Mary Ellen Schneider

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from federally qualified health centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments. In exchange, health centers must pursue Level 3 patient-centered medical home recognition through the National Committee for Quality Assurance. The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources Services Administration.

CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

This project sets out to test what is needed to help health centers make the transition to patient-centered medical homes. What does the existing research tell us about the necessary ingredients?

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in "patient self-management support" and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

How important is the adoption of electronic health records to the success of the medical home?

The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care. Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

This demonstration will show important additional proof of the value of the patient-centered medical home. A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

- Interview by Mary Ellen Schneider

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from federally qualified health centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments. In exchange, health centers must pursue Level 3 patient-centered medical home recognition through the National Committee for Quality Assurance. The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources Services Administration.

CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

This project sets out to test what is needed to help health centers make the transition to patient-centered medical homes. What does the existing research tell us about the necessary ingredients?

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in "patient self-management support" and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

How important is the adoption of electronic health records to the success of the medical home?

The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care. Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

This demonstration will show important additional proof of the value of the patient-centered medical home. A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

- Interview by Mary Ellen Schneider

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from federally qualified health centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments. In exchange, health centers must pursue Level 3 patient-centered medical home recognition through the National Committee for Quality Assurance. The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources Services Administration.

CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

This project sets out to test what is needed to help health centers make the transition to patient-centered medical homes. What does the existing research tell us about the necessary ingredients?

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in "patient self-management support" and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

How important is the adoption of electronic health records to the success of the medical home?

The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care. Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

This demonstration will show important additional proof of the value of the patient-centered medical home. A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

- Interview by Mary Ellen Schneider

Procedures performed on the wrong side of the body, the wrong site, and even the wrong patient continue to happen at a national rate as high as 40 times every week, according to Dr. Mark R. Chassin, president of the Joint Commission.

"Awareness about the problem has increased, but we clearly have to do more to get a lot closer to zero," he said during a recent teleconference.

One indication that things are moving in the right direction is the improvements seen at Rhode Island Hospital in Providence. In November 2009, the hospital was facing a $150,000 fine from the state health department and an order to install video cameras in all of its operating rooms following reports of five wrong-site surgeries in 2 years.

Today, officials at the hospital say they have changed their ways and they have the safety record to prove it. There have been no wrong-site surgeries at the hospital in about 20 months, according to Dr. Mary Reich Cooper, senior vice president and chief quality officer for Lifespan Corp., which owns Rhode Island Hospital.

"We were able to show the front-line staff – as well as the surgeons and the patients coming into the hospital – that not only was safety our first priority, but we [also] were prepared to put a tremendous amount of resources into making safety our first priority," Dr. Cooper said.

Lifespan’s Rhode Island Hospital is one of eight hospitals and ambulatory surgery centers that are working with the Joint Commission’s Center for Transforming Healthcare on a project to reduce wrong-site surgery. As a result of that project, which started at Rhode Island Hospital in 2009, The Joint Commission has released a set of potential causes of wrong-site surgery and the targeted fixes that hospitals and surgery centers can use to eliminate them. The plan is to begin adding those interventions to a Targeted Solutions Tool, an electronic application that allows all accredited or certified organizations to access the information and customize it.

The results of the project will give hospitals and surgery centers around the country a road map for pinpointing and measuring their risks of wrong-site surgery, said Dr. Chassin. He advised hospitals to start reviewing risks at the very beginning of the process, when an operation is scheduled. The Joint Commission’s project revealed that in 39% of cases, errors that increased the risk of wrong-site surgery were introduced during the scheduling process.

The scheduling process is ripe for errors, Dr. Chassin said, because the person supplying the patient and procedure information typically works in the surgeon’s office and often is not directly affiliated with the hospital or center where the surgery will take place. If that person is dealing with many different hospitals and surgery centers, all with different processes and requirements, it’s easy to get confused and relay incomplete or inaccurate information, he said.

And the scheduling process is just one area identified by the Joint Commission as having potential for errors that could lead to wrong-site surgery. The eight pilot organizations, some of which have never had a wrong-site surgery in their facility, found risks in all phases of their surgical processes ranging from inconsistent procedures for marking the surgical site to omissions in the "time-out" process just before surgery.

"It turns out that this is a much more complicated problem than it might seem to be at first," Dr. Chassin said.

But developing specific fixes for each of those risks has helped to sharply reduce the chances of wrong-site surgeries at the eight pilot sites, Dr. Chassin said. For example, addressing documentation and verification issues in the preoperative holding areas decreased the percentage of cases with risks from a baseline of 52% to 19%.

At Rhode Island Hospital, efforts were made to improve the "time-out" before surgery. All other activities were stopped to allow operating room personnel to focus, and they used a script to ensure that all last-minute safety checks – such as asking everyone in the operating room if they could see the surgical mark – were completed, Dr. Cooper said.

The Joint Commission has been working on wrong-site surgery for a number of years, issuing Sentinel Event alerts in 1998 and 2001 and developing the Universal Protocol, a standardized approach to eliminating risks for wrong-site surgery.

Dr. Chassin urged hospitals and surgery centers to perform a systematic assessment of their surgical processes even if they haven’t had a wrong-site surgery. "The magnitude of the risk is often unknown," he said. "Health care facilities and physicians who ignore this fact, or rely on the absence of such events in the past as a guarantee of future safety, do so at their own peril."

The following are commonly identified errors from the Joint Commission – and their solutions:

• Error: Schedulers accept verbal requests for surgery information.

Solution: Use a single fax number for scheduling.

• Error: Someone other than the surgeon marks the site.

Solution: The surgeon marks the site in the preop area.

• Error: Time-outs don’t occur if there are multiple surgeons.

Solution: Complete separate time-outs for each new surgeon.

• Error: Staff isn’t empowered to ask questions.

Solution: Share data and let the team ask questions.

• Error: Staff rushes during patient verification.

Solution: Explain why standardized processes are important.

• Error: The briefing process is ineffective.

Solution: Do a preop briefing in the OR with the patient.

• Error: Staff is distracted during the time-out.

Solution: Perform a standardized time-out and stop all other activities.

For a full list of the 29 main causes of wrong-site surgery, go to the Joint Commission Center for Transforming Healthcare website.

Procedures performed on the wrong side of the body, the wrong site, and even the wrong patient continue to happen at a national rate as high as 40 times every week, according to Dr. Mark R. Chassin, president of the Joint Commission.

"Awareness about the problem has increased, but we clearly have to do more to get a lot closer to zero," he said during a recent teleconference.

One indication that things are moving in the right direction is the improvements seen at Rhode Island Hospital in Providence. In November 2009, the hospital was facing a $150,000 fine from the state health department and an order to install video cameras in all of its operating rooms following reports of five wrong-site surgeries in 2 years.

Today, officials at the hospital say they have changed their ways and they have the safety record to prove it. There have been no wrong-site surgeries at the hospital in about 20 months, according to Dr. Mary Reich Cooper, senior vice president and chief quality officer for Lifespan Corp., which owns Rhode Island Hospital.

"We were able to show the front-line staff – as well as the surgeons and the patients coming into the hospital – that not only was safety our first priority, but we [also] were prepared to put a tremendous amount of resources into making safety our first priority," Dr. Cooper said.

Lifespan’s Rhode Island Hospital is one of eight hospitals and ambulatory surgery centers that are working with the Joint Commission’s Center for Transforming Healthcare on a project to reduce wrong-site surgery. As a result of that project, which started at Rhode Island Hospital in 2009, The Joint Commission has released a set of potential causes of wrong-site surgery and the targeted fixes that hospitals and surgery centers can use to eliminate them. The plan is to begin adding those interventions to a Targeted Solutions Tool, an electronic application that allows all accredited or certified organizations to access the information and customize it.

The results of the project will give hospitals and surgery centers around the country a road map for pinpointing and measuring their risks of wrong-site surgery, said Dr. Chassin. He advised hospitals to start reviewing risks at the very beginning of the process, when an operation is scheduled. The Joint Commission’s project revealed that in 39% of cases, errors that increased the risk of wrong-site surgery were introduced during the scheduling process.

The scheduling process is ripe for errors, Dr. Chassin said, because the person supplying the patient and procedure information typically works in the surgeon’s office and often is not directly affiliated with the hospital or center where the surgery will take place. If that person is dealing with many different hospitals and surgery centers, all with different processes and requirements, it’s easy to get confused and relay incomplete or inaccurate information, he said.

And the scheduling process is just one area identified by the Joint Commission as having potential for errors that could lead to wrong-site surgery. The eight pilot organizations, some of which have never had a wrong-site surgery in their facility, found risks in all phases of their surgical processes ranging from inconsistent procedures for marking the surgical site to omissions in the "time-out" process just before surgery.

"It turns out that this is a much more complicated problem than it might seem to be at first," Dr. Chassin said.

But developing specific fixes for each of those risks has helped to sharply reduce the chances of wrong-site surgeries at the eight pilot sites, Dr. Chassin said. For example, addressing documentation and verification issues in the preoperative holding areas decreased the percentage of cases with risks from a baseline of 52% to 19%.

At Rhode Island Hospital, efforts were made to improve the "time-out" before surgery. All other activities were stopped to allow operating room personnel to focus, and they used a script to ensure that all last-minute safety checks – such as asking everyone in the operating room if they could see the surgical mark – were completed, Dr. Cooper said.

The Joint Commission has been working on wrong-site surgery for a number of years, issuing Sentinel Event alerts in 1998 and 2001 and developing the Universal Protocol, a standardized approach to eliminating risks for wrong-site surgery.

Dr. Chassin urged hospitals and surgery centers to perform a systematic assessment of their surgical processes even if they haven’t had a wrong-site surgery. "The magnitude of the risk is often unknown," he said. "Health care facilities and physicians who ignore this fact, or rely on the absence of such events in the past as a guarantee of future safety, do so at their own peril."

The following are commonly identified errors from the Joint Commission – and their solutions:

• Error: Schedulers accept verbal requests for surgery information.

Solution: Use a single fax number for scheduling.

• Error: Someone other than the surgeon marks the site.

Solution: The surgeon marks the site in the preop area.

• Error: Time-outs don’t occur if there are multiple surgeons.

Solution: Complete separate time-outs for each new surgeon.

• Error: Staff isn’t empowered to ask questions.

Solution: Share data and let the team ask questions.

• Error: Staff rushes during patient verification.

Solution: Explain why standardized processes are important.

• Error: The briefing process is ineffective.

Solution: Do a preop briefing in the OR with the patient.

• Error: Staff is distracted during the time-out.

Solution: Perform a standardized time-out and stop all other activities.

For a full list of the 29 main causes of wrong-site surgery, go to the Joint Commission Center for Transforming Healthcare website.

Procedures performed on the wrong side of the body, the wrong site, and even the wrong patient continue to happen at a national rate as high as 40 times every week, according to Dr. Mark R. Chassin, president of the Joint Commission.

"Awareness about the problem has increased, but we clearly have to do more to get a lot closer to zero," he said during a recent teleconference.

One indication that things are moving in the right direction is the improvements seen at Rhode Island Hospital in Providence. In November 2009, the hospital was facing a $150,000 fine from the state health department and an order to install video cameras in all of its operating rooms following reports of five wrong-site surgeries in 2 years.

Today, officials at the hospital say they have changed their ways and they have the safety record to prove it. There have been no wrong-site surgeries at the hospital in about 20 months, according to Dr. Mary Reich Cooper, senior vice president and chief quality officer for Lifespan Corp., which owns Rhode Island Hospital.

"We were able to show the front-line staff – as well as the surgeons and the patients coming into the hospital – that not only was safety our first priority, but we [also] were prepared to put a tremendous amount of resources into making safety our first priority," Dr. Cooper said.

Lifespan’s Rhode Island Hospital is one of eight hospitals and ambulatory surgery centers that are working with the Joint Commission’s Center for Transforming Healthcare on a project to reduce wrong-site surgery. As a result of that project, which started at Rhode Island Hospital in 2009, The Joint Commission has released a set of potential causes of wrong-site surgery and the targeted fixes that hospitals and surgery centers can use to eliminate them. The plan is to begin adding those interventions to a Targeted Solutions Tool, an electronic application that allows all accredited or certified organizations to access the information and customize it.

The results of the project will give hospitals and surgery centers around the country a road map for pinpointing and measuring their risks of wrong-site surgery, said Dr. Chassin. He advised hospitals to start reviewing risks at the very beginning of the process, when an operation is scheduled. The Joint Commission’s project revealed that in 39% of cases, errors that increased the risk of wrong-site surgery were introduced during the scheduling process.

The scheduling process is ripe for errors, Dr. Chassin said, because the person supplying the patient and procedure information typically works in the surgeon’s office and often is not directly affiliated with the hospital or center where the surgery will take place. If that person is dealing with many different hospitals and surgery centers, all with different processes and requirements, it’s easy to get confused and relay incomplete or inaccurate information, he said.

And the scheduling process is just one area identified by the Joint Commission as having potential for errors that could lead to wrong-site surgery. The eight pilot organizations, some of which have never had a wrong-site surgery in their facility, found risks in all phases of their surgical processes ranging from inconsistent procedures for marking the surgical site to omissions in the "time-out" process just before surgery.

"It turns out that this is a much more complicated problem than it might seem to be at first," Dr. Chassin said.

But developing specific fixes for each of those risks has helped to sharply reduce the chances of wrong-site surgeries at the eight pilot sites, Dr. Chassin said. For example, addressing documentation and verification issues in the preoperative holding areas decreased the percentage of cases with risks from a baseline of 52% to 19%.

At Rhode Island Hospital, efforts were made to improve the "time-out" before surgery. All other activities were stopped to allow operating room personnel to focus, and they used a script to ensure that all last-minute safety checks – such as asking everyone in the operating room if they could see the surgical mark – were completed, Dr. Cooper said.

The Joint Commission has been working on wrong-site surgery for a number of years, issuing Sentinel Event alerts in 1998 and 2001 and developing the Universal Protocol, a standardized approach to eliminating risks for wrong-site surgery.

Dr. Chassin urged hospitals and surgery centers to perform a systematic assessment of their surgical processes even if they haven’t had a wrong-site surgery. "The magnitude of the risk is often unknown," he said. "Health care facilities and physicians who ignore this fact, or rely on the absence of such events in the past as a guarantee of future safety, do so at their own peril."

The following are commonly identified errors from the Joint Commission – and their solutions:

• Error: Schedulers accept verbal requests for surgery information.

Solution: Use a single fax number for scheduling.

• Error: Someone other than the surgeon marks the site.

Solution: The surgeon marks the site in the preop area.

• Error: Time-outs don’t occur if there are multiple surgeons.

Solution: Complete separate time-outs for each new surgeon.

• Error: Staff isn’t empowered to ask questions.

Solution: Share data and let the team ask questions.

• Error: Staff rushes during patient verification.

Solution: Explain why standardized processes are important.

• Error: The briefing process is ineffective.

Solution: Do a preop briefing in the OR with the patient.

• Error: Staff is distracted during the time-out.

Solution: Perform a standardized time-out and stop all other activities.

For a full list of the 29 main causes of wrong-site surgery, go to the Joint Commission Center for Transforming Healthcare website.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

A look at Washington state’s Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published July 7 in the journal Health Affairs (DOI: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

"Several states are using their Medicaid resources in a way that’s helping to reduce the need for more expensive hospital care," Dr. Gilmer said in a statement. "This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending."

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions, according to the study. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staff may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published July 8 in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: One to make it easier to determine patients’ health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician’s office staff seeks information on patient health care coverage, they may have to make their request in a different format for each health plan. But under the operating rules set out by Medicare, the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare & Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely from fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.