February 22, 2018

Category Archives: Health policies

Creating A Culture Of Whole Health: A Realistic Framework For Advancing Behavioral Health And Primary Care Together

Creating A Culture Of Whole Health: A Realistic Framework For Advancing Behavioral Health And Primary Care Together

People present in wholes, not pieces. Despite this irrefutable scientific fact, our health care delivery system has reinforced a false notion that mental health is separate from physical health. We further this fragmentation, whether or not we realize it, in how we pay for care, deliver care, train for care, and create policy. New approaches to integrate behavioral health with primary care have emerged as among the most promising solutions to decades of fragmented care. Mental health, often referred to as behavioral health, needs this type of disruption. What does this integration look like? One word: seamless. Imagine as a patient you walk into your primary care practice—and here, engaging you and all your health care …Continue Reading

Today’s Most Attractive National ACO Model Is Offered By…CMS

Today’s Most Attractive National ACO Model Is Offered By…CMS

A large national payer recently announced the opportunity for Accountable Care Organizations (ACOs) to share in 100 percent of the savings they create for the payer’s largest book of business. Providers will have complete autonomy in how they manage the health of their population, and the payer will ensure the timely flow of datasets needed to support care improvement activities. The payer will pre-define the ACO’s population and its spending benchmark, which will be adjusted for the risk of the ACO population. Consumers aligned to the ACO will be offered supplemental benefits and financial incentives to seek care from the ACO’s network. Market-watching ACOs can be forgiven for wondering how they missed the slew of journal articles, blogs, and op-eds lauding the “best practice” …Continue Reading

Addressing Health In America To Build Wealth

Addressing Health In America To Build Wealth

Today, two of the primary focal points for many policy leaders include boosting individual income growth and, independently, reducing health care spending growth. None that we’re aware of, however, have identified and are considering policies that address a central common cause adversely driving both policy challenges: the rising prevalence of chronic illness. The extent to which chronic conditions drive health care spending is well known. Annual medical costs rise dramatically with onset of a chronic condition, and further compound with additional morbidity. Those spending patterns hold true for both overall health care and out-of-pocket spending by the individuals afflicted. Similarly, the positive…Continue Reading

Health Affairs Forum: Envisioning The Future Of Value Based Payment

Health Affairs Forum: Envisioning The Future Of Value Based Payment

The American health care system is moving toward an era of personalized medicine where the appropriate course of treatment can be defined with greater precision for the individual patient. In this era of “big data,” traditional statistics like readmissions capture a diminishing share of what patients mean by quality and value in health care delivery. You are invited to join Health Affairs on Thursday, May 12, 2016, in Washington, DC, for a half-day forum for policymakers on the topic of, “Envisioning The Future Of Value Based Payment.” Featuring keynote remarks by David Blumenthal, President of the Commonwealth Fund, the program will …Continue Reading

To Identify Patients For Care Management Interventions, Look Beyond Big Data

Five percent of patients incur nearly 50 percent of United States’ health care costs, and there is growing evidence that investing resources in these individuals can improve care while decreasing costs. In kind, provider organizations are increasingly adopting high-risk care management, a strategy that relies on coordinated outpatient care to reduce costly emergency department (ED) visits and inpatient admissions. However, complex care management programs are costly in themselves, so it is important to select patients who are not only high risk but are also most likely to benefit from such programs. We now have a wealth of clinical and financial data …Continue Reading

New Guidance On SHOP Online Enrollment Requirements

Implementing Health Reform. Although the Affordable Care Act’s individual health insurance marketplaces have received far more attention, the ACA also created Small Business Health Options (SHOP) marketplaces, where small businesses and their employees can purchase insurance coverage. The SHOP marketplaces were intended to be operated through an online portal like the individual marketplaces. Small employers would go online and identify a qualified health plan or set plans in which their employees could then enroll in online for coverage. Although the SHOP program was launched in 2014, during the first year the federal online portal was not operational. Small employers and their employees…Continue Reading

An Innovative Patient-Centered Total Joint Replacement Program

An Innovative Patient-Centered Total Joint Replacement Program

Total joint replacement surgery is among the most commonly performed inpatient procedures in the United States. More than 1,000,000 hip and knee replacements are performed each year, and, with the aging of our population, that number is expected to grow quickly. Despite the general success of such replacements, approximately 20 percent of recipients of well-done replacements are unsatisfied with their surgery, and unmet patient expectations for the procedure are typically an important cause of such dissatisfaction. In fact, one study found that the most important contributing factor to dissatisfaction following total knee arthroplasty was not meeting patients’ expectations. Furthermore, rates of replacement surgery continue to vary across geographic regions and by race, and these differences cannot be explained solely by…Continue Reading

What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It

What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It

For decades before the Affordable Care Act (ACA), American health insurers were very good at avoiding enrolling people who were likely to be high-cost in the individual (or “non-group”) health insurance market. When individuals applied for coverage, they were asked questions such as: “What illnesses do you have?” and “What medical treatment have you had in the last (choose one) three, five, or 10 years?” Any person that answered with a serious (or not so serious) condition was denied coverage. Others with less serious conditions may have been charged additional premiums for a pre-existing condition or had…Continue Reading

CMS White Paper Examines The ACA Risk Adjustment Methodology (Update)

Implementing Health Reform (March 31 update). The Centers for Medicare and Medicaid Services (CMS) held an all-day conference on risk adjustment today, March 31. On March 30, marketplace CEO Kevin Counihan and CMS Acting Principal Deputy Administrator Patrick Conway released a blog post describing the risk adjustment program and changes to at that are being contemplated. Linked in the post is an analysis of the risk adjustment program’s 2014 results by Oliver Wyman Consulting that found: Risk adjustment payments correlated for 2014 correlated highly with reinsurance program payments, showing that risk adjustment payments were going to insurers with high-cost cases; Risk adjustment payments were not highly correlated with insurer size; Risk adjustment payments correlated with insurers’ claims relative to statewide…Continue Reading

Time to Fashion A Quilt From The Patchwork Of Advance Care Planning

Time to Fashion A Quilt From The Patchwork Of Advance Care Planning

Thank you for David Tuller’s outstanding synthesis of the issues and opportunities surrounding end-of-life discussions in the United States, presented in the March 2016 Health Affairs Entry Point, “Medicare Coverage For Advance Care Planning: Just The First Step.” Despite strong public will for these critical conversations, Tuller says that training of the health care workforce is critically needed because “…clinicians [are] woefully unprepared to fulfill their responsibilities to patients.” I agree both as a professional at The John A. Hartford Foundation, where I work to improve end-of-life care for older adults, and personally as someone …Continue Reading