TCC was formed in 2013 to provide health care consulting services that improve the administration of health care, and ultimately health, in the United States. We are a small organization with a focus on state and federal health care programs in California.
TCC provides general management consulting services to the health care industry, including program and project management, process improvement, IT project oversight, analytics, and standards adoption.
Musings and News
The Fairness of Medicaid Expansion under the ACA 01-01-2017
As Congress and the new administration try to figure out what to do with the Affordable Care Act (ACA), it’s important to highlight one particularly impactful provision that's often overlooked: Medicaid expansion. Keeping kids on their parents plans until they are 26 is also terrific, but it’s insignificant in comparison.
Of the approximately 25 million individuals who gained insurance coverage due to the ACA, almost half have been through Medicaid expansion. Those are, of course, individuals in the 29 states that decided to expand – an easy choice for many states since it meant billions of dollars in federal spending with comparatively small state outlays. Although Medicaid eligibility rules remain far too complex, the ACA brought some simplicity, elegance, and I think fairness to at least part of the criteria: all individuals below the poverty line are now eligible. It has always been more politically acceptable to provide government sponsored health care to poor children and their mothers, or even fathers in low-income families, but the pre-ACA rules excluded the poor who were not eligible in some other categorical way. As a result of the ACA, many more childless adults (most of them men) are now eligible for free health care. It always struck me as unfair that they were not previously eligible, and apparently the authors of the ACA agreed.
With the future of the ACA uncertain at best, I worry most about this group of individuals who earn less than $16,390 per year losing their health care coverage. In California, that’s almost three million people that are now covered due to the ACA, double the approximately 1.4 million that gained coverage through the Covered California plans. It’s not cheap – roughly $5,000 per person or $50 billion in federal spending nationwide, but we probably should have been doing it all along, at least if we believed in subsidized health care for the poor. If we don’t have the money, let’s reduce the spending in some other way, but let’s do it in a way that more evenly impacts all low-income individuals.
The Role of Public Purchasers 07-01-2016
Public purchasers, such as State Medicaid Agencies, state employee health benefit plans, and insurance exchanges, account for a huge percentage of health care purchased in a state – sometimes approaching 50%. When combined with other public benefit programs (e.g., health, housing, food assistance, social services, etc.), states have a tremendous opportunity to shape how services are paid for and delivered. Realizing the vision of the Medicaid Information Technology Architecture (MITA) framework, of interconnected systems across public benefit programs, would yield far-reaching benefits for the people served by these programs and for the taxpayers who fund them.
Why Standards in Health Care Matter 06-01-2016
The United States offers the most clinically advanced medical care in the world and spends more per person than other countries. Unfortunately, too much of that spending is inefficient and health care outcomes and other measures of health status lag behind those of other nations. One area of potential improvement is in the administration, or business, of health care – if organizations can realize the administrative simplification improvements originally intended by HIPAA and subsequent national efforts, administrative efficiencies would translate to better care and outcomes for patients. Health care information could be more easily shared and accessed by providers at the point of service. Members could access their treatment history, monitor their conditions, and share information with providers. Health plans could have access to more complete and timely information to help manage their members’ health. In these and other ways administrative simplification serves an important role towards achieving a better, transformed health care system.