Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act (Research Report)
Behavioral economics, which analyzes how behavior sometimes departs from the rational calculation of self-interest, can help Medicaid programs use targeted enrollment strategies more effectively by eliminating apparently modest procedural requirements, which can greatly reduce participation levels. It can also help health coverage applicants receive SNAP, even though demonstrating eligibility for health subsidies and choosing a health plan can tax many consumers' cognitive resources, making it hard to process information about SNAP. For example, health applicants could be given the option to have the state's food agency contact them later to complete a SNAP application by phone.
Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States (Survey Brief)
|Posted to Web: September 15, 2014||Publication Date: July 21, 2014|
Participation of employers in the small group Marketplaces, or Small Business Health Options Program (SHOP), has started very slowly. The reasons for this are largely consistent across the states, and many of them lend themselves to reversal or improvement. Significant challenges remain, but it would be inappropriate to judge the long term prospects of SHOP merely on its first-year experiences. This analysis of early implementation experiences is based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviews were conducted with a broad array of stakeholders in each state.
In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: August 14, 2014||Publication Date: August 14, 2014|
Researchers compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach in this paper. They begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. They next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services and by the European Commission, the executive body of the European Union, emphasizing the US emphasis and race and ethnicity and the European orientation to economic status.
Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
|Posted to Web: June 30, 2014||Publication Date: June 24, 2014|
Safety-net hospitals have long played an essential role in the US health care system. The Affordable Care Act fundamentally changes the health care landscape and safety-net hospitals need to make major changes to compete. This report examines four safety-net hospitals to learn how they are preparing for health reform. While hospitals were employing strategies with different intensities, we found that the study hospitals had implemented an array of financial strategies focused on tapping Medicaid revenues. They also adopted delivery systems reforms, particularly ones related to developing community-based partners, and implemented changes in hospital leadership and management structure as well as efforts to better align physician incentives with hospitals and altering the culture of patient care to be more responsive to the shifting market.
Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Research Report)
|Posted to Web: June 13, 2014||Publication Date: June 11, 2014|
Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designated to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.
Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care (Research Report)
|Posted to Web: May 30, 2014||Publication Date: May 30, 2014|
Consumers choosing health insurance plans inside and outside the new marketplaces may face a tradeoff: narrower provider networks may lower premiums, but they may also limit access to care or increase out-of-pocket costs. This policy brief assesses the benefits and risks of policy options open to federal and state policymakers now reviewing requirements for plans' network adequacy. The authors find that no single policy can achieve the appropriate balance between insurers' flexibility to negotiate with providers and consumers' confidence that plans will deliver on promised benefits. Accordingly, the authors call on policymakers to protect consumers with a combination of regulatory standards, up-to-date information to facilitate consumer choices, and active monitoring of plans' actual performance.
Trends in Prescription Drug Spending Leading Up to Health Reform (Article)
|Posted to Web: May 29, 2014||Publication Date: May 29, 2014|
Over the past decade, prescription drug expenditures grew faster than any other service category and comprised an increasing share of per capita health spending. Using the 2005 and 2009 Medical Expenditure Panel Surveys, this analysis identifies the sources of spending growth for prescription drugs among the nonelderly population. We find that prescription drug expenditures among the nonelderly increased by $14.9 billion (9.2%) from 2005 to 2009 and expenditures increased in 12 out of the 16 therapeutic classes. Changes in the number of users and expenditures per fill were the drivers of spending fluctuations in these categories. The main results also provide insight into generic entry, the price gap between brand and generic drugs, and from a health reform evaluation perspective, the importance of separating pre-policy secular trends in expenditures from changes attributable to specific forces, such as shifts toward generic versions of blockbuster drugs.
Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Base Year (Research Report)
|Posted to Web: May 19, 2014||Publication Date: May 14, 2014|
Medicaid health homes is a new optional benefit for high-need, high-cost beneficiaries with chronic physical conditions or serious mental illness, authorized in Section 2703 of the Affordable Care Act. Distinctive features of the model include the elevated importance placed on integrating physical health care with behavioral/mental health care and on linking enrollees to social services and other community supports. The Urban Institute is conducting the 5-year long-term evaluation for the DHHS Assistant Secretary of Planning and Evaluation. This initial report examines the context, design, and initial implementation challenges and successes of six programs in Missouri, Rhode Island, New York, and Oregon, the first four states with approved programs.
An Estimated $84.9 Billion In Uncompensated Care Was Provided In 2013; ACA Payment Cuts Could Challenge Providers (Article)
|Posted to Web: May 19, 2014||Publication Date: December 01, 2012|
Millions of uninsured people use health care services every year. We estimated providers' uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. In the aggregate, at least 65 percent of providers' uncompensated care costs were offset by government payments designed to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.
Placing Diagnosis Errors on the Policy Agenda (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: May 07, 2014||Publication Date: May 06, 2014|
Between 5 and 15 percent of health care encounters result in a diagnosis error. While misdiagnoses and missed diagnoses can have devastating effects on patients and even result in death, the issue does not receive much attention from health care providers and policy leaders as the major quality and safety issue that it deserves to be. A new brief from the Urban Institute explores the different reasons for diagnosis errors, the challenges of measuring them, and fruitful approaches to reducing their prevalence and harm to patients. The brief offers recommendations for policy-makers on how they can place the issue on the policy agenda.
|Posted to Web: April 24, 2014||Publication Date: April 24, 2014|