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Managing The Beginning Of The End: Advanced Disease Management And Concurrent Care Under Current Financing
Editor’s Note: This is the second Health Affairs Blog post from the author on End of Life & Serious Illness. His first post “Why Now? Concerns About End-Of-Life Health Care Policy” was published on December 19, 2016. The Medicare hospice benefit was passed in 1982 as part of the Tax Equity and Fiscal Responsibility Act, the same bill that instituted diagnosis-related groups (DRGs) for hospital reimbursement. Since it was passed with a sunset provision, there was only modest growth in the number of beneficiaries until the hospice benefit was made permanent in 1986. Other changes included in the bill h...
Source: Health Affairs Blog - April 28, 2017 Category: Health Management Authors: Vincent Mor Tags: Costs and Spending End of Life & Serious Illness Long-term Services and Supports Medicare Organization and Delivery Quality advanced disease management End-of-Life Care Hospice care Palliative Care Source Type: blogs

Rethinking The United States ’ Military Health System
During Operations Enduring Freedom and Iraqi Freedom (2001 – 2014), the United States’ military health system completely transformed its approach to casualty care, achieving the highest rate of survival from battlefield wounds in the history of warfare. It is one of the most remarkable accomplishments in the history of US medicine. Ironically, the same health care system that worked miracles “down range” in Iraq and Afghanistan faces mounting criticism at home. How can this be? In part, it is because the military health system has two distinctive missions: support combat and humanitarian assistance missions ove...
Source: Health Affairs Blog - April 27, 2017 Category: Health Management Authors: Arthur Kellermann Tags: Costs and Spending Featured Organization and Delivery Population Health Quality American College of Surgeons Department of Veterans Affairs Jonathan Letterman military health care National Defense Authorization Act TRICARE Source Type: blogs

Health Policy ’s Gordian Knot: Rethinking Cost Control
Medical spending has resumed its long-term rise. After several years of deceptive stability in the last, deep recession’s wake, health spending rose by 3.7 percentage points more than general inflation in 2014, then by 5.8 percentage points more in 2015, to a 17.8 percent share of the US economy. Not only does this spending rise threaten the United States’ fiscal stability and capacity to address other needs; it is undermining the promise of health care for all. To manage rising costs, insurers are hiking premiums, narrowing their networks, and raising deductibles and copayments, making purchase of coverage less appeal...
Source: Health Affairs Blog - April 26, 2017 Category: Health Management Authors: Gregg Bloche, Neel Sukhatme and John L. Marshall Tags: Costs and Spending Drugs and Medical Technology Health IT Insurance and Coverage Payment Policy intellectual property patents Research and Development value-based payment Source Type: blogs

The MacArthur Amendment Language, Race In The Federal Exchange, And Risk Adjustment Coefficients
For a number of days negotiations have apparently been underway with respect to an amendment to the Republican American Health Care Act (AHCA) that has been proposed by Congressman Tom MacArthur (R.N.J.) A summary of this amendment became available on April 20, 2017 and was analyzed here. On the evening of April 25, the actual language of the amendment became available. As described in the summary, the amendment would repeal the enigmatic language included in a March 23, 2017 amendment to the AHCA that would have allowed states, beginning in 2018, to define the essential health benefits for purposes of determining premium ...
Source: Health Affairs Blog - April 26, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs

How to Select the Best Hospice Care Provider
The website of the National Hospice and Palliative Care Organization defines hospice care as follows:“Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury,hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes.Support is provided to the patient's loved ones as well.At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support t...
Source: Alzheimer's Reading Room, The - April 19, 2017 Category: Neurology Authors: rtdemarco at gmail.com Tags: alzheimer's awareness alzheimer's care Alzheimer's Dementia help with dementia care hospice Hospice Care memory care memory care facility nursing home searches related to alzheimer's Source Type: blogs

Yes, Mr. President. Health Care is Complicated. And Also Hard.
By ASEEM SHUKLA, MD “Nobody knew that health care could be so complicated,” President Donald Trump told us a few weeks ago.  As the failure of the House Republican  bill shows: Healthcare is hard. The American Healthcare Act failed to clear the House of Representatives despite catering to longstanding conservative demands: rid the ‘individual mandate’ (designed to force able-bodied people to pay insurance so it’s cheaper for sick people), subsidies to individuals, and revamping Medicaid into block grants to states. Even with the claim it could be deficit-neutral, the act failed to win enough moderat...
Source: The Health Care Blog - April 14, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Medicaid Work Requirements: Who ’s At Risk?
While the American Health Care Act (AHCA) has collapsed, adding work requirements to Medicaid continues as a key theme in conservative health reform efforts. Department of Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sent a letter to state governors offering greater flexibility in approving Medicaid Section 1115 waivers, including those with work-related proposals. Four states, Indiana, Arizona, Kentucky, and Pennsylvania, have submitted waivers to CMS to add work requirements to Medicaid. In his rejection of a Medicaid expansion bill that was ...
Source: Health Affairs Blog - April 12, 2017 Category: Health Management Authors: Leighton Ku and Erin Brantley Tags: Following the ACA Insurance and Coverage Medicaid and CHIP American Health Care Act employment health status medicaid work requirement Section 1115 Waivers Seema Verma tom price work requirements Source Type: blogs

Medicaid Responds To The Opioid Epidemic: Regulating Prescribing And Finding Ways To Expand Treatment Access
Medicaid programs are at the center of the opioid epidemic. Nearly 12 percent of adults covered by Medicaid have a substance use disorder, including opioid use disorder. Available data suggest that Medicaid beneficiaries are prescribed painkillers at higher rates than non-Medicaid patients and have a higher risk of overdose, from both prescription opioids and illegal versions including heroin and fentanyl. In addition to the human toll, abuse of opioids has significant financial effects. In 2010, Arizona Medicaid paid for more than half of all opioid-related emergency department admissions, and in 2012, 81 percent of the $...
Source: Health Affairs Blog - April 11, 2017 Category: Health Management Authors: Amy Bernstein and Nevena Minor Tags: Costs and Spending Medicaid and CHIP Public Health opioid epidemic preferred drug lists prescription drug abuse prescription drug monitoring programs prior authorization requirements Section 1115 Waivers Source Type: blogs

What Now?: A Four Step Plan For Bipartisan Health Reform
As I concluded in my Health Affairs Blog post last Monday, it should be clearer now than ever that new steps to improve our health care system must be pursued on a bipartisan basis. In the past week, several Members of Congress and the President himself have expressed interest in finding consensus solutions to the challenges we face. Democrats, meanwhile, have responded in kind. While it will not be easy, we ought to applaud these gestures and, as health care stakeholders, demonstrate our preparedness to support efforts to improve health care access and reduce costs. With that in mind, I have compiled here a range of sensi...
Source: Health Affairs Blog - April 4, 2017 Category: Health Management Authors: Billy Wynne Tags: Featured Following the ACA Insurance and Coverage Medicaid and CHIP Quality bipartisanship Congress house v. price MACRA section 1333 Source Type: blogs

Overcoming Challenges Of Outcomes-Based Contracting For Pharmaceuticals: Early Lessons From The Genentech – Priority Health Pilot
Conclusion Outcomes-based agreements are a natural extension of a health care delivery-and-reimbursement environment that is moving toward value. With provider organizations taking increasing accountability for both costs and outcomes, it is becoming incumbent upon manufacturers to demonstrate the economic, clinical, and quality-of-life benefits of their medicines. The pilot described here was successful in that Genentech and Priority Health both learned how to overcome clinical, operational, and contractual challenges and demonstrated that this type of agreement is feasible. Genentech and Priority Health believe pilots li...
Source: Health Affairs Blog - April 3, 2017 Category: Health Management Authors: John Fox and Marc Watrous Tags: Costs and Spending Drugs and Medical Innovation Payment Policy Outcomes-based agreements Source Type: blogs

Health Care: What Should a Populist Do Now?
Conclusion The most common response to the suggestion that private contracts could be useful in reforming the health-care system for the benefit of ordinary Americans is the observation that people—ordinary Americans in particular—cannot reasonably be expected to read, let alone understand and compare, the multiple contracts they would confront. This point, however, while valid, is beside the real one, which is to give adequately subsidized consumers meaningful choices with respect to the cost and content of their future health care and enough reliable help in making them that they can be reasonably content with their ...
Source: The Health Care Blog - April 1, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

The Child Sexual Abuse Conspiracy
BY DAVID INTROCASO (After this essay was submitted to THCB the Senate Judiciary Committee held a hearing on March 28th titled, “Protecting Young Athletes From Sexual Abuse.” USA Gymnastics refused to appear and provide testimony likely, in part, because USA Gymnastics’ President, Steve Penny, was forced to resign on March 16th. The issue was framed by Committee Chairman Chuck Grassley as a “heinous crime,” no health care or public health expert testified and the hearing and was reported in sports pages of the The New York Times and The Washington Post.) If you do not read the sports page you ...
Source: The Health Care Blog - March 31, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

After the American Health Care Act
BY JOHN IRVINE We asked THCB’s editors and bloggers for their reactions to Friday’s news. Here are their reactions. DANIEL STONE, MD The late UCLA Professor Richard Brown, once commented that the Clinton healthcare initiative failed because the status quo was everyone’s second choice. Some of that logic applies to today’s failure to vote on the AHCA. Additionally, no one ever lost money betting against the rollback of an established entitlement program. The Republicans opponents of the ACA have not yet faced the fact that the reason coverage is so expensive is because the care is so expensive. You can’t ...
Source: The Health Care Blog - March 26, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized John Irvine Source Type: blogs

A Healthcare Reform Compromise That Just Might Work (Maybe)
By BRIAN JOONDEPH, MD Healthcare reform is stalled, so says Politifact. Fake news or the truth? Hard to know these days. President Trump and Speaker Ryan both sounded optimistic in recent public appearances. The Tweeter-in-Chief this week tweeted, “Great progress on healthcare. Improvements being made – Republicans coming together!” Maybe so, but remember that every TV news network was optimistic over Hillary Clinton’s landslide victory until about 9 PM on election night. Is Trump’s enthusiasm part of “The Art of the Deal”? To quote from the book, “I never get too attached to one deal or one approac...
Source: The Health Care Blog - March 23, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Conservatives Are Using The American Health Care Act To Restrict Private Insurance From Covering Abortion
Earlier this month, House Republicans introduced their first draft of legislation to repeal and replace large portions of the Affordable Care Act (ACA). While they found themselves divided on a wide range of important issues, from the ACA’s Medicaid expansion and subsidies in the form of tax credits, in one area they were united. The new legislation, titled the American Health Care Act (AHCA), includes language barring federal money from being used to support any private insurance plan that covers abortion. These efforts are an extension of a long-term campaign to isolate abortion from the rest of the health care system ...
Source: Health Affairs Blog - March 21, 2017 Category: Health Management Authors: Adam Sonfield Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Abortion abortion coverage ACA repeal and replace Women's Health Source Type: blogs