Health Affairs Web First: Choosing Wisely Campaign
This study was supported by the ABIM Foundation and Agency for Healthcare Research and Quality (AHRQ).
How To Fulfill The Promise In The Next 5 Years
In this analysis, the authors discuss the Choosing Wisely® campaign’s accomplishments over the past five years and summarize what steps could fulfill its promise. They take note of movement’s growth since its founding, with seventy new societies signing on, ; more than 400 recommendations issued, and a steady increase in the number of studies testing interventions to reduce low-value care (see the exhibit below).
Exhibit 1: Cumulative Numbers Of Choosing Wisely Particip...
Source: Health Affairs Blog - October 24, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Choosing Wisely Source Type: blogs
Professionalism And Choosing Wisely
The US health care system is plagued by the use of services that provide little clinical benefit. Estimates of expenditures on overuse of medical services range from 10–30 percent of total health care spending. These estimates are typically based on analyses of the geographic variation in patterns of care. For example, researchers at the Dartmouth Institute focused on differences in care use between high-spending and low-spending regions with no corresponding reductions in quality or outcomes. An analysis by the Network for Excellence in Health Innovation (formerly known as the New England Healthcare Institute) ident...
Source: Health Affairs Blog - October 24, 2017 Category: Health Management Authors: Michael Chernew and Daniel Wolfson Tags: Costs and Spending Quality Choosing Wisely inefficiency overuse of medical services Source Type: blogs
ACA Round-Up: Iowa, Massachusetts Waivers Stymied; States In CSR Case Face Tough Questioning
On October 23, 2017, Governor Kim Reynolds and Insurance Commissioner Doug Ommen announced that Iowa has withdrawn its 1332 state innovation waiver proposal. In a late afternoon press conference, Governor Reynolds and Commissioner Omen announced that the federal government had informed them that it would be several weeks yet before it could tell Iowa how much pass-through funding the state would receive to pay for its waiver program. With open enrollment just days away they could not proceed in the face of that uncertainty. Iowa therefore withdrew its request.
Iowa had applied for a stopgap waiver in June under section 133...
Source: Health Affairs Blog - October 24, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA 1332 waivers cost-sharing reduction payments Source Type: blogs
1332 Reinsurance Waivers Revisited: Could Oregon’s Approval Beget An Oklahoma Do-Over?
Just three weeks ago, CMS came under severe criticism for failing to act expeditiously on Oklahoma’s 1332 reinsurance waiver and only approving part of Minnesota’s waiver. I was among the critics, suggesting that the agency’s action threatened the delicate bonds of trust between CMS and the states. Channeling the Oklahoma letter withdrawing its pending waiver, I said the agency had some serious fence-mending to do if it wanted states to continue pursuing 1332 waivers.
The agency has responded and I want to be among the first to commend CMS Administrator Seema Verma and her tireless staff for their prompt approval...
Source: Health Affairs Blog - October 23, 2017 Category: Health Management Authors: Joel Ario Tags: Following the ACA Medicaid and CHIP 1332 waivers Source Type: blogs
Doctor Of Osteopathic Medicine: A Growing Share Of The Physician Workforce
Conclusion
The doctor of osteopathic medicine workforce is growing rapidly with no signs of decreases in the quality of students accepted or their success in matching into a residency training program, which has been steadily rising. Given the doctor of osteopathic medicine workforce’s higher likelihood of practicing in rural communities and of pursuing careers in primary care, doctors of osteopathic medicine are on track to play an increasingly important role in ensuring access to care nationwide, including for our most vulnerable populations.
Note 1
Since some residencies are jointly accredited by both the ACGME and th...
Source: Health Affairs Blog - October 23, 2017 Category: Health Management Authors: Edward Salsberg and Clese Erikson Tags: Health Professionals Population Health doctors of osteopathic medicine osteopaths physician supply Source Type: blogs
Creating Medicare Advantage Premium Support for All, Part 2: Benefit Design
Conclusion And Next Steps
I would suggest that the key takeaway here is that the Medicare benefit is pretty darn robust, an excellent place to start for a universal coverage regime. With some minor exceptions, it covers everything we would need, has built-in assistance for low-income people, and provides pathways for employers or higher-income households to buy additional benefits. With Medicare Advantage, it would provide additional choices for families to pick a plan that’s best for them, while fostering competition among private carriers on premium, quality, and other factors consumers care about.
As noted, there are ...
Source: Health Affairs Blog - October 23, 2017 Category: Health Management Authors: Billy Wynne Tags: Costs and Spending Health Policy Lab Insurance and Coverage Medicare Payment Policy benefit design MAPSA Medicare Advantage Medicare for All single payer Source Type: blogs
States, Amici Respond In California Cost-Sharing Reduction Payment Case
On October 21, 2017, attorneys general from eighteen states and the District of Columbia filed their responsive brief in California v. Trump, in which they are seeking an order preventing the Trump administration from halting cost-sharing reduction (CSR) payments reimbursing insurers for reducing cost-sharing for low-income consumers as required by the Affordable Care Act (ACA).
The states reiterate their argument that the text and legislative plan of the ACA demonstrate that Congress appropriated funding for the CSR payments through the ACA’s premium tax credit appropriation; they also argue that the insurance markets...
Source: Health Affairs Blog - October 22, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage cost-sharing reduction payments Source Type: blogs
Government Files Response In Cost-Sharing Reduction Payments Suit, Lays Out Tough Standards For Iowa Waiver
On October 20, 2017, the federal government filed a response to the states’ motion for a temporary restraining order and injunction in California v. Trump. The attorneys general of eighteen states and the District of Columbia sued the federal government on October 13 challenging as illegal President Trump’s decision to cease cost-sharing reduction (CSR) payments; these payments reimburse insurers for the reductions in out-of-pocket limits, deductibles, and other cost-sharing that the insurers are legally required to offer low-income enrollees in silver marketplace plans. On October 18, the states moved for a temporary ...
Source: Health Affairs Blog - October 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage 1332 waivers cost-sharing reduction payments Source Type: blogs
Request For Abstracts: Health and Health Care in California
Health Affairs is planning a theme issue focusing on the State of California, scheduled for publication in September 2018. The theme issue will examine developments, trends, and emerging priorities within the State of California, as well as the larger framework of the federal policy environment and how the state is responding.
We plan to publish about 20 peer-reviewed articles in the issue, including several invited overview papers that will highlight distinguishing features of California and activities and trends in the state that bear watching by others.
In filling out the issue, we will put a premium on empirical work&...
Source: Health Affairs Blog - October 20, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs ACA California CalPERS CalSIM Covered California demographics MediCal Source Type: blogs
The President ’s Executive Order: Less Than Meets The Eye?
The executive order (EO) signed by President Donald Trump on October 12 directs the Departments of Health and Human Services (HHS), Labor, and Treasury to develop federal regulations that could allow new and less expensive health insurance options for employers and consumers.
The EO marks a shift in the administration’s strategy on health care. After failing to get legislation through Congress to repeal and replace the Affordable Care Act (ACA), the administration is now attempting to move away from the ACA’s heavily-regulated markets through changes that can be implemented without a change in the law.
The executive or...
Source: Health Affairs Blog - October 20, 2017 Category: Health Management Authors: Joseph Antos and James Capretta Tags: Following the ACA Insurance and Coverage association health plans health reimbursement arrangements short term limited duration insurance Source Type: blogs
Single Payer Is Not The Solution To The Problem Of Uninsured Americans
For years, some Democrats have proposed a “single payer” or “Medicare for all” health system as the solution to the problem of millions of Americans going without health insurance coverage. Lack of coverage is a serious problem that must be corrected by government action, but “political control” single payer (as opposed to market control) is not the answer. If single payer means that all health care providers should be paid by the same government entity, this would probably mean a continuation of the current and all-too-pervasive open-ended uncoordinated fee-for-service system, with resource allocation and pric...
Source: Health Affairs Blog - October 20, 2017 Category: Health Management Authors: Alain Enthoven Tags: Insurance and Coverage Affordable Care Act Medicare repeal and replace single-payer health system Source Type: blogs
ACA Round-Up: Oregon 1332 Waiver Approved, Silent Returns Rejected, And More
On October 19, 2017, the Centers for Medicare and Medicaid Services approved Oregon’s 1332 state innovation waiver proposal. This is the fourth 1332 waiver proposal CMS has approved and the third proposal involving a reinsurance program. Oregon will reinsure 50 percent of claims, in excess of an attachment point to be determined, up to $1 million.
Oregon is financing part of its program through a 0.3 percent tax on major medical premiums but projects that the program will reduce premiums by 7.5 percent in 2018, 7 percent in 2019, and 6.4 percent in 2027 compared to what premiums would have been without the waiver. The wa...
Source: Health Affairs Blog - October 19, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA 1332 waivers individual responsibility requirement minimum essential coverage Source Type: blogs
The Next Chapter In Transparency: Maryland ’s Wear The Cost
Historically, the State of Maryland’s per capita health spending has been substantially higher than the national average. In an attempt to control health care costs, the state has been administering an all-payer rate setting system for Maryland hospitals—fixing the rates for Medicare and private payers—for more than 40 years. Regardless of one’s view of the desirability of these regulatory interventions, the Maryland system has been unable to address the wide disparity among providers in terms of both price and quality.
In an effort to address this disparity, Maryland is launching a new initiative to make i...
Source: Health Affairs Blog - October 19, 2017 Category: Health Management Authors: Robert Moffit, Marilyn Moon, François de Brantes and Suzanne Delbanco Tags: Costs and Spending Quality Maryland Maryland Health Care Commission wear the cost Source Type: blogs
State Attorneys General Ask Court For Injunction Reversing CSR Payment Halt
On October 18, 2017, the attorneys general of eighteen states and the District of Columbia asked the United States District Court for the Northern District of California for a temporary restraining order and order to show cause why a preliminary injunction should not issue to compel the Trump administration to continue making cost-sharing reduction (CSR) payments until the lawsuit they have filed is resolved. The motion asks the court to make a decision by 4:00 PM tomorow, October 19, as the next cost-sharing reduction payment is due on October 20. The plaintiffs ask for a nationwide injunction as the issue it addresses is...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage cost-sharing reduction payments Source Type: blogs
ACA Round-Up: Alexander-Murray And CSR Payments, QHP Quality Ratings, And More
The language of the Alexander/Murray bill is now available. Our post of yesterday, October 17 provides an on the whole accurate description and analysis of the bill.
One late addition deserves further discussion, however. As noted in an earlier post, many states have already required or allowed their insurers to increase premiums to account for the shortfalls the insurers will experience for the CSR payment cut off. Rather than require the insurers to refile their rates again, delaying the 2018 open enrollment period, the proposed language would leave the increased rates in place but require insurers to rebate overpayments...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA section 1557 agents and brokers cost-sharing reduction payments gender identity qualified health plans Source Type: blogs
