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Survey Says … Attendees Respond During NWRPCA’s 2015 Spring Conference

Monday, June 22, 2015   (0 Comments)
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By Adele Allison

Director, Provider Innovation Strategies, DST Health Solutions


Question: During the NWRPCA Spring Primary Care Conference, I attended one of your sessions where you polled the audience on a number of questions.  Will you share the results?



Answer: Absolutely! And, thank you for your participation.


Admittedly, much of my personal study of the industry is focused at the federal level and the intent of legislation and policy in transforming healthcare as a country. Because of this, the nuances of implementation change within a state – at a more local level – often get lost. In an effort to make discussion more relevant to the Northwest, during several sessions attendees were asked to engage by answering survey questions on their smartphones.


Pre-Conference Board Member Session We started on Saturday, May 16, 2015,  when I had the honor of speaking with the CHC board members. Prior to the conference, I had the pleasure of connecting with local PCA experts in each Region X state to obtain their insight on ACA-related issues. Here are the results:



In your state, which of the following healthcare business trends stands to have the greatest overall impact in 2015? Choices:

  • Advances in Health IT
  • Patient Consumerism
  • Effects of the Economy
  • Affordable Care Act (at large)
  • Increased Consumer Cost-Sharing
  • Population Health and Wellness Initiatives
  • Government Funding Cuts)


State-level PCA responses

CHC Board Member responses

Advances in Health IT 5.60%

Patient Consumerism 11.10%

Effects of the Economy 38.90%

Affordable Care Act 11.10%

Increased Consumer Cost-Sharing 11.10%

Population Health and Wellness Initiatives 0.00%

Government Funding Cuts 22.20%


We also asked this question of other attendees, slightly modified, at a later session as relates to their clinics, and here’s what they said:

Advances in Health IT 31.60%

Patient Consumerism 5.30%

Medicaid Expansion 21.10%

Population Health Management 15.80%

Funding Cuts 0.00%

Alternative Payment Models (E.g., Capitation) 26.30%



Which of the following ACA healthcare reform provisions will most impact your state in 2015 (to the positive/negative)? Choices:

  • ACO Development
  • Health Insurance Marketplace
  • Extension of Dependent Coverage
  • EHR Development
  • Guaranteed Coverage
  • Medicaid Eligibility Expansion
  • Alternative Payment and Care Models/Methods


State-level PCA responses


State PCA respondents were asked to rate each category on a scale of 1-5, with 1 being no impact and 5 being significantly impactful:


CHC Board Member responses

ACO Development 12.50%

Health Insurance Marketplace 8.30%

Extension of Dependent Coverage 8.30%

EHR Development 8.30%

Guaranteed Coverage 4.20%

Medicaid Eligibility Expansion 33.30%

Alternative Payment and Care Models (Methods) 25.00%




In 2015, who will be the economic winners (better off) and losers (worse off), or the same by this time next year?


State PCA responses

CHC Board Member responses

Who will be economic winners


Patients/Consumers 24.00%

Employers 16.00%

Health Plans 20.00%

Medicaid 4.00%

Medicare 0.00%

Hospitals 16.00%

Physicians/Providers 16.00%

Caregivers 4.00%


CHC Board Member responses

Who will be economic losers

Patients/Consumers 27.30%

Employers 22.70%

Health Plans 22.70%

Medicaid 4.50%

Medicare 4.50%

Hospitals 13.60%

Physicians/Providers 0.00%

Caregivers 4.50%



Open-ended Questions: Barrier to Success

Board member attendees were also asked a few open-ended questions, which were placed into a word-cloud – the larger the word, the more people who responded with this answer. Here are the “cloud” responses:


What is the biggest barrier to success in improving quality and lowering costs of coverage in your state?



What is the biggest barrier to success in improving quality and lowering costs of coverage in your clinic?


Open-ended Questions:Value-based Design

State PCA experts were also asked to provide an understanding of a few other areas, which I will share in this accounting. One such area centered on value-based design in benefits to patients and payment methodologies to providers (e.g., reduced copayment for some chronic disease medications such as diabetes or asthma; bundled payments, capitation, etc.). As part of healthcare reform, value-based design in health plan benefits and provider reimbursement is emphasized by ACA and increasing around the country. When asked what the trend was in their individual states, here is how they responded:



It is Increasing – Alaska is beginning to see them. For example, the state employee health plan encourages travel for care outside of AK to save money. Moda is also looking to start value-based payment (VBP). They want to start a pilot. Although Medicaid is not getting into it yet, they are starting to look at it.



It is increasing - If anything it will increase, but the pace remains to be seen because ID is in its infancy when it comes to adopting new methodologies.



Capitation is increasing; Nine out of 30 CHCs are participating in alternative payment models. Coordinated Care Organizations (CCOs) have been playing with capitation rates independent of the alternative payments. Also, prenatal bundling pre-existed ACA. Benefit design is also changing – PEBB (Public Employee Benefits Board) started to roll-out plans with a lowering monthly premium if you complete a health risk assessment.



It is increasing - Within Medicaid, they have had full capitation with some plans and FFS for others. The future will move towards VBP, but it is hard to predict exactly when, who and how. The State allows full capitation for Medicaid, but then adds reconciliation on the back-end (starting in 2008) to a fee-for-service equivalency. Most CHCs have to give money back. It completely undermines the capitation/risk-bearing model and has developed frustration across the Medicaid provider communities.



Open-ended Questions: Health Homes and Accountable Care

PCA experts were also asked about the prevalence of both health homes and accountable care organizations (ACOs) in their state. Here is how things are trending by state:



Neither is dominant, but a lot of folks are working on the health home model.



High Prevalence of Health Homes – All FQHCs are health homes in ID. Low prevalence of ACOs –There are very few ACOs.



High prevalence of Health Homes – Within the state, there is an Oregon-specific recognition program; HRSA also recognizes this program. There are also 17 Medicaid Coordinated Care Organizations (CCOs) – a hybrid of the ACO model. CCOs define their own geographic region with no more than 2 allowed to exist in a given geographic area. CHCs may belong to more than 1 CCO, which creates administration issues. Patient attribution is a challenge because of this.



High prevalence for Health Homes – around 80% of CHCs are health homes with most facilitated through NCQA or AAAHC accredited. Medicaid has created Accountable Communities of Health (ACHs) – an ACO hybrid. Today there are 10 regions for ACHs with 3 having county boundaries in the more heavily populated areas. Medicaid’s goal is to place ACHs in each region by 2020. Understanding the elements and how providers will participate is central to discussions.


General Sessions Surveys

Throughout the conference, additional surveys were launched related to health IT, patients and even Congress. Here is what you said:


Which therapeutic areas need more technical support? 

Cardiovascular Disease and Diabetes 17.40%

Behavioral Health 21.70%

Substance Abuse 8.70%

Oral Health 4.30%

Overall Population Management 47.80%


What is your biggest barrier to health IT adoption and use?

Time and Resources 41.70%

Culture Change Management 25.00%

Financial 12.50%

Setting Priorities 4.20%

Technology Limitations (E.g. Internet) 16.70%


Which of the following is operational in your practice?

Patient Engagement Strategy 17.50%

Health Information Exchange 12.50%

Immunization Interface 27.50%

Lab Interface 30.00%

PACS Interface 10.00%

Device Interface 2.50%


Which of the following is the biggest barrier to patient adherence in your practice?

Work, school or caregiving commitments 24.30%

Lack of time 8.10%

Transportation Issues 10.80%

Distrust of clinicians 0.00%

Privacy concerns 5.40%

Financial issues 37.80%

Lack of interest 5.40%

Other 8.10%


Which of the following ACA healthcare reform provisions will most impact your clinic in 2015?

ACO/Hybrid Development 31.80%

Health Insurance Marketplace 9.10%

EHR Interoperability 31.80%

Medicaid Expansion 22.70%

Guaranteed Coverage 0.00%

Individual Mandate 4.50%


Over the past 5 years, which of the following changes have occurred in your organization as a result of healthcare reform?

Population Health Management 30.60%

Become a Health Home 30.60%

Increased Patient Engagement 8.30%

Embracing Alternative Payment Models 11.10%

Advanced Data Analytics 8.30%

Using Direct Messaging or HIE 11.10%


Where is your organization in adoption and use of interoperability technology(ies)? (Note: there was low attendance at this session)

Interoperability?! 0.00%

We are working on it 66.70%

We have successfully tested 33.30%

We are actively using Direct 0.00%

We are connected to an HIE 0.00%


We also built a few word-clouds from open-ended questions among conference attendees, as follows:


What is the action Congress most needs to take during the 114th session?


What are you currently doing to engage patients?


What are your top 3 concerns this year?




Again, thank you for your participation. I hope to see you in October in Seattle for the 2015 Fall Primary Care Conference!



Do you have a question? Let us know! Contact membership@nwrpca.org to submit your questions to “Ask Adele.”


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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