Georgia Project Quarterly e-Newsletter
Volume 2, No. 1 (March 2008)
Welcome!
Welcome to the first 2008 issue of the Georgia Project Quarterly e-Newsletter. We offer this e-Newsletter as a way to keep you informed of our activities and progress in Georgia. In addition, since transformational leadership training is one of CHT’s key activities, we include in each issue a key principle, idea or passage from our book The Art of Transformation, co-authored by CHT founder Newt Gingrich and CHT CEO Nancy Desmond.
The basic strategy of the Georgia Project is to work collaboratively with transformational leaders to accelerate the creation and adoption of solutions, technologies and policies that drive system-wide transformation into a 21st Century Health System that saves lives and saves money for all Americans. Although we work actively in 39 states, Georgia serves as an implementation project where we identify and build models to replicate in other states. Our members and allies play key roles in the identification and development of the models that are transforming health and healthcare.
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The Healthy Georgia Diabetes and Obesity Project
As part of the Healthy Georgia Diabetes and Obesity Project, the collaboration launched one of the nation's largest Bridges to Excellence pay-for-performance initiatives in the country. To obtain the rewards available through the BTE diabetes reward program, eligible physicians must demonstrate that they provide high levels of diabetes care by passing NCQA's diabetes performance assessment program. As a result of a focused effort to recruit physicians throughout the state for participation in the NCQA Diabetes Physician Recognition Program [DPRP], the number of physicians recognized by NCQA as delivering best standards of diabetes care in Georgia has grown from only 5 to 159. Major recruitment efforts continue in Atlanta, Columbus, and Savannah.
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21st Century Healthy Community Project
The Columbus, Georgia Project
The Columbus Research Foundation, with the support of the Columbus Chamber of Commerce and Columbus Consolidated Government screened fasting subjects in the working population of Columbus as the Metabolic Syndrome Project continues. Parameters screened include blood pressure, fasting blood sugar, HDL, LDL, Triglycerides, waist measurement, and Hemoglobin A1c. 775 individuals have been screened to date. Analysis of the data indicates that 53% were found to have at least one abnormality in the parameters screened, 36% were found to have metabolic syndrome, and only 11% were found to have no abnormalities. Initial findings suggest that metabolic syndrome is more common than thought according to Steven Leichter, MD, of the Columbus Research Foundation. Dr. Leichter and his team are partnering with CHT on the project. The Columbus, Georgia Project has been selected as the major work of the Health Committee of the Columbus Chamber of Commerce. Laura Linn, CHT’s Georgia Project Director, has been asked to serve on the Health Committee.
A new CHT member, VSP, a provider of vision care, has joined the collaboration of leaders working to develop 21st century models of health care in Georgia. VSP network doctors in Columbus, Georgia, agreed to provide health screenings for up to 2000 residents by means of performing an eye exam, blood pressure, and BMI test. These doctors will track the results of these 2000 exams and share that data with VSP and the Columbus Research Foundation, as appropriate. The patients participating in this study will receive a complimentary eye exam, health screening, and glasses (as needed) from VSP. Screening for metabolic syndrome is expanded beyond the working population through this initiative. We are excited to see the impact of these screening efforts.
Gainesville, Georgia
Gainesville, Georgia, another of the participants in the Center’s 21st Century Healthy Communities Project, held a successful 5K run/walk in March. When the Greater Hall Chamber of Commerce began planning the event last year the goal was for 200 citizens to participate. The First Annual Get Fit Stay Fit event had the support of over 1500 runners and walkers!
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Advancing the Adoption of Electronic Health Records
In February, Center for Health Transformation CEO Nancy Desmond participated in a small roundtable discussion in Georgia, featuring Secretary of the U.S. Department of Health and Human Services Michael Leavitt, Congressman Phil Gingrey, M.D. and Georgia Governor Sonny Perdue, along with approximately twenty Georgia leaders. The purpose of the roundtable was to discuss Georgia’s potential role in a new Medicare Electronic Health Records Demonstration Project. The roundtable, which was led by Georgia Department of Community Health Secretary Rhonda Medows, was held at the Georgia Tech Research Institute before a public audience.
Medicare is currently collecting applications from communities across the nation to become part of the project, which plans to provide financial incentives to as many as 1200 small- to mid-sized primary care practices who implement electronic health records to change how they practice medicine. Participating physicians could earn incentives of up to $58,000.
Georgia hopes to be one of the communities selected to participate in the demonstration project. Dr. Rhonda Medows was named Georgia’s convener by Secretary Leavitt. Community stakeholders, including physicians, medical professional associations, employers, and commercial insurers, are providing input into the development of the application which will be submitted to CMS by May 13, 2008.
The CHT Georgia e-Prescribing Working Group met on March 18, 2008. They discussed recent federal activity on e-prescribing including the DEA issue and Sen. John Kerry’s e-MEDS legislation which calls for “mandate lite” within the Medicare program. Sen. Kerry and Speaker Gingrich were part of a press event on the legislation and the need to create incentives for physicians to adopt e-prescribing solutions.
Kate Berry of SureScripts was present and discussed the 2008 Safe Rx Awards. Each year, SureScripts recognizes the top ten states which have the largest percentage of electronic prescriptions transmitted. View final standing of each of the 50 states plus the District of Columbia >>
While Georgia’s 38th place raking is not where it needs to be, significant progress is being made. Since e-prescribing laws were passed and regulations written to allow physicians to order and pharmacist to dispense medications from an electronically generate prescription, Georgia has moved from 50th in 2005 to 42nd in 2006 to 38th for 2007. Last year, there were 418,567 electronic prescriptions generated by Georgia physicians.
Source: http://www.surescripts.com/Safe-Rx/
Speaker Gingrich was the keynote speaker and served as honorary host of the Third Annual Safe Rx Awards which were sponsored by SureScripts. Newt presented the top Safe Rx Award to Senator John Kerry for the Commonwealth of Massachusetts. This was the second year in a row that Massachusetts has been the number one state in e-prescribing penetration. In addition to recognizing the leadership of the top 10 states, Newt also presented an award to HHS Secretary Micheal Leavitt for being supportive of e-prescribing and HIT solutions. Watch video of event >>
Jerry Dubberly, pharmacy director for the Georgia Department of Community Health provided an update on State Medicaid Technology Grants which the department awarded to two east Georgia collaboratives – one in Swainsboro and one in Savannah. Both grants were provided to non-profit organizations which will build out e-prescribing projects centered around patient safety.
Michael Heekin, executive director of the Georgia Health Information Exchange (GHIE) provided an update on the work of GHIE which has plans to implement a pilot in northwest Georgia. The proposed pilot will work with local providers to accelerate the adoption of e-prescribing solutions in Dalton.
Ms. Berry also provided an update on the “Get Connected Campaign.” Five of the nation’s leading physician groups announced the launch of a new program designed to help more physicians begin sending prescriptions to pharmacies electronically. The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Cardiology (ACC), the American College of Obstetricians and Gynecologists (ACOG) and the Medical Group Management Association (MGMA) are launching an online portal – www.GetRxConnected.com – where physicians can follow a step-by-step process designed to help them transition from paper-based prescribing to e-prescribing.
In an effort to prevent medication errors, the Institute of Medicine has called for all prescriptions in the U.S. to be written and received electronically by 2010. Through GetRxConnected.com, physicians and their staffs can find out if their existing software is compliant with the new Medicare regulations and can receive a free, personalized report to help them request an electronic connection to pharmacies through their vendor.
At the November meeting of the CHT Georgia e-Prescribing working group, members asked for presentations on the activities and organizational structure of other state collaboratives. Walt Culbertson, the executive director of e-Prescribe Florida was invited to discuss what his organization is doing to move e-prescribing in his state. In addition to hosting an e-Prescribing Summit, e-Prescribe Florida is working closely with insurance carriers to develop incentive programs and grassroots efforts to enroll physicians into e-prescribing programs.
Wayne Oliver provided some insight on Southeast Michigan E-prescribing Initiative (SEMI). This organization grew out of the Henry Ford Health System in partnership with Ford, GM and Chrysler. SEMI has enrolled over 2,900 physicians into their program. Recently, SEMI conducted one of the largest and most comprehensive surveys of physicians participating in e-prescribing or a regular basis. The survey revealed that physicians were positive about the safety features of electronic prescribing as well as reducing the administrative burden of ordering medications since drug formulary information and patient medication histories were available at the time of prescribing.
The working group plans another quarterly meeting for May or early June.
The 2008 Georgia General Assembly is considering legislation to lower the number of uninsureds in Georgia and to make HSA eligible plans more affordable to all Georgians. The bill has passed the Georgia House and is working its way through the Senate. We feel confident that the Senate leadership understands the importance to Georgia and will pass the bill on to the Governor for his signature. We will know by the end of this week.
The following provides the facts about the legislation that supports a free-market solution to making health insurance more affordable.
1. Do HSA eligible policies require coverage for all existing Georgia mandates?
Yes, HSA eligible policies are subject to the same insurance laws and regulations as other policies (HMOs, PPOs, indemnity policies, etc.). This means that the same benefit mandates, premium regulations, and consumer protections prescribed by each state (and the federal government) apply to these policies. No existing mandates are added or removed by the proposed legislation.
2. Do HSA eligible policies offer first-dollar coverage of preventive care?
Yes, HSA eligible policies are allowed by federal law to pay for preventive care services and screenings at 100% before the application of any plan deductible. HSA eligible plans voluntarily cover preventive care services at a higher rate (84% of the time) than tradition insurance. The changes proposed in the Georgia law would also allow “dividend” additions (in the form of rewards and incentives) to be added to HSA accounts to further cover preventive and wellness at 100% while satisfying any deductible.
3. Do HSA eligible plans with preventive care cover well-child care, women’s health, and male screenings?
Yes, in a recent survey of policies offering first-dollar 100% coverage for preventive care before the application of any plan deductible:
100% cover well-baby and well-child care,
100% cover child and adult immunizations,
100% cover annual physical exams,
90% cover prostate cancer screenings,
4. Can HSA eligible policies help reduce the number of low income uninsured?
Yes, approximately one of every three HSA eligible policies sold are to individuals who were previously uninsured. Some insurers found that about one of every two purchasers with incomes under $35,000 had not had coverage for at least six months prior to enrollment.
HSA eligible polices are particularly attractive to seasonal and part time workers, the unemployed between jobs, employees of small companies that do not offer coverage, and younger adults who can not afford and do not find value in traditional insurance coverage.
The Center for Health Transformation is hosting a series of lectures at our Atlanta location on diabetes focused on employers and designed to augment efforts to stimulate a robust dialogue between providers and payers. The Spring Series consists of presentations on the pathology of diabetes, the use of genetic risk factors in screening for diabetes and the impact of benefit plan design on patient adherence to treatment protocols.
The series is being videoed and will be packaged as a Video Magazine; a new format that we will be launching in late April to make the content of the Employer Series readily accessible to a larger audience.
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From The Art of Transformation: Principles of Transformational Communications
Knowing What “Yes” Means and How to Get to “Yes”
The first thing we always tell people who go to see key decision-makers is this: don’t tell them your problem. Tell them what success would be. People tend to spend all of their time talking about their problem when seeking help. The person whose help they’re seeking listens and says, “Let me understand: this is your problem,” and the person says, “Yes, that’s my problem.” Once that person leaves the room, somebody else walks in saying, “Here is my problem.” This typically happens before the decision-maker whose help is being sought ever has time to think about the first problem, let alone think about how to solve it.
On the other hand, if a person walks in and says, “What I need you to do is this,” that is a totally different conversation. The decision-maker is relieved of the burden of solving the problem and instead is presented with a solution to consider. The chance of actually getting what we need is dramatically increased if we always share a solution rather than simply sharing a problem.
We need to understand who actually has to say “yes.” It’s often not the person at the top—someone three levels down may make the decision. We may not need buy-in from the top. If we do, once we get it, we need to ask them who else needs to say “yes.” We’ve found this to be true within almost every large system we’ve looked at. The person at the top can say “yes” but nothing happens unless the people below him also say “yes.” You have to unlock layer after layer.
If everyone says “yes,” we have to be able to tell them how to implement the solution. This is critical. One of the reasons people don’t do things is because they don’t know how. Imagine giving a car key to someone who had never seen a car, who didn’t know what a key was, or what a steering wheel was, or how to start the ignition. Even if he says he’d like to drive the car, he’s not going to be able to do anything. So we have to think through the process of putting our solution into practice.
We have to understand the realities in the current and future environment that impact the people whose buy-in we need, so we can determine when they are most likely to listen to us.
For example, we always know that around budget time, governors will listen to Medicaid issues because around budget time, the bad news comes and they realize Medicaid is eating the university system. Once we figure out when people will be compelled to listen to us, we need to think through why they will listen to us, what’s in it for them, and how will they profit. We have a very simple model of how free societies work—centered on the individual. The questions everyone always asks are: How does it affect me? How does it affect my family? How does it affect my neighborhood? How does it affect my country? The “me” aspect is always there.
The final question is: what are the metrics of success? We need to define these so that, once people say yes, we know in the end whether success truly happened. Otherwise, people will change the metrics to justify whatever happens.
If we can focus on always following these five steps, the chance of getting people to “yes”—and making that “yes” actually mean something— is dramatically improved.
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