Global Health Budget Tracker Eases Funding Analysis

In August 2014, the Kaiser Family Foundation (KFF) launched a new interactive tracking tool designed to provide the latest data on the U.S. government’s global health funding budget in an easy-to-use format. The U.S. Global Health Budget Tracker is a regularly updated tool that enables users to monitor the entire budget process and budget trends, from the President’s budget request through the appropriations process in Congress, with dates ranging from 2006 to 2015. The tool tracks funding data for program areas such as HIV, Tuberculosis (TB), Global Fund, Neglected Tropical Diseases (NTD), Family Planning and Reproductive Health, and Malaria.

The user-friendly tracker has four menus from which to view funding information. Users can click on the Fiscal Year (FY) Snapshot (FY appropriations status), Agency, Program Area, and/or Initiative menus. Funding information is calculated in U.S. million dollar increments for each category.

Each page of the four menus has unique filter data features. The FY Snapshot contains a legislative financial comparison feature that allows users to analyze the difference in millions spent by the House and Senate and the difference between those amounts and the requested funding amount.

The Agency function breaks down what each federal agency, such as the Centers for Disease Control and Prevention (CDC) or Department of Defense (DOD), has allowed or will allow for each program area. For example, in FY 2015, USAID requested $330 million for HIV and $14.5 million for Vulnerable Children (VC) programs. Users may also choose all agencies’ budget data to compare in one window.

The Program Area highlights the dollar amounts certain agencies have funded or will fund per each global health problem. For FY 2015, using the same program areas as above, the DOD has not budgeted any funding for HIV, while overall agency requests for HIV funding in 2015 total approximately $4.9 billion. Overall agency requests for VC remained at $14.5 million.

The federal Initiative menu provides cumulative amounts for the President’s Emergency Plan for AIDS Relief (PEPFAR) budgets for HIV and the Global Health Initiative (GHI) budgets, which can be customized by either using a sliding scale to view varying time ranges between 2006 and 2015 or by selecting a two-year comparative button.

Each Agency and Initiative page provides informative historical background at the bottom of the page. The tracking tool is up and running. Those interested in U.S. health budget analysis should find the tool useful.

IOM Recommends Communication, Focus on Patient in End-of-Life Care

“Broad improvements to end-of-life care are within reach,” according to a report by the Institute of Medicine (IOM) titled  Dying in America: Improving Quality and Honoring Individual Preferences Hear the End of Life. The report notes that such improvements could enhance the quality of life through the end of life and can help to support a more sustainable health care system.

Person-Centered, Family-Oriented Care

The report notes that transitions between health care settings near the end of life “can fragment the delivery of care and create burdens for patients and families.” Thus, the demand for family caregiving is growing to include not just personal care and household tasks, but also medical and nursing tasks, such as the management of medication. The patients’ comfort is also of the utmost importance, as the study notes that palliative care, which helps aid symptoms, pain, and stress, “is associated with a higher quality of life, including better understanding and communication, access to home care, emotional and spiritual support, well-being and dignity, care at time of death, and lighter symptom burden.” Despite the benefits of palliative care, timely referrals to such care have not been widely adopted.

Clinician-Patient Communication and Care Planning

Patients near the end of life are often unable to make their own decisions about care, and those being given acute care are receiving treatment from physicians with whom they do not have a long-standing relationship. Advance planning helps to take into consideration patients’ values, goals, and preferences. The report states that frequent clinician-patient conversations as to these preferences can “ensure that patient and family decision making is based on adequate information and understanding.

Other Improvements

The report adds that professional education, public engagement, and programs integrating health care and long-term social services have the potential to reduce hospitalizations and costs and improve patients’ quality of life. With the “rapidly increasing number of older Americans with some combination of frailty, physical and cognitive disabilities, chronic illness, and functional limitations,” and due to the cultural diversity becoming more widespread in the U.S., end-of life care can be more responsive and more patient-centered.

 

Health Spending Sprung in Spring, But Not As Much as Expected

Health revenues increased steadily in the second quarter of 2014, yet the rise did not meet expectations of increased expenditures after the implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The numbers indicating a steady rise in services provided and payments collected by providers were based on data gathered as part of the U.S. Census Bureau’s latest Quarterly Service Report for the second quarter of 2014.

Census Report

The U.S. Census Bureau report contained quarterly estimates for selected service industries for the second quarter of 2014. Included in the selected industries was data for health care and social assistance. Specifically, the report concluded that, “the estimate for U.S. health care and social assistance revenue for the second quarter of 2014, not adjusted for seasonal variation, or price changes, was $565.6 billion, an increase of 3.0 percent…from the first quarter of 2014 and up 3.7 percent…from the second quarter of 2013.” Notably, it was recorded that while some sectors of the health industry saw significant growth, such as the increase of hospital revenue by 4.9 percent, other areas barely experienced any growth at all. For instance, the revenue increase in physician’s offices from the second quarter of 2014 compared to the second quarter of 2013 was just 0.6 percent.

Previous Projections

While the increases in revenue recorded by the Census Bureau were thought to describe an overall positive change in the health care spending arena, according to some projections the data was disappointing. A Kaiser Family Foundation article noted that increases were lower than what CMS and at least one non-profit health care spending organization expected. Indeed, earlier this month on September 3, 2014, CMS announced that it expected health care spending growth to “accelerate” and for 2014, it was estimated that the growth percentage rate would be 5.6 percent as 9 million more Americans will likely gain insurance through the expansion of Medicaid and by coverage through enrollment in the Health Insurance Marketplace.

Highlight on Louisiana: Treasurer Kennedy Gives the Lowdown on Health Care Spending in the Bayou

Louisiana Treasurer John Kennedy recently discussed the state employee health insurance program, state budgetary practices, state healthcare costs and what some consider “the lack of a healthcare funding plan and the state’s dependency upon the Obama administration to approve hospital privatization funding.” The entire  interview was conducted in a Google Hangout session. According to Kennedy, healthcare spending is the number one issue, and Louisiana needs to do some “wholesale reform in our healthcare delivery system.” Although the state has adjusted its spending, Kennedy believes those adjustments haven’t really solved the problem.

Louisiana has been using taxpayer money in the state savings accounts to fund the state’s health insurance program. It’s self-insured for health insurance, with retirees and employees paying in, with a state match. Approximately a year ago, the fund had five hundred million in it, but Kennedy predicts that if spending continues the way it is now, “in short order, it will be down to zero.” The state has spent” more than its taking in and trying to fill the hole by cutting higher education and spending all of the money.”

Currently, Louisiana is waiting for CMS to approve the state’s Medicaid plan, and its that plan or no plan. Kennedy indicated that negotiations between Louisiana’s Department of Health and Hospitals and the federal government over the plan. A recent Associated Press article reports that the Medicaid proposal, which analyzed the current performance of private managed-care networks handling Medicaid services, may have included “mathematical errors and inconsistencies” and used primarily self-reported data from the managed-care organizations that “the department didn’t appear to verify.” According to the auditors, “The report included global assertions about Bayou Health cost savings and improved outcomes … but support was not provided for these assertions.”

Louisiana Governor Bobby Jindal privatized much of the state Medicaid program in 2012, by shifting two-thirds of its patients to the insurance model. CMS wanted “details of whether the privatization delivered the improved health outcomes and cost savings that the Jindal administration promised for the multibillion-dollar Medicaid program.”

Louisiana’s other plan to save money on health care was to privatize charity hospitals. Kennedy believes that the quality of care is better now, but that Louisiana hasn’t yet realized the savings it had hoped for. So far, Kennedy said, “we haven’t saved any money, in fact, we’ve spend more than we were spending.”