Traveling The Valley Of The Shadow Of Death In 2017
My mother has a letter from her mother written in 1942, telling of the death from pneumonia of a middle-aged neighbor with whom my grandmother had spoken at the post office just a week earlier. For most of human history, that sudden turn to death has been the common experience. Few managed to live into old age; and even for elders, the dying was usually fairly abrupt. There was little risk of living long with dementia, Parkinson’s disease, heart failure, cirrhosis, serious injuries, childbirth complications, or other fatal illnesses. Diabetes was fatal within a few months in 1900. Now, most of us will instead experience ...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Joanne Lynn Tags: End of Life & Serious Illness elder care health care reform long-term care reform MediCaring Communities Program of All-Inclusive Care of the Elderly Source Type: blogs
The Alexander-Murray Market Stabilization Package: What ’s In It And Where’s It Going?
They may have done it. The apocryphal bipartisan deal to “fix” Obamacare is being struck (at least by two important Senators, for now, in part …). Today, Senators Lamar Alexander of Tennessee and Patty Murray of Washington announced they are converging on an agreement on a short-term package to help stabilize the individual insurance market.
Even better, the policies included would likely be somewhat successful in achieving their purported purpose. This post will explore each of them in some detail and consider the impact they may have, as well as the probability Congress will send the legislation to President Trump,...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Billy Wynne and Timothy Jost Tags: Costs and Spending Featured Following the ACA Insurance and Coverage 1332 waivers copper plans cost-sharing reduction payments interstate insurance reinsurance Source Type: blogs
Despite Leaving Key Questions Unanswered, New Contraceptive Coverage Exemptions Will Do Clear Harm
On October 6, the Trump administration released an overhaul of federal regulations governing religious objections to the Affordable Care Act’s (ACA) contraceptive coverage guarantee. The move had been long expected. In early May, President Donald Trump issued an executive order on “religious liberty” that signaled his intent to undermine the guarantee; a few weeks later, media outlets published a leaked draft of the new regulations. The two regulations issued on Friday—which took effect immediately—closely match the draft from May by creating sweeping new exemptions from the contraceptive coverage guarant...
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: Adam Sonfield Tags: Following the ACA Public Health Contraception contraceptive coverage executive order moral objection preventative care religious exemptions Trump administration Source Type: blogs
Salvaging MACRA Implementation Through Medicare Advantage
Conclusion
The implementation of MACRA will have a profound and lasting effect on the future US health care system and the practice of medicine. However, unless there are substantive changes to how the law is implemented, MACRA is unlikely to realize the goal of establishing a Medicare payment system that rewards the value and not the volume of health care services. Many of the key objectives of the legislation can be achieved using Medicare Advantage as the platform. (Source: Health Affairs Blog)
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: John O'Shea Tags: Medicare Payment Policy advanced alternative payment model APM MACRA Medicare Advantage Merit-Based Incentive Payment System mips Source Type: blogs
A Framework For Understanding ‘ Savings ’ From Accountable Care Organizations
Medicare’s Accountable Care Organization (ACO) program is the Centers for Medicare and Medicaid Services’ (CMS) flagship population-based payment model. In the ACO program, groups of providers form ACOs and take accountability for the spending and quality of care for the Medicare beneficiaries they serve. The ACO is given a spending target (benchmark) and receives a bonus (i.e. gets to share savings) if actual spending is below the target. In some ACO programs, the ACO must return money to Medicare if spending exceeds the target.
The release of the Office of the Inspector General’s (OIG) report on the savings res...
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: Michael Chernew and Christopher Barbey Tags: Costs and Spending Featured Medicare Organization and Delivery Accountable Care Organizations Medicare Shared Savings Program payer savings Pioneer ACOs societal savings utilization savings Source Type: blogs
A New Plan To Rescue The ACA: Medicare-At-55
On October 12, 2017, the Trump Administration announced that it would end subsidies that reduce out-of-pocket payments for low-income individuals. This action might drive insurers out of the exchanges and might encourage younger people to drop their individual insurance plans — thereby destabilizing the individual insurance market.
Extending Medicare to the 55-64 age group—who have relatively high health care costs—is a potential fix that could insure the near-elderly and provide stability to the marketplaces. It would remove expensive individuals and families from coverage by private insurance companies,...
Source: Health Affairs Blog - October 16, 2017 Category: Health Management Authors: Thomas Bodenheimer Tags: Costs and Spending Featured Following the ACA Medicare individual insurance market Medicare-At-55 Source Type: blogs
ACA Repeal Votes Defy Preferences Of Constituents
Despite repeatedly failing to advance legislation through the Senate, Republicans in Congress have not abandoned their goal of repealing and replacing the Affordable Care Act (ACA). The latest attempt at repeal in the form of the Graham-Cassidy bill would have established a per capita cap on federal Medicaid financing, eliminated the individual mandate, and undermined protections for older adults and people with preexisting conditions, by allowing states to opt out of key ACA insurance regulations. It would also have eliminated funding for the ACA’s Marketplace premium and cost-sharing subsidies and Medicaid expansion, a...
Source: Health Affairs Blog - October 16, 2017 Category: Health Management Authors: Michael Karpman, Sharon Long and Nikhil Holla Tags: Featured Following the ACA ACA repeal and replace. health care legislation Affordable Care Act health care access health care affordability Source Type: blogs
A Fateful Thursday For The ACA: Likely Effects And Legal Reactions
Thursday, October 12, 2017, was one of the most eventful days in the history of the Affordable Care Act. Late Thursday morning, President Trump released an executive order directing the Departments of Labor, Treasury, and Health and Human Services to begin the process of drafting rules that will expand the use of association health plans, exempting small employer plans from the ACA’s small group consumer protections and perhaps preempting state regulation; expand the length and renewability of short-term coverage; and expand the ability of employers to use health reimbursement accounts to shift coverage of their employ...
Source: Health Affairs Blog - October 14, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage association health plans cost-sharing reduction payments health reimbursement arrangement short-term limited duration plans Source Type: blogs
Who Cares For The Caregivers? We All Do
Nearly 44 million people in the United States, three-quarters of whom are women in their late 40s, spend at least 22 hours a week providing unpaid care to loved ones with a disability, illness, or terminal diagnosis, and one in four spend at least twice that amount. Typically, they assist with the activities of daily living such as bathing, dressing, toileting, and feeding their loved one, as well as taking care of shopping, finances, and transportation to and from medical appointments.
These responsibilities generally last at least three years, with demands increasing as the loved one nears death. Caretaking offers emotio...
Source: Health Affairs Blog - October 13, 2017 Category: Health Management Authors: Nicole Cadovius Tags: End of Life & Serious Illness addiction Aging anxiety caregivers depression End-of-Life Mental Health mental health first aid National Council for Behavioral Health support services Source Type: blogs
Administration ’ s Ending Of Cost-Sharing Reduction Payments Likely To Roil Individual Markets
Yesterday, October 12, 2017, the White House press office announced that the administration will no longer be reimbursing insurers for the cost-sharing reductions they are legally required to make for low-income individuals. The Affordable Care Act requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. These provisions reduce the out-of-pocket limit for these enrollees—particularly for those with incomes below 200 percent of poverty—and sharply reduce deductibles, coinsurance, and copayments. The redu...
Source: Health Affairs Blog - October 13, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA Marketplaces advance premium tax credits California cost-sharing reduction payments individual market Source Type: blogs
Trump Executive Order Expands Opportunities For Healthier People To Exit ACA
On October 12, 2017, President Donald Trump issued an executive order concerning health care coverage. The White House also posted two summaries of the order. If carried into action, the provisions of the executive order would likely siphon healthy people from of the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.
The executive order has several main components. First, it calls generally for expanding competition and choice in health care markets and for improving the information available to consumers while reducing reporting bur...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage 21st Century Cures Act association health plans health reimbursement arrangement short-term limited duration plans Source Type: blogs
Taking A Long View: A Foundation ’s Rapid-Response, Data-Driven Strategy To Inform Recovery From Hurricane Harvey In Texas
When Hurricane Harvey made landfall as a Category 4 hurricane near Rockport, Texas, on August 25, 2017, we knew there would be massive winds and torrential rains. But none of us understood, and will probably not understand for some time, the full extent of the impact of this natural disaster in communities throughout the Gulf Coast region—from Texas to Louisiana.
What we do know is that with a record fifty-two inches of rainfall in parts of the region, the flooding has had devastating effects. To date, 829,825 individual assistance applications have been received by the Federal Emergency Management Agency (FEMA) and $1.8...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Shao-Chee Sim Tags: Featured GrantWatch Organization and Delivery Public Health Centers for Disease Control and Prevention disaster preparedness emergency planning Federal Emergency Management Agency (FEMA) Health Philanthropy homelessness Hurricane Harve Source Type: blogs
Giving Urban Health Care Access Issues The Attention They Deserve In Telemedicine Reimbursement Policies
A May 2017 Wall Street Journal analysis highlights the plight of rural America: People there who are sick are getting sicker because health systems are struggling to deliver care in rural areas. The challenges are multifactorial, but a key driver is the availability of providers. Only 10 percent of physicians serve rural populations, and the number of specialists per capita is a third of the number that practice in urban areas. The Centers for Medicare and Medicaid Services (CMS) considers the per capita physician shortage to be an important health care access problem. In an effort to improve access to care, CMS has create...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Yash S. Huilgol, Aditi U. Joshi, Brendan G. Carr and Judd E. Hollander Tags: Featured Health Equity appointment timeliness health care access Medicare reimbursement Telemedicine Source Type: blogs
The Insufficiency Of Medicaid Block Grants: The Example Of Puerto Rico
Medicaid block grants have been a centerpiece of Republican health proposals for more than a decade. Proponents, including House Speaker Paul Ryan (R-WI), argue that giving states a fixed amount of money through a block grant or per-person limit with few strings attached gets Washington out of the way and allows for state innovation. Although the most recent block grant legislation did not reach the Senate floor, proponents have promised to continue to push for it.
But one need look no further than the growing health crisis in Puerto Rico to understand why capped federal money and state flexibility will not solve serious h...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Vikki Wachino and Tim Gronniger Tags: Medicaid and CHIP block grants disaster relief Puerto Rico Source Type: blogs
Health Affairs Briefing: Choosing Wisely — Opportunities and Challenges in Curbing Medical Overuse
You are invited to join Health Affairs on Tuesday, October 24, in Washington, DC, for an important event:
“Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse.”
“Choosing Wisely” is an initiative launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports — and which has received funding from the Robert Wood Johnson Foundation — to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures. At the five-year mark of the initiative, Health Affairs will gather leaders of the effort, p...
Source: Health Affairs Blog - October 11, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs ABIM alexander mainor american board of internal medicine arthur s. hong Choosing Wisely Consumer Reports daniel b. wolfson eric wei eve kerr jessica rich john n. mafi kellie slate vitcavage matt handley Source Type: blogs
