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Health Care Systems and HMOs

 
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Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States (Survey Brief)
Linda J. Blumberg, Shanna Rifkin

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.

Posted to Web: August 14, 2014Publication Date: August 14, 2014

In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson

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.

Posted to Web: June 30, 2014Publication Date: June 24, 2014

Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Additional Authors

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.

Posted to Web: June 13, 2014Publication Date: June 11, 2014

Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Research Report)
Teresa A. Coughlin, John Holahan, Kyle Caswell, Megan McGrath

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.

Posted to Web: May 30, 2014Publication Date: May 30, 2014

Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care (Research Report)
Sabrina Corlette, JoAnn Volk, Robert A. Berenson, Judy Feder

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.

Posted to Web: May 29, 2014Publication Date: May 29, 2014

Trends in Prescription Drug Spending Leading Up to Health Reform (Article)
Fredric Blavin, Timothy Waidmann, Linda J. Blumberg, Jeremy Roth

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.

Posted to Web: May 19, 2014Publication Date: May 14, 2014

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Base Year (Research Report)
Brenda Spillman, Barbara A. Ormond, Elizabeth Richardson

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.

Posted to Web: May 19, 2014Publication Date: December 01, 2012

An Estimated $84.9 Billion In Uncompensated Care Was Provided In 2013; ACA Payment Cuts Could Challenge Providers (Article)
Teresa A. Coughlin, John Holahan, Kyle Caswell, Megan McGrath

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.

Posted to Web: May 07, 2014Publication Date: May 06, 2014

Placing Diagnosis Errors on the Policy Agenda (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Divvy Upadhyay, Deborah R. Kaye

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, 2014Publication Date: April 24, 2014

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model (Methodology Report)
Jennifer M. Haley, Victoria Lynch, Genevieve M. Kenney

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model is a microsimulation that uses rules about Medicaid/CHIP eligibility to approximate adults' and children's eligibility for Medicaid and CHIP. It has been used to simulate eligibility in the 50 states and Washington DC for the years 2008-2012 (before the Affordable Care Act [ACA] was implemented) and 2014 (simulating the new coverage provisions of the ACA). It has also been used to simulate eligibility in Puerto Rico in 2011 and enrollment under hypothetical statehood. It relies on the American Community Survey (ACS) and the Puerto Rico Community Survey (PRCS).

Posted to Web: March 26, 2014Publication Date: March 26, 2014

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