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Structuring Payment to Medical Homes After the Affordable Care Act (Article)
Robert A. Berenson, Additional Authors
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models.
Development of a Model for the Valuation of Work Relative Value Units: Objective Service Time Task Status Report (Press Release)
Stephen Zuckerman, Robert A. Berenson, Additional Authors
This pilot project is part of the Centers for Medicare & Medicaid Services' efforts to address potentially misvalued services in the Medicare Physician Fee Schedule. It aims to develop a validation process for the fee schedule's relative value units for physician or nonphysician practitioner work. One of the project's key elements is the development of objective time estimates based on data from several physician practices, health systems, or other entities. This status report describes that task, including selection of services to be studied, identification and engagement of data collection sites, and development of data collection protocols and tools.
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.
Primary Care Access for New Patients on the Eve of Health Care Reform (Article)
Genevieve M. Kenney, Douglas A. Wissoker, Additional Authors
This study uses a simulated patient approach to assess appointment availability and wait times for new primary care appointments in late 2012/early 2013 by insurance status and state. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Outreach programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.
New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions (Article)
Genevieve M. Kenney, Additional Authors
The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have expanded coverage earlier to a portion of low-income childless adults. Using administrative records, the authors document that the ramp-up of enrollment was gradual over time in California, Connecticut, and D.C. Survey data on the two earliest expansions show strong evidence of increased Medicaid coverage in Connecticut and positive but weaker evidence of increased coverage in D.C. Medicaid enrollment rates were highest among people with health-related limitations. In Connecticut, evidence of some crowd-out of private coverage as well as a positive spillover effect on Medicaid enrollment among previously eligible parents was found.
Risk-Based Managed Care in Kentucky: A Second Year Implementation Report and Assessment of Beneficiary Perceptions (Research Report)
Ashley Palmer, Embry M. Howell, Genevieve M. Kenney, Additional Authors
This report summarizes findings from a qualitative assessment of implementation of Kentucky Medicaid managed care. It provides an update on the implementation issues identified in our year one report based on 18 stakeholder interviews and document review, and incorporates information obtained in ten focus groups across the state to provide insights about beneficiary experiences and their perceptions of changes to care. We find that many implementation issues identified in our year one report have stabilized over time. Focus group participants report few problems gaining access to health care services, though access to prescription drugs and behavioral health services remain areas of concern.
Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP (Article)
Kelly J. Devers, Additional Authors
We examine quality improvement (QI) collaboratives in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation. Overall, practice staff highly valued aspects of the collaboratives and supplemental strategies but also reported a variety of challenges.
Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts (Article)
Brenda Spillman, Additional Authors
Only about a third of Americans ages 65 and older are fully able to manage all daily activities independently, according to new research from the 2011 National Health and Aging Trends Study (NHATS). Another 30 percent are able to accommodate declining health or functioning by using assistive devices or scaling back their activities, 18 percent have trouble managing even with any devices they may use, and 21 percent receive help. These findings are based on innovative data NHATS collected for a nationally representative sample of 8,077 older Medicare beneficiaries. The data allow a more nuanced look at late life function than previously has been possible and can contribute to better understanding of ways older adults adapt to disability and to development of public health policies to maximize the quality of life for older Americans.
Using Qualitative Comparative Analysis (QCA) to Study Patient-Centered Medical Homes (Research Report)
Kelly J. Devers, Nicole Cafarella Lallemand, Rachel A. Burton, Stephen Zuckerman, Additional Authors
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) – an approach based on set theory and Boolean algebra – in patient-centered medical home evaluations. Specifically, QCA can be used to identify practice-level "conditions" (e.g., practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). The guide includes a description of key analytic steps involved in the QCA approach.
Stabilizing Premiums Under the Affordable Care Act: State Efforts to Reduce Adverse Selection (Research Report)
Linda J. Blumberg, Shanna Rifkin, Sabrina Corlette, Additional Authors
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.