Replicating Effective Models Of Complex Care Management For Older Adults
Improving our system of care for older adults with complex, chronic illnesses requires wrestling with a vexing dilemma. Models of care that are readily scalable have limited effectiveness, and effective models are difficult to scale. As an example of the former, the patient-centered medical home (PCMH) has become widespread, but its impact on population health and health care costs varies and has been modest overall. As a stand-alone solution, the PCMH appears insufficient to deliver the diverse set of interventions required by chronically ill, older adults with complex needs—a growing segment of the US population th...
Source: Health Affairs Blog - June 7, 2017 Category: Health Management Authors: Ken Coburn, Charlotte Grinberg, Sophia Demuynck and Margaret Hawthorne Tags: Costs and Spending Diffusion of Innovation Featured Medicare chronically ill older adults complex care management health and aging Health Quality Partners Source Type: blogs
Supreme Court Endorses Broad Government View Of ERISA ‘Church Plan’ Definition
On June 5, 2017, the Supreme Court released Advocate Health Care Network v. Stapleton, unanimously (with Justice Gorsuch not yet participating) accepting the federal government’s interpretation of the Employee Retirement Income Security Act’s (ERISA) definition of “church plan.” The Court rejected a challenge brought by employees covered by defined-benefit pension plans offered by entities that qualified as “church plans” under the government’s interpretation.
Separately, on the same day, the Department of Justice filed a brief in Texas v. United States in support of the federal government’s motion for summ...
Source: Health Affairs Blog - June 6, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA ERISA Source Type: blogs
Investing In Policy And Advocacy: A Foundation Shares Lessons Learned
Working on advocacy and policy is challenging. Not only is it complex, fluid, and increasingly politicized, it is also challenging to measure progress and communicate success.
Some Background
Understanding this, in 2012, the Foundation for a Healthy Kentucky, a statewide foundation located in Louisville, launched Promoting Responsive Health Policy (PRHP)—a six-year, multifaceted initiative to address four broad health policy areas—increasing access to integrated health care; increasing the proportion of Kentuckians living in smoke-free jurisdictions; improving children’s health; and strengthening local public health....
Source: Health Affairs Blog - June 6, 2017 Category: Health Management Authors: M. Gabriela Alcalde and Maggie Jones Tags: GrantWatch Insurance and Coverage Medicaid and CHIP Health Law Health Philanthropy Health Reform Kentucky Matt Bevin Policy Politics States Source Type: blogs
The Tower Of Babel In Clinical Research: PCORnet ’s Common Data Model Cracks The Foundation
Across all medical specialties, there is a severe lack of high-quality clinical evidence, in part because the gold standard for evidence is large-scale randomized controlled clinical trials. Such trials are on an unsustainable cost trajectory, as they require expensive, stand-alone data capture infrastructures. Furthermore, they typically enroll highly selected populations that are not necessarily representative of real-world patients. Although the emergence of the electronic health record (EHR) holds great promise for generating much-needed evidence, medical research lags far behind other industries in its ability to use ...
Source: Health Affairs Blog - June 6, 2017 Category: Health Management Authors: Lesley H. Curtis Tags: Costs and Spending Featured Health IT Quality big data clinical research clinical trials Common Data Model PCORI PCORnet Source Type: blogs
The CBO ’s Updated Estimate Of The AHCA
On May 24, the Congressional Budget Office (CBO) released its assessment of the American Health Care Act (AHCA). The estimate reflects the impact of two amendments that were key to the US House of Representatives’ passage of the bill three weeks earlier. The MacArthur amendment allows states to apply for waivers from key Affordable Care Act (ACA) regulatory requirements. The Upton amendment creates an $8 billion fund to help make insurance more affordable to high-cost individuals in states that change ACA insurance rules. Much of the discussion in the updated cost estimate explains the CBO’s rationale for determining h...
Source: Health Affairs Blog - June 6, 2017 Category: Health Management Authors: Joseph Antos and James Capretta Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP American Health Care Act Congressional Budget Office Source Type: blogs
Health Affairs ’ June Issue: Pursuing Health Equity
The June issue of Health Affairs, a theme issue, explores the pursuit of health equity and the obligations of the health care sector to achieve it. The issue examines the subject from two perspectives: equity in care, and the relationship between social factors and health equity.
The issue was supported by The Kresge Foundation, The California Endowment, Aetna Foundation, The Colorado Health Foundation, Episcopal Health Foundation, and the Robert Wood Johnson Foundation.
US virtually tops list of countries with highest health and health care disparities across income levels
Comparing health and health care disparities in t...
Source: Health Affairs Blog - June 5, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Health Affairs journal Source Type: blogs
This Intervention Helps Underserved Women Access Needed Postpartum Care
Pregnancy and childbirth can exacerbate many health risks, especially among underserved women or those who have a hard time getting health care. Diabetes, hypertension, and depression are all serious health conditions that occur frequently during pregnancy and childbirth, and are more common (during pregnancy and overall) among racial and ethnic minority women. Many women with these conditions have worsened health throughout their life course.
Yet pregnancy and the postpartum period also present an opportunity for providers to intervene and improve the health trajectories of these women by connecting them to health care, h...
Source: Health Affairs Blog - June 5, 2017 Category: Health Management Authors: Elizabeth A. Howell Tags: Health Equity Medicaid and CHIP Payment Policy Quality maternal depression Maternal Health postpartum care Primary Care Women's Health Source Type: blogs
The Senate Should Build Automatic Enrollment Into Health Reform. Here ’s How.
Conclusion
Take-up of health insurance has been below its potential for a long time. Even with the ACA’s penalties for going uninsured, large numbers of Americans are forgoing coverage and either paying additional tax penalties for doing so or applying for an exemption from the law’s individual mandate. The House GOP’s replacement plan for the ACA provides incentives for enrollment and penalties for going uninsured too, but Congressional Budget Office (CBO) believes them to be even weaker than those contained in ACA. If enacted, Congressional Budget Office forecasts there would be much lower take-up of insurance unde...
Source: Health Affairs Blog - June 5, 2017 Category: Health Management Authors: Lanhee Chen and James Capretta Tags: Following the ACA Insurance and Coverage ACA repeal and replace AHCA auto-enrollment high deductible health plans Source Type: blogs
On Objections To Contraceptive Coverage, Trump Administration Appears Set To Reverse Obama Approach
On May 30, 2017, a draft of an interim final rule promulgated by the Departments of Health and Human Services, Labor, and Treasury, addressing conscience-based objections to the coverage of contraceptives under the preventive services requirement of the Affordable Care Act, was leaked to the media. The draft seems authentic and has been widely reported in the media.
However, the draft is currently at the Office of Management and Budget for review, and the interim final rule when released may be different from the draft. It will also be accompanied by Health Resources and Services Administration (HRSA) women’s preventive ...
Source: Health Affairs Blog - June 2, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptive coverage ERISA HRSA Preventive Services Mandate Women's Health Source Type: blogs
ERISA: A Bipartisan Problem For The ACA And The AHCA
The Supreme Court has once again been called on to mediate the boundaries of a far-reaching, infamously complex, federal employee benefits law. And once again this law may have an important and unanticipated effect on health care.
The main goal of this law, the Employee Retirement Income Security Act of 1974 (ERISA), was to provide uniform, federal regulation of pensions and employee benefit plans (including health care). But the law has had a far more dramatic impact on health policy beyond what Congress ever contemplated. Because ERISA pushes aside state regulation of these plans, it has impeded the states’ ability to ...
Source: Health Affairs Blog - June 2, 2017 Category: Health Management Authors: Abbe R. Gluck, Allison K. Hoffman and Peter D. Jacobson Tags: Following the ACA Insurance and Coverage Advocate Health Care Network v. Stapleton AHCA All-Payer Claims Database church plans ERISA Essential Health Benefits Gobeille v. Liberty Mutual Insurance Co. SCOTUS States Zubik v. Burwell Source Type: blogs
Debunking The Pharmaceutical Research ‘Free Rider’ Myth: A response To Yu, Helms, And Bach
Policy researchers at the Memorial Sloan Kettering Center for Health Policy and Outcomes have published a recent, valuable Health Affairs Blog post. The post shows that major pharmaceutical companies that manufacture some of the top-selling drugs “charge much more for their drugs in the United States than they do in other Western countries.” US prices averaged 2.4 times more than the $81 billion Americans would have paid at the average prices in other affluent countries; Americans paid a total of about $197 billion, or an excess of $116 billion per year. That would be $1.16 trillion in higher charges in a decade.
The o...
Source: Health Affairs Blog - June 2, 2017 Category: Health Management Authors: Donald W. Light Tags: Costs and Spending Drugs and Medical Innovation Payment Policy Big Pharma drug innovation drug pricing free-rider myth Research and Development Source Type: blogs
Drug Prices And Medical Innovation: A Response To Yu, Helms, and Bach
In a recent Health Affairs Blog post, Nancy Yu, Zachary Helms, and Peter Bach note that prices for top-selling drugs are higher in the United States than in other countries. They conclude that “premium pricing [in the United States] exceeds what is needed to fund global R&D.” They further suggest that “lowering the magnitude of the US premium” would have saved $40 billion for US prescription drug purchasers in 2015.
Essentially, the authors imply that the US price premium could be significantly reduced without affecting research and development investments or having other adverse effects. This is a strikingly b...
Source: Health Affairs Blog - June 2, 2017 Category: Health Management Authors: Henry Grabowski and Richard Manning Tags: Costs and Spending Drugs and Medical Innovation Featured Big Pharma drug innovation drug pricing Research and Development Source Type: blogs
ACA Round-Up: Litigation Over Cost-Sharing Reductions And Reinsurance Fees, Tax Filings, And More
On May 30 the House of Representatives filed its response to the motion of attorneys general from 15 states and the District of Columbia asking that the stay in House v. Price be lifted and that they be allowed to intervene in the appeal. The federal government had filed its response on May 26.
In its short response to the states’ motion, the federal government simply asked that the case remain in abeyance and that the court not address the motion to intervene while negotiations continued with the House. The House, however, went further, also arguing that “it is entirely speculative whether the Administration will ever...
Source: Health Affairs Blog - June 1, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage house v. price risk corridor payments Source Type: blogs
What Evidence Is Needed To Transform Health And Health Care?
While there is consensus that more reform is needed to improve value in the US health care system, there is less agreement on the mechanisms for achieving that broad aim. Put simply, while many agree on the what, they do not agree on the how.
Efforts to repeal and replace the Affordable Care Act (ACA) remain on Congress’ legislative agenda, with a bill called the American Health Care Act (AHCA) recently passing in the House of Representatives, yet it is unclear whether, or in what form, this bill will pass in the Senate. There is an extensive evidence base evaluating the implementation of the ACA, but more research is ne...
Source: Health Affairs Blog - June 1, 2017 Category: Health Management Authors: Megan Collado and Mona Shah Tags: GrantWatch Insurance and Coverage Medicaid and CHIP Affordable Care Act American Health Care Act Consumers evidence Health Care Costs Health Law Health Philanthropy health policy research Health Reform Robert Wood Johnson Foundatio Source Type: blogs
For Patients With Multiple Chronic Conditions, Improving Care Will Be A Bipartisan Effort
Editor’s Note: This is the third in a five-part Health Affairs Blog series, produced in conjunction with the Bipartisan Policy Center, examining current issues and care models in the delivery system reform effort. Each post will be jointly authored by Democratic and Republican leaders in health policy. Check back for more posts in the series.
While federal policy makers are undertaking controversial and divisive debates over the future of the Affordable Care Act, Republicans and Democrats have had a good track record of working together to improve health care delivery and payment frameworks. Most recently, the bipartisa...
Source: Health Affairs Blog - June 1, 2017 Category: Health Management Authors: Thomas Daschle and Bill Frist Tags: Costs and Spending Insurance and Coverage Long-term Services and Supports Medicaid and CHIP Medicare Payment Policy Alternative Payment Models bipartisan delivery system reform Bipartisan Policy Center Chronic Care CHRONIC Care Act i Source Type: blogs
