The Kaiser Family Foundation recently released an issue brief which compares the expected value of benefits for individuals ages 65 and older under Medicare's fee-for-service program to two "typical" plans offered by large employers: a typical large employer preferred provider organization (PPO) plan and the Blue Cross/Blue Shield Standard Option for enrollees in the Federal Employees Health Benefits Program (FEHBP), also a PPO plan. The analysis updates a 2008 Kaiser Family Foundation report that found...

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. According to Commonwealth, early provisions of the Affordable Care Act (ACA) are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

In the Health Affairs article, "How Medicare Could Use Comparative Effectiveness Research In Deciding On New Coverage And Reimbursement," the authors call for research regarding ways to control escalating Medicare costs, while maintaining access to beneficial services. The article proposes a payment model that would incorporate comparative effectiveness research into the Medicare reimbursement model. The authors suggest that Medicare pay equally for services that yield comparable benefits and appropriate higher payment for services with benefits proven to exceed those derived from alternative options. New services without such evidence would receive usual reimbursement rates until enough evidence mounted to justify reevaluation. Although difficult to modify Medicare reimbursement, especially in such partisan political times, the authors urge government to employ comparative effectiveness research in service rewards, improve incentives for cost-effective innovation, and place Medicare on a more stable fiscal footing.

The Institute of Medicine (IOM) of the National Academy of Sciences (NAS) has released their highly-anticipated essential benefits report. The report, "Essential Benefits: Balancing Coverage and Cost," recommends that the U.S. Department of Health and Human Services (HHS) consider cost of services as factor when determining the specific benefits qualified health plans (QHPs) must include. The Affordable Care Act (ACA) requires the Secretary of HHS to come up with a minimum essential benefits package that all health plans must offer by January 1, 2014, and HHS tasked the IOM with making recommendations on how HHS should determine which benefits to include. For more information on essential benefits, click here.

In their recent publication, "Building Tomorrow's Healthcare System: The Pathway to High Quality, Affordable Care," BlueCross BlueShield Assocation (BCBSA) calls for incentives to reward safety and reinforce primary care. One of the nation's largest insurance companies, BCBSA encourages federal government to adopt "value-based purchasing" and urges individuals eligible for Medicare or Medicaid to enroll in managed care plans. The Association also wants faster implementation of these types of programs in order to show savings more quickly.