Week of February 8-12, 2016

HEALTH POLICY RESEARCH REPORTS AND KEY TAKEAWAYS

Health Care Leadership and Management

With a budget of $3.5 million, the Stanford University Clinical Research Center (CERC) aims to save billions for the U.S. health system through its efforts to redesign care for chronic kidney disease, cancer, obesity, and other costly conditions. A new case study, part of ongoing Commonwealth Fund research to track how health systems are transforming care delivery to meet the needs of high-need, high-cost patients and other vulnerable populations, examines CERC’s approach.  Designing More Affordable and Effective Health Care, 

The University of Pennsylvania Health System founded the Center for Health Care Innovation in 2012 to test new models of care and build evidence of their effectiveness. The center is also designed to help Penn Medicine?—?a $4.9 billion system based in Philadelphia?—?prepare for payment models that reward clinicians for the value of the care they deliver.  Enabling Change in Health Care, 

Scaling up complex health interventions to large populations is not a straightforward task. Without intentional, guided efforts to scale up, it can take many years for a new evidence-based intervention to be broadly implemented. Drawing from the previously reported frameworks for scaling up health interventions and our experience in the USA and abroad, we describe a framework for taking health interventions to full scale, and we use two large-scale improvement initiatives in Africa to illustrate the framework in action.  A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa, 

Coastal Medical, an accountable care organization (ACO) in Rhode Island, ranks third in the nation for quality among 333 Medicare Shared Savings ACOs. Chief Operating Officer Meryl Moss explains why she believes teamwork is helping her ACO thrive.  No More ‘Shining Stars’: Why Teamwork Should Matter to Accountable Care Organizations, 

The shift from volume-based to value-based health care is inevitable. Although that trend is happening slowly in some communities, payers are increasingly basing reimbursements on the quality of care provided, not just the number and type of procedures. But because most providers’ business models still depend on fee-for-service revenues, reducing volume (and increasing value) cuts into short-term profits. How, then, are innovative providers redesigning care so that, despite financial pain in the short term, they achieve long-range success? Turning Value-Based Health Care into a Real Business Model, 

If we’re to unlock the potential of value-based health care for driving improvement, outcomes measurement must accelerate. That means committing to measuring a minimum sufficient set of outcomes for every major medical condition — with well-defined methods for their collection and risk adjustment — and then standardizing those sets nationally and globally. HBR’s Michael Porter, NEJM, Standardizing Patient Outcomes Measurement, 

ACA Implementation

Department of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.  But she made clear that her priorities are enrolling more Americans in the 2010 health law and implementing its provisions designed to improve the quality of care while lowering its cost.  Burwell Says ‘Beat Goes On’ As HHS Seeks To Expand Health Law’s Influence, 

Sen. Mark Warner said a strong bipartisan coalition of lawmakers from both chambers could succeed in clearing legislation to expand Medicare payments for telehealth services, even with the November presidential contest expected to limit the number of laws enacted this year.  Warner Sees Medicare Telehealth Bill Defying Election-Year Odds,

A co-pay cap on drugs is just one way Covered California chose to shape the health insurance marketplace this year. Experts say the California exchange uses more of its powers as an “active purchaser” than the vast majority of other states. The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug co-pay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design.  Will Healthcare.gov Get A California Makeover?,  

Hospital, physician prices driving health costs, business groups say, Boston Globe, 

In response to rising drug costs, some policymakers and presidential candidates have proposed allowing Medicare to negotiate directly with pharmaceutical companies over the price of prescription drugs, in contrast to the current approach under Medicare Part D drug where private plans do the negotiating.  A version of this proposal was also included in the Obama Administration’s FY 2016 and FY 2017 budgets.  While the idea wins majority support among the public overall and also among both Democrats and Republicans, the Congressional Budget Office has estimated that such proposals would have a “negligible” impact on federal spending without stronger enforcement tools.  Searching for Savings in Medicare Drug Price Negotiations, 

In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses why political reality and the diverse makeup of the remaining uninsured population mean that the likeliest path to universal coverage is a step-by-step approach.  Behind the Challenges to Universal Health Coverage, 

Despite much hand-wringing over the size and quality of provider networks on the health insurance marketplaces, many top-notch hospitals are available in-network in marketplace plans this year, a new study found. However, more than half of those hospitals participated in fewer plans than last year, limiting their in network availability to just one marketplace plan in a growing number of cases.  Most Regionally Ranked Hospitals Stay In-Network with Marketplace Plans, But Participation Declines, 

We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM)—a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources—and we discuss its limitations. Building on the Census Bureau’s Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot is intended to demonstrate the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the poverty rate. Among low-income families who purchased individual insurance, premium subsidies reduced poverty by 9.4 percentage points.  Including Health Insurance in Poverty Measurement: The Impact of Massachusetts Health Reform on Poverty, 

ELSEWHERE IN THE NEWS

Drug Industry Launches Ad Campaign Aimed at Lawmakers, WSJ,
What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics, National Bureau of Economic Research,
Give Up Your Data to Cure Disease, NY Times, 
The Economic Cost of Zika Virus, Bloomberg, 
Politics Likely Would Limit Medicare’s Drug-Bargaining Clout, Commonwealth Fund, 
Delivery Models for High-Risk Older Patients – Back to the Future? JAMA, 
New Online Tools Offer Path to Lower Drug Prices, NY Times, 
State Of Emergency On Hawaii’s Big Island Over Dengue Fever Outbreak, NPR, 
15 things for healthcare leaders to know about Obama’s 2017 budget, Becker’s, 
Incidence of Dementia over Three Decades in the Framingham Heart Study, NEJM, 
Lead Contamination in Flint — An Abject Failure to Protect Public Health, NEJM, 
CMS gives healthcare 6 years to repay Medicare overpayments in final rule, Healthcare Finance, 
Northwell Health-backed insurer sees huge enrollment spike, Crain’s, 
Citing Huge Patient Load, NY Nurses Seek Rules on Staffing, AP, 
NIH officials accelerate timeline for human trials of Zika vaccine, saying they will now begin in the summer, Washington Post, 
Baptist Health’s Miami Cancer Institute joins Memorial Sloan Kettering alliance, Miami Herald,
Major Causes of Injury Death and the Life Expectancy Gap Between the United States and Other High-Income Countries, JAMA, 

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