March 3rd, 2014
Health Affairs’ March issue, released today, explores how the Affordable Care Act (ACA) could affect two key sectors of the population with unique public health needs—those living with HIV/AIDS and people who have recently cycled through local jails.
When it comes to HIV treatment, timing is everything. Dana Goldman of the University of Southern California and coauthors modeled HIV transmission and prevention based on when HIV-positive individuals started combination antiretroviral treatment (cART). They estimate that from 1996-2009, early treatment initiation in the US prevented 188,700 HIV cases and avoided $128 billion in life expectancy losses.
The authors highlight treatment at “very early” stages (when CD4 white blood cell counts are greater than 500, consistent with current treatment guidelines in the US) as responsible for four-fifths of prevented cases. Early treatment both reduces morbidity and mortality in people living with HIV/AIDS, and decreases the transmission of the disease to the uninfected. Goldman and coauthors conclude that early treatment has clear value for both HIV-positive and HIV-negative populations in the US. Read the rest of this entry »
February 28th, 2014
David Harlow at HealthBlawg offers this week’s edition of the Health Wonk Review. All of the posts in David’s “In Like A Lion” Review reward reading, including the Health Affairs Blog post by Mark McClellan and coauthors at Brookings on how to pay for Medicare physician payment reform. Read the rest of this entry »
February 28th, 2014
One of the least explored yet most important parts of the Affordable Care Act (ACA) are provisions that hold promise for addressing serious health care challenges facing the 1.1 million Americans who are living with HIV/AIDS — and others like them — most of whom are impoverished and uninsured.
Please join Health Affairs Founding Editor John Iglehart on Tuesday, March 11, in Washington, DC, for a Health Affairs briefing on our March issue where we will spotlight topics related to the ACA and people with HIV/AIDS.
Tuesday, March 11, 2014
9:00 a.m. – Noon
National Press Club
529 14th Street NW, Washington, DC, 13th Floor (Metro Center)
Follow live Tweets from the briefing @HA_Events, and join in the conversation with the hashtag #HA_HIVAIDS Read the rest of this entry »
February 27th, 2014
At Health Affairs Blog, we’re excited to introduce a new regular feature. Each month, Health Affairs editors will review all the tables, charts, graphs and maps that have run in the latest print edition of the journal. After deliberating in a dark, but smoke-free, backroom, we’ll emerge to crown the most compelling, creative or surprising exhibit as our Exhibit of the Month! 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 exhibit shows how, within the Kaiser Permanente Northern California system, the number of virtual physician visits grew from 4.1 million in 2008 to 10.5 million in 2013. Read the rest of this entry »
February 26th, 2014
Pay-for-performance—reimbursing health care providers based on the results they achieved with their patients as a way to improve quality and efficiency—has become a major component of health reforms in the United States, the United Kingdom, and other affluent countries. Although the approach has also become popular in the developing world, there has been little evaluation of its impact. A new study, released today as a Web First by Health Affairs, examines the effects of pay-for-performance, combined with capitation, in China’s largely rural Ningxia Province.
Between 2009 and 2012, authors Winnie Yip, Timothy Powell-Jackson, Wen Chen, Min Hu, Eduardo Fe, Mu Hu, Weiyan Jian, Ming Lu, Wei Han, and William C. Hsiao, in collaboration with the provincial government, conducted a matched-pair, cluster-randomized experiment to review that province’s primary care providers’ antibiotic prescribing practices, health spending, and several other factors. They found a near-15 percent reduction in antibiotic prescriptions and a small decline in total spending per visit to community clinics.
The authors note that the success of this experiment has motivated the government of Ningxia Province to expand this intervention to the entire province. “From a policy perspective, our study offers several additional valuable lessons,” they conclude. “Provider patterns of overprescribing and inappropriate prescribing cannot be changed overnight; nor can patient demand, for which antibiotics are synonymous with quality care. Provider payment reform probably needs to be accompanied by training for providers and health education for patients.” Read the rest of this entry »
February 26th, 2014
The latest Health Policy Brief update from Health Affairs and the Robert Wood Johnson Foundation, published February 6, describes the new marketplaces created for small businesses to buy cheaper coverage more easily. These exchanges were created under the Affordable Care Act (ACA)’s Small Business Health Options Program (SHOP). Employers with fewer than 25 employees must purchase coverage through a SHOP if they want the small-business tax credit. This policy brief discusses the potential impact of the problems with the online exchange systems on health benefits offered by small employers.
The preceding Health Policy Brief update, published January 23, describes the current status of the Consumer Operated and Oriented Plan (CO-OP) program especially now that ACA implementation has begun. Because of funding cuts, one CO-OP was disbanded, and now 23 remain in 23 states. An updated partial list of approved CO-OPs and their sponsoring organizations is included. This policy brief discusses CO-OP funding, competency, competitive premium rates, and provision of care. Despite its early success, the next steps will be to see how many people the CO-OPs are able to enroll, whether their premium rates are sustainable, and their plans offer the same quality of care as the commercial market. Read the rest of this entry »
February 26th, 2014
A health reform proposal introduced by three Republican Senators is a positive development both substantively and politically, Dan Mendelson, CEO of Avalere Health, said in a recent interview. He said the greater flexibility in benefit design afforded by the GOP proposal could be a boon for many uninsured people dissatisfied with the choices allowed by the Affordable Care Act.
Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT) offered the proposal, designed to replace the ACA, earlier this year. “This is the discussion that I wish had happened before the passage of the law, said Mendelson, who served as Associate Director for Health at the White House Office of Management and Budget under President Clinton. “We have here three very knowledgeable, relatively moderate Republican Senators coming together on a construct that embraces a lot of what was passed in the ACA. There’s an individual market … prohibited from discrimination on the basis of pre-existing condition; there are patient protections like the age band ratings, albeit less restrictive than the ones that were enacted in the bill.”
Mendelson noted that the Burr-Coburn-Hatch framework retains the ACA’s Medicare provisions. “Everything related to health system change stays: The Medicare Advantage Star ratings, which are very significant and far reaching policy, the Center for Medicare and Medicaid Innovation, and the like,” he said.
The Senate GOP proposal also contains some “very significant changes” from the ACA, many of which provide greater state flexibility in the individual market and Medicaid, Mendelson pointed out. On Medicaid, the proposal “really goes much closer to the block grant proposal that Republicans have felt comfortable with for quite some time. Ironically block granting might actually result in more coverage [than the ACA Medicaid provisions], given where Texas and some of the other Republican states are right now, because they would accept this,” in contrast to their rejection of Medicaid expansion under the ACA. Read the rest of this entry »
February 25th, 2014
The Obama administration touted a recent increase in the enrollment rate for young adults in the Affordable Care Act’s health insurance exchanges – how significant was this trend? What should we make of the recent Congressional Budget Office findings regarding projected decreases in hours worked by Americans as a result of the ACA? How does the recent introduction of a new health reform proposal by three Republican Senators affect the policy and political discussions around reform? And what should we expect as states continue to assess whether to expand their Medicaid programs?
In the latest edition of our Health Affairs Conversations podcast series, our guests address these and other health reform developments. James Capretta is a Senior Fellow at the Ethics and Public Policy Center and a Visiting Fellow at the American Enterprise Institute; Genevieve Kenney is Co-Director and a senior fellow in the Health Policy Center of the Urban Institute; and Larry Levitt is Senior Vice President for Special Initiatives at the Kaiser Family Foundation and Senior Advisor to the President of the Foundation.
You can access the podcast recording here. Read the rest of this entry »
February 24th, 2014
Those who have watched the debate in Washington over the increasing use of Senate filibusters will likely have considerable sympathy for Arkansas Governor Mike Beebe (D), the guest at today’s Health Affairs/Kaiser Health News Newsmaker Breakfast. At least the majority party in the Senate can break a filibuster with 60 out of 100 votes. In Arkansas, it takes 75-percent votes in both legislative Houses to pass an appropriations bill — including the funding necessary to continue operating Arkansas’s path-breaking “private option” approach to expanding Medicaid under the Affordable Care Act, in which those newly eligible for Medicaid under the ACA are insured through private plans rather than the state’s traditional Medicaid program.
The ACA requires states to expand their Medicaid program to cover all those making up to 138 percent of the federal poverty level and funds 100 percent of the state costs of the expansion, declining to 90 percent in 2020. After the ACA was passed, the Supreme Court made the Medicaid expansion optional for states. Arkansas was the first state to secure federal approval for the private option — sometimes called the “Arkansas Plan” – and this approach has since attracted attention from Republicans in other states interested in expanding coverage with federal dollars but averse to increasing the size of their traditional Medicaid programs.
The Republican-controlled Arkansas state Senate has voted to fund the private option – or “Arkansas plan,” as it is sometimes called – for its second fiscal year (beginning July 1), but several ballots last week in the 100-member state House of Representatives – also controlled by the GOP — fell a handful of “yeas” short of the needed 75 votes. The House plans to continue voting on the plan this week, and Beebe said he remains optimistic that it will pass. He said the case for approval is just “arithmetic,” referring not to counting votes but counting the dollars – all $89 million of them – that the state will need to cut from its next budget if the Arkansas does not reapprove the private option and thus loses the federal funding that goes with it, money that has already been committed to a tax cut that legislators are not about to repeal. That’s on top of the tens of millions more dollars that state businesses and hospitals would lose. Read the rest of this entry »
February 21st, 2014
In a recent GrantWatch Blog post, Jeffrey Brenner raises the question, “What if Thomas Edison had to write grant proposals to invent the light bulb?” Brenner is a MacArthur fellow, medical director of the Urban Health Institute, and executive director and founder of the Camden Coalition of Healthcare Providers.
Brenner uses the Edison analogy to look at current grant funding and population health.
Since 1945 the National Institutes of Health (NIH), a federal government agency that funds medical research, has spent $547 billion dollars to cure disease and push the frontiers of medical knowledge. This spending has been supplemented by funding from private foundations. Sadly, despite all of this spending we have little understanding of how to deliver better care at lower cost to every American. At best, in the field of population health, we have a few light bulbs that stay lit for an hour or two, but we lack even basic knowledge to drive this field forward.
With 85 million baby boomers in the midst of retiring and a health care system that consumes 18 percent of our economy, it is not a small problem. We do not understand the fundamental drivers of health care utilization; the basic rules for designing and implementing effective interventions; the best ways to use data to plan, implement, manage, and evaluate interventions; nor how to train staff to run and lead these interventions. Why the lack of progress? Read the rest of this entry »