Third Party Resources
Health Affairs article evaluates bundled payment pilot project
Posted on November 8, 2011
The Affordable Care Act (ACA) introduced bundled payments, which provides payment for all of the care a patient needs over the course of a defined clinical episode. The goal of bundling payment is to encourage doctors, hospitals, and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. An article recently released by Health Affairs evaluates the initial “road test” of the PROMETHEUS Payment, one of the bundled payment pilot projects. The pilots have taken longer to set up than expected, primarily due to the intricate payment model and the fact that it builds on the existing fee-for-service payment system. Although participants were hopeful regarding the success of the bundled payment program, the report found that desired benefits may take some time to materialize.
To read CMS’s Fact Sheet regarding Bundled Payments, click here.
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Urban Institute paper reviews status of ACO implementation
Posted on November 1, 2011
“Accountable Care Organizations in Medicare and the Private Sector,” a policy paper written by the Urban Institute and funded by the Robert Wood Johnson Foundation, examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations issued last month by the Centers for Medicare & Medicaid Services (CMS). The paper provides an overview of ACOs, the key complaints about CMS’ proposed regulations and their resolutions in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans.
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Oliver Wyman report finds insurer fees will increase premiums
Posted on October 31, 2011
A new report commissioned by the insurance industry and authored by Oliver Wyman, “Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans,” quantifies the impact of insurer fees on private and public sector coverage. According to the report, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) have both concluded that such fees will increase insurance premiums. The analytical data presented in the report estimates that the insurer fees will increase premiums in fully insured coverage markets by an average of 1.9% to 2.3% in 2014. This translates into a $2,800 average increase in individual coverage cost, and $6,800 for a family over a 10-year period, beginning in 2014.
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UC Berkeley policy brief addresses health coverage maintenance during transitions
Posted on October 31, 2011
UC Berkeley, funded by grants from the Robert Wood Johnson Foundation and The California Endowment, recently released the brief, “The Promise of the Affordable Care Act, the Practical Realities of Implementation: Maintaining Health Coverage During Life Transitions,” which discusses seamless health coverage under the Affordable Care Act for individuals and families who lose health insurance because of a work or life transition. While outreach and education are essential for enrollment, such efforts are not sufficient to assure that those eligible will enroll in programs during these transition periods. This policy paper addresses the question, “How can implementation of the Affordable Care Act build on institutional connections and develop widespread cultural knowledge of the availability of coverage during life transitions that precipitate the loss of private coverage?”
KCMU and HMA track Medicaid spending, coverage and policy trends in 11th annual report
Posted on October 28, 2011
The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) along with Health Management Associates (HMA) recently published “Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends,” which summarizes the results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012. The report also includes background on the Medicaid program, as well as current issues facing the program including how states are preparing for the implementation of national health reform.
Health Affairs article estimates that ACA would still cover 23 million without individual mandate
Posted on October 27, 2011
Many policy gurus fear that repeal of the minimum coverage provision and corresponding penalty from the Affordable Care Act (ACA) would lead to adverse selection and thus a premium spiral. However, a recent Health Affairs article highlights other ACA provisions that would mitigate the negative repercussions of an individual mandate repeal. For example, the ACA subsidies to help people purchase coverage would restrain a premium spiral by absorbing much of the impact of premium increases. The article proffers that without the individual mandate, 7.8 million people would lose coverage, as opposed to other estimates in the 16-24 million range. In sum, the ACA would still cover 23 million people who otherwise would have been uninsured. Although the individual mandate would have important effects, the article says, perhaps it is not crucial to the successful implementation of health reform.
Health Affairs article warns of contingencies and uncertainties under Medicaid expansion
Posted on October 27, 2011
An article recently published in Health Affairs, “Policy Makers Should Prepare For Major Uncertainties in Medicaid Enrollment, Costs, And Needs For Physicians Under Health Reform,” presents findings from a simulation model using two nationally representative data sets to estimate Medicaid eligibility, participation, and population growth. The article warns that the number of Medicaid enrollments, associated costs, and number of new physicians needed could vary hugely under Medicaid expansion. The estimated number of people enrolling in Medicaid for the first time could vary by more than 10 million when the program changes are implemented in 2014. Additionally, costs could range from anywhere between $34 billion to $98 billion per year. The new enrollments could necessitate at least 4,500 and at most 12,100 new physicians. The study results indicate that policy makers should prepare for a great deal of unpredictability associated with Affordable Care Act’s (ACA’s) Medicaid reform.
AMA’s annual survey finds competition often sparse in commercial health insurance market
Posted on October 26, 2011
The American Medical Association recently issued the 2011 edition of “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” The survey reports that four out of five metropolitan areas in the United States lack a competitive health insurance market. Those markets are rate “highly concentrated” based on Department of Justice and Federal Trade Commission findings. In approximately half of such markets, at least one commercial health insurer had a market share of at least 50 percent. In 24 out of the 48 states covered, the two largest commercial insurers controlled a market share of 70 percent or more.
Urban Institute brief explores impact of ACA on ESI
Posted on October 24, 2011
The Affordable Care Act (ACA) was designed to build off of the existing employer sponsored health insurance that currently covers most Americans. A displacement of the privately financed employer sponsored insurance (ESI) could have made the ACA’s coverage subsidies for low-income households, now covered through tax credits and Medicaid, politically unfeasible due to financial constraints. Although the Congressional Budget Office (CBO), the Rand Corporation, the Urban Institute, and others have concluded that ESI will remain intact under the ACA, there are speculations regarding a wholesale shift away from ESI. Specifically, prominent economists worry that the ACA’s incentives will cause a diversion from employer based health insurance, thereby encouraging workers to take advantage of publicly subsidized coverage. This brief, funded by The Robert Wood Johnson Foundation and authored by The Urban Institute, considers how employers might react to provisions of the ACA and offers an analysis of factors that likely will influence their decision regarding the retention of ESI. The authors explain that although the ACA will leave the ESI largely intact, the decision to continue or drop ESI will be determined by whether employers and their employees stand to benefit more from ESI or from coverage available through state insurance exchanges.
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Commonwealth guide outlines strategies to measure care coordination in medical homes
Posted on October 22, 2011
Patient-centered medical home models offer accessible, coordinated, comprehensive care focused on the needs of the patient. One of the most notable attributes of medical homes is the care coordination, which, if executed effectively, results in better health outcomes, reduced waste and duplication, and higher patient satisfaction. Yesterday, the Patient-Centered Primary Care Collaborative, an arm of the Commonwealth Fund, released a guide outlining seven key strategies to help health systems measure care coordination within medical homes. The seven strategies are 1) Work with a broad stakeholder group to reach consensus on measures; 2) Clarify purpose of measurement: quality improvement, accountability, evaluation; 3) Use standardized measures; 4) Incorporate patient feedback in assessing quality of care coordination; 5) Develop a tracking system that facilitates ongoing monitoring of performance; 6) Build and nurture relationships with providers outside of your medical home–the “medical neighborhood”–to facilitate data sharing, monitoring, and improvement; and 7) Use the data to improve care coordination. Share results at the practice and care-team levels.
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