Grading a Physician's Value - The Misapplication of Performance Measurement (Commentary)
There is bipartisan agreement on the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. The Affordable Care Act (ACA) created the physician "value-based payment modifier," a pay-for-performance approach that, by 2017, will reward or penalize physicians based on the calculated value of care each provides to Medicare beneficiaries. This paper argues that although value-based payment is right aspirationally, in practice, it is impossible to accurately measure any physician's overall value. It recommends abandoning this approach and using performance measurement more strategically to support approaches to complement fundamental payment reform.
Medicaid and the Young Invincibles Under the Affordable Care Act: Who Knew? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: December 06, 2013||Publication Date: November 28, 2013|
Not getting much attention is the 5.4 million uninsured young adults who will be eligible for Medicaid in 2014. Young adults eligible for Medicaid are a heterogeneous group but over half have an existing connection to another government program. However, 4.3 million uninsured young adults with incomes below 138 percent of the Federal Poverty Level will not be eligible for Medicaid because they live in states that are not expanding, most of whom will remain uninsured, given their lack of access to affordable coverage.
Stabilizing Premiums Under the Affordable Care Act: State Efforts to Reduce Adverse Selection (Research Report)
|Posted to Web: November 21, 2013||Publication Date: November 01, 2013|
As a consequence of the ACA's reformed nongroup insurance market, some have raised concerns about short-term "rate shock" — an increase in premiums as a result of enhanced consumer protections and more risk-sharing compared with the pre-reform market – as well as longer-term instability due to adverse selection, the phenomenon by which particular insurance plans or markets attract an enrollment with higher than average health care risks. While the ACA includes strategies intended to mitigate these effects, some states are introducing additional strategies to strengthen the protections. This paper explores policies designed to address these concerns being implemented in 11 states.
How the CHIPRA quality demonstration elevated children on State health policy agendas (Research Brief)
|Posted to Web: November 19, 2013||Publication Date: November 01, 2013|
This Evaluation Highlight is the fourth in a series that presents descriptive and analytic findings from the national evaluation of the CHIPRA Quality Demonstration Grant Program. The CHIPRA quality demonstration grants have provided a unique opportunity not only to advance child health quality in the short term, but also to link child health quality issues to broader Federal and State health reforms. In this Highlight, we give examples of activities in five States—Maine, Maryland, Massachusetts, Vermont, and Oregon—and how they used their CHIPRA quality demonstration grants to elevate children's health care issues on their States' health policy agendas.
Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States: Final Report to the Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services (Research Report)
|Posted to Web: October 22, 2013||Publication Date: October 01, 2013|
This study of Medicaid and CHIP managed care programs in 20 states indicates that capitation rate-setting became more data-driven and transparent during the time period 2001-2010. Benefit packages were fairly consistent over time and among states, with carve outs in every state for a least one acute service. Total spending on managed care services for Medicaid enrollees varied considerably across states and subgroups; nondisabled children had the lowest average monthly spending and adults with disabilities had the highest.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
|Posted to Web: October 17, 2013||Publication Date: December 01, 2012|
Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.
Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.
Reaching and Enrolling the Uninsured: Early Efforts to Implement the Affordable Care Act (Research Report)
|Posted to Web: October 10, 2013||Publication Date: October 10, 2013|
The Affordable Care Act's success depends on whether eligible, uninsured persons can enroll in health coverage. Meeting enrollment goals partially hinges on the effectiveness of marketing campaigns to raise public awareness, and application assistance programs that help consumers enroll. This brief describes early state efforts, and finds that government officials have taken many positive steps including launching multi-pronged campaigns that combine broad marketing with grass-roots outreach, and funding community-based organizations and providers to provide hands-on assistance. Differences in the intensity of these efforts across states are stark, however, and may contribute to noticeably different enrollment experiences during early ACA implementation.
Lessons from the Literature on Electronic Health Record Implementation (Research Report)
|Posted to Web: October 09, 2013||Publication Date: October 09, 2013|
This report summarizes the findings of 75 articles that identify best practices for implementing and optimizing electronic health records (EHRs). The report includes a conceptual framework to structure the analysis and describe lessons learned for organizations that might be facing EHR implementation obstacles. Throughout the EHR implementation process, planning and modifications are continually needed to address technological, professional, and organizational perspectives. These perspectives must be incorporated at each stage to promote implementation and optimization of a system that is technically functional, integrated into the workflow of its users, and is part of a larger strategy to meet organizational goals.
|Posted to Web: October 04, 2013||Publication Date: August 01, 2013|