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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

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

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

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

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

Traveling The Valley Of The Shadow Of Death In 2017
My mother has a letter from her mother written in 1942, telling of the death from pneumonia of a middle-aged neighbor with whom my grandmother had spoken at the post office just a week earlier. For most of human history, that sudden turn to death has been the common experience. Few managed to live into old age; and even for elders, the dying was usually fairly abrupt. There was little risk of living long with dementia, Parkinson’s disease, heart failure, cirrhosis, serious injuries, childbirth complications, or other fatal illnesses. Diabetes was fatal within a few months in 1900. Now, most of us will instead experience ...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Joanne Lynn Tags: End of Life & Serious Illness elder care health care reform long-term care reform MediCaring Communities Program of All-Inclusive Care of the Elderly Source Type: blogs

Despite Leaving Key Questions Unanswered, New Contraceptive Coverage Exemptions Will Do Clear Harm
On October 6, the Trump administration released an overhaul of federal regulations governing religious objections to the Affordable Care Act’s (ACA) contraceptive coverage guarantee. The move had been long expected. In early May, President Donald Trump issued an executive order on “religious liberty” that signaled his intent to undermine the guarantee; a few weeks later, media outlets published a leaked draft of the new regulations. The two regulations issued on Friday—which took effect immediately—closely match the draft from May by creating sweeping new exemptions from the contraceptive coverage guarant...
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: Adam Sonfield Tags: Following the ACA Public Health Contraception contraceptive coverage executive order moral objection preventative care religious exemptions Trump administration Source Type: blogs

Salvaging MACRA Implementation Through Medicare Advantage
Conclusion The implementation of MACRA will have a profound and lasting effect on the future US health care system and the practice of medicine. However, unless there are substantive changes to how the law is implemented, MACRA is unlikely to realize the goal of establishing a Medicare payment system that rewards the value and not the volume of health care services. Many of the key objectives of the legislation can be achieved using Medicare Advantage as the platform.
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: John O'Shea Tags: Medicare Payment Policy advanced alternative payment model APM MACRA Medicare Advantage Merit-Based Incentive Payment System mips Source Type: blogs

A Framework For Understanding ‘ Savings ’ From Accountable Care Organizations
Medicare’s Accountable Care Organization (ACO) program is the Centers for Medicare and Medicaid Services’ (CMS) flagship population-based payment model. In the ACO program, groups of providers form ACOs and take accountability for the spending and quality of care for the Medicare beneficiaries they serve. The ACO is given a spending target (benchmark) and receives a bonus (i.e. gets to share savings) if actual spending is below the target. In some ACO programs, the ACO must return money to Medicare if spending exceeds the target. The release of the Office of the Inspector General’s (OIG) report on the savings res...
Source: Health Affairs Blog - October 17, 2017 Category: Health Management Authors: Michael Chernew and Christopher Barbey Tags: Costs and Spending Featured Medicare Organization and Delivery Accountable Care Organizations Medicare Shared Savings Program payer savings Pioneer ACOs societal savings utilization savings Source Type: blogs

Trump Executive Order Expands Opportunities For Healthier People To Exit ACA
On October 12, 2017, President Donald Trump issued an executive order concerning health care coverage. The White House also posted two summaries of the order. If carried into action, the provisions of the executive order would likely siphon healthy people from of the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA. The executive order has several main components. First, it calls generally for expanding competition and choice in health care markets and for improving the information available to consumers while reducing reporting bur...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage 21st Century Cures Act association health plans health reimbursement arrangement short-term limited duration plans Source Type: blogs

Health Affairs Briefing: Choosing Wisely — Opportunities and Challenges in Curbing Medical Overuse
You are invited to join Health Affairs on Tuesday, October 24, in Washington, DC, for an important event: “Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse.” “Choosing Wisely” is an initiative launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports — and which has received funding from the Robert Wood Johnson Foundation — to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures. At the five-year mark of the initiative, Health Affairs will gather leaders of the effort, p...
Source: Health Affairs Blog - October 11, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs ABIM alexander mainor american board of internal medicine arthur s. hong Choosing Wisely Consumer Reports daniel b. wolfson eric wei eve kerr jessica rich john n. mafi kellie slate vitcavage matt handley Source Type: blogs

Diffusing Innovation: A Case Study Of Care Management In Louisiana
Conclusion The diffusion of innovation in health care doesn’t happen on its own. As we learned in Louisiana, it takes strong support for early adopters and gleaning from their experiences to tailor workflows as implementation efforts are spread to other practices. It also takes a collaborative learning environment, inclusive of both online and in-person forums, and standardized training content that can be tailored to the unique needs of each practice. With local leaders, a dedicated team in the field, support from a growing national value-based care network, and comprehensive population health technology that helps prac...
Source: Health Affairs Blog - October 11, 2017 Category: Health Management Authors: Charisse Hunter, Nadine Robin and Erin Flowers Tags: Diffusion of Innovation Accountable Care Organization chronic care management Louisiana value based care Source Type: blogs