From The Staff

Health Affairs Web First: National Health Spending In 2013 Continued Pattern Of Low Growth


December 3rd, 2014

A new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) estimates that in 2013 health care spending in the United States grew at a rate of 3.6 percent in 2013 to $2.9 trillion, or $9,255 per person. The increase was slower than the 4.1 percent growth in 2012 and continued a pattern of low growth that has held relatively steady at between 3.6 percent and 4.1 percent annual growth for five consecutive years.

The continued low growth in health spending is consistent with the modest overall economic growth since the end of the recent severe recession and with the long-standing relationship between economic growth and health spending—particularly several years after the end of economic recessions, when health spending and overall economic growth tend to converge. As a result, health spending’s share of the nation’s gross domestic product (GDP) remained at 17.4 percent in 2013.

The study was released today by Health Affairs as a Web First and will appear in the January issue of Health Affairs. It was discussed this morning at a reporters briefing in the National Press Club.   Read the rest of this entry »

Takeaways From Health Affairs’ Twitter Chat With PCORI


November 26th, 2014

Recently, we at Health Affairs hosted our first Twitter chat with the Patient Centered Outcomes Research Institute (PCORI) on patient engagement in research. The chat was a follow-up to the Health Affairs patient engagement issue and the recent release of three videos, produced in partnership with PCORI, on the ways patients and practitioners are incorporating patient engagement in health care decisions. The videos are hosted and reported by journalist John Dimsdale.

During the Twitter chat, we moderated a question-and-answer session with PCORI’s director of patient engagement, Sue Sheridan, while many users joined in the conversation with #PatientHC. So what does patient engagement in research look like (question courtesy of the National Partnership for Women and Families)? PCORI responded with the following tweet: “Should engage early and often, but it is not one size fits all,” and then referenced their engagement rubric. Read the rest of this entry »

Exhibit Of The Month: Maps Tell Powerful Stories About Children, Neighborhoods, And Possible Policy Solutions


November 25th, 2014

Editor’s note: This post is part of an ongoing “Exhibit of the Month” series. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

Maps and health have been powerfully intertwined since nineteenth-century British physician John Snow produced a hand-drawn map that famously showed a correlation between the locations where cholera was killing hundreds of Londoners during an 1854 epidemic and the Broad Street pump where locals unknowingly drew water contaminated with the deadly bacterium.

Fast-forward to the twenty-first century, and maps that tell compelling stories about health, policy, and place are ubiquitous. If Snow were alive today, no doubt his stethoscope would be spinning.

The power and art of mapping, geospatial analysis, and health policy research are regularly featured in Health Affairs, but never before to the extent in the journal’s November issue. Four research papers give readers five maps that depict meaningful findings about children, low-income neighborhoods, and other local characteristics that affect health and offer valuable insights for policy makers. Read the rest of this entry »

What Is The Future For Community Health Workers?


November 25th, 2014

I recently attended a symposium entitled “Community Health Workers: Getting the Job Done in Health Care Delivery.” (My concluding remarks begin at the 6:00:40 mark in the video.) Speakers examined the evolving role of Community Health Workers (CHWs) in the current era of delivery system reform. Health Affairs has published work documenting the importance of this part of the workforce, and our November issue is dedicated to the topic of “Collaborating for Community Health.”

I was asked to summarize some key points from the day-long conversation. In this post I highlight some of the themes covered.

Over the course of the day I heard the elements of two very different paths forward for community health workers. Each path was coherent and compelling, but they lead in very different directions. Read the rest of this entry »

Health Affairs December Briefing: Children’s Health


November 24th, 2014

Threats to children’s health have changed dramatically over the past few generations, but America’s health care system has been slow to transform to meet children’s evolving needs. The December 2014 thematic issue of Health Affairs examines the current state of children’s health, health care delivery, and coverage.

You are invited to join us on Monday, December 8, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.  Panels will cover financing, delivery, access, and the social determinants of children’s health, and spotlight innovative programs that are making a difference.

WHEN: 
Monday, December 8, 2014
9:00 a.m. – 12:30 p.m.

WHERE: 
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live tweets from the briefing @Health_Affairs, and join in the conversation with #HA_ChildHealth.  Read the rest of this entry »

New On GrantWatch Blog


November 21st, 2014

Health Affairs GrantWatch Blog brings you news and views of what foundations are funding in health policy and health care.

Here are the most recent posts:

Read the rest of this entry »

The Latest Health Wonk Review


November 21st, 2014

In this week’s “turkey edition” of the Health Wonk Review, David Harlow of HealthBlawg provides a veritable smorgasbord of health policy posts, including a Health Affairs Blog essay by Jordan Paradise on biosimilars and patent disclosures.  Read the rest of this entry »

Health Affairs Web First: In 11-Country Survey Of Older Adults, Americans Are Sickest But Have Quickest Access To Specialists


November 20th, 2014

A new survey of the health and care experiences of older adults in eleven different countries, released recently as a Web First by Health Affairs, found that Americans were sicker than their counterparts abroad, with 68 percent of respondents living with two or more chronic conditions and 53 percent taking four or more medications. Also, Americans were most likely to report cost-related expenses for care (19 percent of respondents) than residents in any of the other countries surveyed.

On the other hand, the United States compared favorably in some aspects: For example, 83 percent of US respondents had a treatment plan they could carry out in their daily life, one of the highest rates across the surveyed countries.

A few other key findings: Read the rest of this entry »

Narrative Matters: Connecting With Community Health Workers


November 19th, 2014

The November issue of Health Affairs features two Narrative Matters essays.

A program connecting community health workers with patients in Boston shows benefits but is shuttered after funds dry up. Heidi L. Behforouz’s article is freely available to all readers, or you can listen to the podcast.

A community health worker and his patient share stories to create an empowering narrative of diabetes and treatment. Samuel Slavin’s article is freely available to all readers, or you can listen to the podcast. Read the rest of this entry »

New Health Policy Brief: The 340B Drug Discount Program


November 18th, 2014

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines the 340B Drug Discount Program. This federal program, established in 1992, was created to allow safety-net health care organizations serving vulnerable populations to buy outpatient prescription drugs at a discount. In the past few years, government reports have highlighted deficiencies in the oversight and management of the 340B program, whose sales in 2012 were reported by the Department of Health and Human Services (HHS) to total $6.9 billion.

The program has also received more attention as a result of two factors: the Affordable Care Act’s (ACA’s) addition of more program-eligible institutions and new guidelines from the Health Resources and Services Administration (HRSA) allowing program participants to contract with multiple pharmacies. Some critics have raised concerns about a philosophical difference between the original intent of the program (helping safety-net institutions to stretch limited resources) from the fact that many institutions see a profit when public and private payers reimburse them at a rate higher than what they paid for the drugs. Read the rest of this entry »

Contributing Voices

The Accidental Administrative Law Of Policymaking In The Medicare Program


December 11th, 2014

Editor’s note: This post is part of a series of several posts stemming from presentations given at “The Law of Medicare and Medicaid at Fifty,” a conference held at Yale Law School on November 6 and 7.

When Congress establishes a new regulatory program, it lodges the program in a regulatory agency or executive department. A regulatory agency generally has presidentially appointed commissioners with staggered terms and expert staff. This design provides insulation from politics and facilitates applying technical expertise to regulatory problems. Also, administrative agencies make rules and policy and have the powers of investigation, adjudication, and sanction to enforce compliance. Administrative law, an essential instrument of democracy, regulates the operation and procedures of government agencies.

The Social Security Amendments of 1965 established Medicare in the Social Security Administration (SSA). Medicare initially contained two parts, hospital insurance for hospital and related services and supplementary medical insurance for physician and other outpatient services. Pursuant to contract, Medicare contractors handle claims and pay providers as well as adjudicate appeals and make program policy.

This post chronicles the development administrative law, policymaking, and regulation in the Medicare program. It describes how the program evolved a revolutionary collaborative model of regulation that could provide a useful guide for other programs. Read the rest of this entry »

Two Theologies Have Blocked Medicare-For-All


December 11th, 2014

Editor’s note: This post is part of a series of several posts stemming from presentations given at “The Law of Medicare and Medicaid at Fifty,” a conference held at Yale Law School on November 6 and 7.

In the 50 years since Medicare was enacted, Congress has never seriously considered extending Medicare to all Americans, nor even lowering Medicare’s eligibility age below 65. This pattern persisted even during those periods when national health insurance was at the top of the national agenda. This is not what the original advocates of Medicare anticipated when Medicare was enacted in 1965. They saw Medicare as the cornerstone of a national system of health insurance that would eventually cover all Americans.

Two Myths that Undercut Medicare-for-All: Managed Care and Competition

In the paper we presented at the Yale conference, we reviewed short- and long-term factors affecting the debate about Medicare over its lifetime, and then turned to a discussion of two long-term factors: the rise of what came to be called the managed care movement, and the resurgence of a longstanding campaign promoting the idea that competition can right the wrongs of American medicine. Read the rest of this entry »

Should Doctors Deny Ebola Patients CPR?


December 11th, 2014

The first time I did CPR, coagulated blood spurted onto my new white coat from a wound in the patient’s chest. Another time a patient’s urine soaked through the knees of my pants as I knelt at his side.

Even in the best of conditions, cardiopulmonary resuscitation (CPR) is a spit-smeared, bloody business that can expose health care workers to all kinds of body fluids. Like all health care workers, I put on gloves and a game face and accept such things as part of patient care.

The 2014 Ebola outbreak changes all that. Hospitals all around the world are now training staff in personal protective equipment (PPE) use and convening rapid response teams. A key part of this process involves grappling with how dangerous it will be to perform CPR on patients with Ebola. Read the rest of this entry »

What To Watch For During This Year’s Open Enrollment Period: Lessons From The Health Reform Monitoring Survey


December 10th, 2014

The Obama Administration recently lowered its expectations on the number of individuals that are likely to enroll in health insurance plans through the Marketplace by the end of 2015—suggesting that it might be more difficult than expected to find and enroll remaining uninsured residents while retaining people who signed up during the first open enrollment period (New York Times; Wall Street Journal; Washington Post’s “Wonkblog”).

One potential barrier to enrollment is low levels of Marketplace awareness among the uninsured: September 2014 estimates from the Urban Institute’s Health Reform Monitoring Survey (HRMS) indicate that only 52 percent of uninsured adults reported hearing some or a lot about the health insurance Marketplace created by the Affordable Care Act (ACA). Despite this large knowledge gap, awareness of the Marketplace has improved since last September, when only 30 percent of the uninsured reported hearing some or a lot about the Marketplace prior to the first open enrollment period.

While increasing awareness of the Marketplace will continue to be important as the second open enrollment period unfolds, there are two additional issues that may determine how many more uninsured people actually gain coverage this year. First, will the remaining uninsured be reluctant to seek coverage and enroll during the current open enrollment period, and if so, why?  Second, for people seeking information on health plans, what sources of information are they likely to turn to, and will those sources be adequate to meet the demand?  Read the rest of this entry »

California’s Proposition 46 And The Uncertain Future Of Medical Malpractice Liability Reform


December 10th, 2014

On November 4, 2014, Californians voted against Proposition 46, an unprecedented statewide ballot initiative that would have, among other things, raised the $250,000 cap on noneconomic damages to $1.1 million and indexed it to the rate of inflation in future years. The margin was significant — 67 percent voted against it.

For nearly 40 years, noneconomic damages, which entail payments to patients for pain and suffering resulting from medical malpractice (as opposed to economic damages such as lost wages and medical costs), have been at the forefront of debates over the U.S. medical liability system. Currently, 22 states have caps on noneconomic damages of varying sizes in place. If it had passed, the ballot initiative would have raised the cap on noneconomic damages in California from among the most restrictive to the least restrictive among all states with caps.

Opponents of Proposition 46, and supporters of malpractice reform more generally, argued that raising the noneconomic damages cap would have increased malpractice awards and subsequently malpractice premiums, which would be passed on to patients and insurers as higher costs. Read the rest of this entry »

Does Public Health Have A Future?


December 10th, 2014

Ebola’s arrival in the U.S. hit Americans with a jolt. Regardless of how you feel about the response to date, it should remind everyone of the importance of public health.

Fortunately, public health in the U.S. has built an extraordinary track record of success. Smallpox, one of the most dreaded diseases in history, was eradicated worldwide. New vaccines have sharply cut the toll of deaths and disabilities from H flu meningitis, tetanus, pneumococcal sepsis and other deadly diseases.

Adding folate to foods dramatically reduced neural tube defects in newborns. Safer cars and better roadway designs cut fatal crashes per million vehicle miles traveled by 90 percent. Because smoking is far less popular than it once was, 8 million Americans have been spared early and agonizing deaths from cancer, heart disease, emphysema, and other smoking-related diseases. Read the rest of this entry »

CMS Proposes Coverage For Lung Cancer Screening With Low Dose CT


December 9th, 2014

Update, December 12: As a technical matter, commenter Laurie Fenton Ambrose is correct that CMS did not officially propose coverage with evidence development (CED), and this post has been edited to reflect this fact. However, in my view, it would be misleading to describe CMS’ proposed decision as simply  “coverage” given the requirements imposed for lung cancer screening with Low Dose Computed Tomography (LDCT). Stringent requirements include limits on eligibility  to Medicare beneficiaries between 55-74 years of age with at least a 30 pack-year history of smoking; additional requirements extend to screening imaging facilities and providers. In addition, the outcomes data on these individuals must be submitted to a CMS-approved national registry. Such data will help to address concerns regarding gaps in evidence. However, as previously noted, such restrictions will lead to troubling disparities in access, particularly for low-income and minority populations, which could only be overcome with a full coverage decision.

Original post: On November 11, the Centers for Medicare and Medicaid Services (CMS) released its Proposed Decision Memo for Screening Lung Cancer with Low Dose Computed Tomography (LDCT), which is expected to be finalized in mid-December. Despite a negative assessment by its own advisory committee, CMS has proposed coverage for an annual “lung cancer screening counseling and shared-decision-making visit” and, for appropriate beneficiaries, additional screening with LDCT.

Through this proposed decision, CMS has followed the lead of numerous other expert and advisory groups, which have concluded that the overall benefits of such screening for at-risk individuals outweigh concerns regarding gaps in evidence, generalizability and potential harms. Read the rest of this entry »

The Health Care Holy Grail?


December 9th, 2014

A friend practicing internal medicine in Massachusetts is a pillar of his community, a beloved physician — and he is miserable.

“The practice of medicine has deteriorated to that point where many of my colleagues would like to get out,” he told us. “I certainly would. Medicine now is about production lines, insurance company power, regulations. It is one fire drill after another throughout the day, day after day with a bureaucrat peering over your shoulder all the while.”

In countless conversations in recent years we have found that these sentiments are as common as they are troubling. Imagine going through the rigors of medical school and training and then looking back and regretting your career choice? Burnout is sweeping physician ranks throughout the country. Read the rest of this entry »

From The National Coordinator For Health IT: The Federal Strategy For Collecting, Sharing, And Using Electronic Health Information


December 8th, 2014

Making our nation’s health and wellness infrastructure interoperable is a top priority for the Administration, and government plays a vital role in advancing this effort. Federal agencies are purchasers, regulators, and users of health information technology (health IT), as they set policy and insure, pay for care, or provide direct patient care for millions of Americans. They also contribute toward protecting and promoting community health, fund health and human services, invest in infrastructure, as well as develop and implement policies and regulations to advance science and support research.

The Office of the National Coordinator for Health IT (ONC) has a responsibility to coordinate across the federal partners to achieve a shared set of priorities and approach to health IT.  To that end, today we released the draft Federal Health IT Strategic Plan 2015-2020, and we are seeking feedback on the federal health IT strategy.  This Strategic Plan represents the collective priorities of federal agencies for modernizing our health ecosystem; however, we need your input. We will accept public comment through February 6, 2015. Please offer your insights on how we can improve our strategy and ensure that it reflects our nation’s most important needs.

A collection of 35-plus federal departments and agencies collaborated to develop the draft Federal Health IT Strategic Plan: 2015-2020, identifying key federal health IT priorities for the next six years (Exhibit 1). The landscape has dramatically changed since the last federal health IT strategyWhen we released that Plan, the HITECH Act implementation was in its infancy. Since then, there has been remarkable growth in health IT adoption. Additionally, the Affordable Care Act implementation has begun to shift care delivery and reimbursement from fee-for-service to value-based care. Read the rest of this entry »

Evolving Medicaid To Better Serve Children With Medically Complex Conditions


December 8th, 2014

The fragmented Medicaid system must evolve to better meet the needs of children with medically complex conditions, a growing population responsible for a high proportion of health care spending. Regional care networks and national data support are two viable tools for containing costs while improving care for our nation’s most vulnerable children.

The Case for Change

Medicaid has evolved into an essential health care payor for the nation’s children, supporting health care coverage for more than 30 million children.

The program has become particularly vital to families of children with complex medical conditions. Care for this population was not widespread when Medicaid was created nearly 50 years ago. In the early 1960s very few infants born with extreme prematurity and/or congenital conditions survived. Thanks to advances in pediatric subspecialty training and technology, the life prospects for these children have greatly improved, and Medicaid now supports an estimated 2 million children with medical complexity. This population is projected to double over the coming decade. Read the rest of this entry »

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