http://healthaffairs.org/blog The Policy Journal of the Health Sphere Tue, 18 Jun 2013 00:12:59 +0000 en-US hourly 1 http://healthaffairs.org/blog/2013/06/17/collaborative-filtering-an-interim-approach-to-identifying-clinical-doppelgangers/?utm_source=rss&utm_medium=rss&utm_campaign=collaborative-filtering-an-interim-approach-to-identifying-clinical-doppelgangers http://healthaffairs.org/blog/2013/06/17/collaborative-filtering-an-interim-approach-to-identifying-clinical-doppelgangers/#comments Mon, 17 Jun 2013 17:44:39 +0000 Eric Caplan http://healthaffairs.org/blog/?p=32168 “The real challenge of human biology, beyond the task of finding out how genes orchestrate the construction and maintenance of the miraculous mechanism of our bodies, will lie ahead as we seek to explain how our minds have come to organize thoughts sufficiently well to investigate our own existence.”

The initial enthusiasm following the mapping of the human genome has given way to a more circumspect outlook. With the exception of a small number of promising interventions, advances in genomic science have yet to yield a critical mass of therapeutic breakthroughs – thus forestalling the birth of the era of precision medicine (PM).

While a comprehensive genomic understanding of disease and concomitant molecular-based patient taxonomy would doubtless hasten the arrival of PM, a significantly less costly alternative offers a promising interim approach. A methodology known as collaborative filtering (CF) which has already achieved widespread use in advertising and marketing, has the potential to offer powerful insights not only to advertisers and others desiring to influence purchasing behavior but also to physicians, allied health care professional, patients, and their families by offering personalized advice and recommendations regarding health and disease.

CF relies directly on aggregated subject/user behavior to reveal complex and unexpected patterns that would otherwise be difficult to capture using known data attributes. Recommendations generated from analyses of these patterns have demonstrated significantly greater reliability than those using more traditional demographic categories. The core idea behind applying CF to clinical decision-making is to make decisions about a patient based on historical data derived from multiple “similar” patients presenting multiple “similar” cases. As Victor Streecher explains, “collaborative filtering in the health area could match the coping strategies, medical decisions, and preferences of similar others with specific needs and interests of the user.”]]> http://healthaffairs.org/blog/2013/06/17/collaborative-filtering-an-interim-approach-to-identifying-clinical-doppelgangers/feed/ 0 http://healthaffairs.org/blog/2013/06/15/implementing-health-reform-program-integrity-and-other-exchange-and-market-reform-issues/?utm_source=rss&utm_medium=rss&utm_campaign=implementing-health-reform-program-integrity-and-other-exchange-and-market-reform-issues http://healthaffairs.org/blog/2013/06/15/implementing-health-reform-program-integrity-and-other-exchange-and-market-reform-issues/#comments Sat, 15 Jun 2013 18:28:58 +0000 Timothy Jost http://healthaffairs.org/blog/?p=32137 notice of proposed rulemaking (NPRM) entitled “Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards.” Although the proposed rule does include a number of provisions related to program integrity, it covers a great deal more. It resolves a host of outstanding issues that must be tied up before the exchanges, premium stabilization programs, and market reforms become fully operational in 2014. (The proposal, by the way, uses the term “exchange” throughout rather than “marketplace,” which I have never gotten used to).

In some instances the NPRM modifies existing rules, as when it modifies the exchange final rule of March 2012 to allow states to operate SHOP exchanges only, ceding the individual exchange to the federal government. In many instances, it puts into regulation form guidance that has been issued earlier, such as the May 1, 2013 guidance on agents and brokers and the May 14, 2013 Frequently Asked Questions on Health Insurance Marketplace. It also, however, addresses problems that have only recently been identified, such as the problem of the “unbanked,” persons who will be eligible for premium assistance but are unable to pay premiums with checks because they do not have bank accounts.]]> http://healthaffairs.org/blog/2013/06/15/implementing-health-reform-program-integrity-and-other-exchange-and-market-reform-issues/feed/ 0 http://healthaffairs.org/blog/2013/06/14/lessons-from-early-medicaid-expansions-under-the-affordable-care-act/?utm_source=rss&utm_medium=rss&utm_campaign=lessons-from-early-medicaid-expansions-under-the-affordable-care-act http://healthaffairs.org/blog/2013/06/14/lessons-from-early-medicaid-expansions-under-the-affordable-care-act/#comments Fri, 14 Jun 2013 16:05:26 +0000 Benjamin Sommers, Emily Arntson, Genevieve Kenney, and Arnold Epstein http://healthaffairs.org/blog/?p=32114 Health Affairs, new research from DeLeire and colleagues on Wisconsin’s 2009 BadgerCare expansion and from Price and Eibner on predicted cost and coverage impacts of the Medicaid expansion provides insights on the implications of state decision-making about whether to expand the program.

Since 2010, six states have already expanded Medicaid to cover some or all of the low-income adults targeted for coverage under health reform. To provide additional information on the impacts of such expansions, we undertook an in-depth exploration of the experiences of these states – California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington – through qualitative interviews with 11 high-ranking Medicaid officials across all six states. In analyzing these interviews, we identified several key policy lessons that help elucidate the opportunities and challenges of expanding Medicaid under the ACA. Below are some of our preliminary findings.]]> http://healthaffairs.org/blog/2013/06/14/lessons-from-early-medicaid-expansions-under-the-affordable-care-act/feed/ 0 http://healthaffairs.org/blog/2013/06/13/request-for-abstracts-health-affairs-alzheimers-disease-theme-issue/?utm_source=rss&utm_medium=rss&utm_campaign=request-for-abstracts-health-affairs-alzheimers-disease-theme-issue http://healthaffairs.org/blog/2013/06/13/request-for-abstracts-health-affairs-alzheimers-disease-theme-issue/#comments Thu, 13 Jun 2013 14:47:37 +0000 Chris Fleming http://healthaffairs.org/blog/?p=32081 Health Affairs plans a thematic issue on Alzheimer’s disease in April 2014. We plan to cover a range of topics with the aim of providing “one stop shopping” for our policy-oriented audience. Topics include overview papers on the state of the science of causes and treatment, costs, screening and diagnosis, drug development, medical and non-medical management, caregiver populations, federal and state roles, and more.

Request for abstracts

In addition to the papers we have already invited, we are seeking papers on several additional topics and therefore welcome proposals for papers, analyses, and commentaries on the following topics: .

• Exemplary models from around the globe (either individual countries or comparative pieces with lessons for other countries)
• Exemplary state or local approaches to care and treatment
• Opportunities for primary prevention

In order to be considered, abstracts must be submitted by August 1, 2013. We regret that we will not be able to consider any abstracts submitted after that date.]]> http://healthaffairs.org/blog/2013/06/13/request-for-abstracts-health-affairs-alzheimers-disease-theme-issue/feed/ 0 http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/?utm_source=rss&utm_medium=rss&utm_campaign=unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/#comments Wed, 12 Jun 2013 20:02:54 +0000 Chris Fleming http://healthaffairs.org/blog/?p=32048 Health Affairs Web First study released today. Over the 2000-2009 period, US natives accounted for about $1 trillion in average annual health care spending; all immigrants spent about one-tenth of that amount, or $96.7 billion. Unauthorized immigrants accounted for $15.4 billion of that total, or 15.9 percent.

Analyzing health expenditure data from the Medical Expenditure Panel Survey by nativity and legal status, Stimpson and coauthors found that just 7.9 percent of unauthorized immigrants had health care spending from public sources, averaging $140 per person per year. By contrast, 30.1 percent of US natives had health care spending from public sources, for an average of $1,385 per person per year. Average emergency department expenditures for unauthorized immigrants were $54 per year, compared to $138 per year for US natives.

The authors also found that an estimated 5.9 percent of unauthorized immigrants received care that providers are not reimbursed for, compared to 2.8 percent of US natives in the same category. They posited that this may be because unauthorized immigrants are much more likely to lack health insurance when compared to US natives.]]> http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/feed/ 1 http://healthaffairs.org/blog/2013/06/12/what-do-you-mean-im-getting-old-denial-about-aging-and-our-impending-long-term-care-crisis/?utm_source=rss&utm_medium=rss&utm_campaign=what-do-you-mean-im-getting-old-denial-about-aging-and-our-impending-long-term-care-crisis http://healthaffairs.org/blog/2013/06/12/what-do-you-mean-im-getting-old-denial-about-aging-and-our-impending-long-term-care-crisis/#comments Wed, 12 Jun 2013 18:35:17 +0000 Bruce Chernof http://healthaffairs.org/blog/?p=32025
As Chair of the newly created federal Commission on Long-Term Care, I believe it is imperative for Americans to understand that 70 percent of us who live beyond the age of 65 will need some form of long-term care, on average for three years. This is a potentially dangerous statistic given the reality that our nation’s system of care is outdated and lacks the tools to meet the needs of our growing senior population.

To better understand Americans’ attitudes and perceptions around aging and long-term care, as well as levels of preparedness for future care, the Associated Press - NORC Center for Public Affairs Research conducted a national poll of adults age 40 and older with funding from The SCAN Foundation. Implications of these findings are profound considering the population of adults over 65 will nearly double to 19 percent -- nearly 72 million people -- by 2030.]]> http://healthaffairs.org/blog/2013/06/12/what-do-you-mean-im-getting-old-denial-about-aging-and-our-impending-long-term-care-crisis/feed/ 0 http://healthaffairs.org/blog/2013/06/11/hospital-community-benefit-expenditures-looking-behind-the-numbers/?utm_source=rss&utm_medium=rss&utm_campaign=hospital-community-benefit-expenditures-looking-behind-the-numbers http://healthaffairs.org/blog/2013/06/11/hospital-community-benefit-expenditures-looking-behind-the-numbers/#comments Tue, 11 Jun 2013 16:46:51 +0000 Sara Rosenbaum, Amber Rieke, and Maureen Byrnes http://healthaffairs.org/blog/?p=31988 valued by the Joint Committee on Taxation at $12.6 billion in 2002 alone. Neither Congress nor the IRS has established a minimum expenditure level for valuing the community benefit; indeed, the IRS allows hospitals “broad latitude” in determining their activities and contributions. However, in the wake of increasing scrutiny by Congress, the IRS established a nationwide reporting system that enables a deeper dive into the question of nonprofit hospital community investment.

Two recent studies – one released by the hospital industry, the other, by academic researchers -- provide a look behind the numbers. The industry study offers up a deceptively rosy spin, but a close look at both studies reveals strikingly small levels of true community benefit spending by many hospitals – particularly in states where hospitals are not required to report spending levels to state regulators.]]> http://healthaffairs.org/blog/2013/06/11/hospital-community-benefit-expenditures-looking-behind-the-numbers/feed/ 0 http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/?utm_source=rss&utm_medium=rss&utm_campaign=saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/#comments Mon, 10 Jun 2013 18:00:32 +0000 Arthur Kellermann http://healthaffairs.org/blog/?p=31962 The New York Times on Jan 8, 2008, it was widely assumed it would be the next to go. However, at its darkest hour, Grady received help from an unexpected quarter.

In the June issue of Health Affairs, a young physician, Dr. Kate Neuhausen, describes how she and other leaders of a little-known student organization mobilized hundreds of health professions students from around the state of Georgia to join the fight for Grady’s survival. It is difficult to overstate how perilous the hospital’s situation was at the time. Because Grady provides such a disproportionate share of uncompensated care in the state of Georgia, it would have been impossible for metro Atlanta’s hospitals and private health care providers to absorb the sudden loss of more than 900 inpatient beds; the highly specialized trauma, burn and psychiatric services Grady provides; or the displacement of tens of thousands of inpatient days and hundreds of thousands of outpatient visits. The resulting social, medical and financial upheaval would have sent shockwaves throughout the region—the economic engine for the state and a vital financial, commercial and transportation hub for the Southeastern United States.

Fortunately, Atlanta’s business community and philanthropies grasped the gravity of the situation. So did Georgia’s governor, the leaders of Georgia’s General Assembly, the Commissioners of Fulton and DeKalb Counties, the appointed members of the Hospital Authority that ran Grady, the leadership of Emory University and Morehouse School of Medicine (which provides the hospital’s medical staff), Grady’s employees, and its patients. But each group had a different concept of what needed to be done. Urban-rural, partisan and racial politics came into play. Time was running out.]]> http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/feed/ 0 http://healthaffairs.org/blog/2013/06/07/health-policy-brief-medicaid-premium-assistance/?utm_source=rss&utm_medium=rss&utm_campaign=health-policy-brief-medicaid-premium-assistance http://healthaffairs.org/blog/2013/06/07/health-policy-brief-medicaid-premium-assistance/#comments Fri, 07 Jun 2013 20:12:14 +0000 Chris Fleming http://healthaffairs.org/blog/?p=31948 A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines a range of policy issues surrounding the concept of Medicaid premium assistance. States that decide not to expand Medicaid under the Affordable Care Act (to date, 19 states fall in that category) could create large coverage gaps for many of its low-income residents. One potential solution to this problem would be to use federal Medicaid expansion funds as “premium assistance,” enabling eligible Medicaid beneficiaries to purchase insurance through its newly minted exchange.

As some states explore this option, proponents hope the program will allow states to enroll more people, improve beneficiaries’ care, and reduce churning between Medicaid and the exchange. However, skeptics believe the program’s cost-efficiency is yet to be proven.]]> http://healthaffairs.org/blog/2013/06/07/health-policy-brief-medicaid-premium-assistance/feed/ 2 http://healthaffairs.org/blog/2013/06/07/the-medicare-trustees-report-in-perspective/?utm_source=rss&utm_medium=rss&utm_campaign=the-medicare-trustees-report-in-perspective http://healthaffairs.org/blog/2013/06/07/the-medicare-trustees-report-in-perspective/#comments Fri, 07 Jun 2013 18:39:01 +0000 Lee Goldberg http://healthaffairs.org/blog/?p=31883 annual report from the Medicare Trustees reflects small but noteworthy improvements in the financial outlook of part of the program. Annual growth in Medicare spending per beneficiary slowed to less than 1 percent last year, well below the per capita growth of the economy as measured by gross domestic product (GDP) and enough to push back the projected insolvency date for the Hospital Insurance (HI) Trust Fund (Part A, which pays for inpatient care) to 2026 -- two years later than last year’s report.

This is good news but should be seen in context. As Figure 1 shows, annual estimates of HI solvency since 1990 have ranged from four years to 28 years, averaging 13.6 years. So this year’s projection falls just below the 24-year average.

The Trustees Report includes various ways to view Medicare’s fiscal health over time. One metric is to look at long-term projections of Medicare as a share of GDP over the next 75 years. Total Medicare spending includes Supplementary Medical Insurance (SMI, or Part B, which covers physician, outpatient hospital, and some home health costs that are unrelated to a stay in a hospital) as well as prescription drug benefits (Part D). Under the Trustees’ intermediate assumptions, total Medicare expenditures will grow from 3.7 percent of GDP in 2012 to 3.9 percent of GDP in 2020 and 6.5 percent of GDP in 2087, as shown in Figure 2. In the near term -- that is, from now through about 2035 -- the increase is being driven largely by the increasing numbers of Medicare-eligible baby boomers, who began entering the ranks of beneficiaries in 2011.]]> http://healthaffairs.org/blog/2013/06/07/the-medicare-trustees-report-in-perspective/feed/ 1