http://healthaffairs.org/blog The Policy Journal of the Health Sphere Tue, 21 May 2013 19:38:38 +0000 en-US hourly 1 http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/?utm_source=rss&utm_medium=rss&utm_campaign=implementing-health-reform-progress-but-much-work-remains http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/#comments Thu, 25 Apr 2013 14:26:06 +0000 Timothy Jost http://healthaffairs.org/blog/?p=30413 stakeholder calls in every state where a federal exchange (now called a “marketplace”) will be established. It is also locating navigator programs, signing up insurers, and preparing for the October 1, 2013 beginning of open enrollment. The states have also been very active, either trying to implement their own state exchanges and the 2014 ACA market reforms or doing everything they can dream up to keep implementation from moving ahead.

Final rules have been issued governing the exchanges, the 2014 market reforms, the premium tax credits, and the premium stabilization programs, while guidance has been issued on the federal exchanges and the navigator program. Final rules on Medicaid eligibility and appeals are expected shortly. A public hearing was held on April 23, 2013 regarding the proposed employer responsibility regulations, while another will be held on May 29, 2013 reviewing proposed individual responsibility regulations. Final rules will follow in due course. In sum, implementation is progressing, although a lot of ground must be covered between now and 2014.]]> http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/feed/ 2 http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/?utm_source=rss&utm_medium=rss&utm_campaign=rachael-fleurence-on-patient-engagement http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/#comments Wed, 03 Apr 2013 19:15:32 +0000 Rachael Fleurence http://healthaffairs.org/blog/?p=29805 In today's Q and A on Patient Engagenment, we feature Rachael Fleurence, a Senior Scientist at PCORI where she leads the research prioritization initiative to help identify important patient and stakeholder generated questions and establish a rigorous research prioritization process to rank these questions. (Also, check out her recent blog post and follow the link to her February Health Affairs article here.)]]> http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/feed/ 0 http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/?utm_source=rss&utm_medium=rss&utm_campaign=reflections-on-the-federal-budget-resolutions http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/#comments Thu, 21 Mar 2013 12:53:37 +0000 Uwe E. Reinhardt http://healthaffairs.org/blog/?p=29573
Alas, for governance, the President has missed that deadline for fiscal 2014 (starting in October 1, 2013). He is likely to submit a budget only by early April – two months late. In the meantime, both chambers have worked up their own budget resolutions, without the President’s budget as a starting point. It shows, because the tax- and spending numbers in these two budgets, and the visions for America they reflect, differ so starkly that it is hard to imagine the emergence of a joint conference report reconciling the two budgets in one that could pass both chambers.

But all is not lost. At least the American people now have before them the visions the two parties have for our country, especially in regard to health policy.]]> http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/feed/ 1 http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/?utm_source=rss&utm_medium=rss&utm_campaign=ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/#comments Wed, 13 Mar 2013 15:33:46 +0000 Jesse Singer http://healthaffairs.org/blog/?p=29197 Health Affairs (“What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology”) about the unrealized promise of health IT to lower costs and improve care.

Electronic health records (EHRs) are a tool, not a solution. But our experience at the New York City Department of Health and Mental Hygiene with the Primary Care Information Project (PCIP) demonstrates that with the proper support, EHRs can be a powerful tool for improving clinical care and managing population health. Now we are about to turn another corner on our journey, to see if we can use the data we collect from New York City EHRs to paint an accurate picture of the population at large.

Since 2005, PCIP has helped more than 3,200 providers implement EHRs, and we currently provide assistance to more than 7,700 providers in New York City. Our staff members help with everything from choosing an EHR to billing, coding, and documenting workflows, to assisting providers with navigating the federal EHR incentive program, to reviewing their clinical quality measures and helping them with numerous quality improvement (QI) activities. We are the home of New York City’s Regional Extension Center (REC), one of 62 such centers nationwide that are funded to support primary care providers through the transition to an EHR and help them achieve the federal Meaningful Use standards.]]> http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/feed/ 4 http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/?utm_source=rss&utm_medium=rss&utm_campaign=a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/#comments Mon, 11 Mar 2013 15:20:36 +0000 Sara Rosenbaum http://healthaffairs.org/blog/?p=29116 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.]]> http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/feed/ 5 http://healthaffairs.org/blog/2013/03/04/in-new-health-affairs-mortality-rates-ehrs-wellness-programs-and-cesareans/?utm_source=rss&utm_medium=rss&utm_campaign=in-new-health-affairs-mortality-rates-ehrs-wellness-programs-and-cesareans http://healthaffairs.org/blog/2013/03/04/in-new-health-affairs-mortality-rates-ehrs-wellness-programs-and-cesareans/#comments Mon, 04 Mar 2013 20:59:54 +0000 Chris Fleming http://healthaffairs.org/blog/?p=28882 The March issue of Health Affairs, released today, includes a variety of articles revolving around health and wellness, including an examination of mortality rates among American men and women by county. The issue also addresses whether physicians will see a return on investment from the adoption of electronic health records (EHRs), and it raises questions about cost savings from workplace wellness programs and the impact on less healthy workers.

Female mortality rates increased in 42.8 percent of counties in the United States during 1992–2006. Although mortality rates are falling in most counties in the United States, female mortality rates increased in 1,224 counties, compared to an increase in 108 counties for men, write David Kindig, professor emeritus of population health sciences at the University of Wisconsin–Madison, and Erika Cheng, a doctoral candidate there. Their study is the first to examine the relationship between socioeconomic and behavioral factors and mortality at the county level.

The authors found that for both men and women, factors associated with lower mortality included having a college degree, higher median household income, Hispanic ethnicity, and living in a higher population density area. For women, living in counties in the South and West was associated with a 6 percent higher mortality rate than living in the Northeast. Smoking rates were also a key factor in higher mortality rates. The researchers recommend targeted approaches that are suited to the unique needs of a county; they observe that investments in health care, public health, behavioral change, and social and physical environment will be needed to improve mortality rates.]]> http://healthaffairs.org/blog/2013/03/04/in-new-health-affairs-mortality-rates-ehrs-wellness-programs-and-cesareans/feed/ 1 http://healthaffairs.org/blog/2013/02/22/medicaid-expansion-benefits-for-women-of-childbearing-age-and-their-children/?utm_source=rss&utm_medium=rss&utm_campaign=medicaid-expansion-benefits-for-women-of-childbearing-age-and-their-children http://healthaffairs.org/blog/2013/02/22/medicaid-expansion-benefits-for-women-of-childbearing-age-and-their-children/#comments Fri, 22 Feb 2013 16:38:56 +0000 Cynthia Pellegrini http://healthaffairs.org/blog/?p=28537
One of the ACA’s main goals was to address the upstream determinants of health, shifting the focus of the health care system “sick care” to “well care.” However, the promise of preventive care will not be realized if women of childbearing age are denied access to health insurance coverage. Medicaid expansion has the potential to drive meaningful improvements in maternal and child health by promoting health at every stage of life, including before and between pregnancies.

Today, Medicaid coverage is unavailable in most states to childless women who are not pregnant.

As a result, low-income women may have little or no source of regular health care before or between pregnancies, or after their childbearing is concluded. These women often lack a medical home and go without both regular preventive care and acute care for illness or injury. This lack of preconception and interconception care can have a significant impact on women’s health, and on the health of future pregnancies and children. The ACA has the potential to transform this dynamic.]]> http://healthaffairs.org/blog/2013/02/22/medicaid-expansion-benefits-for-women-of-childbearing-age-and-their-children/feed/ 0 http://healthaffairs.org/blog/2013/02/14/will-the-readmission-rate-penalties-drive-hospital-behavior-changes/?utm_source=rss&utm_medium=rss&utm_campaign=will-the-readmission-rate-penalties-drive-hospital-behavior-changes http://healthaffairs.org/blog/2013/02/14/will-the-readmission-rate-penalties-drive-hospital-behavior-changes/#comments Thu, 14 Feb 2013 17:41:51 +0000 Nikhil Sahni, David Cutler, and Robert Kocher http://healthaffairs.org/blog/?p=28219 development of the metric in 1984 by Anderson and Steinberg, inpatient hospital readmission rates have been used as a marker for hospital quality. A good deal of attention is now being paid to the new readmission rate penalties in the Affordable Care Act (ACA).

While the penalties have garnered significant attention, it is unknown whether they will materially change hospital behavior. In this post, after reviewing the mechanics of the penalties, we take a close look at how they are likely to affect hospital incentives. We also suggest some refinements to the penalties that could help achieve the aim of reducing preventable readmissions.

How The Penalties Work

The readmission penalty in the ACA is based on readmissions for three conditions: Acute Myocardial Infarction (AMI), Heart Failure, and Community Acquired Pneumonia. For each hospital, the Centers for Medicare and Medicaid Services (CMS) calculates the risk-adjusted actual and expected readmission rates for each of these conditions. Risk-adjustment variables include demographic, disease-specific, and comorbidity factors. The excess readmission ratio is the actual rate divided by the expected rate.]]> http://healthaffairs.org/blog/2013/02/14/will-the-readmission-rate-penalties-drive-hospital-behavior-changes/feed/ 8 http://healthaffairs.org/blog/2013/02/11/the-patient-is-in-listening-to-low-income-californians/?utm_source=rss&utm_medium=rss&utm_campaign=the-patient-is-in-listening-to-low-income-californians http://healthaffairs.org/blog/2013/02/11/the-patient-is-in-listening-to-low-income-californians/#comments Mon, 11 Feb 2013 18:21:05 +0000 Peter Long http://healthaffairs.org/blog/?p=28099
Against this backdrop, Blue Shield of California Foundation commissioned a series of representative, random-sample surveys of Californians aged 19 to 64 with household incomes less than 200 percent of the federal poverty level. The ultimate goal of these surveys is to bring the voices of low-income Californians into the conversation about how best to deliver care in the ACA-shaped future in order to inform policy choices and help providers prepare for a reformed healthcare system.

Resetting Expectations

The first report, On the Cusp of Change: The Healthcare Preferences of Low-Income Californians, based on a spring 2011 survey, revealed that fewer than half of low-income residents feel satisfied with their current health care and six in ten report being interested in switching to a new facility if they had the insurance to cover it. With full implementation of the ACA rapidly approaching in 2014, providers serving low-income Californians will have to change the way that they practice in order to retain their current patients, and attract those who are newly eligible for coverage.]]> http://healthaffairs.org/blog/2013/02/11/the-patient-is-in-listening-to-low-income-californians/feed/ 1 http://healthaffairs.org/blog/2013/02/02/implementing-health-reform-contraceptive-coverage-and-religious-accommodation/?utm_source=rss&utm_medium=rss&utm_campaign=implementing-health-reform-contraceptive-coverage-and-religious-accommodation http://healthaffairs.org/blog/2013/02/02/implementing-health-reform-contraceptive-coverage-and-religious-accommodation/#comments Sat, 02 Feb 2013 14:32:37 +0000 Timothy Jost http://healthaffairs.org/blog/?p=27821 joint notice of proposed rulemaking and fact sheet describing how they intend to implement this provision as it affects religious organizations. This post discusses the proposed rule and its context.

As discussed in earlier posts, the ACA requires that insurers and group health plans cover designated preventive services without cost sharing. The provision specifies that the Health Resources and Services Administration must determine the women’s preventive services that must be covered. Based on recommendations from the Institute of Medicine, HRSA designated all FDA-approved contraceptives for required coverage. This requirement was effective for the first plan year following August 1, 2012.

Some religious groups, however, most notably the Catholic Church, believe that the use of contraceptives is sinful. Other religious groups do not object to all contraceptives, but do object to specific contraceptives that they believe to be abortifacients. When HHS issued initial rules adopting the HRSA determination, therefore, it excluded religious employers, defined as churches, religious orders, and similar groups, from the contraceptive coverage requirement.]]> http://healthaffairs.org/blog/2013/02/02/implementing-health-reform-contraceptive-coverage-and-religious-accommodation/feed/ 2