Health Affairs

This week’s Health Wonk Review is available at the Disease Management Care Blog, where Jaan Sidorov offers great write-ups of a very interesting collection of posts. Jaan is kind enough to include a Health Affairs Blog piece about a shared savings program started in 2007 by Blue Shield of California, CalPERS, Hill Physicians Medical Group... Read the rest of this entry »

On Tuesday, June 5, Health Affairs will hold a briefing to discuss its June 2012 issue, “Focus On The Care Span For The Elderly And Disabled.” The volume explores a wide range of topics — from avoidable hospital admissions and readmissions, to coordination of care for dual eligibles, to reforming Medicare payment for skilled nursing... Read the rest of this entry »

More than 11 million Americans below the age of 65 are now covered by private individual health insurance plans. A new study, released yesterday by Health Affairs as a Web First, measures the actuarial value (the percentage of medical bills an insurance company pays) for a sample of 2010 health plans offering group and individual... Read the rest of this entry »

Editor’s note: Kathryn Gilbert, a J.D. candidate at the University of Michigan Law School, is a coauthor of this post, in addition to Jill Horwitz and Helen Levy (photos and linked bios above). The case that will decide the fate of the most important piece of health care legislation in the past fifty years has,... Read the rest of this entry »

As Integrated Delivery Networks (IDNs) assess the financial implications of accountable care, six key variables deserve special attention. These variables are unique because they will shape both the accuracy of future financial projections and begin to set the broader strategy for the ACO. Variable 1: The Halo Effect. As IDNs shift utilization patterns of their... Read the rest of this entry »

At the heart of the Affordable Care Act (ACA) health care reforms are the premium tax credits, which will extend health insurance coverage to 18 million lower and middle-income Americans.  The idea of using tax credits to purchase private health insurance for the uninsured is one of a number of the historically conservative policy positions... Read the rest of this entry »

Currently, individual health insurance typically has less generous benefits than employment-related insurance. However, under the Affordable Care Act, individual insurance will probably become more generous and more like employment-related insurance. For a Health Affairs May 16 Web First study, Steven Hill of the Agency for Healthcare Research and Quality compared out-of-pocket spending on health care... Read the rest of this entry »

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the... Read the rest of this entry »

On May 16, 2012, the Department of Health and Human Services moved three steps closer to the implementation of the Affordable Care Act’s health insurance exchanges, which will happen on January 1, 2014.  First, HHS announced the award of 5 new level 1 exchange establishment grants (Illinois, Nevada, Oregon, South Dakota, and Tennessee) and one... Read the rest of this entry »

On April 29, 2012, four days after his 74th birthday, Larry Lewin (pictured below) died from complications of an underlying cancer. The funeral was May 1 and his wife, Marion asked me to speak briefly about his professional life. What follows is adapted from those remarks. It will be obvious that anyone who knew Larry... Read the rest of this entry »

Editor’s note: For more on the adoption of electronic health systems, see these recent Health Affairs articles by Decker and coauthors, DesRoches and coauthors, and Hsiao and coauthors, which were discussed at an April 25 event. Since the American Recovery and Reinvestment Act passed in 2009, healthcare professionals, researchers, analysts and policy makers have been... Read the rest of this entry »

Background:  The Centers for Medicare and Medicaid Services’ designation of 32 accountable care organizations (ACOs) across the U.S. to enroll Medicare fee-for-service patients beginning in 2012 makes ACOs an important feature of the national healthcare landscape–at least for publicly insured patients.However in 2007, Blue Shield of California, along with provider and employer partner organizations, began... Read the rest of this entry »

In a recent Health Affairs paper, we documented that the United States has a significant survival advantage over much of Europe when it comes to cancer: 1.8 years for those diagnosed during our study window.  Furthermore, we showed over a 17-year period that this gap had widened, not narrowed, and that this widening was more... Read the rest of this entry »

The two most significant—and controversial–Affordable Care Act (ACA) insurance reforms of 2012 are the minimum medical loss ratio (MLR) rebate and the summary of benefits and coverage (SBC) requirement.  On Friday, May 11, 2012, further regulatory guidance was released on both of these initiatives. Tidying Up The MLR Rules The minimum medical loss ratio requirement... Read the rest of this entry »

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines trends in workplace wellness programs and the potential impact of provisions of the Affordable Care Act of 2010. About two-thirds of companies that offer health benefits to workers also provide a wellness program, such as health-risk assessments and screenings for... Read the rest of this entry »

On May 9, 2012, the Center for Medicare and Medicaid Services released proposed regulations to implement section 1202 of the Health Care and Education Reform Act of 2010. Section 1202 increases Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates, with the additional... Read the rest of this entry »

Knee osteoarthritis is a common ailment—and treatment is expensive: in 2008 total knee replacement inpatient costs in the United States exceeded $9 billion—the highest among the ten procedures for which demand is growing the fastest. A new study, released today as a Web First by Health Affairs, compares operating times, hospital lengths-of-stay, discharge dispositions, and... Read the rest of this entry »

If one were to try and identify what issue has most roiled the biomedical community in the past few months it is surely the effort to censor two papers describing genetic modifications of the H5N1 flu virus. Background.  Last December, the U.S. National Science Advisory Board for Biosecurity (NSABB) was asked by the U.S. National... Read the rest of this entry »

To calculate physicians’ fees under Medicare—which in turn influence private payers’ decisions on how they will pay doctors—the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of a controversial advisory panel known as the RUC (the Relative Value Update Committee), which mainly represents a broad group of national physicians’ organizations. In recent... Read the rest of this entry »

A recent spate of commentaries on the continuing health spending moderation raise an important policy question:  If the cost curve is well and truly bent, why are we investing so much of our policy energy on bending it further, when the more pressing problem is the declining percentage of Americans that can afford our health... Read the rest of this entry »