CareFirst to give $8.5 million in grants to safety-net clinics

CareFirst to give $8.5 million in grants to safety-net clinics
By Lena H. Sun, Washington Post, February 28

CareFirst BlueCross Blue­Shield, the largest private insurer in the Washington region, plans to announce Tuesday that it will give $8.5 million to a dozen safety-net clinics to help them use a coordinated primary-care approach to treat their most vulnerable patients, executives said.

Over the next three years, the funded programs are expected to treat as many as 66,000 patients with costly chronic illnesses such as diabetes, heart disease and high blood pressure. The clinics are in Maryland, Virginia and the District.

The initiative expands on an approach known as the patient-centered medical home, which is being tested in dozens of public and private experiments across the country as part of the health-care overhaul. Federal policymakers are watching closely to see whether the strategy can improve care and reduce costs.

Instead of doctors waiting to see patients mostly when they have a specific problem, a team of doctors, nurses and other staff members aims to take care of the whole person on a continuing basis, with an emphasis on prevention and comprehensive care, often targeting the sickest patients. The strategy is expected to translate into better care and fewer emergency visits, hospital stays and trips to specialists, clinic officials said.

Many of the experiments are taking place in privately insured networks. CareFirst, with 3.4 million members, has been conducting one of the largest of its kind in the Washington area since January 2011. About 3,100 doctors, or 81 percent of the region’s actively practicing primary-care physicians, are participating in the program, according to Chet Burrell, CareFirst’s chief executive.

The program uses a team approach and relies on a host of financial incentives to encourage doctors to increase the emphasis on helping their sickest patients. Doctors who join the program receive a 12 percent increase in their insurance reimbursements, $200 for each detailed care plan they set up for a patient, and additional fees for improving quality and reducing overall cost.

In the initiative to be announced Tuesday, CareFirst will provide grants to the safety-net clinics to jump-start their own programs. CareFirst will also give technical support and guidance on electronic health record systems, clinic officials said.

Clinics were asked to submit proposals and were chosen based on how well they could coordinate care for the most needy patients.

“We’re not paying for the care, we’re paying for the coordination,” Burrell said.

One of the recipients is the Arlington Free Clinic, which provides free health care to about 1,600 low-income, uninsured residents. The clinic will receive about $350,000 over three years, roughly a third of the total cost of the program, said Nancy Sanger Palleson, the clinic’s chief executive.

The clinic will use the money to hire additional personnel and upgrade electronic medical records to allow the staff to better track the care of “the sickest of the sick” — about 160 people — she said.

For example, medical assistants could make sure the necessary bloodwork is completed before a patient’s appointment with a specialist, Palleson said. “Otherwise it would be a wasted trip for her and for the physician, who could be seeing someone else.”

With 140 affiliated doctors providing their services free, she said, “the more efficiently we can use them, the more people we will be able to see down the road.”

And the need appears to be growing. The clinic takes new patients through a monthly lottery system. Typically, about 120 show up for the lottery, and the clinic takes 25 of them, Palleson said — but last week, for the first time, 220 people showed up. “We could only take 25,” she said.

The other clinics include Mary’s Center and Unity Health Care in the District, the Spanish Catholic Center in D.C. and Maryland, and Community Clinic Inc. and partner Greater Baden Medical Services in Montgomery County and Prince George’s County.

Experts say the key will be whether the clinics can sustain the programs over time. “The kind of people who have complex medical problems as well as social and economic issues might be the people who would benefit most by this kind of initiative,” said Judy Feder, a health-care expert at the Urban Institute.

Those patients are most likely to “fall prey to the inappropriate use of health care, whether on the back end with preventable high-cost hospital admissions or on the front end with insufficient primary care,” she said.

Leveling the playing field will be even more important in the run-up to 2014, when primary-care doctors will be in greater demand as insurance coverage expands to millions more Americans, experts said.


Conservatives and the Mandate

Conservatives and the Mandate

ObamaCare is a specific instance of a broader truth about America’s health-care policy: It’s grossly regressive.

  • By HOLMAN W. JENKINS, JR., The Wall Street Journal

ObamaCare’s individual mandate, it turns out, is no more popular with the public than it is with the GOP hopefuls. A USA Today poll this week finds that 72% of voters believe the mandate to be unconstitutional.

Only fools and angels, then, might tread forth to defend a now-embarrassing history of conservative support for the unpopular mandate. Former Bush speechwriter David Frum, in a blog post, courageously applauds pundit Ann Coulter for a similar act of courage. "It’s not as if we had a beautifully functioning free market in health care until Gov. Mitt Romney came along and wrecked it by requiring that Massachusetts residents purchase their own health insurance," Ms. Coulter wrote, in a sort-of defense of Mr. Romney.

From a more ecumenical perspective, Businessweek happily observes of the debate: "President Barack Obama never tires of noting [that] the notion that the government should require individuals to carry health insurance was first pushed by Republicans, encouraged by the conservative Heritage Foundation. . . ."

Context is everything. Barack Obama says his mandate is about extending health care to the uninsured. But look closely. It’s also partly about forcing the young, healthy and otherwise uninclined to overpay for health insurance so the money can be used to pay for heavy users of the health-care system.

To put a round guess-estimate on it, people who might consume $900 worth of health care in a year will be asked to buy $5,000 policies so the money can be used for somebody else.

We won’t try to synthesize what Newt Gingrich, the Heritage Foundation, the Manhattan Institute and others once had in mind when they championed a mandate in a now-disavowed past. But as a general rule conservatives have supported a mandate to take care of a "free rider" problem—that is, to make people pay for their own health care, not as a tax to pay for someone else’s.

This is a distinction, as they say, with a big difference, and, as we’ll see, a conservative mandate is all but meaningless unless part of a larger body of reforms.


Mitt Romney

Let’s step back. ObamaCare is a specific instance of a broader truth about America’s health-care policy: It’s grossly regressive. The giant tax subsidy for employer-provided health insurance is most rewarding to those in the highest brackets. Medicare is regressive: It transfers money from working people, with few assets, to the elderly, who own most of America’s wealth. Even Medicaid, the program for the poor, is morphing into a program for helping the middle class shield its assets from long-term care bills.

The cumulative impact of these interventions has given us the health-care system we have. Because it subsidizes third-party payership, it destroys any hope of price-value comparisons by consumers. Because it commits the cardinal economic impossibility of trying to subsidize everybody, the end result is not better health but higher costs in the form of rising prices and the provision of services of questionable value.

Now to worry about a free rider problem, as conservatives have done, is almost pointless when everybody is getting a subsidy. Those who don’t buy private insurance and don’t qualify for Medicaid simply receive a different kind of subsidy, through emergency room bills transferred to the rest of us. Think of it this way: Such a person is merely recapturing a bit of the subsidy he’s been paying through his taxes to support health care for people who are mostly richer. Yes, his actions distort the market, but it’s a drop in an ocean.

But suppose the policy bias in favor of third-party payership were corrected. Suppose insurance became insurance again, i.e., protection against large, unpredictable costs. Suppose patients began paying for a bigger share of health care out of their own pockets. Suppose providers responded by putting price-tags back on medical services and competing to offer value-for-money.

A young, healthy person might still choose to skip insurance and rely on the emergency room. But the problem would be a small one, because many fewer people would be voluntarily uninsured, because insurance would no longer be an overpriced luxury to anybody not benefiting from a direct subsidy.

By the way, this critique of health-care policy is not a conservative critique, but was once shared by Bill Clinton and plenty of Democrats. Nor are the policy difficulties insoluble: The solution can be summarized as "stop subsidizing the unneedy" (and a well-conceived tax reform would go a long way toward doing just that).

In a sense, ObamaCare, RomneyCare and George W. Bush’s major legislative efforts were but revisitations of a single question: Are we ready to act? So far the answer has been no, with the tiny exception of President Bush’s promotion, in his otherwise execrable Medicare drug act, of health savings accounts.

Why politicians like to shovel benefits at the capable, self-sustaining majority is not a mystery—that’s where the votes are. Yet notice that what little progress has been made in corralling health insurance costs in recent years has come from corporate America, using health savings accounts and other tools to make subsidized users cognizant of the value (or lack thereof) of the services they consume.

Republicans join forces to free D.C. from Congress

Republicans join forces to free D.C. from Congress
Harry Jaffe, Thu, 2012-02-23 19:58, Examiner

Virginia Gov. Bob McDonnell is no Tom Davis.

Former Rep. Davis, you might recall, carried the District’s water in Congress for the decades that he represented Fairfax County. A Republican, though a moderate one in the era when they could survive and thrive, Davis was a true friend of D.C.

McDonnell is conservative on matters of business, crime, social issues such as abortion, and the environment. How then, are we to explain the letter McDonnell sent to Congress on Feb. 9 in support of the District’s right to have budget authority over local funds?

Incomprehensible though it might seem, the nation’s capital cannot spend funds it collects in taxes from its residents until Congress approves its budget. This congressional oversight is a vestige of the Home Rule Act of 1974, which bestowed limited self-government on D.C.

In venturing into the budget morass, McDonnell is even surpassing superliberal Doug Wilder, Virginia governor in the early 1990s. During his tenure, Wilder didn’t support budget authority for D.C. Wilder didn’t care much for D.C. or venture our way, except when he came on official business.

In comparison, after sending his letter supporting more Home Rule, McDonnell has cast himself as a friend of the District. Perish the thought!

For decades District leaders have been trying to get Congress to pass a bill giving it authority over its own funds. Del. Eleanor Holmes Norton has introduced a bill, with few backers. President Obama supports financial freedom for D.C.

Republicans? Not so much.

So it was a "shock," Norton tells me, when California Rep. Darrell Issa held a hearing last fall on D.C. budget autonomy. A conservative with a sharp tongue and no love for Obama, Issa came away in favor of D.C.’s rights and wrote legislation to free D.C. from Congress. His bill has been modified, still has a rider that prohibits D.C. from using local funds for abortions, but he’s promised to work "until it becomes law."

McDonnell’s letter, sent to Issa and Mayor Vince Gray, was "even more unexpected" than Issa’s support, Norton says, "and it’s of great significance."

McDonnell is a rising star in the GOP and thought to be vice presidential material. To have a powerful conservative back D.C. budget authority changes the game.

"For the first time," Norton says, "Congress has to look at the impact the District has on the entire capital region." McDonnell isn’t talking about the letter, but his central point is that if and when the federal government cannot come to a budget agreement and shuts down, the District shuts down, too, and that would damage Virginians.

Let’s be real. McDonnell has little interest in cozying up to D.C. His letter is all business. If D.C. shuts down or suffers because Congress is messing with its budget, Virginia’s economy might suffer collateral damage. I say — whatever it takes.

It’s going to take much more than a letter from a Virginia governor to force Congress to take its boot off of D.C.’s budget. But it sure is a big step in the right direction.

Crunch time for health exchanges

Crunch time for health exchanges

Posted by Sarah Kliff, Washington Post at 05:45 PM ET, 02/22/2012

The Obama administration announced Wednesday that it’s sending $229 million to 10 states to set up health insurance exchanges, where individuals will buy subsidized health coverage come 2014 (think of them as an Expedias for insurance). So far, the federal government has spent nearly $1 billion to get the exchanges up and running by 2014.

This year will be a pretty important one for states on health exchanges. All 50 are eligible to apply for multimillion-dollar planning grants, and, so far, 33 have received them (you can see which ones in the map above from Kids Well Campaign). To establish the new marketplace, however, nearly all states need to pass laws creating new legislative authorities. There, progress has been slower: Only 15 states have passed exchange legislation.

A state has to have made enough progress on setting up an exchange by January 2013 to be certified by the Obama adminstration as able to launch a marketplace the following January.

The White House wants every state to set up its own exchange so that they don’t have to face the prospect of the federal government having to do it for them. The number of states that obtain the grants and move legislation in 2012 could have a strong impact on the federal government’s workload.

Taxi drivers cry foul, want representation on cab commission

Taxi drivers cry foul, want representation on cab commission

Liz Essley, Wed, 2012-02-22 17:22, Examiner

D.C. taxi drivers aired their grievances before a D.C. Council committee Wednesday, crying out for representation on the regulatory agency that governs them, the D.C. Taxicab Commission.

The Commission currently has five members and three vacant seats, and usually only one or two members attend hearings and meetings.

Cab drivers said the empty seats are supposed to be filled by cab drivers, and that the watered-down commission is refusing to listen to drivers’ need for higher fares.

"We believe that we should have a world class system, but at the same time we need a fair seat at the table," said Nathan Price, president of the D.C. Professional Taxicab Drivers Association.

Councilmember Mary Cheh, D-Ward 3, who heard the testimonies, told cab drivers that she had urged Mayor Vince Gray to make his appointments to the board.

But that wasn’t enough for some incensed drivers, who want to be paid more than the $2.16 per mile that the commission recently proposed, up from the current $1.50 per mile.

"You are trying to bring slavery to us," cab driver Tadelle Tilahun said. "You’re going to give us 66 cents as a raise? People are laughing at you guys."

D.C. Taxicab Commission Chairman Ron Linton was not at the hearing for medical reasons, Cheh said.

Poll Finds Weak Support for Vincent Orange in Re-Election Bid

Poll Finds Weak Support for Vincent Orange in Re-Election Bid
By Martin Austermuhle in News on February 22, 2012 1:30 PM,

A recent poll has found that Councilmember Vincent Orange (D-At Large) has weak citywide support in his re-election bid, but he may sneak into a full term the same way he won last year’s At Large Special Election — by facing a divided field of competitors.

According to a telephone poll done by North Carolina-based Public Policy Polling, only 30 percent of likely D.C. voters would side with Orange on April 3, while 48 percent would vote for someone else and 22 percent are undecided. But much like with other candidates, a stark demographic split has emerged — Orange has the backing of 45 percent of African American voters, while only 11 percent of whites support his re-election. Still, 41 percent of African Americans said they would vote for someone else, leaving Orange at something of a disadvantage if he runs against one good candidate.

But he’s not. Currently, Orange is facing three main challengers: former interim At Large Councilmember Sekou Biddle, former Prince George’s County Councilman Peter Shapiro and Ward 1 ANC commissioner and pastor E. Gail Anderson Holness. Both Biddle and Shapiro espouse similar progressive beliefs, and supporters of Shapiro have already said that Biddle should drop out, lest Orange win another term because his opposition remained divided. But others point out that Shapiro, who only recently returned to the District after a stint in Maryland, has even less citywide name recognition than Biddle, who served on the D.C. State Board of Education and D.C. Council, albeit only briefly. (The poll won’t really help settle who, if anyone, should drop out — only Orange was name-tested.)

One aside, though — the poll tested likely voters, not registered Democratic voters. There are some 80,000 voters that are not associated with any political party, and unless they become Democrats before the March 5 deadline, they won’t be able to vote for a Democratic At-Large candidate on April 3. Still, the poll tracks closely with one done before last year’s Special Election. In that poll, Orange only enjoyed citywide support of 28 percent, which means that his base has remained somewhat static over the last year.

What Orange seems to lack in popular support he certainly makes up for in fundraising prowess, though. Through the end of January, he had raised over $145,000 and had $108,000 remaining on hand. Biddle only raised $47,000 and had $33,000 on hand, while Shapiro had taken in $90,000 and had $73,000 in the bank. (Shapiro’s fundraising included a $50,000 personal loan.) With Orange’s existing bankroll and six weeks left until the Democratic primary, the incumbent could just pay for buses to get his supporters to the polls and likely sneak into another term.

The At-Large contenders square off tomorrow during a forum hosted by the Ward 3 Democrats.

Interestingly, the poll was commissioned and paid for by former mayoral candidate and millionaire developer Don Peebles, according to a seasoned political operative not affiliated with Peebles that provided us with the At-Large responses. (A Peebles spokesman opted not to comment, saying only that any leaks came from unauthorized sources.) While the At-Large race may be one of the more contested races to watch, Peebles was more interested in other issues — notably how a recall of Mayor Vince Gray and D.C. Council Chair Kwame Brown would poll amongst District voters. Peebles recently said that he’d be willing to fund such an effort, and this poll seemed to be one step in deciding whether to do so or not.

Where’s the Money?: Council Challengers Aren’t Finding Much Green. They Say it’s the System’s Fault.

Where’s the Money?: Council Challengers Aren’t Finding Much Green. They Say it’s the System’s Fault.

Posted by Alan Suderman on Feb. 22, 2012 at 6:00 pm, Washington City Paper

To knock off an incumbent councilmember in this town, it helps to be hardworking, a little bit crazy, and to raise enough money to buy a gently-used Bentley.

Many challengers this election season have the first two qualities covered. The third part is proving tougher. None of the challengers for the six council seats up for re-election has raised enough to stand much of a chance.

The incumbents, on the other hand, are pulling in donations at a steady clip. Ward 2 Councilmember Jack Evans, who doesn’t even have an opponent, has raised $313,000.

So much for the council’s dismal approval ratings: This state of affairs suggests that the home team could win a clean sweep.

Money alone doesn’t guarantee success. But successful past challengers prove that it helps. Kwame “Fully Loaded” Brown was outspent four to one when he beat at-large incumbent Harold Brazil in 2004. But Brown had still raised $130,000 by election day. By contrast, none of the current wannabes had raised even $50,000 by the Jan. 31st filing deadline.

“Everyone says it’s real dry out there for challengers,” says former council candidate Bryan Weaver. “It’s a little bit of a mystery.”

What’s holding donors back? It could be that the current challengers just aren’t that inspiring, no matter how unpopular the council may be. Or perhaps the year’s ethics scandals, with attendant media stories featuring words like “subpoena” and “bank records,” have scared donors away in general.

The challengers, though, have another theory: They think the system is rigged.

Weaver, who’s not running this time, is pushing for a November referendum asking voters to ban corporate political giving. The change, he says, would wind up “lowering the threshold” for challengers.

At the very least, it might shrink the incumbents’ coffers. A review by WAMU last year found that the amount of donations from corporations had risen to 45 percent of all campaign giving. LL’s review of campaign finances shows that incumbents rely almost exclusively on donors who give the maximum permitted amount. Challengers, by contrast, are more likely to be funded by small donations from nobodies.

To good-government types, these patterns demonstrate a local “pay-to-play culture” that unduly rewards those with current legislative power. Under D.C. law, councilmembers can put the brakes on contracts of $1 million or more. That gives them the power to make life miserable for any contractor who had the temerity to fund a councilmember’s opponent.

The safe bet? Go with whomever is in office. “A lot of people out there are quite frankly afraid to go against incumbents,” says Sekou Biddle, who is running for the at-large seat currently held by Vincent Orange.

Biddle’s is a good example of just what a difference incumbency makes. A year ago, after all, he was an incumbent, albeit an unusual one who’d been appointed to his seat thanks to a predecessor’s resignation. But the mere fact that he had the word “councilmember” before his name was what mattered.

The little-known Biddle had scarcely taken his seat when well-known power-brokers started cutting checks. A fundraiser at Ben’s Chili Bowl was co-hosted by the mayor’s campaign chairwoman and the D.C. Council chairman’s father. Another event at Smith Commons, the trendy H Street NE restaurant, was co-hosted by Mayor Vince Gray himself, along with superlobbyist David Wilmot. By the end of his first month in office, Biddle had raised more than $50,000. He would raise $200,000 in less than six months. (He wound up losing to Orange, an ex-councilmember whose campaign was also nicely funded.)

That was then. Nowadays, Biddle’s trying to wrest the seat back as a private citizen. He had raised only $47,000 as of the Jan. 31 campaign finance filing.

The idea that councilmembers are liable to punish contractors who fund rivals has been playing out lately on the Washington Post editorial page, which has launched something of a jihad against Ward 1’s Jim Graham.

In January, the Post published emails between Graham and the lobbyist for Warren Williams, who was seeking a lottery contract. The email shows the lobbyist trying to mollify Graham’s concerns. Those concerns, the email implies, had something to with a past donation to one of Graham’s opponents.

“The Williams family confirmed with me again that no family member ever made a contribution to the campaign of Chad Williams, who challenged your seat,” lobbyist Jim Link wrote in the suck-up email published by the Post. Graham declined to answer LL’s questions about the exchange.

To counter their money disadvantage, some challengers have tried to make incumbents’ fundraising a liability. Max Skolnik, who is challenging Ward 4’s Muriel Bowser, has needled Bowser for taking 38 percent of her donations from corporations. (Bowser defended herself on the Kojo Nnamdi Show, saying she’s proud to receive money from local businesses.) And David Grosso, who hopes to unseat at-large Councilmember Michael Brown in November’s general election, issued a challenge to every candidate to go beyond the District’s paltry disclosure rules and disclose the connections donors have with city contractors.

Amazingly, no incumbents have taken him up on his offer.