in Oklahoma
  13. Infant Mortality Rate per 100,000 Population 2001-2006
  14. Infant Mortality Rate per 1,000 Population 2005-?
  15. Top 3 Cause of Infant Mortality Death in Oklahoma
  16. Risk factors for Infant Mortality – lack of prenatal care, poor nutrition, etc.
  17. Health Behaviors and Risk Conditions in OK
  18. Adult Obesity – OK at 32%, trending up.  Expensive to treat, this is an economic issue.
  19. Tobacco Use – slight reductions in use, still over 25% of our population still smokes.
    1. Physical Inactivity – our citizenry is not active enough.  If more active they are well, and less sick. A lot of these are due to choice and we can contribute to that choice, to encourage them to choose health
    2. Fruit and Vegetable Consumption – we trend down.  We are teaching our children that we don’t eat enough fruits and vegetables (teaching this in our schools.)
  20. Summary of Health Status in Oklahoma.

Q & A – [00:53:27 to 1:07:30]

Q.   Mulready – cancer state question;

Q.   McDaniels – women’s health conditions;

Q.   Rep. –  obesity;

Q.   Morgan re Hospital Costs associated with top four causes of death in OK 2009.  A: These health outcomes are the result of multiple factors, per capita cost for treatment, will factor in to cost of insuring them. Mulready re United Health Care Rankings about infant mortality and access to prenatal care.  “We want mothers to get proper nutrition and supplements and get them early in her pregnancy.”

Q.   Mulready re $5 billion attributed to obesity, could you name the top three things we could do to impact that, those are public dollars.

A.    One thing we can do is create the expectation that we expect wellness, physical activity in school, we need to support communities and empower them to make good choices, increase access to fruits and vegetables.  These are available in Certified Health Communities program. Certified Healthy Business program, too.  Q. Rep. Grau re ratio of primary care physicians ranking near the bottom, physician assistance, nurse practitioners, telemedicine?

A.    Run the state office of primary care.

Q.    Grau re pancreatic cancer – outside factors that contribute?

A.   Can’t answer.

Q.   Rep. Nelson re death and mortality rate, is there any correlation between infant

mortality and teen pregnancy?

A.    High teen pregnancy rate so parents don’t have time to educate their offspring on the issue.

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Additional speakers included Mike Fogarty, CEO of the Oklahoma Health Care Authority (OHCA); Buffy Heater and Cindy Roberts, both with the OHCA; and Jason Sutton of OCPA. (Sutton was the only non-government presenter, and the one who provided a dose of reality about the tremendous growth of expenditures (169%) versus number of enrollees (47%)  since the creation of the OHCA.)

The rest of notes on this meeting are on the OK-SAFE, Inc. website here.

March 2, 2011

OK Republicans Implementing “Obama Care”

On Friday, Feburary 25, 2011 OK Governor Mary Fallin issued a press release announcing “Oklahoma Will Accept $54 M “Early Innovator Grant” to Support Oklahoma-Based Health Insurance Exchange.” 

Noticably missing from the announcement is the fact that the “Early Innovators” grants are to fund implementation of the Information Technology (IT) infrastructure needed to operate Health Insurance Exchanges, a cornerstone of the Patient Protection and Affordable Care Act, aka “ObamaCare.”

The grant application, officially called the Cooperative Agreements to Support Innovative Exchange Information Technology Systems, is a 41-page document outlining the purpose, authority, and background of the funding “opportunity”, as well as eligibility requirements states must meet in order to qualify. 

The application also notes the specific sections of the Patient Protection and Affordable Care Act (and the Health Care and Education Reconciliation Act, together referred to as the Affordable Care Act) authorizing the funding of the grant.

Oklahoma was one of seven initial grant awardees, with our state getting the largest dollar amount – $54,582,269.  The grantee in Oklahoma is the Oklahoma Health Care Authority.

According to Grants.gov, the expected number of awards is 51 – all 50 states, plus the District of Columbia.

All of the exchanges are to be interoperable and usable by other states.

Exchanges – Cornerstone of the PPACA

The creation of Health Insurance Exchanges is a cornerstone of  PPACA (ObamaCare), without which there would be no socialized health care plan.  The plan requires an IT infrastructure to be in place in order to function.  No Exchanges, no ObamaCare.

These insurance Exchanges are mentioned 278 times in the Act.

The specific section of PPACA (ObamaCare) noted in the grant application are:

Page 5 of the grant application cites Section 1311 of the PPACA.
 
“C. Background
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act includes a wide variety of provisions designed to expand coverage, provide more health care choices, enhance the quality of health care for all Americans, hold insurance companies more accountable, and lower health care costs. Among its provisions, the law provides grant funding to assist States in implementing parts of the Affordable Care Act.

Section 1311 of the Affordable Care Act provides funding assistance to the States for the planning and establishment of Health Insurance Exchanges (“Exchanges”). The Affordable Care Act provides that each State may elect to establish an Exchange that would: 1) facilitate the purchase of qualified health plans (QHPs); 2) provide for the establishment of a Small Business Health Options Program (“SHOP Exchange”) designed to assist qualified employers in facilitating the enrollment of their employees in QHPs offered in the SHOP Exchange; and 3) meet other requirements specified in the Act.”

Pages 6 & 7 of the application cite Section 1323 of the PPACA:

“The products of this Cooperative Agreement will be available to all States and the District of Columbia for evaluation and adaptability throughout the process so that non-grantee-States will not have to wait until a complete product is finished to test for adaptability for its existing systems. As IT systems are developed, attention should be paid to assuring that information gathered will be accessible for evaluation purposes. U.S. Territories that establish Exchanges under Section 1323 will be eligible to participate in the evaluation and adaptability process and the products developed under this Cooperative Agreement will be available to them.”

Pages 7, 17, 21, 28, and 29  of the application cite Section 1561 of PPACA:

Key Principles of Exchange IT capabilities for Early Innovators
• The organization governing the design, development, and implementation of the core capabilities must follow standard industry Systems Development Life Cycle (SDLC) frameworks including the use of iterative and incremental development methodologies. The governing body must also be able to produce requirement specifications, analysis, design, code, and testing that can be easily shared with other interested and authorized stakeholders (i.e., other States, consortia of States, or any entity that is responsible for establishing an Exchange).
• The design must take advantage of a Web Services Architecture (using XML, SOAP and WSDL or REST) and Service Oriented Architecture approach for design and development leveraging the concepts of a shared pool of configurable computing resources (e.g., Cloud Computing).
• The services description/definition, services interfaces, policies and business rules, must be published in a web services registry to support both internal and external service requests that are public and private, and be able to manage role-based access to underlying data.
Per Section 1561 of the Affordable Care Act, all designs must follow the standards thatare currently outlined in the recommendations published by the Office of the National Coordinator (ONC). For details on Section 1561 Standards, see: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3161.
• Per National Institute of Standards and Technology (NIST) publications, the design and implementation must take into account security standards and controls. (For details on NIST publications, see: http://csrc.nist.gov/publications/PubsSPs.html)

Health Insurance Exchange Legislation

Currently there are several live bills implementing the Health Insurance Exchange but two worth noting are SB 960 by Sen. Bill Brown, and HB 2130 by Rep. Kris Steele.

Health Insurance Exchange Impact on Independent Brokers

Several independent insurance brokers in Oklahoma are concerned about the impact the exchanges will have on their businesses.  The exchanges operate contrary to the free enterprise system and most likely will put the independent insurance broker out of business.  Click here to hear the 2/27/11 interview with Mark Croucher of WHY-Insurance. 

To contact Governor Fallin about this issue:
Phone: 405-521-2342

To call Senate Pro-Temp Brian Bingman:
Phone: 405-521-5528
Email: bingman@oksenate.gov

To call House Speaker Kris Steele:
Phone: 1-405-557-7345
Email: krissteele@okhouse.gov

More on this subject in the weeks ahead.

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