Health Affairs

Americans increasingly distrust what they perceive as poorly run and conflicted government. Yet rarely can we see far enough inside the federal apparatus to examine what works and what doesn’t, or to inspect how good and bad decisions come to pass. Comparing the behaviors of two influential federal advisory bodies provides valuable lessons about how [...]

In April 2012 a number of accountable care organizations (ACOs) will begin their contracts with the Centers for Medicare and Medicaid Services (CMS) under Medicare’s Shared Savings and Pioneer ACO programs. The latest health policy brief from Health Affairs and the Robert Wood Johnson Foundation provides an overview of ACOs, their origins, and the current [...]

In June of 2011, I flew to Washington, D.C. to say good-bye to my friend, Alvin.  I wanted to be there with him and his family during his peaceful passage from this life.  Unfortunately, his end was not peaceful.  It was a nightmare because he, like too many patients being transferred from one level of [...]

One of the priorities established in the Affordable Care Act is providing better, more efficient care to the “dual eligibles,” low-income seniors enrolled in both Medicare and Medicaid. AcademyHealth’s 2012 National Health Policy Conference (NHPC) will feature a panel on this topic, which is crucial to the nation’s goal of restraining health care cost growth [...]

An extraordinary slowing of the growth in use of health care goods and services contributed to a second year of slow health spending growth in 2010, federal analysts reported in the January issue of Health Affairs. Persistently high unemployment, a substantial loss of private health insurance coverage, lower median household income, and the burden of [...]

On November 8, 2011, the Centers for Medicare & Medicaid Services (CMS) solicited the public for feedback on Medicare’s controversial coverage with evidence development (CED) policy. Although CMS did not finalize the CED policy until 2006, the agency first applied the CED concept in 1995 through a national coverage determination (NCD) on lung volume reduction [...]

The most-read Health Affairs Blog post in 2011 was Tim Jost’s analysis of the arguments before the 11th Circuit Court of Appeals over the Affordable Care Act’s constitutionality.  Posts on accountable care organizations, the relative efficiency of Medicare and private insurance, and other topics also appear on HA Blog’s 2011 most-read list. Another post by [...]

Editor’s note: See additional posts discussing Pioneer accountable care organizations by Debra Ness and William Kramer and Douglas Hastings. The December 19 announcement by the Centers for Medicare and Medicaid Services (CMS) of 32 Medicare Pioneer ACOs underscores the transition of “shared savings” and “accountable care” from policy concepts to implementation. Perhaps more than any [...]

Editor’s note: See additional posts discussing Pioneer accountable care organizations by Steven Lieberman and Douglas Hastings. We have commended the Centers for Medicare and Medicaid Services (CMS) on this blog in the past for actions regarding Accountable Care Organizations (ACOs) – but we’ve also noted the need to establish strong enough criteria to ensure that [...]

Editor’s note: See additional posts discussing Pioneer accountable care organizations by Steven Lieberman and Debra Ness and William Kramer. With the announcement by the Centers for Medicare and Medicaid Services on December 19 of the Pioneer accountable care organization (ACO) model participants, CMS and its Centers for Medicare and Medicaid Innovation (CMMI) conclude a year [...]

With primary care medicine facing ever increasing pressures—fewer doctors to treat more patients and a continual maze of restrictions on reimbursement—primary care practitioners are trying to diagnose and treat obesity with one hand tied behind their backs. The result, unfortunately, is that for what is likely the nation’s costliest disease, strains on coverage have been [...]

Yesterday, House Budget Committee chair Paul Ryan (R-WI) and Sen. Ron Wyden (D-OR) introduced a new “premium support” Medicare reform proposal. Among other features of the plan, beginning in 2022, private plans would compete against the traditional fee-for-service Medicare program on a federally regulated Medicare exchange. Premium support levels would be determined by the cost [...]

An important and controversial element of the Affordable Care Act is the Independent Payment Advisory Board (IPAB). Beginning in 2013, the panel will have significant authority to recommend ways to put on the brakes if projected increases in Medicare spending exceed target growth rates. The latest health policy brief from Health Affairs and the Robert [...]

The week of December 5 was a particularly busy week in health care reform implementation.  After a lull over the Thanksgiving holiday, new regulations, proposed regulations, guidance, and grant announcements have poured out of the agencies.  This post will briefly summarize three of these issuances: the final rule on the Establishment of Consumer Operated and [...]

Now that the Obama Administration has suspended implementation of the CLASS Act, what long-term care financing system should take its place? That is the question that Gloria Eldridge and Joanne Lynn address in the most-read Health Affairs Blog post for November. The November most-read list also features posts about reducing health care spending. For example, [...]

As Don Berwick ends his tenure as Administrator of the Centers for Medicare and Medicaid Services, a Health Affairs Web First article discusses what he has meant to the agency and to the American health care system. Author Harris Meyer also looks at the future of the agency under Marilyn Tavenner, Berwick’s principal deputy who [...]

The Joint Select Committee on Deficit Reduction wasn’t dubbed the “super committee” for nothing. In theory at least, it had immense and unprecedented power.  If the select committee had been able to produce a consensus plan on deficit reduction, that legislation would have been guaranteed an up or down vote in the House and Senate [...]

The effort to cut federal budget deficits resembles nothing so much as the old movie serials in which each week the hero ran a gantlet of perils the last of which threatened imminent death or dismemberment.  Seven days later, the intrepid adventurer would somehow escape unscathed, only to repeat the cycle. The courageous crusader of [...]

The Medicare Payment Advisory Commission (MedPAC) is the closest thing Congress has to adult supervision on important health policy questions. The Commission commands bipartisan respect both for its record of sound policy advice and for its leadership. With its October recommendations, MedPac attempted to solve the sustainable growth rate (SGR) physician payment formula budget crisis [...]

As Congress faces mounting pressure to rein in Medicare spending, two sides seem to be squaring off. The don’t-touch-a-thing-other-than-squeezing-provider-fees position seems to appeal to mainly Democrats, while eat-your-spinach reforms, including more cost sharing and higher premiums, seem to appeal mainly to Republicans. Neither position is very appealing to voters, however, nor should they be. Is [...]