CBO Report, ACO Contract, HRO at NWH, and more...

CBO Report: Short-Term, Long-Term Effects of Subsidy Cuts

If the Trump Administration ends the Affordable Care Act’s cost-sharing reductions that help insurance companies provide lower income people with more affordable plans, premiums for that population would increase 20% in 2018, and the number of uninsured would rise by about 5%, according to the Congressional Budget Office (CBO) report issued this week.

But CBO noted that when premiums rise for the affected population tax credit amounts would also increase because the tax credits are linked to rising premiums. Therefore, CBO said, affected people would experience a wash but the government through the increased tax credits would see the deficit rise by about $194 billion from 2018 to 2026.

Also, while the number of people living in areas with no insurance would increase over the next two years, by 2020 that number would be about the same as now.

The Administration’s mixed messages about whether it will extend the cost-sharing reductions has caused turmoil in the insurance market, with insurers – which favor the CSRs – saying they need some sort of certainty to set rates. The administration has been extending the CSRs on a month-by-month basis; at this point they only exist through the end of August with a decision on extending them further expected as soon as next week.

The full CBO report is here.

Final Contracts Okayed for Sweeping MassHealth ACO Program

On Wednesday contracts for the MassHealth Accountable Care Organization (ACO) program were finalized between the state and 17 ACOs. The massive shift of the MassHealth program from fee-for-service to the ACO model is the most sweeping change to the MassHealth program in a generation.

The ACO program is the centerpiece of the state’s five-year Medicaid waiver that was approved by the federal government in November 2016.  Throughout that waiver process, and since its inking, MHA and the hospital community have been working with the state to work out the fine details of how the ACO model would work and how to minimize the significant uncertainty and risk for organizations participating in it.

The 17 ACOs are as follows:
1.       Atrius Health with Tufts Health Public Plans
2.       Baystate Health Care Alliance with Health New England
3.       Beth Israel Deaconess Care Organization with Tufts Health Public Plans
4.       Boston Accountable Care Organization with Boston Medical Center HealthNet Plan
5.       Cambridge Health Alliance with Tufts Health Public Plans
6.       Children's Hospital Integrated Care Organization with Tufts Health Public Plans
7.       Community Care Cooperative, an organization of 13 federally qualified health centers.
8.       Health Collaborative of the Berkshires with Fallon Community Health Plan
9.       Lahey Health
10.     Mercy Health Accountable Care Organization with Boston Medical Center HealthNet Plan
11.     Merrimack Valley ACO with Neighborhood Health Plan
12.     Partners HealthCare ACO
13.     Reliant Medical Group with Fallon Community Health Plan
14.     Signature Healthcare Corporation with Boston Medical Center HealthNet Plan
15.     Southcoast Health Network with Boston Medical Center HealthNet Plan
16.     Steward Medicaid Care Network
17.     Wellforce with Fallon Community Health Plan.

This week, the UMass Memorial Health Care system, which had been working to create an ACO in Central Massachusetts announced that it would be withdrawing its proposal after finding that the financial risks were too great.

QUALITY CORNER: Newton-Wellesley Hospital’s Journey to High Reliability

Newton-Wellesley Hospital’s poster presentation on the hospital’s journey to become a high-reliability organization (HRO) was featured last month at the Health Research and Educational Trust (HRET) Hospital Improvement Innovation Network (HIIN) The Journey Ahead national conference in San Diego. The HRET/HIIN conference preceded the American Hospital Association’s leadership conference.

HIIN comprises 32 state hospital associations, including MHA, and more than 1,600 hospitals collaborating to reduce inpatient harm and readmissions. For participating hospitals, HIIN provides, among other benefits, guidance and assistance for becoming an HRO.

High-reliability organizations operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. To become an HRO, an organization does not merely follow certain best practice processes for improving safety, but also changes its culture, ensuring that everyone on staff is ever-mindful of the need to relentlessly prioritize safety.

Newton-Wellesley’s presentation outlined its challenges—executive leadership changes and solid but stagnant patient experience and staff engagement scores—and the following steps taken toward becoming an HRO:

Dr. Michael R. Jaff, who became Newton-Wellesley Hospital president in October 2016, immediately made the delivery of high-quality, safe care with a great experience a primary strategy for the hospital. To achieve this strategy, Dr. Jaff focused the team on high-reliability and the elimination of harm.
Jaff created two new positions—Chief Quality & Experience Officer and Associate Chief Quality Officer, VP of Patient Experience and Medical Staff Services—to lead the high-reliability strategy.
Newton-Wellesley leveraged other hospitals in the Partners HealthCare System that had already undertaken the high-reliability journey to learn about their experiences. A core team at Newton-Wellesley then drew up strategic plans for each component of the HRO framework, along with a roadmap for implementation of each tactic.
Throughout the process, the hospital participated in MHA’s Clinical Issues Advisory Council and the MHA-led HIIN. It completed the Joint Commission’s Center for Transforming Healthcare ORO 2.0 tool to assist with further defining the roadmap.
Newton-Wellesley also added Patient Family Advisory Council members to the Patient Safety Steering Committee, and the Experience/Engagement Work Group.
The Newton-Wellesley team underscored the following key takeaways:
First and foremost, the journey toward HRO has no end; rather it is a continuous, never-ending journey.
Top leadership needs to make HRO a focus.
It’s important to set the quality goal as “zero harm.”
It is imperative to develop a “roadmap” for implementation and to use robust process improvement tools to hold leadership and staff accountable.
Adding patient and family advisory council members to the process through active participation in key committees also proved invaluable to Newton-Wellesley’s effort.

AHRQ Safety Program for Improving Antibiotic Use

The Agency for Healthcare Research and Quality (AHRQ), in conjunction with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and NORC at The University of Chicago has created a safety program for improving antibiotic use.  The program will help hospitals develop and implement a bundle of interventions designed to improve antibiotic stewardship and antibiotic prescribing practices.

While antibiotics are inarguably helpful to humanity, they also have the potential to cause patient harm, including allergic reactions, Clostridium difficile infections, and antibiotic resistance for society as a whole.

Acute-care hospitals across the United States and Puerto Rico can now register for this 12-month project, which begins in December 2017. Learn about participating by clicking here.  Future cohorts are planned for long-term care facilities (beginning December 2018) and ambulatory and urgent care facilities (December 2019).


Fairlawn Rehabilitation Hospital has named Mary Louise D'Avino as CEO. She replaces David Richer who left Fairlawn earlier this summer. D’Avino is the founder and administrator of OmniTherapy Center in Bloomfield, N.J., and most recently was associate administrator at HealthSouth City View Rehabilitation Hospital in Fort Worth, Texas.

2017 Lean in Healthcare Certificate Program at Lahey Health

Starting: Thursday, September 21, 2017
(8 sessions total); 8:30 a.m. - 4:30 p.m.
Lahey Health, Burlington, Mass.

In this program, participants will learn the fundamentals of continuous improvement in a classroom setting. They will then work in teams to apply the principles and tools of continuous improvement in an actual healthcare process at Lahey Health in Burlington, Mass. Each day participants will be introduced to appropriate best practices to address the challenges facing healthcare professionals. This learn-by-doing method will prepare students to return to their own workplaces with the confidence to implement continuous improvement methodologies. This essential program was developed to provide the healthcare professional with the knowledge and experience needed to effect positive change within their own organizations. The program will be held Lahey Health so that a combination of classroom instruction and learning by doing can take place. Visit here for details.

John LoDico, Editor