Health Affairs

Mark Grube, Kenneth Kaufman and Robert York’s analysis of the decline in hospital utilization rates leads the Health Affairs Blog most-read list for March. Also on the top-ten list are articles on: the human face of hospital readmissions by Risa Lavizzo-Mourey; the impact of the Affordable Care Act by Kathleen Sebelius; the health care workforce by Thomas Daschle; and physician payment reform by Bill Frist and Steven Schroeder.

The most-read list also includes David Muhlestein’s survey of the accountable care organization landscape; Diane Archer’s discussion of the effects of concentration in the health care market, and Jesse Singer’s look at the use of electronic health records by the New York City Primary Care Information Project. Also among the top ten are Tim Jost’s article about the role of federally facilitated and partnership exchanges; and an article by Sara Rosenbaum and Joel Teitelbaum on the impact of the Essential Health Benefits rule on persons with disabilities.

Among its myriad elements, the Affordable Care Act contains a breakthrough provision that, if implemented, could dramatically alter the way that health insurance coverage works for persons with disabilities. [PPACA § 1302(b)(4)(B)] This provision applicable to health insurance products sold in the individual and small group markets and therefore subject to the essential health benefits (EHB) coverage standard, requires the Secretary of Health and Human Services to bar the use of insurance coverage rules that discriminate on the basis of disability. See

However, final EHB rules issued on February 20^th, 2013 effectively leave this ban unimplemented. A draft CMS document made available to the public on February 21 by Inside Health Policy suggests that the agency will monitor qualified health plans (QHPs) for potential discrimination. But the monitoring process suggested in the draft excludes any mechanism for detecting one of the most potent forms of plan discrimination, the use of benefit designs and coverage determination procedures that cause the denial of coverage for children and adults whose disabilities prevent them from “recovering” from their disability. Whether the ACA protections are left unimplemented remains to be seen.

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines efforts to better manage and coordinate care of more than nine million Americans covered by both Medicare and Medicaid, also known as dual eligibles. This heterogeneous group includes the sickest and most vulnerable adults, many with complex chronic medical or... Read the rest of this entry »

Research and analysis in the newly released June 2012 issue of Health Affairs, supported by a grant from The SCAN Foundation, emphasizes the need to develop new ways of paying for and providing care for the roughly 9 million Americans who are eligible for both Medicare and Medicaid benefits because of age, income, and/or disability.... 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 »

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 »

The federal government is spending a lot to support working-age people with disabilities. Federal outlays in fiscal year 2008 for this population totaled $357 billion – representing 12 percent of all federal spending.  By way of comparison, the federal government spent $616 billion for national defense in the same year. States spent another $71 billion on federal-state... Read the rest of this entry »