From The Staff

Health Affairs Event Reminder: Collaborating For Community Health


November 4th, 2014

Policymakers are paying increasing attention to the relationship between the characteristics of communities and the health of the people living in them. The November 2014 issue of Health Affairs, “Collaborating For Community Health,” examines new possibilities created by alignment of the fields of health and community development.

These possibilities come from both sides, including recent changes in the community development field that have set the stage for the new focus on improving health, as well as new approaches to health care financing that create incentives for improving health outcomes.

You are invited to join us on Wednesday, November 5, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.

WHEN:
Wednesday, November 5, 2014
9:00 a.m. – 12:00 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_CommunityHealth. Read the rest of this entry »

Social Services And Community Health: Health Affairs’ November Issue


November 3rd, 2014

The November issue of Health Affairs includes a number of studies looking at how social services and community support programs can improve the health of local residents. Other subjects covered: the potential for pay-for-performance payment models to create a market that values health, not just health care; how one safety-net accountable care organization is uniquely improving care coordination; a three-year progress report on a regional health collaborative; and more.

This issue of Health Affairs is supported by The Kresge Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation. It will be discussed at a Wednesday, November 5 briefing at the National Press Club in Washington, DC. Read the rest of this entry »

Health Affairs Web First: Vietnam’s Health Care System, Explained By Its Minister Of Health


October 30th, 2014

In August, Vietnam’s Minister of Health, Nguyen Thi Kim Tien, was interviewed for Health Affairs by Tsung-Mei Cheng, recently released as a Health Affairs Web First.

Among the topics discussed was an overview of the unique characteristics of Vietnam’s health system; its strengths and weaknesses; health financing reform aimed at reaching the goal of universal health coverage; the prevention and control of infectious diseases; and how Vietnam has performed in achieving the Millennium Development Goals.

Cheng is a health policy research analyst at the Woodrow Wilson School of Public and International Affairs, Princeton University, in New Jersey. Health Affairs has previously published Cheng’s interviews with other world health ministers, including Thomas Zeltner of Switzerland (2010) and Chen Zhu of China (2012). Read the rest of this entry »

Health Affairs Briefing: Collaborating For Community Health


October 29th, 2014

Policymakers are paying increasing attention to the relationship between the characteristics of communities and the health of the people living in them. The November 2014 issue of Health Affairs, “Collaborating For Community Health,” examines new possibilities created by alignment of the fields of health and community development.

These possibilities come from both sides, including recent changes in the community development field that have set the stage for the new focus on improving health, as well as new approaches to health care financing that create incentives for improving health outcomes.

You are invited to join us on Wednesday, November 5, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.

WHEN:
Wednesday, November 5, 2014
9:00 a.m. – 12:00 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_CommunityHealth. Read the rest of this entry »

Exhibit Of The Month: Comparing The Cost And Value Of Specialty And Traditional Drugs


October 27th, 2014

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

This month’s exhibits, from the article, “Despite High Costs, Specialty Drugs May Offer Value For Money Comparable To That Of Traditional Drugs,” published in the October issue of Health Affairs, compare the value and costs of specialty and traditional drugs approved by the Food and Drug Administration from 1999-2011. Read the rest of this entry »

The Latest Health Wonk Review


October 24th, 2014

Louise Norris at Colorado Health Insurance Insider provides this week’s “falling leaves” edition of the Health Wonk Review. Jennifer’s insightful read includes a Health Affairs Blog post from J. Stephen Morrison on the U.S. Ebola response and the role of CDC head Thomas Friedan. Read the rest of this entry »

Narrative Matters: Sensitizing Doctors To Patients With Disabilities


October 23rd, 2014

In the October Health Affairs Narrative Matters essay, a doctor who stutters confronts the stigma against patients—and providers—with disabilities. Leana Wen’s article is freely available to all readers, or you can listen to the podcast. Read the rest of this entry »

Health Affairs Web First: Noneconomic Damage Caps Reduced Medical Malpractice Payments, With Varied Effects


October 22nd, 2014

With the 2014 election weeks away, a provision of California’s Proposition 46, raising the cap on medical malpractice payments for noneconomic damages, has been in the news. This provision would increase the payment cap from $250,000 to $1.1 million. A new study, being released today by Health Affairs as a Web First, sheds light on the potential effect of this proposition.

Study authors Seth A. Seabury, Eric Helland, and Anupam B. Jena looked at the impact of medical malpractice reforms on the average size of malpractice payments in several physician specialties and compared how the effects differed according to the size of the cap. It found that caps reduced the average payments by 15 percent compared to no cap—and a $250,000 cap reduced average payments by 20 percent.

On the other hand, a less restrictive $500,000 cap had no significant effect. The authors also found specialty variations, with the largest impact involving pediatricians and the smallest for claims of surgical subspecialties and ophthalmologists. Read the rest of this entry »

Resources Don’t Solve Design Flaws


October 21st, 2014

The first three sessions of a conference I recently attended tackled some complex and important questions: How do we extend health insurance to people such as migrant and informal workers who don’t fit neatly into mainstream coverage programs? As we increase our investment in primary care, how do we assure that the performance of the primary care system is at the highest possible level? What types of evidence should we use as we make decisions in a dynamic health care system with limited opportunities for “gold standard” randomized controlled trials?

These are excellent questions, and they were perfect topics for a cutting-edge conference discussing the challenges facing the U.S. health care system.

But this conference was not about the U.S. health care system. These were opening “satellite” sessions at the Third Global Symposium on Health Systems Research held in Cape Town, South Africa. Read the rest of this entry »

Health Policy Brief: The Ninety-Day Grace Period


October 17th, 2014

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines the ninety-day grace period, a provision of the Affordable Care Act (ACA). Of the eight million people who enrolled in the insurance Marketplaces between October 2013 and March 2014, 85 percent received an advance premium tax credit. This provision allows a three-month grace period for nonpayment of insurance premiums for this group of consumers–and this group only–if they have previously paid at least one month’s full premium in that benefit year.

This grace period allows these new enrollees continuity of care, preventing them from shifting or “churning” in and out of coverage for nonpayment. Health care providers, however, have expressed concerns that this provision and the way the Centers for Medicare and Medicaid Services (CMS) has implemented it could expose them to considerable financial risk. This Health Policy Brief focuses on how this provision is being implemented and the concerns from the provider community. Read the rest of this entry »

Contributing Voices

Continuity Of Care For Chronic Conditions: Threats, Opportunities, And Policy


November 18th, 2014

Continuity of care is a bedrock principle of the patient-doctor relationship and is believed to be a fundamental attribute of high-quality medical care. Mounting evidence suggests that continuity of care for patients with chronic conditions prevents hospitalizations, reduces health care costs, and may prolong life in some populations.

Because patients are most likely to have longitudinal relationships with their pediatricians, family physicians, and internists, taken together, these primary care doctors are integral to translating continuity into meaningful care coordination. However, within the rapidly shifting landscape of health care delivery in the United States, continuity of care is simultaneously threatened and promoted by emerging care models. Read the rest of this entry »

How Consumers Might Game The 90-Day Grace Period And What Can Be Done About It


November 17th, 2014

Under the Patient Protection and Affordable Care Act (ACA), individuals receiving a federal subsidy are entitled to a three-month premium nonpayment grace period. As long as such an individual has paid at least the first month’s premium of the year, in any subsequent month the individual has three months to make the premium payment before coverage is terminated.

The grace period has obvious benefits for consumers, yet as a recent Health Affairs Health Policy Brief describes, this provision of the law has created significant apprehension among doctors and other health care providers who worry they will go unpaid when coverage is retroactively terminated for their patients. Unfortunately, as we explain here, this provision could have even broader adverse implications for the health care system.

The grace period law could encourage subsidized individuals to regularly pay only nine months of premiums and receive, in effect, twelve months of coverage. Should this gaming become widespread it could increase premiums (perhaps by as much as several percentage points) for everyone who purchases coverage in the individual (non-group) exchanges. Read the rest of this entry »

Battle Lines Drawn Over Biosimilar Application And Patent Disclosure Process


November 17th, 2014

The Biosimilars Price Competition and Innovation Act of 2009 (BPCIA) introduced a long-awaited, and highly-supported, abbreviated route to market for “biosimilar” and “interchangeable” biologic products. The goal was to create incentives for development and reduce health care costs in the same way that previous legislation had accomplished in the generic arena over three decades ago.

However, widespread criticism of BPCIA provisions to facilitate interactions between biosimilar applicants and reference biologic sponsors regarding application submission and patent status was swift and unrelenting. Attorneys practicing in the realm of Hatch-Waxman litigation for generic drugs balked at the drastic differences between the familiar public process grounded in required patent disclosures, FDA Orange Book listings, and generic applicant certifications and the private, iterative process set forth in the BPCIA. Legal scholars, industry representatives, and practitioners alike projected that a courtroom battle regarding real-world operation of the provisions was imminent. Read the rest of this entry »

Implementing Health Reform: Setting The Stage For 2015 Open Enrollment


November 16th, 2014

On November 15, 2014, the Affordable Care Act marketplaces reopened for 2015 enrollment, the second year of ACA coverage.  On November 14, the Centers for Medicare and Medicaid Services and the Office of Personnel Management released guidance and reports laying the groundwork for the second year.  This post covers these and notes briefly a couple of ACA court decisions that also came down on November 14.

Plan data release.  CMS released a number of data files containing information on plans available on the marketplaces for 2015 and their rates.  First, the release includes “landscape files” including plans available by county along with premium and cost-sharing data for selected scenarios and services for the 2015 plan year for the federally facilitated marketplace and federally facilitated SHOP. Read the rest of this entry »

Medicaid At 50: From Exclusion To Expansion To Universality


November 14th, 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.

For almost five decades, Medicaid has been a safety net with gaping holes. Medicaid has provided invaluable health care access for the “deserving poor”—the impoverished blind, disabled, children, pregnant women, and elderly—but they only comprise approximately 40 percent of the nation’s poor. The Patient Protection and Affordable Care Act (ACA), as part of its comprehensive insurance coverage architecture, rendered all Americans earning up to 138 percent of the federal poverty level (FPL) eligible for Medicaid. Through the effort to “provide everybody … some basic security when it comes to their health care,” the ACA adopted a universal approach to health care access. Universality is a fundamentally different philosophical approach in American health care, and an important progression away from the stigmatizing rhetoric of the “deserving poor.”

The Supreme Court nearly thwarted the possibility of universality by holding the Medicaid expansion unduly coercive and rendering expansion optional for the states. Ever since, states have been exercising that option, deciding whether to expand in a highly dynamic dialogue that has occurred both intrastate and extra-state with the Secretary of the Department of Health and Human Services (HHS). This dialogue has resulted in four waves of Medicaid expansion, each of which has exhibited greater boldness on the part of the states in their proposals to HHS, and greater flexibility on the part of HHS in accepting state ideas for expansion. On a spectrum of federalism, the waves move from cooperation to assertions of state sovereignty. But, Medicaid’s new universality provides an absolute backstop for HHS in these negotiations, a point at which federal policy should not accommodate the rent-seeking behavior of the states. Read the rest of this entry »

Risk And Reform Of Long-Term Care


November 14th, 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.

The 50th Anniversary of Medicare and Medicaid offers an opportunity to reflect on how U.S. social policy has conceived of the problem of long-term care.

Social insurance programs aim to create greater security—typically financial security—for American families (See Note 1). Programs for long-term care, however, have had mixed results. The most recent attempt at reform, which Ted Kennedy ushered through as a part of the Patient Protection and Affordable Care Act (ACA), called the CLASS Act, was actuarially unsound and later repealed. Medicare and especially Medicaid, the two primary government programs to address long-term care needs, are criticized for failing to meet the needs of people with a disability or illness, who need long-term services or supports. These critiques are valid.

Even more troublesome, however, long-term care policy, especially in its most recent evolution toward home-based care, has intensified a second type of insecurity for Americans. This insecurity arises when someone becomes responsible for the long-term care of a loved one. In a longer forthcoming article, I argue that this insecurity—which I call “next-friend risk”—poses a serious threat to Americans and needs to be addressed. (I borrow the phrase next friend from a legal term for a person who in litigation represents someone with a disability who is otherwise unable to represent him or herself. Although not a legal guardian, the next friend protects the interests of an incompetent person.) Read the rest of this entry »

Using Mobile Technology To Overcome Jurisdictional Challenges To A Coordinated Immunization Policy


November 14th, 2014

On March 20, 2014, the Government of Canada and the federal Minister of Health announced the release of ImmunizeCanada (ImmunizeCA), a smart phone application (app) designed to both provide accurate information on immunization for Canadians and allow them to track their and their family members’ immunizations. Based on a prototype developed for parents in Ontario and in partnership with the Canadian Public Health Association, our development team received funding from the Public Health Agency of Canada to build a national immunization app. Our task was to build an Apple- and Android-compatible app, containing all 13 provincial/territorial schedules and vaccine information from each jurisdiction in both Canadian official languages (French and English).

The application uses demographic information entered by the user and the most recent recommended provincial vaccination schedule to create a custom profile for multiple family members. It allows parents to track and carry their children’s immunizations records on their mobile device. The application also permits the creation of adult-specific schedules and includes information on travel vaccines. It is also possible to sync the app with your smartphone calendar, generate appointment reminders, print or share an immunization record by email, and access answers to common questions. Read the rest of this entry »

Reforming Medicare: What Does The Public Want?


November 13th, 2014

Is Medicare adequately meeting the needs of seniors, or are there ways that its core attributes could be improved? Numerous elected officials, policymakers, and other thought leaders have offered perspectives on ways to change the program. Few efforts, however, have been directed at understanding how the public—given accurate information, a variety of options, and a valid structure for weighing the pros and cons—would change Medicare’s basic design.

The MedCHAT Project

Recently, the American Enterprise Institute and the Brookings Institution co-hosted a briefing on the results of a California project that did just that. The “MedCHAT” project, sponsored by the nonprofit, nonpartisan Center for Healthcare Decisions, asked 800 residents—the lay public, as well as health care professionals and community leaders—to consider Medicare’s current benefits and decide if those should be changed. Respondents represented the full spectrum of age, race, ethnicity, education, and income level.

Using an interactive, computer-based system, participants were asked to respond as “social decisionmakers;” they were tasked with making Medicare more responsive to the needs of current and future generations without imposing a greater cost burden on the country. The computer-based CHAT (“Choosing All Together”) program uses actuarial estimates to show the relative costs of health care benefits, allowing participants to make trade-offs with an understanding of the fiscal impact each benefit has on the program. Read the rest of this entry »

High Quality, Affordable Care: Making The Case For Smarter Networks


November 13th, 2014

Narrow networks are one means health insurance plans have used to mitigate increases in health insurance premiums. These networks have become more prevalent since the expansion of coverage brought about by the Affordable Care Act (ACA). But these narrow networks have given rise to complaints that consumers are being denied access to, and choice of, providers. These complaints are causing policymakers to consider, and in some cases adopt, new laws and regulations on network adequacy.

In the following blog post, I argue that policymakers should consider that there are different types of narrow networks and should be careful not to adopt policies that inhibit new contractual arrangements among payers, providers, and hospitals, such as Accountable Care Organizations, which hold the promise of better quality care at lower cost. At the same time, issuers must provide accurate and current information on which hospitals and providers are in the network and are accepting new patients, and must make the case that smarter networks can lead to better outcomes at lower cost. Read the rest of this entry »

Health Care Accelerators: An Innovative Response To Federal Policy Mandates


November 12th, 2014

Health-focused startup “accelerators” are a new approach to developing solutions to problems in health care. An accelerator serves as a short-term incubator for startups to build innovative new businesses through funding, mentorship, network access and coaching.

Accelerators have been a critical part of the technology economy and innovation ecosystem since the 2006 launch of YCombinator. Health care-focused accelerators emerged in 2011, largely as a result of changes in national health care policy–including the HITECH Act and the Affordable Care Act–and the perceived new opportunities these changes created. Since that time, there has been tremendous growth in accelerators across the nation supported by a diverse set of stakeholders, part of a larger innovation economy that has formed in response to federal policy making. Read the rest of this entry »

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