The most recent edition of Health Affairs is available at the FMHI Research Library.

Volume 31, number 9: “Payment Reform to Achieve Better Health Care”

Medicare Hospital Payment

• The lessons of Medicare’s prospective payment system show that the bundled payment program faces challenges (Altman, p. 1923)
• A giant of health policy reflects on past reforms (p. 1931)
• Medicare’s new hospital value-based purchasing program is likely to have only a small impact on hospital payments (Werner & Dudley, p. 1932)

Postacute Care Payment

• Medicare postacute care payment reforms have potential to improve efficiency of care, but may need changes to cut costs (Grabowski, Huckfeldt, Sood, Escarce & Newhouse, p. 1941)

Capitation & Shared Savings

• Beyond capitation: How new payment experiments seek to find the ‘Sweet Spot’ in amount of risk providers and payers bear (Frakt & Mayes, p. 1951)
• The design and application of shared savings programs: Lessons from early adopters (Weissman, Bailit, D’Andrea & Rosenthal, p. 1959)
• A global budget pilot project among provider partners and Blue Shield of California led to savings in first two years (Markovich, p. 1969)

Physician Payment

• Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment (Ginsberg, p. 1977)
• Many large medical groups will need to acquire new skills and tools to be ready for payment reform (Mechanic & Zinner, p. 1984)
• Michigan’s physician group incentive program offers a regional model for incremental ‘Fee for Value’ payment reform (Share & Mason, p. 1993)

Patient-Centered Medical Homes

• Early results show WellPoint’s patient-centered medical home pilots have met some goals for costs, utilization, and quality (Raskas, Latts, Hummel, Wennders, Levine & Nussbaum, p. 2002)
• Colorado’s patient-centered medical home pilot met numerous obstacles, yet saw results such as reduced hospital admissions (Harbrecht & Latts, p. 2010)
• Horizon’s patient-centered medical home program shows practices need much more than payment changes to transform (Patel, Rathjen & Rubin, p. 2018)

Payers & Reference Pricing

• Payers test reference pricing and centers of excellence to steer patients to low-price and high-quality providers (Robinson & MacPherson, p. 2028)

Government’s Role

• Posing a framework to guide government’s role in payment and delivery system reform (Sood & Higgins, p. 2043)

End-Stage Renal Disease

• Medicare’s payment strategy for end-state renal disease now embraces bundled payment and pay-for-performance to cut costs (Swaminathan, Mor, Mehrotra & Trivedi, p. 2051)

Effects on Drugs and Devices

• Providers’ payment and delivery system reforms hold both treats and opportunities for the drug and device industries (Robinson, p. 2059)

Compensating Doctors

• How Geisinger structures its physicians’ compensation to support improvements in quality, efficiency and volume (Lee, Bothe, & Steele, p. 2068)

Medicare Advantage

• Payer-provider collaboration in accountable care reduced use and improved quality in Maine Medicare advantage plan (Claffey, Agostini, Collet, Reisman & Krakauer, p. 2074)

Variations in Costs

• Wide variation in episode costs within a commercially insured population highlights potential to improve the efficiency of care (Ellis, Sandy, Larson, & Stevens p. 2084)

Shared Decision Making

• Introducing decision aids at group health was linked to sharply lower hip and knee surgery rates and costs (Arterburn, Wellman, Westbrook, Rutter, Ross, McCulloch, Handley, and Jung, p. 2094)

Report from the Field

• Personal Responsibility: How Mitt Romney embraced the individual mandate in Massachusetts health reform (Bebinger, p. 2015)

Web First

• In amenable mortality- Deaths avoidable through health care – Progress in the US lags that of three European countries (Nolte & McKee, p. 2114)
• Visits to retail clinics grew fourfold from 2007-2009, although their share of overall outpatient visits remains low (Mehrotra & Lave, p. 2123)
• Health in all policies: The role of the US Department of Housing and Urban Development and present and future challenges (Bostic, Thornton, Rudd & Sternthal, p. 2130)

The most recent edition of Health Affairs is available at the FMHI Research Library.

Volume 31, number 8: “Challenges Facing the Safety Net”

Medicaid Expansion

• The Supreme Court’s surprising decision on the Medicaid expansion: How will the Federal Government and states proceed? (Rosenbaum & Westmoreland, p. 1663)
• In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help (Decker, p. 1673)

Public Hospitals

• Strained local and state government finances among current realities that threaten public hospitals’ profitability (Kane, Singer, Clark, Eeckloo, & Valentine, p. 1680)

Coordination & Integration

• How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform (Coughlin, Long, Sheen, & Tolbert, p. 1690)
• Safety-net providers in some US communities have increasingly embraced coordinated care models (Cunningham, Felland, & Stark, p. 1698)
• Integrating community health centers into organized delivery systems can improve access to subspeciality care (Neuhausen, Grumbach, Bazemore, & Phillips, p. 1708)
• In ten California counties, notable progress in system integration within the safety net, although challenges remain (Pourat, Davis, Salce, Hilberman, Roby, & Kominski, p. 1717)
• Shining a light on the reinvention of the safety net (p. 1728)
• The post-Katrina conversion of clinics in New Orleans to medical homes shows change is possible, but hard to sustain (Rittenhouse, Schmidt, Wu, & Wiley, p. 1729)

Quality Measures

• Based on key measures, care quality for medicare enrollees at safety-net and non-safety-net hospitals was almost equal (Ross, Berheim, Lin, Drye, Chen, Normand, & Krumholz, p. 1739)

Emergency Care

• Case studies at Denver health: ‘Patient dumping’ in the emergency department despite EMTALA, the law that banned it (Rosenbaum, Cartwright-Smith, Hirsh, & Mehler, p. 1749)
• Solutions to emergency department ‘boarding’ and crowding are underused and may need to be legislated (Rabin, Kocher, McClelland, Pines, Hwang, Rathlev, Asplin, Trueger, & Weber, p. 1757)
• California hospitals serving large minortiy populations were more likely than others to employ ambulance diversion (Hsia, Asch, Weiss, Zingmod, Liang, Han, McCreath, & Sun, p. 1767)

Accountable Care

• The promise of peril of accountable care for vulnerable populations: A framework for overcoming obstacles (Lewis, Larson, McClurg, Boswell, & Fisher, p. 1777)

Complex Patients

• A discharge panel at Denver health, focused on complex patients, may have influenced decline in length of stay (McKenzie, Kukolja, house, Loehr, Hirsh, Boyle, Sabel, & Mehler, p. 1748)

Coverage for Children

• Increase in Federal match associated with significant gains in coverage for children through Medicaid and CHIP (Patrick, Choi, & Davis, p. 1796)

Disparities

• Differences in life expectancy due to race and educational differences are widening, and may may not catch up (Olshansky, Antonucci, Berkman, Binstock, Boersch-Supan, Cacioppo, Carnes … & Rowe, p. 1803)

Emergency Preparedness

• A hospital system’s response to a hurricane offers lessons, including the need for mandatory interfacility drills (Verni, p. 1814)

Diabetes Care

• Substantial Medicare savings may result if insurers cover ‘artificial pancreas’ sooner for diabetes patients (O’Grady, John, & Winn, p. 1822)
• Medical groups can reduce costs by investing in improved quality of care for patients with diabetes (Kralewski, Dowd, & Xu)
• Greater adherence to diabetes drugs is linked to less hospital use and could save nearly $5 billion annually (Jha, Aubert, Yao, Teagarden, & Epstein, p. 1836)

The Care Span

• Low cognitive ability and poor skill with numbers may prevent many from enrolling in Medicare supplemental coverage (Chan & Elbel, p. 1847)

Web First

• In the wake of the Supreme Court decision, many stakeholders still support the Affordable Care Act (Ario & Jacobs, p. 1855)
• Medicare beneficiaries less likely to experience cost- and access-related problems than adults with private coverage (Davis, Stremikis, Doty & Zezza, p. 1866)
• The sharp slowdown in growth of medical imaging: An early analysis combination of policies was the cause (Lee & Levy, p. 1876)
• The ‘alternative quality contract,’ based on a global budget, lowered medical spending and improved quality (Song, Safran, Landon, Landrum, He, Mechanic, Day, & Chernew, p. 1885)