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Look At Consequences Of Rejecting Medicaid Expansion Leads First Quarter Health Affairs Blog Most-Read List

April 14th, 2014
by Tracy Gnadinger

Given their recent mention in Paul Krugman’s New York Times‘ column, it’s not surprising that Sam Dickman, David Himmelstein, Danny McCormick, and Steffie Woolhandler‘s discussion of the health and financial impacts of opting out of Medicaid expansion was the most-read Health Affairs Blog post from January 1 to March 31, 2014.

Next on the list was Robert York, Kenneth Kaufman, and Mark Grube‘s discussion of a regional study on the transformation from inpatient-centered care to an outpatient model focused on community-based care. This was followed by Susan Devore‘s commentary on changing health care trends and David Muhlestein‘s evaluation of accountable care organization growth.

Tim Jost is also listed four times for contributions to his Implementing Health Reform series on Medicaid asset rules, CMS letter to issuers, contraceptive coverage, and exchange and insurance market standards.

The full list appears below.

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Takeaways From The Aspen Institute’s Care Innovation Summit

April 10th, 2014
by Matthew Richardson

Back in February, The Aspen Institute and The Advisory Board Company sponsored the Care Innovation Summit in Washington, DC. With a keynote address from Secretary of Health and Human Services Kathleen Sebelius, the daylong summit featured some of the newest data and research on the rapidly evolving U.S. health care landscape.

Featured speakers such as Jeffrey Brenner of the Camden Coalition of Healthcare Providers and Claudia Grossmann of the Institute of Medicine in addition to others from State and Federal government, insurers, hospitals, and research institutions offered insights on higher-value care and improved health for individuals and populations.

Here are five most memorable takeaways:

1. Health Care Cost Inflation Has Slowed

Perhaps the most eye-catching data trend presented was the dramatic slowing of Medicare spending showcased by Patrick Conway, Director of CMMI (presentation available here). The collapse of annual per capita spending growth is important not only because it implies significant value changes are underway in the provision of ever more services by Medicare, but also because it can further mean many things to many people.

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New Health Policy Brief: Transitioning To ICD-10

March 20th, 2014
by Tracy Gnadinger

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation looks at an important change expected in the American health system later this year: the transition to the ICD-10 coding system by all health providers for diagnoses and inpatient procedures. ICD stands for the International Classification of Diseases, which is maintained by the World Health Organization. The ICD system, which began in the nineteenth century, is periodically revised to incorporate changes in the practice of medicine.

While the most current version, ICD-10, has been used in most countries since its initial adoption in 1990, the United States has until now limited its use to the coding and classification of mortality data from death certificates. This brief examines the debates that have accompanied the broad conversion in this country to ICD-10, set to take place on October 1, 2014.

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Health Information Exchange In NYC Jails: Early Policy Challenges

March 20th, 2014
by Michelle Martelle

Editor’s note: This post is published in conjunction with the March issue of Health Affairs, which features a cluster of articles on jails and health. For more on jails and health information technology in particular, see here, here, and here.

New York City has the second largest jail system in the United States, with an average daily census of approximately 12,000 and 80,000 annual admissions. It is well documented that the population that cycles in and out of US jails each year is statistically sicker than the general population and therefore would benefit from greater care coordination between correctional and community settings. The Department of Health and Mental Hygiene’s Bureau of Correctional Health Services (CHS) is responsible for the care delivered in all 12 NYC jail facilities. The mission of CHS is to provide a community standard of care based on three core frameworks; patient safety, population health and human rights.

As part of this mission, CHS implemented a full electronic health record (EHR) system starting in 2008, completing the implementation of the final facility in 2011. One of the most promising features of EHRs is the ability to share information electronically to facilitate care coordination, referred to as Health Information Exchange (HIE).  Preliminary research of the use of HIE in community based settings is encouraging, with the use of HIE in the Emergency Department resulting in 30 percent fewer admissions and use in ambulatory settings resulting in 56 percent fewer readmissions within 30 days of hospital discharge. (Results pending review; presented 11/14/13 at NYeC Digital Health Conference by Center for Healthcare Informatics and Policy (CHiP).) In the hopes of realizing the full benefits of its EHR system, CHS recently launched an HIE pilot in its women’s facility.

The goals of integrating HIE into jail-based health care are to inform the care patients receive while incarcerated and to coordinate care upon release.  Currently, CHS has access to two external sources of information: BHIX, a Regional Health Information Organization (RHIO) that recently merged with Healthix and now includes patient data from some major hospital systems and community providers in parts of Brooklyn, Queens and Long Island; and PSYCKES, a Medicaid claims-based data warehouse that includes claims information (both medical and mental health) on patients who have had a substance abuse or mental health diagnosis and/or substance abuse or mental health treatment within the last five years.

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Nine Questions About My New Medical Home

March 17th, 2014
by Matthew Anderson

Sometime in the past five years — it’s hard for me to say exactly when — I suddenly found myself living in a new home. I must admit I am still a bit disoriented by how this happened. But it did. People keep telling me that everything will be ok but I am not entirely sure.

For example, in my old home we had occasional family meetings; things are different now. We now have weekly (and monthly) meetings. The many new administrators ask us to complete personality surveys. Once we had to figure out what items we should take from a sinking yacht in the South Pacific (hint: the $100 bill will be useful). Another time we had to decide if we were a “Wow” or a “Thinker.” We are asked to figure out how we can do a better job for them. I guess, like all forms of therapy you don’t get better unless you change.

Despite all these meetings there are a series of things I still don’t understand. I am afraid to raise my hand at the meetings and give the impression I’m a bad sport so I have written my questions down. Please, please don’t think I am a Luddite who wants to go back to the old home. In fact, what I dislike most about the new home is precisely the way — even in its differences — it resembles the old home.

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Physicians’ Concerns About Electronic Health Records: Implications And Steps Towards Solutions

March 11th, 2014

Policy makers and professional organizations have become increasingly concerned about physician professional satisfaction. As in the managed care expansion of the 1990s, recent health reforms, including but not limited to the Affordable Care Act (ACA) and the American Recovery and Reinvestment Act (ARRA), have begun to have effects “in the exam room,” changing how patients, physicians, and allied health professionals interact. To better understand how these reforms are affecting patient care and other aspects of physicians’ professional lives, we recently conducted an in-depth study of professional satisfaction using a combination of open-ended interviews and written surveys with physicians and other professionals in 30 practices (encompassing 55 distinct practice sites) across the United States.

We found several factors that enhanced physician professional satisfaction in 2013, including:

  • perceived ability to deliver high-quality patient care
  • reasonable control over the environment, pace, and content of work
  • sharing clinical values with organizational leadership
  • respectful professional relationships
  • incomes perceived as predictable and fair

Intense Physician Reaction To Electronic Health Records

At the time of our study, the ACA did not yet seem to have measurable effects on physician professional satisfaction, either positive or negative. Instead, regulations stemming from the ARRA—specifically, incentives and penalties to adopt electronic health records (EHRs)—have provoked widespread and intense responses from practicing physicians. Despite recognizing the value of EHRs in concept, many physicians are struggling to use their EHRs, which they describe as negatively impacting patient care in several important ways and undermining their professional satisfaction.

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The Changing Health Care World: Trends To Watch In 2014

February 10th, 2014
by Susan DeVore

While today’s news is bombarding us with headlines about, the Affordable Care Act isn’t just about insurance coverage. The legislation is also about transforming the way health care is provided. Consequently, it has ushered in new competitors, services and business practices, which are in turn generating substantial industry shifts that affect all players along healthcare’s value chain. Following are some of the top trends that our alliance is preparing for in 2014:

Chronic Care, Everywhere. It’s no secret that providers are moving quickly to implement accountable care organizations (ACOs). Recently, the Premier healthcare alliance released a survey of hospital executives projecting that ACO participation will nearly double in 2014. As providers work to improve their way to shared savings payments, look for a more intensive focus on the biggest health care consumers: those with multiple chronic conditions.

Since each chronic condition increases costs by a factor of three, managing this population is the sweet spot for the ACO, and the deepest pool from which to pull savings. To do it, an increasing number of providers will deploy Ambulatory Intensive Care Units (A-ICUs) or patient centered medical homes as part of their ACO, which will be charged with better managing chronic conditions exclusively within a clinically integrated, financially accountable primary care practice. As part of the approach, providers will develop care pathways for better managing chronic conditions and behavioral health needs, with an eye toward lowering hospital utilization, including inpatient bed days, length of stay, admissions, readmissions, and ED visits.

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Payors In Care Delivery: When Does Vertical Integration Make Sense?

February 5th, 2014
by Shubham Singhal

Editor’s note: In addition to Shubham Singhal (linked bio above) this post is authored by Rohit Kumar and Jeris Stueland. Rohit Kumar is a consultant in McKinsey’s Chicago office. Jeris Stueland, an expert in McKinsey’s Healthcare Systems and Services Practice, is also in the Chicago office.

This is the third in a periodic series of posts by McKinsey analysts on the landscape facing payors in the post-reform world. Read the first and second post in the series.

In recent years, much of the payor industry has transitioned away from a medically-underwritten to a guaranteed-issue, community-rated, risk-adjusted model. As a result, managing the total cost of care has become the dominant imperative for achieving competitive advantage.

As payors have sought ways to develop effective managed-care approaches for this new environment, interest in vertical integration has increased considerably. In the four years between 2005 and 2008, payors announced just 12 vertical integration M&A deals. In the subsequent four years, the number jumped to 26, and recent targets have largely been physician groups and integrated care organizations. These deals have not just been attempts to create competitive advantage—they have also been defensive plays to counteract potential challenges from provider consolidation and the acquisition of physician practices by hospital systems interested in vertical integration of their own.

Our research suggests that the economics of vertical integration makes sense for payors in only a minority of markets. For example, when we identified the markets in which the acquisition of physician groups appears to create economic value for payors, the total population included only about 80 million Americans. Furthermore, the significant execution challenges involved in integrating payors and physician practices at scale suggests that the markets we identified likely represent the outer limit of the feasible set.

We describe below the economic drivers of net value creation (or destruction) through vertical integration, the market conditions that indicate a given area may be fertile ground for positive value creation, and the execution challenges that must be overcome to capture the value.

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Connected Health And America’s War On Error

February 5th, 2014
by Joseph Smith and Michael Johns

Editor’s note: For more on connected health, see Health Affairs‘ newly published February thematic issue on the subject. The issue was discussed at a Washington DC briefing this morning, keynoted by the new National Coordinator for Health Information Technology, Karen DeSalvo. The Office of the National Coordinator and West Health Institute are cosponsoring a conference tomorrow on developing an interoperable health care system.

recent analysis, the annual losses are worse than any other war in our nation’s history, including the Civil War, World War II and our War on Terror. It is an undeclared “war on error” within our healthcare delivery system. It is the most deadly war we have ever waged, with errors and resultant harm in hospitals contributing to the death of nearly 1,000 people each day in the U.S., potentially more than 400,000 a year.

As with any other war, there is an enormous economic burden. The U.S. spent approximately $2.8 trillion on health care in 2012, with about 30 percent of total health care expenditures attributed to hospital services. That’s just over $800 billion annually, making America’s war on error not only the deadliest, but also the most expensive.

Until now, this war has often been waged in hospitals, where small, poorly outfitted groups of combatants have used simple, unconventional means like prompts for hand washing, autographing surgical sites and implementing ‘no interruption zone’ for medicine preparation – with limited success. But now, new technologies like integrated sensor networks, fully integrated electronic medical records (EMRs), clinical-decision support systems and algorithm-based care, all embedded in smart and learning systems, may finally provide the tools needed to win the war.

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The Need For A Smart Approach To Big Health Care Data

January 27th, 2014

Today, academic medicine and health policy research resemble the automobile industry of the early 20th century — a large number of small shops developing unique products at high cost with no one achieving significant economies of scale or scope. Academics, medical centers, and innovators often work independently or in small groups, with unconnected health datasets that provide incomplete pictures of the health statuses and health care practices of Americans.

Health care data needs a “Henry Ford” moment to move from a realm of unconnected and unwieldy data to a world of connected and matched data with a common support for licensing, legal, and computing infrastructure. Physicians, researchers, and policymakers should be able to access linked databases of medical records, claims, vital statistics, surveys, and other demographic data. To do this, the health care community must bring disparate health data together, maintaining the highest standards of security to protect confidential and sensitive data, and deal with the myriad legal issues associated with data acquisition, licensing, record matching, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Just as the Model-T revolutionized car production and, by extension, transit, the creation of smart health data enclaves will revolutionize care delivery, health policy, and health care research. We propose to facilitate these enclaves through a governance structure know as a digital rights manager (DRM). The concept of a DRM is common in the entertainment (The American Society of Composers, Authors and Publishers or ASCAP would be an example) and legal industries.  If successful, DRMs would be a vital component of a data-enhanced health care industry.

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Examination Of Health Information Technology’s Disappointing Impact Leads Health Affairs 2013 Top-Fifteen List

January 21st, 2014
by Chris Fleming

Years after promises of large gains from health information technology, evidence of the impact of health IT on efficiency and safety remain mixed, Arthur Kellermann and Spencer Jones report in the most-read Health Affairs article of 2013. Achieving health IT’s original promise will require standardized systems that are easier to use and more interoperable, and that provide patients with more control over their health information; providers must re-engineer care systems as well, Kellermann and Jones write. To celebrate the New Year, Health Affairs is making this piece and all the articles on the journal’s 2013 most-read list freely available to all readers for one week.

Second on the 2013 top-fifteen list is a report on 2011 health spending by analysts at the Centers for Medicare and Medicaid Services Office of the Actuary. Every year, Health Affairs publishes a retrospective analysis of National Health Expenditures by the CMS analysts, as well as their health spending projections for the coming decade. In the latest installment in this series, the analysts reported on 2012 health spending in our January 2014 issue and discussed their findings at a Washington DC briefing.

In the third most-read Health Affairs article of 2013, Linda Green and coauthors caution against projecting primary care physician shortages based on simple patient-physician ratios. They argue that increasingly popular strategies — such as the use of teams and nonphysicians, and better information technology and data-sharing — can potentially eliminate projected physician shortages.

The top fifteen articles for 2013 also include studies addressing the impact of states’ opting out of Medicaid expansion, the cost-shifting effects of some workplace wellness programs, and several other topics. The full list appears below. The list is based on online viewing statistics and covers all articles published in 2013.

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Views From the Hospital Executive Suite Leads Health Affairs Blog December Top Ten

January 9th, 2014
by Tracy Gnadinger

Since the majority of Americans believe the Affordable Care Act will have a negative impact on the health care system, it’s no surprise Andrew Steinmetz, Ralph Muller, Steven Altschuler, and Ezekiel Emanuel‘s post about hospital executives’ largely positive view of health care reform was the most-read post on Health Affairs Blog in December. Next on the list, for the third month in a row, was James Rickert’s discussion of patient-centered care, followed by Timothy Jost‘s post on exemptions from the individual mandate and Mary Ersek and David Stevenson‘s post on challenges and opportunities of integrating palliative care into nursing homes, the first in a series on palliative care.

The full list appears below.

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A Standard Model For Evaluating Return On Investment From Electronic Health Record Implementation

January 6th, 2014
by Jonathan Perlin

The Institute of Medicine (IOM) Roundtable on Value and Science-Driven Healthcare views electronic health information as a pillar for the improved effectiveness, efficiency and safety of health care. Information is also fundamental to the concept of a “learning health system,” which IOM has described as having the capacity both to apply and generate scientific evidence in the delivery of care. While it is conceivable that such learning could occur without electronic health records (EHR), it is clear that the capacity the EHR offers to generate “big data” and thus a “collective memory” — from health care services delivered, resources used in that process, and patient and population health outcomes — would markedly accelerate improvement.

While the evolving transition from traditional fee-for-service to outcomes-based reimbursement, other forms of value-based purchasing (including networks restricted to higher value providers), and ultimately integration of clinical and financial risk would seem to make the need for provider implementation of EHR self-evident, the HITECH program demonstrates the need for external stimulus to accelerate EHR adoption. Perhaps a better understanding is needed of the relationship between investment and return to organizational efficiency, effectiveness, and sustainability.

A reluctance to adopt an EHR may have many reasons, including both the performance and cost of the EHR itself. Usability challenges complicate adoption, especially by physicians, and some arguments have been made that productivity can suffer. Provider resistance to adoption may also result from concern that financial benefits accrue disproportionately to payor organizations. In aggregate, slow adoption may represent concern that the business case for adopting EHR is poor. However, in the absence of data from comparable analyses, we have more opinion than evidence.

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Health Care Reform: Views From The Hospital Executive Suite

December 18th, 2013

Pessimism pervades the national dialogue surrounding healthcare reform. Despite fixes to the federal exchange website and marked improvements in enrollment, politicians and pundits continue to assail the Affordable Care Act (ACA), offering grim predictions about the future of healthcare after its implementation. The law, they claim, is an unworkable train-wreck. It will produce a healthcare system with significantly higher costs, lower quality, and bureaucratic confusion.

The public has seemed equally pessimistic. Fifty-four percent of Americans, according to a recent poll, believe the ACA will have a negative impact on the healthcare system, compared to only 24 percent who anticipate a positive impact. Nearly three-quarters expect the quality of healthcare to decline or stay the same, while only 11 percent expect it to improve. More than half expect costs to rise while only 9 percent expect them to fall.

Such pessimism, however, is hardly a credible predictor of the success or failure of the ACA. Politicians, pundits, and the public are largely removed from the inner workings of the healthcare system, so it is difficult for them to form an accurate, 360-degree view of reform. Moreover, most Americans (70 percent) readily admit they know little about the ACA or its potential impact.

A more meaningful source for an appraisal of healthcare reform, and for predictions about how it will fair, would be individuals who are especially informed—people who have spent their entire careers on the front lines of the healthcare system deciding how budgets are managed and how care is delivered—people like the leaders of America’s hospitals and health systems. Healthcare reform is catalyzing major changes for these executives and their institutions. Wouldn’t it be helpful to know if they share the public’s apprehension and pessimism?

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The Untold Story Of 2013: Governors Lead In Health Care Transformation

December 17th, 2013
by Dan Crippen and Frederick Isasi

As 2013 winds to a close, it is a good time for the health policy community to reflect on a historic year for our nation. The most talked about health care issues have centered on the rollout of new health insurance and Medicaid coverage as part of the Affordable Care Act. However, another watershed reform of our health care system has been taking root across the country, relatively unnoticed and with many governors at the helm.

These efforts are focused on broad, statewide reforms designed to dramatically alter the way we think about, deliver and pay for health care. The reforms move away from a siloed and fractured delivery system and are focused on two key objectives: improving the health of the nation, and reducing the financial burden of health care on the government, employers and individuals.

The drive for these reforms results from several key pressures. Perhaps most urgent is the fiscal pressure bearing down on states. Governors have acutely experienced the effect of decades of rapidly escalating health care costs, and almost all states are under a requirement to balance their budgets. Governors must, therefore, account for growth in spending in Medicaid and CHIP, state employee and retiree health insurance, and indigent health care. Often these increases must be funded by increased tax revenue or reductions in other areas of state spending, for example education or transportation.

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Implementing Health Reform: The Liberty University Case And Exchange Workarounds

December 2nd, 2013
by Timothy Jost

On December 2, 2013, the Supreme Court denied review of the Fourth Circuit Court of Appeals’ decision in Liberty University v. Lew. I discussed this decision in an earlier post. Liberty University had originally filed suit in 2010 challenging the individual and employer mandates and raising certain religious liberty issues. The Fourth Circuit had dismissed their lawsuit, claiming that the Tax Anti-Injunction act barred consideration of their case.

After the Supreme Court’s decision in the National Federation of Independent Business case, in which the Court held that the Tax Anti-Injunction act did not bar consideration of the individual mandate, the Supreme Court reversed the Fourth Circuit’s Tax Anti-Injunction Act decision and remanded the Liberty University case for further consideration of the plaintiff’s claims. On reconsideration, the Fourth Circuit rejected all of the plaintiff’s claims, holding that Congress had authority under both the commerce and tax and spend clauses to adopt an employer mandate and that neither the Constitution nor the Religious Freedom Restoration Act barred the religious exceptions to the individual mandate.

The court also held that the Affordable Care Act does not require coverage of abortion, and thus the plaintiff’s religious liberty challenges to abortion coverage could not proceed. Finally, the Fourth Circuit held that the plaintiffs challenge to the preventive services regulation’s contraceptive coverage requirement was raised too late in the litigation to be considered. That issue is now, of course, before the Supreme Court in other litigation.

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Bigger May Not Be Better: Does Scale Matter For Payors?

November 15th, 2013
by Shubham Singhal

Editor’s note: In addition to Shubham Singhal (photo and linked bio above), this post is authored by Rohit Kumar and Jeris Stueland. Rohit Kumar is a consultant in McKinsey’s Chicago office. Jeris Stueland, an expert in McKinsey’s Healthcare Systems and Services Practice, is also in the Chicago office. The authors would like to thank Ellen Rosen, Jim Oatman, and Michael K. Park for their contributions to this article.

This is the second in a periodic series of posts by McKinsey analysts on the landscape facing payors in the post-reform world. You can read the first post in the series here.

Whether scale brings competitive advantage to payors is a topic of hot debate. Many believe that consolidation is likely as the industry goes through the disruptive changes set in motion by reform. Some contend that anticipated margin compression and medical-loss-ratio floors will make scale efficiencies critical for achieving sustainable economics in the future. Others, however, note that managing the total cost of care is becoming central to a payor’s success, and question what advantages scale provides in such a world. If most health care is locally delivered, they argue, how much of the value created by cost-of-care management can scale drive?

Our research and experience suggest that for payors, the minimum threshold for efficient and effective scale is low. The primary rationale for scale emerges from the large fixed investments payors must make to develop the new capabilities needed to compete effectively in a rapidly changing regulatory and market environment (and to comply with evolving regulations). This rationale holds particularly true for payors that choose to build these capabilities themselves rather than through partnerships with external vendors, noncompeting plans, or other stakeholders in the value chain.

Yet, once the minimum level of scale is achieved, performance variability on administrative costs continues to be quite high. This suggests that for many payors the bigger opportunity to achieve administrative efficiencies is through operating model and organizational redesign, productivity enhancements, and application of design-to-value principles to core processes.

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Medicare Physician Payment Reform: The Bipartisan Congressional Proposal And How To Strengthen It

November 12th, 2013
by Mark McClellan

Note: In addition to Mark McClellan (photo and linked bio above), this post is coauthored by John O’Shea, a Visiting Scholar at the Engelberg Center for Health Reform at the Brookings Institution, and Erica Socker, a Research Analyst there. The post is part of the Richard Merkin Initiative on Payment Reform and Clinician Leadership and the Bending the Curve Project at Brookings. In particular, the post reflects the contributions to the projects by Sara Bencic, Christine Dang-Vu, Keith Fontenot, Larry Kocot, Farzad Mostashari, Kavita Patel, Alice Rivlin, and Darshak Sanghavi. We also thank the Irene Diamond Fund for financial support.


Bipartisan health care reform recently reappeared in Congress, when the Senate Finance and House Ways & Means committees released a framework to reform the Sustainable Growth Rate (SGR) formula for physician payment in Medicare. The proposal builds on an earlier bipartisan bill passed by the House Energy & Commerce committee this summer.

Permanent reform of Medicare’s physician payment system is urgently needed. No provider is more important than physicians in determining how patients are treated, yet Medicare’s physician payment system is based on a SGR formula that is not focused on quality of care and has not worked to reduce overall health care costs. The formula was enacted as part of the Balanced Budget Act of 1997 to constrain Medicare spending growth on physician-related services in line with growth of the overall economy, through across-the-board, proportional reductions in physician payments when projected spending exceeds the growth target.

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Medicare Physician Payment Reform: An Analysis Of The New Congressional Proposal

November 8th, 2013
by Ron Klar

On October 31, 2013 the House Ways & Means and Senate Finance Committees unveiled a bicameral and bipartisan press release and Discussion Draft of a proposal to repeal the SGR (sustainable growth rate) update to professional fees and replace it with: (1) reforms for future fee-for-service (FFS); (2) incentives for alternative payment models (APMs); and (3) provisions regarding care coordination, relative valuation, service use, and data availability. After a decade of simply “kicking the SGR down the road” with last-minute and temporary authorizations, a “permanent fix” to this “fundamentally broken” program will be universally welcome. The task at hand: analyzing the elements of what is proposed to replace it.

We all know that the future of Medicare is at a critical state, and it is therefore imperative that we use this rare opportunity of Congressional harmony to do it right. I am delighted to contribute to this discussion, especially as feedback was solicited by the Committees and due to them by November 12. My overall conclusion: the objectives should be applauded, the legislation should be supported, but some changes to the details need to be encouraged before the final legislative text is reported.

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Health Affairs Interview: Shanghai’s Health Care Reforms Explained

November 6th, 2013
by Chris Fleming

“I think health reform is not like what some say—a matter of two, three, or four years of efforts, and you get a brand-new health system. So I do not look for one-shot earthshaking effects. Instead, I focus on whether the policies we put in place will be sustainable,” says former Shanghai Vice Mayor Shen Xiaoming in an interview released today as a Web First by Health Affairs. Shanghai, China’s largest city, offers its residents the country’s most advanced health care system. Through a powerful health information technology system, there have been great strides, though challenges remain.

Shen, who served as vice mayor from January 2008 through July 2013, spoke to Tung-Mei Cheng, Policy Research Analyst at the Woodrow Wilson School of Public and International Affairs at Princeton University, in Shanghai on June 18, 2013. In addition to reading the interview, you can listen to Cheng discuss her conversation with Vice Mayor Shen and the lessons of the Shanghai experience.

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