Reducing Waste in Health Care (Research Report)
A recent study by former Centers for Medicare and Medicaid Services administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that waste may constitute a third of US health spending. This policy brief examines waste in health care that may result from poor delivery of care, failed care coordination, overtreatment, administrative complexity, and uncompetitive pricing. The author concludes with presenting opportunities and challenges associated with efforts to eliminate waste in health care without harming consumers or reducing the quality of care provided.
Will There Be Enough Providers to Meet the Need? Provider Capacity and the ACA (Research Report)
|Posted to Web: February 21, 2013||Publication Date: February 21, 2013|
Much of the success of the Affordable Care Act (ACA) will hinge on issues surrounding access to care, particularly as millions of individuals become newly-insured and strain the capacity of provider systems. New service delivery reforms in state Medicaid programs and the private sector, as well as provisions in the ACA focused on increasing primary care reimbursement and provider supply, and increasing funding for Community Health Centers, hold promise to improve access to quality care. Drawing on the experiences of ten study states participating in the Robert Wood Johnson Foundation’s health reform monitoring and implementation project, this brief examines how states are addressing the complex issues of provider capacity and access to care.
Evaluation of Statewide Risk-Based Managed Care in Kentucky: A First Year Implementation Report (Research Report)
|Posted to Web: November 20, 2012||Publication Date: November 20, 2012|
This report is the first of a series of reports that will be prepared during a three-year evaluation of the statewide implementation of risk-based managed care in Kentucky's Medicaid program. The evaluation will assess the short- and medium-term effects of risk-based managed care implementation on the major partners- beneficiaries, providers, plans, and the Cabinet- with an eye toward understanding the impacts on costs and on the provision of care. In this report, we provide an overview of managed care implementation in Kentucky as of mid-2012 based on our case study analysis, conducted about eight months after the state began enrolling Medicaid beneficiaries in risk-based managed care state-wide.
Health Policy Brief: Improving Care Transitions (Policy Briefs)
|Posted to Web: November 02, 2012||Publication Date: November 02, 2012|
The term care transition describes a continuous process in which a patient's care shifts from being provided in one setting to another, such as from a hospital to a patient's home. Poorly managed transitions can diminish health and lead to hospital readmissions, thus driving up costs for Medicare and other payers. This Health Affairs brief examines the factors contributing to poor care transitions, describes effective care delivery models aimed at improving care transitions, describes initiatives in the recent health reform law aimed at incentivizing greater attention to care transitions, and explores policy issues surrounding payment reform in this area.
Payment Reform: Bundled Episodes vs. Global Payments (Opinion)
|Posted to Web: October 05, 2012||Publication Date: September 13, 2012|
There is widespread agreement that the current fee-for-service approach to paying for health care is problematic, but there is a lack of consensus on what should replace it. Medicare is pursuing bundled episode payments, and proponents like Francois de Brantes of the Health Care Incentives Improvement Institute have been laying the groundwork for implementation. But other experts, such as the Urban Institute's Robert Berenson, worry that the current interest in bundled payments will distract policy-makers from moving more decisively away from fee-for-service. In this Robert Wood Johnson Foundation-funded paper, de Brantes and Berenson debate the benefits and drawbacks of bundled payments and global capitation.
Medicaid and CHIP Risk-Based Managed Care in 20 States: Experiences Over the Past Decade and Lessons for the Future (Research Report)
|Posted to Web: September 18, 2012||Publication Date: September 18, 2012|
Over the first decade of the 21st century the role of risk-based managed health care for publicly insured beneficiaries has expanded substantially. This report examines this form of health care delivery in 20 states for both Medicaid and CHIP non-elderly adults and children, including people with disabilities. The 20 states were chosen because they include over 80 percent of both Medicaid and CHIP beneficiaries who are enrolled in risk-based managed care. Findings are based on interviews with state Medicaid and CHIP officials, as well as representatives from 40 Managed Care Organizations (MCOs) serving Medicaid and CHIP beneficiaries, and 40 health care providers or provider organizations. In addition, the report contains published data from various sources, including measures of access to care, quality of care, and satisfaction with care over the study period (2001-2010).
How Five Leading Safety-Net Hospitals Are Preparing For The Challenges And Opportunities Of Health Care Reform (Research Report)
|Posted to Web: September 07, 2012||Publication Date: September 07, 2012|
Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.
ACA Implementation-Monitoring and Tracking: Virginia Site Visit Report (Research Report)
|Posted to Web: August 31, 2012||Publication Date: August 31, 2012|
This report is one in a series of 10 on state implementation of the Affordable Care Act. There is significant political opposition to the implementation of health reform in Virginia. The state has not yet indicated how it will respond to the now optional expansion of Medicaid coverage or whether it will establish an exchange. But meanwhile, the state has created a highly regarded process for debate on the exchange. The state experiences ongoing budget pressure because of the recession which is affecting state decision-making. The state could benefit from strong competition within its insurance and provider markets under reform.
Massachusetts under the Affordable Care Act: Employer-Related Issues and Policy Options (Research Report)
|Posted to Web: August 16, 2012||Publication Date: August 16, 2012|
Using the Health Insurance Policy Simulation Model, this report analyzes four policy options for assessing employers who do not provide affordable health insurance to their workers as Massachusetts brings its health reform law into compliance with the Affordable Care Act (ACA). Overall coverage and costs are similar across all options, but replacing the state's Fair Share Contribution (FSC) requirement with the ACA assessment would eliminate a source of state revenue. Similarly, maintaining the FSC for small employers only would raise one-fifth as much revenue as leaving the current assessment in place.
Obtaining Providers' 'Buy-In' And Establishing Effective Means Of Information Exchange Will Be Critical To HITECH's Success (Research Report)
|Posted to Web: July 25, 2012||Publication Date: July 25, 2012|
In a March 2012 article in Health Affairs, a team of authors from the Urban Institute and Mathematica Policy Research finds that achieving ambitious goals for the adoption of electronic health records and the nationwide exchange of electronic health information will require overcoming a number of hurdles. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the tradeoffs between sharing information electronically and safeguarding the privacy and security of patients’ health care data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.
|Posted to Web: May 18, 2012||Publication Date: March 31, 2012|