The Tennessee Department of Children’s Services announced a pilot program to expand access to information and streamline communications between child services agencies across the state. The live test phase is scheduled for completion at the end of this month, where it will be released statewide to 5,000 users.

As part of a 28-month partnership with Dynamics Research Corporation (DRC) the state’s Dept. Of Children’s Services will replace its legacy system, TNKIDS, with the Tennessee Family and Child Tracking System (TFACTS). The new Statewide Automated Child Welfare Information System, or SACWIS, is designed to help agencies see individuals in the system as part of a more connected, family-focused whole, DRC’s chairman and CEO, Jim Regan, said.

“This statewide child welfare practice model will allow the Department of Children’s Services to provide better care to children and families in Tennessee through a greater focus on family reunification,” Mr. Regan said in a statement.

According to the company, twenty child service agencies in the Mid-Cumberland Region are already live testing the system. When launched statewide, TFACTS is designed to enable users to document and access case-specific information on intake, provider payment and closure details – all accessible from a central repository for case documents. Tom Kelly, DRC’s senior vice president and general manager for Systems Engineering and Information Technology, said, “By eliminating standalone, disjointed legacy systems, TFACTS will have a major impact on how Department and private providers carry out their daily mission of aiding children and families.”

According to HHS’s Administration for Children & Families, Tennessee is one of eight other states with SACWIS models in development. Nine states have elected not to implement SACWIS models, meaning they have not approached their child welfare case management according to HHS guidelines, and are not eligible to receive part of the more than $2.3 billion in approved SACWIS developmental project costs.

This will be DRC’s fourth automated case management system, the company said, including implementations in Colorado, Ohio and New Hampshire.

Colorado will be opening a new temporary insurance pool for people with pre-existing conditions. Under the plan, the state will offer coverage until new federal health care reforms beginning in 2014.

Colorado will be one of 30 states that have decided to start offering the temporary coverage ahead of federal requirements. Residents will have to have been uninsured for at least six months or longer and unable to obtain their own coverage because of their existing medical history.

Under the federal health care reform package passed earlier this year, insurers will no longer be able to deny coverage to individuals with pre-existing conditions. However, that rule won’t go into effect until 2014, leaving those people uninsured for another four years. In response to this effort some states are looking for ways to begin early with the understanding that the requirements mandated at the federal level will eventually take over. Pre-existing conditions aren’t the only areas where states are starting to get a jump start on health care reform. As CivSource reported last month, states like Pennsylvania are also looking at measures to keep rising premiums under control and are asking for federal help on Medicaid costs.

“Thousands of Coloradans are unable to get health insurance because of a pre-existing condition,” Gov. Ritter said. “I look forward to working together with our partners, Rocky Mountain Health Plans and CoverColorado, to provide Coloradans who have been denied coverage access to much-needed relief through this temporary insurance plan. This will be an important step toward improving the health security of Colorado families.”

As Congress gets set to break, a bipartisan group of Governors have joined together to ask Congress and the Obama Administration for an extension of the Federal Medicaid Assistance Percentages funding. The Governors say that without the extension, their states may be forced to make harsh cuts to already slashed budgets. As of now, the funding extension is still awaiting approval.

The ten Governors calling for the extension represent states of all sizes, from all regions of the US and both political parties. According to their statements, state budgets across the country are already cut so far that without an extension they may be forced to consider mass layoffs and other extreme measures. Medicaid costs, they say, are not a political issue but rather significant fiscal and economic issue that must be dealt with immediately.

The extension requested is on a temporary 6.2 % raise in federal Medicaid payments outlined in the stimulus package; the raise was larger in some states with very high unemployment. The funds haven’t come in yet and nearly 30 states assumed the funds when they passed their budgets. This has left some states scrambling to make up the gaps while still others have started cutting.

Medicaid makes up such a significant part of  budgets, that without the funds many high priority programs are likely to face significant cuts. Last week,  CivSource reported on the overall dire picture facing states when it comes to Medicaid funding. Without this money, things are only expected to get worse faster. Medicaid rolls have seen significant increases as the recession takes its toll, a figure that is only expected to get larger with the measures passed under health care reform.

The Senate may consider a bill after the Independence Day recess that would pass a six month extension on to the states. However, that may not be long enough for states with low revenues and high unemployment. The timing may be off as well, if Congress waits to take up the bill until after the holiday states may be forced into making cuts ahead of any new extensions. Both the House and the Senate have approved Medicaid funds twice before.

Deliotte has issued a new report – “Medicaid Long-term Care: The Ticking Time Bomb,” which examines the long term impact that unchecked Medicaid spending will have on state budgets. According to the report, without serious action from state governments’ cost obligations to Medicaid enrollees could take over 35% of discretionary budget spending over time. CivSource spoke with Robert N. Campbell Vice Chairman and Principal at Deloitte about the report’s findings.

Medicaid is the nation’s primary source of long-term care services, as well as one of the principal health care safety nets for numerous Americans and the passage of health care reform ensures that the program will only expand.  According to the report, if current trends continue, by the year 2030 state budgets will see Medicaid taking anywhere from 20-40% discretionary spending, much of this going to long-term care patients.  Campbell said that without urgency on this issue states could face some dire choices, “failure to innovate with medical and administrative best practices is likely to result in runaway costs, poor quality care and challenging fiscal budget holes for states.”

Deloitte’s Center for Health Solutions which authored the report, created four scenarios and tested them against the ten largest states, examining the resulting the cost trends.  The four scenarios covered actions ranging from doing nothing to a worst case of a 40% increase in enrollments and no cost cutting measures.  The result wasn’t exactly uplifting. The report shows that even with the new federal reforms states are in for a rough ride, “while the bill states that new Medicaid enrollees will be subsidized through 100 percent federal funds from 2014 to 2016, state budget deficits are projected to be more than $350 billion between 2010 and 2011, a dangerous fiscal scenario for which there is no short-term solution.”

Dr. Paul Keckley, one of the report’s authors underlined the lack of help for states going forward, “there is currently no coordinated, comprehensive system of the provision and financing for long-term care services in the United States. States are left to fend for themselves, and they will have to find ways to meet the demands of the health care reform bill with decreasing resources.”

Despite this grim picture, Campbell did point to some areas where states can have immediate impact or are already making strides. He sees significant opportunities in the emerging field of health care analytics – which looks at health trends over populations and makes recommendations based on those trends. He also said there may be more to learn from long term care waiver programs and personal care programs.

Although not directly covered in the report, I asked Campbell about the impact on public safety net care providers like clinics – he was quick to point out that the public safety net is an important piece of the puzzle and one that is experiencing its own changes.  “The public safety net is evolving through investments, in some cases that may mean an upgrade in capacity and care. In some cases it might mean more public-private partnerships or being sold to private concerns outright.”

Ultimately, states are going to have to start making choices about what to do early. Campbell put the report into perspective with this comparison, “if the largest state Medicaid programs were corporations, all of them would rank on the Fortune 500.”

The full report is available for download here.

Yesterday,  Connecticut Governor M. Jodi Rell announced that the state will be awarding $9.8 million in grants to support stem cell research projects at the University of Connecticut and Yale.  The money comes from the state’s Stem Cell Research Fund, created in 2005 to support research in this area.  Connecticut is only the third state in the nation to offer public funding for human stem cell research.

The Governor hopes that by offering the awards through the fund, that the bioscience industry will continue to grow in Connecticut. The Bioscience industry employs more than 18,000 people state-wide and adds more than $6 billion to the state’s economy through operations spending.

The Connecticut Stem Cell Research Advisory Committee is chaired by the state’s Public Health Commissioner Dr. J. Robert Galvin and reviews researchers’ applications annually.  The Committee received 89 applications this cycle and awarded nearly two dozen with grants.  Applications are considered against guidelines provided by the National Institutes of Health.

The grants are expected to fund the following projects:

• Reconstitution of human hematopoietic system by HSCs derived from human embryonic stem cells in humanized mice, Yale University, New Haven, Richard A. Flavell, Principal Investigator, $1,000,000.00
• Use of human embryonic stem cells and inducible pluripotent stem cells to study megakaryoblastic leukemia, Yale University, New Haven, Diane Krause, Principal Investigator, $1,000,000.00.
• Generation of hematopoietic stem cells and T-cell progenitors from human ESCs, University of Connecticut Health Center, Farmington, Laijun Lai, $1,000,000.00.

• Modeling Parkinson’s disease using human embryonic stem cells and patient-derived induced pluripotent stem cells, University of Connecticut Health Center, James Yuanhao Li, Principal Investigator, $992,500.00.

• Mechanical control of neural stem cell fate, Yale University, New Haven, Angelique Bordey, Principal Investigator, $947,975.00.

• Co-differentiation of hESC-derived retinal and retinal pigment epithelial progenitors, Yale University, New Haven, Lawrence J. Rizzolo, Principal Investigator, $832,608.00.

• Regulations of Lin28 in Human Embryonic Stem Cell Self-renewal And Differentiation, Yale University, New Haven, Caihong Qiu, Principal Investigator, $750,000.00

• Stem Cell Physiology and Chemistry Core, University of Connecticut Health Center, Farmington, Srdjan D. Antic, M.D., Principal Investigator, $500,000.00

• Maturation of human embryonic stem (hES) cell-derived cardiomyocytes in vitro using 3D engineered tissue model system, Yale University, New Haven, Lee, Principal Investigator, $200,000.00.

• The Role of Dormant Replication Origins in Ensuring Genome Integrity in Human Embryonic Stem Cells, Yale University, New Haven, XinQuan Ge, Ph.D., Principal Investigator, $200,000.00

• Regulating Caspase Activity to Enhance Differentiation Efficiency of Human Embryonic Stem Cells, University of Connecticut Health Center, Farmington, Xiaofang Wang, Ph.D., M.D., Principal Investigator, $200,000.00.

• Novel roles of long non-coding RNAs in human embryonic stem cells, University of Connecticut Health Center, Farmington, Li Yang, Principal Investigator, $200,000.00.

• Molecular mechanisms of germ layer induction in human embryonic stem cells, Yale University, New Haven, Efrat Oron, Principal Investigator, $200,000.00.

• Identification and characterization of multipotent cell populations from human adipose tissue for application in regenerative thereapies, Yale University, New Haven, Matthew S. Rodeheffer, Principal Investigator, $200,000.00.

• Efficient Gene Targeting in Human Embryonic Stem Cell via Recombineering Based Long Arm Targeting Vector, Yale University, New Haven, Chunsheng Dong, Principal Investigator, $200,000.00.

• The role of epigenetic factor-HP1 in regulating human embryonic stem cell pluripotency and differentiation, Yale University, New Haven, Ee-Chun Cheng, Principal Investigator, $200,000.00.

• In vivo Evaluation of Humans ES, IPS and Adult Brain Derived Neural Progenitor Cell Tranplantation and Migration Using MRI, Yale University, New Haven, Erik M. Shapiro, PhD, Principal Investigator, $200,000.00.

• Discovering treatments to prevent neurodegeneration in Huntington’s Disease using hESCs and patient-derived iPSCs, University of Connecticut Health Center, Farmington, Carolyn Drazinic, M.D., Ph.D., Principal Investigator, $200,000.00.

• Generation of a novel source of iPS cells for the treatment of osteoarthritis, University of Connecticut Health Center, Farmington, Rosa M. Guzzo, Ph.D., Principal Investigator, $200,000.00.

• To develop efficient methodologies to generate customized anti-tumor effecter T cells from human embryonic stem cells (hES) and induced pluripotent stem cells (iPS) by TCRengineering approach, University of Connecticut Health Center, Farmington, Arvind Chhabra, Principal Investigator, $200,000.00.

• Generation of layer V pyramidal neurons from human embryonic stem cells, University of Connecticut, Storrs, Radmila Filipovic, Principal Investigator, $199,945.00.

• Nuclear Receptor Control of Human Epidermal Stem Cells, University of Connecticut, Storrs, Brian J. Aneskievich, Ph.D., Principal Investigator, $199,894.00.

Yesterday, Pennsylvania Governor Rendell announced that the state’s Insurance Department will be launching an investigation into the pricing practices of Pennsylvania’s nine largest health insurers.  The investigation hopes to determine the reasons behind several controversial rate increases and whether or not those increases were driven by dubious health profiling tools.

Typically, rate increases have averaged 5-10% in the state however, some have seen annual increases in excess of 50%.  The Governor charges that these increases are being pushed through before federal reforms are in place in order to have the highest possible rates ahead of new regulation.  The state’s Insurance Commissioner Joel Ario said the investigation came about after market research, surveys and reports all suggested that insurers were expanding their use of individualized medical questionnaires and drug profiling – practices which influence rates and that many view as questionable.

Two companies Highmark and Independence Blue Cross were not included in the investigation because they do not use these tools.  The administration set up an agreement with Highmark to hold off on the introduction of such questionnaires and was hoping that agreement would temper the use of such tools in the market.

Pennsylvania is one of the weaker states when it comes to protections against rate increases for small businesses. Gaps in regulation like no caps on rate increases for groups with members who have serious health conditions leave the market vulnerable to such practices.

The Governor is pushing for legislation to limit increases and disruptive practices in the state’s health care markets before federal reforms take effect. “The stories coming in from disadvantaged groups are heartbreaking,” the Governor said. “I urge the General Assembly to give the commissioner the authority needed to stop these rate increases, or we’ll likely see a lot more disruption between now and 2014.”

At the federal level, HHS Secretary Kathleen Sebelius announced a new grant program this week that is aimed at helping states increase oversight of insurance premiums and rake hikes.  The grants will go to states that effectively show how the money will be used to develop or enhance their oversight processes.

Steve Rohleder, chief executive of Accenture’s Health & Public Service Operating Group, writes that the US perception of health care delivery has more in common with their international counterparts than one might think. According to a 16-nation, 16,000 person survey, common beliefs about the need for health care access and public engagement in health care spending decisions exist in almost every country.

It is striking to discover how much people around the world have in common when it comes to health care delivery. They share, for example, a perception that their governments should be doing more to make health care accessible to the most vulnerable, and that their governments do not engage them enough when it comes to setting priorities for health care spending.

We learned this in a 16-nation study we unveiled recently at the 2010 World Health Care Congress near Washington, D.C. The Accenture Citizen Experience Study (ACES) was conducted to examine people’s views about the quality of health care and government’s role in improving it. We surveyed more than 16,000 people (adults at least 18 years old) in Australia, Brazil, Canada, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Mexico, Norway, Singapore, Spain, the United Kingdom, and the United States.

We asked people questions on two dimensions – to rate the importance of specific actions related to their health care services, and how well their government is delivering on those actions. While there is great variation not only in the health systems, but also in the social, cultural and economic factors that determine people’s needs and expectations of government, the survey revealed a strong consensus among the participants about what they want from their health systems:

• Fair, easy access to health care for all is a concern for a majority of people, regardless of where they live;
• Citizens want their governments to intervene and help mediate when they have problems or difficulties with their health care;
• Citizens feel disengaged from the decision-making process related to health care; and
• People perceive large gaps between actions they value in health care and how well their respective governments work to ensure those actions happen.

These gaps are perhaps the most telling, and provide the best indication of where governments should concentrate their efforts. On average, 75 percent of respondents worldwide rate government help in resolving problems or difficulties in receiving health care as an essential or very important responsibility. Yet only 26 percent think their government is performing this well – a gap of almost 50 percent.

There are important differences among countries on more specific priorities. For instance, it comes as no surprise that in the United States, the cost of health care is a top concern, while citizens in many other countries list quality of care as their top issue.

People also draw a distinction between the impact of government policies on general health issues and individual health issues. Only two countries – Brazil and Ireland – prioritized the need for government to ensure that health services deliver real improvements in the health of the nation as a whole. Among the remaining locales, 70 percent rated this essential or very important, but not as important as other government actions. I take this to mean that while people value improved public health outcomes, they take a back seat to people having access to health services for themselves and their families and that everyone has the same opportunity to access quality health services when they’re needed.

It is easy to imagine how frustrated people are with their health care systems when they feel they have no voice in setting spending priorities or enlisting their government’s help in solving problems. Conversely, imagine what societies could gain if governments actively solicited their citizens’ views on what works and what doesn’t.

Our research represents a snapshot of citizen input and the message we heard is loud and clear – citizens want to be co-producers of public value to improve health care in their countries. Governments would be wise to take heed.

Despite being one of the states currently contesting federal health care reform, Virginia has announced a new statewide health care reform initiative designed to prepare the state for implementation of the law.  The state will start by creating a plan for Medicaid expansion, implementing in-state health insurance reforms and streamlining health care delivery.

The Initiative will take the form of a working group to be managed under the state’s Health and Human Services Secretariat. The Secretariat will also be appointing all members of the Initiative. The working group will be tasked with studying the impact of and establishing best practices for implementing federal health reform requirements and reporting back to the Governor.

According to estimates from Virginia’s Heath and Human Resources Secretariat, the planned Medicaid expansion will increase the number of enrollees in Virginia from 270,000 to 425,000 at a cost of $1.5 billion dollars.  The Health Care Reform Initiative will be responsible for auditing nationwide Medicaid practices, and making recommendations about the best way to implement the reform requirements in the state.  The Initiative will also be examining consumer driven reforms to the program.

Virginia is also creating a Health Insurance Exchange which will start activities in 2014.  The Initiative will be creating a plan for coordinating federally mandated insurance reforms as well as exploring alternatives to the required reforms and looking for ways to improve competition between health insurers.  This plan will also include measures for improving health care delivery through an audit of the state’s current health care infrastructure and using the findings to make recommendations on how to address gaps in the system, reform implementation and create of market incentives to lower costs and improve efficiency.

The first round of findings will be presented by the Initiative working group on September 30, 2010.  These findings are expected to focus on matters that will impact development of the Executive Budget.  The working group will submit recommendations on a yearly basis thereafter with a final report presented on January 10, 2014 – the year that many of the federal reforms will move into full implementation.

Speaking about the Health Care Reform Initiative, Secretary Hazel remarked, “Expanding access to reasonably priced high quality and safe health care is a bipartisan goal. The Commonwealth must make it easier for Virginians to be healthier and to purchase and retain health insurance. Virginia is one of many states challenging the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act.  However this lawsuit could take two to three years to be settled.  As we wait for court decisions, the Commonwealth must comply with the acts and begin preparing for implementation of federal health care reform.”

According to statements released from the company, IBM filed suit today seeking payment for work the company performed on the state’s welfare eligibility system. IBM says its short $125 million in fees and equipment expenses stemming from the 2006 $1.34 billion welfare modernization project.

Indiana Gov. Mitch Daniels said the state’s eligibility computer system was “broken” before completing a contract that would outsource most of the Indiana Family and Social Services Administration (FSSA) welfare duties. In 2006, IBM and subcontractor ACS were awarded a ten-year, $1.34 billion contract to modernize the way Hoosiers applied and received welfare benefits. But due to a series of early complications, a drastic uptick in welfare applicants and the tightest budgets seen since the Great Depression, three years later FSSA was still looking like the pre-contract agency, dealing with sizable backlogs in Medicaid, food stamp and TANF applications.

IBM was removed from its duties in October 2009 at the behest of the Governor and a growing outcry from politicians in Indianapolis. With IBM out of the picture, ACS assumed lead role in a new strategy that was to see a “hybrid” welfare system. This hybrid system will use much of the technology originally envisioned under the terms of the original contract, but it will use FSSA employees instead of outsourcing/ eliminating the human elements of the eligibility process.

According to FSSA administrator Anne Murphy, Indiana has paid IBM $437.5 million, in addition to $2.64 million in “disengagement costs” as of the end of March, receiving “minimal value” in return. But IBM officials claim that because this new hybrid system is using “IBM technology, infrastructure, applications, automated processes and systems,” it underscores the company’s “contributions to an improved welfare eligibility system in the State.”

IBM is asserting that by not covering expenses incurred at the outset of the project, when the company agreed to defer payment, Indiana is violating terms of the contract. Under the contract, payment of those expenses is owed to IBM if it is removed from the project “for any reason,” the company said.
In its court filing, IBM acknowledges that the contract gives Indiana the right to replace it as the lead contractor and that “All IBM seeks are those payments that the State promised would be paid to IBM in the event that the State chose to terminate.”

Despite the lost contract, the legal battles and the negative press, IBM is moving ahead with similar projects across the country – last week they landed another job with ACS as the prime in California. The duo will be partnering with CGI Group to modernize the state’s Medicaid Management Information System for a reported $1.6 billion.

Illinois Governor Pat Quinn announced two bills yesterday that would create a Health Consumer’s Bill of Rights and build on the recent federal health care reform legislation. Under the proposed legislation,  health care consumers in Illinois would be guaranteed a number of new protections, and the state would also form an expanded high-risk pool with approximately $200 million in federal funds that will be made available this summer.

The new rules outlined in the Health Consumer’s Bill of Rights are similar to many of those already outlined at the federal level, including guarantees on coverage for children with pre-existing conditions, and women’s access to obstetrical and gynecological care. As well as giving state residents health insurance rescissions that will be reviewed by the state, a protection currently offered to new home and automotive insurance policy holders. The bill also requires health insurers to publicly disclose information about premiums, health care costs, enrollment and claims.

The second bill aims to use federal funding to expand the state’s high-risk pool which provides affordable coverage for uninsured persons with pre-existing conditions and is required under the federal health insurance reforms law. The pool will be managed by the Illinois Comprehensive Health Insurance Plan.

The timing of both bills have been questioned by some given that the state’s legislative calendar is wrapping up this week. The Governor is also in the middle of a campaign fight against Republican candidate Bill Brady.

Several other states are currently working on plans or have opted out of handling high-risk pool requirements outlined in the federal health care reform law.