From The Staff

New Health Policy Brief: Employee Choice


September 18th, 2014

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) looks at health coverage choice for employees of small businesses. Unlike large organizations, small businesses have been less likely to provide comprehensive health insurance or a choice of plans, and their employees are more likely to be uninsured or underinsured.

To address this insurance gap, the Affordable Care Act (ACA) created the Small Business Health Options Program (SHOP) Marketplaces in each state. (Note: The SHOP exchange was the subject of an earlier Health Policy Brief.) These Marketplaces (eighteen run by state exchanges, thirty-three by the federal government) will provide “one stop shopping,” for small businesses to compare health plans and enroll their employees.

To make SHOP Marketplaces more attractive to small businesses, the ACA required SHOP Marketplaces to offer a feature known as employee choice, in which employers can offer their employees a choice from multiple health insurance plans. While the majority of state-based SHOP Marketplaces have chosen to offer access to multiple plans, employee choice will not be mandatory until 2016. This Health Policy Brief examines the issue of employee choice, the status of its implementation, and whether the concept is successfully attracting more small businesses to offer coverage through SHOP Marketplaces. Read the rest of this entry »

Narrative Matters: When The System Fails The Intertwined Needs Of Caregiver And Patient


September 15th, 2014

In the September Health Affairs Narrative Matters essay, when a family caregiver becomes injured, she learns the difficulties—and costs—of caring for herself and her chronically ill husband at the same time. Suzanne Geffen Mintz’s article is freely available to all readers, or you can listen to the podcast. Read the rest of this entry »

The Latest Health Wonk Review


September 12th, 2014

At Health Business Blog, David Williams is not ashamed to be a wonk in his September 11 edition of the Health Wonk Review. David highlights many great posts, including “The 125 Percent Solution,” suggested by Jonathan Skinner, Elliott Fisher, and James Weinstein on Health Affairs Blog, which would give consumers and insurers the option of paying 125 percent of the Medicare price for any health care service.  Read the rest of this entry »

ACOs, Bundled Payment Lead Health Affairs Blog August Most-Read List


September 12th, 2014

Posts on payment and delivery reform head the Health Affairs Blog top-fifteen list for August. Suzanne Delbanco and David Lansky’s post on accountable care organizations was the most-read post, followed by Tom Williams and Jill Yegian’s post on bundled payment, written in response to an article published in the August issue of Health Affairs.

Next is Health Affairs’ Editor-in-Chief Alan Weil’s post on the five engagements that will define the future of health, drawn from his keynote presentation at the 2014 Colorado Health Symposium. This is followed by Rosemarie Day and coauthors’ post on the private health insurance exchange system.

The full list is below. Read the rest of this entry »

New Health Policy Brief: Drug Shortages


September 11th, 2014

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) looks at the ongoing problem of drug shortages in the United States. From 2005 to 2010, the number of reported drug shortages almost tripled.

Today, newly reported drug shortages overall are decreasing, but the total amount of drug shortages continues to increase, reflecting just how long it can take to rectify a shortage. Generic sterile injectable drugs, a vital component for patients fighting cancer, combatting an infection, or about to undergo surgery, are in especially short supply.

One of the most cited reasons for generic sterile injectable drug shortages is low reimbursement rates from Medicare Part B that came about after a change in law in 2003. These changes incentivized both physicians and manufacturers to switch to higher-cost drugs, reducing investment in cheaper generic drugs and causing “growing market concentration,” and eventual drug shortages. Read the rest of this entry »

Employer-Sponsored Family Health Premiums Rise 3 Percent In 2014


September 10th, 2014

Average annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, continuing a recent trend of modest increases, according to the Kaiser Family Foundation (KFF)/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey released today. Workers on average pay $4,823 annually toward the cost of family coverage this year. Health Affairs Web First article published today contains select findings from the KFF/HRET report.

This year’s increase continues a recent trend of moderate premium growth. Premiums increased more slowly over the past five years than the preceding five years (26 percent vs. 34 percent) and well below the annual double-digit increases recorded in the late 1990s and early 2000s. This year’s increase also is similar to the year-to-year rise in worker’s wages (2.3 percent) and general inflation (2 percent).

Annual premiums for worker-only coverage stand at $6,025 this year.  Workers on average contribute $1,081 toward the cost of worker-only coverage this year.

“The relatively slow growth in premiums this year is good news for employers and workers, though many workers now pay more when they get sick as deductibles continue to rise and skin-in-the-game insurance gradually becomes the norm,” Foundation President and CEO Drew Altman, said. Read the rest of this entry »

Rethinking Graduate Medical Education Funding: An Interview With Gail Wilensky


September 9th, 2014

A recent Institute of Medicine report has stirred controversy by proposing to significantly reshape the way Medicare graduate medical education funding is distributed. However, before the panel that wrote the report grappled with how the federal government should fund GME, it had to decide whether the federal government should be involved in the area at all.

“We struggled with the rationale [for a federal role] from the first meeting to the last time we convened,” Gail Wilenksy, who co-chaired the panel with Don Berwick, said in a recent interview with Health Affairs Blog.  After all, she said, the federal government “is not in the business of funding undergraduate medical education or other health care professions in any similar way, or funding other professions that are believed to be important to society and in shortage,” such as engineers, mathematicians, or scientists.

GME funding has been discussed at length in the pages of Health Affairs and will be the subject of a briefing sponsored by the journal tomorrow, Wednesday September 10. (Live and archived webcasts will be available for those who cannot attend in person.) Wilensky will offer opening remarks at the briefing. A summary of the GME report is provided in an earlier Health Affairs Blog post by Edward Salsberg, who will also participate in the briefing. Read the rest of this entry »

Think and Act Globally: Health Affairs’ September Issue


September 8th, 2014

The September issue of Health Affairs emphasizes lessons learned from developing and industrialized nations collectively seeking the elusive goals of better care, with lower costs and higher quality. A number of studies analyze key global trends including patient engagement and integrated care, while others examine U.S.-based policy changes and their applicability overseas.

This issue was supported by the Qatar Foundation and World Innovation Summit for Health (WISH), Hamad Medical Corporation, Imperial College London, and The Commonwealth Fund. Read the rest of this entry »

Health Affairs Event Reminder: Advancing Global Health Policy


September 5th, 2014

Please join us on Monday, September 8, when Health Affairs Editor-in-Chief Alan Weil will host a briefing to discuss our September 2014 thematic issue, “Advancing Global Health Policy.” In an expansion of last year’s theme, “The ‘Triple Aim’ Goes Global,” we explore how developing and industrialized countries around the world are confronting challenges and learning from each other on three aims: cost, quality, and population health.

A highlight of the event will be a discussion of international health policy—led by Weil—featuring former CMS and FDA administrator and current Brookings Institution Senior Fellow Mark McClellan and Lord Ara Darzi, surgeon, scholar, and former UK Health Minister. Additional panels will look at how countries are transforming chronic care, lowering costs, and redesigning delivery systems.

WHEN: 
Monday, September 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_GlobalHealth.

If you can’t come in person (we hope you will!), you can watch the webcast of the event.

Read the rest of this entry »

Projected Slow Growth In 2013 Health Spending Ahead Of Future Increases


September 3rd, 2014

Insurance Coverage, Population Aging, and Economic Growth Are Main Drivers of Projected Future Health Spending Increases

New estimates released today from the Office of the Actuary at the Centers for Medicare and Medicaid Services project a slow 3.6 percent rate of health spending growth for 2013 but also project a 5.6 percent increase in health spending for 2014 and an average 6.0 percent increase for 2015–23. The average rate of projected growth for 2013–23 is 5.7 percent, exceeding the expected average growth in gross domestic product (GDP) by 1.1 percentage points.

Increased insurance coverage via the Affordable Care Act (ACA), projected economic growth, and population aging will be the main contributors of this growth, ultimately leading to an expected 19.3 percent health share of nominal GDP in 2023, up from 17.2 percent in 2012.  This compares to the Office of the Actuary’s 2013  report, published in Health Affairs, predicting an average growth rate of 5.8 percent for 2012–22.

Every year, the Office of the Actuary releases an analysis of how Americans are likely to spend their health care dollars in the coming decade. The new findings appear as a Health Affairs Web First article and will also appear in the journal’s October issue. Read the rest of this entry »

Contributing Voices

Arkansas Payment Improvement Initiative: Private Carriers Participation In Design And Implementation


October 15th, 2014

Editor’s note: This post is part of a periodic Health Affairs Blog series, which will run over the next year, looking at payment and delivery reforms in Arkansas and Oregon. The posts will be based on evaluations of these reforms performed with the support of the Robert Wood Johnson Foundation. The authors of this post are part of the team evaluating the Arkansas model.

Since the inception in 2011 of the multi-payer Arkansas Payment Improvement Initiative (APII), the state’s Medicaid program and some of its largest private insurers, including Arkansas Blue Cross Blue Shield (BCBS) and QualChoice, have worked together to help create critical mass toward systemic change.

With private payer alignment on design elements and implementation strategy, providers in Arkansas are now responding to common expectations from payers, including consistent financial incentives, standardized reporting tools and congruent targets for both quality and outcomes. While we’ve referenced the role of private carriers in our previous blog posts, here we provide more detail on this collaborative effort. Read the rest of this entry »

Brownsville: A Culture of Health, Not Health Challenges


October 14th, 2014

Editor’s Note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change.

Brownsville is a culturally diverse, south Texas border town, a stone’s throw from Mexico. The 180,000 residents, mostly Spanish-speaking, live in one of the poorest metropolitan areas in the United States and have massive public health needs. In Brownsville, 48 percent of the children live in poverty, and 80 percent of our population is obese or overweight. Thirty percent have diabetes and half of them don’t know it. About 67 percent have no health insurance.

But in Brownsville, you will also find a robust, bike-friendly city, community gardens, and the world’s largest Zumba® class. That’s because in the last 10 years Brownsville has developed innovative partnerships, extensive outreach efforts, and a shared commitment to achieve wellness. Read the rest of this entry »

Implementing Health Reform: Reference Pricing And Network Adequacy


October 12th, 2014

On October 10, 2014, the Departments of Labor, Treasury, and Health and Human Services issued a frequently asked question (FAQ) regarding the use of reference-based pricing in non-grandfathered large group employer plans.  Although the issue the FAQ addresses specifically is the use of reference pricing, the FAQ is remarkable insofar as it is the first departmental guidance that I am aware of that addresses the use of networks by self-insured ERISA plans.

Network adequacy is an issue that has long been addressed in the nongroup and insured group market in many states by state insurance law.  The ACA also requires qualified health plans, and arguably any individual and small group plan subject to the essential health benefits requirements, to have adequate provider networks.  Special rules implementing ACA section 2719A of the ACA limit cost-sharing for out-of-network coverage for emergency services.

The departments also stated in an earlier FAQ that cost sharing cannot be applied by any non-grandfathered health plan for preventive services provided by out-of-network providers if the services are not available in network.   But I am unaware of the departments otherwise attempting previously to regulate group health plan network requirements, at least under the ACA. Read the rest of this entry »

A Patient Advocate’s Perspective On Paying For Value


October 9th, 2014

When patient-centered outcomes research “is used well, it can be a powerful tool in making medical care better informed, without limiting patients’ and providers’ choices.”  That was the promise that I, and many others, held out with creation of the Patient-Centered Outcomes Research Institute (PCORI) in 2010.  Will PCORI achieve this goal? It is increasingly clear that evolving “value-based” payment models in health care, accelerated via the Affordable Care Act (ACA), will play a central role in how that question gets answered.

The movement to place greater financial risk on providers in an effort to pay for value rather than volume will have the effect of fundamentally changing the way health care providers interact with patients. But the question in value-based payment remains: value to whom?  The answer should be, of course, value to the patient. And the answer will be, intrinsically, shaped by application of evidence.

While I applaud efforts to improve and advance our health care system through payment and delivery reforms, I am also mindful that such value-based payment systems must be built upon the foundation of “patient-centeredness.” Indeed, lawmakers and policy experts have long agreed that a “patient-centered health care system” is the Holy Grail of bipartisan health care reform. Yet despite significant progress in advancing patient-centeredness in our health system, much more work remains to be done. Read the rest of this entry »

Drug Discount Analysis Misses The Mark


October 8th, 2014

Rena Conti and Peter Bach’s analysis of disproportionate share (DSH) hospitals in the 340B drug discount program — published in the October issue of Health Affairs — neglects an essential point: Compared to non-340B DSH hospitals, 340B DSH hospitals provide over twice as much care to Medicaid and low-income Medicare patients, and almost twice as much uncompensated care. 340B DSH hospitals across the board provide high levels of uncompensated care. For these and other reasons enumerated below, the article does not support the criticism that 340B DSH hospitals are no longer serving vulnerable patients.

First, Conti and Bach misconstrue the 340B program’s intent. 340B is not – and never was – a direct assistance program for the poor. According to the Government Accountability Office, “The 340B program allows certain providers within the U.S. health care safety-net to stretch federal resources to reach more eligible patients and provide more comprehensive services, and we found that the covered entities we interviewed reported using it for these purposes.”

For example, 340B savings help The Henry Ford Hospital fund four oncology clinics and related services in Detroit and surrounding townships. The program is also enabling Henry Ford to hire pharmacists and nurses to follow up with their patients to ensure they are taking their medicines properly and that the treatment is effective. Read the rest of this entry »

The Need For A Comprehensive, Current, And Market-Representative Health Care Cost Benchmark


October 7th, 2014

A recent post from Jonathan Skinner and colleagues on Health Affairs Blog posited an interesting solution to ever-increasing health care costs, suggesting that imposing price caps on all medical services, equal to 125 percent of the Medicare payment, would serve to eliminate wide variations in quoted prices for health care services.

While the overall idea of controlling costs through the establishment of a mutually agreed-upon and accessible benchmark is a sound one, the use of Medicare reimbursement levels as a ceiling for this purpose would present a number of challenges. For example, Medicare does not assign a value to all codes; a separate system would be needed to price services not addressed by Medicare’s fee schedule.

Also, Medicare’s reimbursement levels can be influenced by governmental imperatives and therefore may not be truly representative of market costs. And the establishment of a 125 percent of Medicare cap—a standard used by some health plans for in-network care where providers are guaranteed a high volume of patients—might not be adequate reimbursement for one-off, out-of-network services that lack a network’s compensatory volume economics.

We at FAIR Health suggest an alternative approach using measures that are acceptable to all stakeholders as reference points for out-of network charges to help achieve the proposal’s laudable goal: to provide quality health care at transparent prices that are reasonable for consumers and fair to providers. Read the rest of this entry »

500 Days And Counting: Critical Steps In The Countdown To Achieving MDG 6


October 6th, 2014

Editor’s note: For more on global health, see the September issue of Health Affairs.

We are now less than 500 days away from December 31, 2015, the target date for reaching the world’s Millennium Development Goals (MDG). This includes MDG 6, the goal of combatting HIV/AIDS, malaria, and other diseases.

Astonishing progress has been made to date (as mentioned previously in our Health Affairs Blog post): AIDS-related deaths have fallen 35 percent since their peak in 2005; global mortality from tuberculosis has fallen by 45 percent since 1990; and global malaria mortality rates dropped 42 percent globally between 2000 and 2012. The key, of course, is maintaining this momentum in order to reach our goal.

It’s certainly no small task. But, three immediate steps can and must be taken:

  1. Enhance cost efficiencies;
  2. Build and strengthen partnerships; and
  3. Translate scientific developments into practice.

Read the rest of this entry »

The VA Post-Scandal: New Law And New Leadership


October 2nd, 2014

Editor’s note: For more on this topic, see the Health Affairs Blog posts from Theodore Stefos and James Burgess and Jonathan Bush

In the wake of the recent scandals in the Department of Veterans Affairs (VA), new leadership was installed with former Procter & Gamble CEO Robert McDonald confirmed as Secretary by Congress on July 29 and the Veterans Access, Choice and Accountability Act of 2014 became law on August 7. The Act, fashioned with VA cooperation and described as a VA overhaul, provides resources for the Veterans Health Administration (VHA), demands greater accountability and transparency and introduces the ability of certain VHA enrollees to choose private health care.

The Act’s bipartisan support and the rapidity of its design and passage (perhaps a model of productive legislative discussions) reflect strong support in the country for veterans. As the new law and new VA leadership pass the one-month mark of the two-year window to the end of this administration, the focus will be on how effectively VA implements the law and makes other strides. Read the rest of this entry »

Vets Deserve The Right To Shop For Care


October 2nd, 2014

Editor’s note: For more on this topic, see the Health Affairs Blog post from Theodore Stefos and James Burgess, and stay tuned for an upcoming blog post from Joel Kupersmith. 

As former Procter & Gamble CEO Robert McDonald steps in to lead the Department of Veterans Affairs (VA), it’s difficult not to think about the thousands of physicians across the U.S. who are chomping at the bit to contribute to the fix. Even before his recently confirmed appointment, McDonald said his focus would be on getting veterans the benefits and care they deserve. This customer-focused approach and his appointment in general have been greeted with rare bipartisan praise and unanimous passing. However, as the saying goes, the devil is in the details.

According to reports, tens of thousands of veterans have been waiting three months or longer for an initial appointment. Three months? Data from athenahealth’s national, cloud-based network of more than 55,000 health providers representing approximately 57 million patient records, recently found that the median wait time for a primary care visit for a new patient last year was about three days; non-well-visit wait times averaged around one day.

The point is that veterans have been waiting far longer for appointments than the general population at a time when the health care provider ecosystem – whether hospital or practice – outside the VA often struggles to fill beds and open slots. Seemingly, there are providers nationwide who would be eager to care for these vets and benefit from their business. For new VA Secretary Robert McDonald, a renowned consumer-goods leader, this supply and demand scenario nearly solves itself. Read the rest of this entry »

Establishing Vouchers For Veteran Health Care


October 2nd, 2014

Editor’s note: For more on this topic, stay tuned for additional Health Affairs Blog posts today from Jonathan Bush and Joel Kupersmith. 

Recent disclosures of long wait times at Department of Veterans Affairs (VA) facilities that are presumed to lead to adverse patient outcomes have led to calls for reorganization. Possible reorganization approaches include privatization and the provision of vouchers to enrolled veterans. However, this discussion must recognize that Medicare already provides comprehensive services to the majority of VA patients.

Provider care coordination accompanied by financial incentives such as subsidized co-pays and deductibles, or purchased MEDIGAP policies, could induce veterans who use relatively little VA care to choose most, if not all, of their health care from Medicare providers. This would affect budget allocations under current VA funding and the new funding under the PL 113-146 (Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014), potentially freeing up VA resources to deal with increasingly complex patients, without creating another bureaucracy or insurance program. Combined with VA management reforms which should include provider productivity requirements and more intense quality reviews, financial incentives to focus VA care have the potential to help VA return to performing its core mission successfully. Read the rest of this entry »

Authors: Click here to submit a post.




Search Blog
  
Health Affairs Conversations
Email Notifications
Recent Comments
Categories
Twitter Updates
Blogroll