Week of September 14-18, 2015


Value-Based Insurance Design (VBID) approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with chronic diseases. The CMS Center for Medicare and Medicaid Innovation is announcing the Medicare Advantage Value-Based Insurance Design (MA-VBID) model, an opportunity for Medicare Advantage plans to offer clinically-nuanced benefit packages aimed at improving quality of care while also reducing costs. Read the CMS release here.

Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. However, during this same time period, health centers’ performance decreased in the area of coordinating with external providers. “The community health center is a cornerstone of health care systems in underserved areas, providing comprehensive primary, behavioral health, and dental care to patients regardless of insurance coverage or ability to pay. But with the increasing demand for health services expected from the Affordable Care Act’s coverage expansions, how will the nation’s health centers cope?” Read The Commonwealth Fund report.

People with insurance had significantly higher probabilities of diagnosis than matched uninsured people, and among those with existing diagnoses, having insurance was associated with significantly better outcomes in key lab values indicating improvement. If the number of non-elderly Americans without health insurance were reduced by half, the authors estimate that there would be 1.5 million more people with a diagnosis of one or more of chronic conditions and 659,000 fewer people with uncontrolled cases. “Policy makers have paid considerable attention to the financial implications of insurance expansion under the Affordable Care Act (ACA), but there is little evidence of the law’s potential health effects.” Read this publication in Health Affairs in which the authors analyzed data to evaluate relationships between health insurance and the diagnosis and management of diabetes, hypercholesterolemia, and hypertension.

The authors identified financial, institutional, and regulatory policy barriers that have hindered the diffusion of successful care innovations. Across the three case study examples, financial barriers proved to be most critical due to a discrepancy between the new models of care and many existing payment policies. The authors suggested financing reforms, such as linking provider payment to scores on “meaningful, outcome-oriented” performance measures, offering add-on payments to providers, or making subsidies available to patients. “The rising rate of diabetes worldwide has in recent years spurred a number of innovative prevention and treatment programs focused on community-based care and information technology.” Read how these researchers identified financial, organizational, and regulatory barriers to broader adoption in this Commonwealth report.

Researchers compared referral patterns between independent doctors and those working for hospitals. Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital. Doctors working for hospitals admitted an average of 83 percent of their hospitalized patients to the proprietor hospital. What’s more, the researchers found that patients are more likely to be treated in “a high-cost, low-quality hospital when their admitting physician’s practice is owned by that hospital.” “Why did hospitals binge-buy doctor practices in recent years?” Read this article from Kaiser Health News describing the findings in a recent Stanford study.

Segmenting patients can make it easier to target interventions and deploy resources to those most in need of them. Combining that information with clinical data and data derived from social media and smart phones may be the next frontier in population health. However, the data also need to be made actionable within the contexts of existing care management programs. “There are just five or six types of patients in the United States, experts in consumer profiling say.” This report from The Commonwealth Fund outlines how segmenting patients by their motivations and behaviors can make it easier to target interventions.

Developing meaningful measures of overall health system quality, and how it is changing, requires a combination of indicators that can reliably show how the system – which in our view includes providers, payers, and public health – is influencing the health of the population. Establishing a new set of national healthcare system quality measures that can be presented in a consistent manner over time would permit more definitive assessments about the status and trends in healthcare system quality and could be used to bring healthcare quality to the forefront of policy discussions and decisions. “How can we know if the performance of the health system overall in the U.S. is good and if it is getting better or worse over time?” Read this new report from The Kaiser Foundation

The results suggest that the rapid growth of HSA use was concentrated among high-income households and large employers. The highest-income filers at all ages were substantially more likely to fund their HSAs fully than filers in the lowest-income quintile. We did not detect a marked slowdown or acceleration of HSA take-up rates in 2008 or during the ensuing years of recession. “Between 2005 and 2012, the share of employers whose employees had health savings accounts (HSAs) and the share of employees working at these employers grew more than tenfold.” Read about who is contributing to this surge in this Health Affairs publication


U.S. District Court Judge Rosemary M. Collyer ruled that the House can sue the administration for spending money on new consumer health care subsidies that was not appropriated by Congress. Read the full article from The Washington Post.

“Kraft-Heinz Co., is pushing some of its retirees to health exchanges as the company cuts expenses.” Read this article from Bloomberg,

“A new Partners HealthCare, Center for Population Health established at Massachusetts General Hospital will train Partners HealthCare and Health Catalyst clinical/administrative teams in care management and population health best practices. Read about this $30 million population health management initiative to accelerate adoption of best practices nationally to improve patient care and lower costs in Health Data Management.

“With an eye on improving patient engagement, IBM Watson Health this morning announced the launch of a new population health tool.” Read the article in Fierce Health.  

“Doctors, hospitals and health insurance companies clashed Thursday over the merits of mergers planned by four of the five biggest insurers in the United States.” Read this update on the House Judiciary subcommittee hearing from The New York Times. 

“Last week brought the first U.S. launch in a new drug category called “biosimilars.” Read how this will impact drug prices for biologics in this article from The Washington Post. 


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