Week of October 26-30, 2015


ACA Implementation
Ahead of the third annual Affordable Care Act open enrollment period, the Kaiser Family Foundation has updated and expanded its searchable collection of nearly 300 Health Reform Frequently Asked Questions.  
Updated FAQs Help Consumers Understand the ACA Marketplaces As Third Open Enrollment Begins,

Premiums will increase an average of 7.5 percent for the second-lowest-cost silver insurance plan to be offered next year in the 37 states where the federal government operates health marketplaces, according to an analysis by the Department of Health and Human Services.
Kaiser Health News, Premiums For Key Marketplace Silver Plans Rising An Average Of 7.5 Percent, HHS Says,

Researchers from the Urban Institute and the March of Dimes Foundation underscored the ACA’s long-term potential to improve health care for women in their child-bearing years, 18 to 44. The report was released Tuesday.
Changes in Insurance Coverage, Access to Care, and Health Care Affordability for Women of Childbearing Age,

This JAMA study examines access to specialists in US physician networks participating in the Affordable Care Act’s insurance marketplaces in 2015. 
Adequacy of Outpatient Specialty Care Access in Marketplace Plans Under the Affordable Care Act,  

In recent weeks, prominent business and labor groups and leaders across the political spectrum have called to repeal the “Cadillac tax,” which is an important source of funding for the ACA’s coverage expansion. This excise tax is similar in practical effect to a cap on the current-law tax exclusion of employer contributions to health insurance. 
The Urban Institute, The ACA’s “Cadillac” Tax Versus a Cap on the Tax Exclusion of Employer-Based Health Benefits: Is This a Battle Worth Fighting?

Health Care Operations and Management
Health officials across the country face a vexing quandary – how do you help the sickest and neediest patients get healthier and prevent their costly visits to emergency rooms? Los Angeles County is testing whether community health workers like Lopez may be one part of the answer.  
Kaiser Health News, In L.A., Community Health Workers Are Part Of The Medical Team,

A multi-payer medical home program piloted in Colorado led to a sustained reduction in emergency department use and costs over three years, although there were no overall cost savings for practices or patients. Commonwealth Fund, Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot,

One in 20 perioperative medication administrations included an Medication Error (ME) and/or Adverse Drug Event (ADE). More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. Anesthesiology, Evaluation of Perioperative Medication Errors and Adverse Drug Events,
New analysis from The Commonwealth Fund offers guidance on how to improve outcomes and lower costs for “high-need, high-cost” patients. In a blog post, Melinda Abrams and Eric Schneider, M.D., lay out six principles for improving care for this population—and all patients—starting with identifying patients with similar needs and challenges.  
Fostering a High-Performance Health System to Care for the Sickest and Frailest, 

Faced with workforce shortages and rising costs, health systems around the world are assigning advanced practice nurses tasks that have traditionally been done by physicians. In a recent study the authors examined how this task-shifting is managed in different countries. 
The Commonwealth Fund,  The Role of Governance in Implementing Task-Shifting from Physicians to Nurses in Advanced Roles in Europe, U.S., Canada, New Zealand, and Australia. 

CMS and Medicare/Medicaid
Since October 2012, the Medicare program has penalized hospitals when too many patients in traditional Medicare are re-hospitalized within a month of discharge. This policy appears to be having unintended consequences for patients in Medicare and in the commercial market. 
Health Affairs, Is Observation Status Substituting For Hospital Readmission?

A growing share of Medicare beneficiaries have been enrolling in Medicare Advantage plans over the past decade, prompting some to question whether the balance between traditional Medicare and Medicare Advantage could be on the verge of tipping. 
Medicare Advantage and Traditional Medicare: Is the Balance Tipping?

Health Care Finance and the Market
Think for a moment about what would happen if you upended the whole system of financial incentives for hospitals.
In Maryland, A Change In How Hospitals Are Paid Boosts Public Health,

With some presidential candidates laying out details of their health care platforms, the cost of prescription drugs remains at the top of the public’s health care priority list for the President and Congress, the October Kaiser Health Tracking Poll finds. 
Prescription Drug Costs Remain Atop the Public’s National Health Care Agenda, Well Ahead of Affordable Care Act Revisions and Repeal, 

As health care organizations take on contracts with insurers that reward them for providing high-quality care and controlling costs, they must align their new organizational priorities with the incentives they offer providers. After all, it’s the many decisions frontline providers make daily that add up to the cost and quality achieved by health systems. 
Commonwealth Fund,  Tying Value-Based Contracting in Health Care to Value-Based Pay for Physicians, 

Although patient-centered care is not new, increasing emphasis on quality measurement as part of health care reform has led to a renewed focus on it. The path to achieving patient-centered care is not always clear, even to those who believe in its importance. This paper informs a discussion of federal policies affecting patient-centered care.
The Urban Insitute, The Road to Making Patient-Centered Care Real

Population Health
Public health focuses on denominators — what proportion of all people who can benefit from an intervention actually benefit. Maximizing health requires contributions from many sectors of society, including broad social, economic, environmental, transportation, and other policies in which government plays key roles; involvement of civil society; innovation by the public and private sectors; and health care and public health action. NEJM, Tom Friedman,  The Future of Public Health,

HealthCare.gov to open on Nov. 1 with upgrades and one delay (Washington Post)
Revamped HealthCare.Gov Opens With New Tools for Gauging True Cost of Insurance, (NY Times)
Costs for Dementia Care Far Exceeding Other Diseases, Study Find (NY Times) 
Anthem customer base grows in 3Q, tops expectations (AP)
The Good and Bad of Those Ubiquitous Drug Ads (WSJ) 
United Healthcare Expands Effort To Rein In Rising Costs Of Cancer Treatment, (Kaiser Health News
NY to Require Training for Doctors Who OK Pot for Patients (Reuters) 
The Most Crucial Half-Hour at a Hospital: The Shift Change (WSJ) 
Some new doctors are working 30-hour shifts at hospitals around the U.S. (Washington Post) 
Obama Administration Campaign Will Publicize Health Care Subsidies (NY Times
Big insurers remain upbeat on fledgling ACA exchanges (AP)
Having trouble finding a primary care doc? Here’s what med schools are doing about it. (Washington Post)
Stark Law, Anti-Kickback waivers extended for ACO (Becker’s Hospital Review)



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