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 ...
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On October 23, 2017, Governor Kim Reynolds and Insurance Commissioner Doug Ommen announced that Iowa has withdrawn its 1332 state innovation waiver proposal.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 t...
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 an...
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 ...
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...
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 te...
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 w...
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 exec...
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 reso...
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. Th...
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 t...
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

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 experie...
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

The Alexander-Murray Market Stabilization Package: What ’s In It And Where’s It Going?
They may have done it. The apocryphal bipartisan deal to “fix” Obamacare is being struck (at least by two important Senators, for now, in part …). Today, Senators Lamar Alexander of Tennessee and Patty Murray of Washington announced they are converging on an agreement on a short-term package to help stabilize the individual insurance market. Even better, the policies included would likely be somewhat successful in achieving their purported purpose. This post will explore each of them in some detail and consider the impact they may have, as well as the probability Congress will send the legislation to Pre...
Source: Health Affairs Blog - October 18, 2017 Category: Health Management Authors: Billy Wynne and Timothy Jost Tags: Costs and Spending Featured Following the ACA Insurance and Coverage 1332 waivers copper plans cost-sharing reduction payments interstate insurance reinsurance 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 cove...
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)
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 sav...
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

A New Plan To Rescue The ACA: Medicare-At-55
On October 12, 2017, the Trump Administration announced that it would end subsidies that reduce out-of-pocket payments for low-income individuals. This action might drive insurers out of the exchanges and might encourage younger people to drop their individual insurance plans — thereby destabilizing the individual insurance market. Extending Medicare to the 55-64 age group—who have relatively high health care costs—is a potential fix that could insure the near-elderly and provide stability to the marketplaces. It would remove expensive individuals and families from coverage by private insurance companies,...
Source: Health Affairs Blog - October 16, 2017 Category: Health Management Authors: Thomas Bodenheimer Tags: Costs and Spending Featured Following the ACA Medicare individual insurance market Medicare-At-55 Source Type: blogs

ACA Repeal Votes Defy Preferences Of Constituents
Despite repeatedly failing to advance legislation through the Senate, Republicans in Congress have not abandoned their goal of repealing and replacing the Affordable Care Act (ACA). The latest attempt at repeal in the form of the Graham-Cassidy bill would have established a per capita cap on federal Medicaid financing, eliminated the individual mandate, and undermined protections for older adults and people with preexisting conditions, by allowing states to opt out of key ACA insurance regulations. It would also have eliminated funding for the ACA’s Marketplace premium and cost-sharing subsidies and Medicaid expansio...
Source: Health Affairs Blog - October 16, 2017 Category: Health Management Authors: Michael Karpman, Sharon Long and Nikhil Holla Tags: Featured Following the ACA ACA repeal and replace. health care legislation Affordable Care Act health care access health care affordability Source Type: blogs

A Fateful Thursday For The ACA: Likely Effects And Legal Reactions
Thursday, October 12, 2017, was one of the most eventful days in the history of the Affordable Care Act.  Late Thursday morning, President Trump released an executive order directing the Departments of Labor, Treasury, and Health and Human Services to begin the process of drafting rules that will expand the use of association health plans, exempting small employer plans from the ACA’s small group consumer protections and perhaps preempting state regulation; expand the length and renewability of short-term coverage; and expand the ability of employers to use health reimbursement accounts to shift coverage of thei...
Source: Health Affairs Blog - October 14, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage association health plans cost-sharing reduction payments health reimbursement arrangement short-term limited duration plans Source Type: blogs

Who Cares For The Caregivers? We All Do
Nearly 44 million people in the United States, three-quarters of whom are women in their late 40s, spend at least 22 hours a week providing unpaid care to loved ones with a disability, illness, or terminal diagnosis, and one in four spend at least twice that amount. Typically, they assist with the activities of daily living such as bathing, dressing, toileting, and feeding their loved one, as well as taking care of shopping, finances, and transportation to and from medical appointments. These responsibilities generally last at least three years, with demands increasing as the loved one nears death. Caretaking offers emotio...
Source: Health Affairs Blog - October 13, 2017 Category: Health Management Authors: Nicole Cadovius Tags: End of Life & Serious Illness addiction Aging anxiety caregivers depression End-of-Life Mental Health mental health first aid National Council for Behavioral Health support services Source Type: blogs

Administration ’ s Ending Of Cost-Sharing Reduction Payments Likely To Roil Individual Markets
Yesterday, October 12, 2017, the White House press office announced that the administration will no longer be reimbursing insurers for the cost-sharing reductions they are legally required to make for low-income individuals. The Affordable Care Act requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. These provisions reduce the out-of-pocket limit for these enrollees—particularly for those with incomes below 200 percent of poverty—and sharply reduce deductibles, coinsurance, and copayments. The redu...
Source: Health Affairs Blog - October 13, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA Marketplaces advance premium tax credits California cost-sharing reduction payments individual market 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

Taking A Long View: A Foundation ’s Rapid-Response, Data-Driven Strategy To Inform Recovery From Hurricane Harvey In Texas
When Hurricane Harvey made landfall as a Category 4 hurricane near Rockport, Texas, on August 25, 2017, we knew there would be massive winds and torrential rains. But none of us understood, and will probably not understand for some time, the full extent of the impact of this natural disaster in communities throughout the Gulf Coast region—from Texas to Louisiana. What we do know is that with a record fifty-two inches of rainfall in parts of the region, the flooding has had devastating effects. To date, 829,825 individual assistance applications have been received by the Federal Emergency Management Agency (FEMA) and ...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Shao-Chee Sim Tags: Featured GrantWatch Organization and Delivery Public Health Centers for Disease Control and Prevention disaster preparedness emergency planning Federal Emergency Management Agency (FEMA) Health Philanthropy homelessness Hurricane Harve Source Type: blogs

Giving Urban Health Care Access Issues The Attention They Deserve In Telemedicine Reimbursement Policies
A May 2017 Wall Street Journal analysis highlights the plight of rural America: People there who are sick are getting sicker because health systems are struggling to deliver care in rural areas. The challenges are multifactorial, but a key driver is the availability of providers. Only 10 percent of physicians serve rural populations, and the number of specialists per capita is a third of the number that practice in urban areas. The Centers for Medicare and Medicaid Services (CMS) considers the per capita physician shortage to be an important health care access problem. In an effort to improve access to care, CMS has create...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Yash S. Huilgol, Aditi U. Joshi, Brendan G. Carr and Judd E. Hollander Tags: Featured Health Equity appointment timeliness health care access Medicare reimbursement Telemedicine Source Type: blogs

The Insufficiency Of Medicaid Block Grants: The Example Of Puerto Rico
Medicaid block grants have been a centerpiece of Republican health proposals for more than a decade. Proponents, including House Speaker Paul Ryan (R-WI), argue that giving states a fixed amount of money through a block grant or per-person limit with few strings attached gets Washington out of the way and allows for state innovation. Although the most recent block grant legislation did not reach the Senate floor, proponents have promised to continue to push for it. But one need look no further than the growing health crisis in Puerto Rico to understand why capped federal money and state flexibility will not solve serious h...
Source: Health Affairs Blog - October 12, 2017 Category: Health Management Authors: Vikki Wachino and Tim Gronniger Tags: Medicaid and CHIP block grants disaster relief Puerto Rico 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 ...
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 ...
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

The 340B Program: Mandatory Reporting, Alternative Eligibility Criteria Should Be Top Priorities For Congress
Policymakers have renewed their focus on how the 340B drug discount program functions among “safety net” hospitals, particularly Disproportionate Share  Hospitals (DSH), which qualify for the 340B program because they provide a sufficient amount of inpatient care to Medicaid and low-income Medicare beneficiaries. In June, a leaked executive order from the Trump administration suggested that the program would start to tie the volume of discounted drugs to indigent patient volume. In July, the Centers for Medicare and Medicaid Services (CMS) proposed cuts to physician reimbursements for outpatient drugs cove...
Source: Health Affairs Blog - October 10, 2017 Category: Health Management Authors: Sayeh Nikpay, Melinda Buntin and Rena Conti Tags: Costs and Spending Drugs and Medical Innovation Hospitals Medicaid and CHIP Medicare 340B 340B program disproportionate share hospitals DSH Source Type: blogs

Sessions Outlines Religious Liberty Principles To Guide Government Actions
On October 6, 2017, Attorney General Jeff Sessions released a memorandum on religious liberty protections for all executive departments and agencies and guidance to Department of Justice staff on how to implement this memorandum. The memorandum outlines 20 principles of religious liberty to guide the federal government in accommodating religious observance and practice in federal employment, contracting, and programming. The principles themselves refer to the Constitution and federal laws, such as the Religious Freedom Restoration Act of 1993 (RFRA), in a general way, but much of the detailed legal analysis is found in the...
Source: Health Affairs Blog - October 10, 2017 Category: Health Management Authors: Katie Keith Tags: Following the ACA ACA section 1557 contraceptive coverage mandate free exercise of religion Religious Freedom Restoration Act Title VII of the Civil Rights Act Source Type: blogs

CMS Beefs Up Enforcement On QHP Coverage Of Abortions Outside The Hyde Amendment
On October 6, 2017, the Center for Consumer Information and Insurance Oversight (CCIIO) released a new bulletin regarding the coverage of abortion by qualified health plans (QHPs) sold through the ACA marketplaces. The bulletin provides additional guidance on how rules and restrictions on abortion coverage will be enforced by federal officials beginning in plan year 2018. The ACA And Abortion Coverage Coverage of abortion was one of the most contentious and last resolved issues in the debate over the ACA. The final Senate compromise, which was adopted as part of the ACA, largely reinforces the Hyde Amendment, which has bee...
Source: Health Affairs Blog - October 7, 2017 Category: Health Management Authors: Katie Keith and Timothy Jost Tags: Following the ACA Insurance and Coverage Abortion Hyde Amendment qualified health plans Source Type: blogs

Trump Administration Regulatory Rebalancing Favors Religious And Moral Freedom Over Contraceptive Access
On October 6, 2017, the Departments of Health and Human Services, Labor, and Treasury, released two interim final rules addressing religious and moral objections to the coverage of contraceptives under the preventive services requirement of the Affordable Care Act, as well as accommodations for those objections. Treasury released with the interim final rules two accompanying proposed rules (here and here) apparently required for technical reasons because Treasury released temporary rules. HHS also updated the Health Resources and Services Administration women’s health guidelines to reflect the rule change. Finally, H...
Source: Health Affairs Blog - October 7, 2017 Category: Health Management Authors: Timothy Jost and Katie Keith Tags: Following the ACA Insurance and Coverage Uncategorized contraceptive coverage contraceptive mandate Preventive Services Mandate Religious Freedom Restoration Act Source Type: blogs

Nearly One-Third Of New Drugs Are No Better Than Older Drugs, And Some Are Worse
A Focus On Expediting Drug Development Congress has instructed the Food and Drug Administration (FDA) to expedite the development and review of promising new drugs through the creation of four programs: accelerated approval, fast-track, breakthrough, and priority review. In a recent Health Affairs article, James D. Chambers and colleagues reported that drugs approved under one or more expedited programs were, on average, associated with larger health gains than those approved under conventional development and review programs. They concluded that the FDA has prioritized the review of drugs that offer the largest clinical a...
Source: Health Affairs Blog - October 6, 2017 Category: Health Management Authors: Jonathan Darrow and Aaron Kesselheim Tags: Drugs and Medical Innovation expediting drug development Food and Drug Administration Prescription Drugs QALY quality-adjusted life years Source Type: blogs

Calling All Wonder Women —The US Health System Needs Strong Leaders, Healthy Mothers
Legend has it that the creation of Wonder Woman—the super hero and pop culture icon who has saved us from imminent doom since World War II—was inspired by real-life women’s health activists from the early twentieth century. These were women who bucked convention and championed causes like reproductive rights and suffrage. Women who saw opportunities for collective action where others saw insurmountable obstacles. Women who refused to be relegated to second-class status and instead became the driving force for creating a more just, inclusive world. We have come a long way since the days of Margaret Sanger ...
Source: Health Affairs Blog - October 5, 2017 Category: Health Management Authors: Karen Wolk Feinstein Tags: Featured GrantWatch Health Professionals Population Health Quality community health workers Disparities Health Philanthropy Jewish Healthcare Foundation Latinas maternal mortality pregnancy Women's Health Source Type: blogs

The CHRONIC Care Act Passes Senate, Obstacles Remain
Late last Tuesday night, only hours after Republican leaders announced they were pulling the Graham-Cassidy repeal and replace bill from Senate consideration, the body unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (the Act). Aiming to improve care for seniors with chronic conditions, the Act first passed the Senate Finance Committee in May of this year. A Health Affairs blog post by former Senators Tom Daschle and Bill Frist, along with in-depth analysis from the Bipartisan Policy Committee, helpfully outline the need for a bipartisan effort to add...
Source: Health Affairs Blog - October 5, 2017 Category: Health Management Authors: Billy Wynne Tags: Costs and Spending Insurance and Coverage Medicaid and CHIP Medicare Organization and Delivery ACA ACO bipartisanship chronic CHRONIC Care Act dual eligibles Long-Term Care Medicare Advantage Telehealth Source Type: blogs

Reducing The Externalities Caused By Limited Benefit Plans
Limited benefit or non-Affordable Care Act (ACA)-compliant health insurance products are much discussed of late, since a proposal to ease restrictions on short-term health plans is currently under consideration. Critics have argued that these plans hurt both consumers and the individual market, while defenders have suggested that those who can benefit from this competitively priced option should be free to do so. That these plans may be harmful to at least some consumers is difficult to dispute. In its comment letter, the National Association of Insurance Commissioners supported increased disclosure requirements, noting th...
Source: Health Affairs Blog - October 5, 2017 Category: Health Management Authors: Katherine Hempstead Tags: Insurance and Coverage ACA-compliant market individual market stability limited benefit plans short-term plans skinny plans state insurance regulation Source Type: blogs

Community Approaches To Improving Children ’s Health: Addressing Childhood Obesity And ACEs In Kentucky
Investing in children’s health is a sound economic decision with a long-term impact on achieving sustainable human, social, and economic development. The Foundation for a Healthy Kentucky’s Investing in Kentucky’s Future initiative was designed as a partnership with local community health coalitions to reduce the risk that today’s children will develop chronic diseases as they grow into adults. Background The Foundation for a Healthy Kentucky is a statewide nonprofit organization working to address the unmet health needs of Kentuckians. In 2012 the foundation launched a six-year, $3 million initiati...
Source: Health Affairs Blog - October 4, 2017 Category: Health Management Authors: M. Amalia Mendoza Tags: GrantWatch Public Health ACEs adverse childhood experiences Children chronic disease prevention equity Health Philanthropy Health Promotion and Disease PreventionGW Kentucky Nonmedical Determinants Obesity Prevention resiliency S Source Type: blogs

ACA Round-Up: Bipartisan Proposal To Revamp Employer Reporting Requirements And More
Throughout a summer of intensely partisan efforts to repeal and replace parts of the Affordable Care Act, there have been flickers of bipartisanship, including a sustained effort by Senators Alexander (R-TN) and Murray (D-WA) and the Senate Health, Education, Labor, and Pensions Committee to find bipartisan consensus for a short-term market stabilization package. On October 3, 2017, another bipartisan effort emerged from another quarter. Senators Portman (R-OH) and Warner (D-VA) introduced a bill that is surprising in that it emerged out of nowhere (at least as far as I am aware) and addresses a problem that obviously need...
Source: Health Affairs Blog - October 4, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP Source Type: blogs

The 2017 ACO Survey: What Do Current Trends Tell Us About The Future Of Accountable Care?
This article presents an overview of the results from the inaugural 2017 Annual ACO Survey and provides important insights into the current and future state of the ACO industry. Overall, we found that a large number of ACOs are currently considering or have firm plans to participate in future risk-based contracts (47 percent planning for shared savings/shared risk and 38 percent planning for capitation), although care management strategies are largely unchanged. This and the data below suggest that ACOs are slowly becoming willing to accept increased financial risk, but they are largely still learning how to actually manag...
Source: Health Affairs Blog - October 4, 2017 Category: Health Management Authors: Kate de Lisle, Teresa Litton, Allison Brennan and David Muhlestein Tags: Medicare Payment Policy Quality Accountable Care Organizations delivery reform NAACOS Payment Reform Source Type: blogs

Is Paid Family And Medical Leave Inevitable? Perhaps, But There ’s A Long Way To Go From Here
The push for paid parental, family, and medical leave is gaining traction. But legislative action in Congress is still iffy and could easily be eclipsed by events or partisan rancor over the next year. This blog is an update to a Health Affairs Policy Brief that I wrote last year on paid family and medical leave policies. The brief, published November 21, 2016, provides an overview of the basic issues, research, and policy options. Those remain relevant 10 months later. But some things have progressed. The Trump administration and lawmakers on both sides of the aisle in Congress have released competing paid-leave proposals...
Source: Health Affairs Blog - October 3, 2017 Category: Health Management Authors: Steven Findlay Tags: Elsewhere@ Health Affairs Long-term Services and Supports Quality employee benefits maternity leave paid family leave paid medical leave paid parental leave paternity leave unpaid leave Source Type: blogs

Health Affairs October Issue: Emergency Departments, Behavioral Health & More
The October issue of Health Affairs includes several studies relating to the ultimate health care safety net: the emergency department (ED). Additional content in this variety issue focuses on behavioral health, spending, clinician satisfaction, and more. A DataGraphic spotlights aging and health. US emergency department visits for firearm-related injuries, 2006–14 According to the Centers for Disease Control and Prevention (CDC), firearm-related deaths accounted for more than 36,000 deaths in the United States in 2015. However, due to the politicized environment surrounding gun violence, Congress has yet to app...
Source: Health Affairs Blog - October 2, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs journal Source Type: blogs

California Takes On Drug Pricing: Real Progress Or Illusion?
Californians and others around the country following the California legislature’s multiyear debate on prescription drug pricing may have stood up and taken notice on September 13 when the state Senate followed the Assembly in passing SB-17 to facilitate greater transparency in brand-name and generic drug pricing. While sponsors often make grandiose claims about the potential impact of their legislation, California senator Ed Hernandez may have set a new standard when he declared that the passage of SB-17 was “a monumental achievement for the entire nation” and “one of the most transformative pieces ...
Source: Health Affairs Blog - October 2, 2017 Category: Health Management Authors: Ian Spatz Tags: Costs and Spending Drugs and Medical Innovation California California SB-17 prescription drug pricing Source Type: blogs

Failure To Approve Oklahoma Waiver Undermines Trust Between HHS And States
By failing to follow through on repeated assurances to Oklahoma that its 1332 reinsurance waiver would be approved on an expedited timeline, the federal government dealt a devastating blow to Oklahoma consumers and magnified suspicions that the Department of Health and Human Services (HHS) is more interested in undermining the Affordable Care Act than partnering with the states to stabilize the individual market for the nearly 20 million Americans who depend on that market for their health security. Oklahoma’s Governor Lambasts The Federal Government For Breaking A Promise To His State In a blistering letter to now f...
Source: Health Affairs Blog - September 30, 2017 Category: Health Management Authors: Joel Ario Tags: Following the ACA Insurance and Coverage 1332 waivers Oklahoma reinsurance Source Type: blogs

ACA Round-Up: CMS Acts To Aid Hurricane Victims; Oklahoma Withdraws 1332 Wavier Application; And More
On September 29, 2017, the Centers for Medicare and Medicaid announced several measures that it is taking with respect to federal health care programs to aid people affected by hurricanes Harvey, Irma, and Maria. Several of these measures that will affect people who are covered or eligible for coverage through the Federally Facilitated Exchange (FFE) will be covered here. CMS also announced steps it is taking with respect to the Medicare program, including creating special Medicare enrollment periods and other public health emergency measures. Individuals who experienced an event that would have qualified them for a specia...
Source: Health Affairs Blog - September 29, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage 1332 waivers Hurricane Harvey Hurricane Irma Hurricane Maria special enrollment periods state marketplaces Source Type: blogs

Advancing The Mental Health And Well-Being Movement Through Grant Making: Engaged Philanthropy
Investing in the health of a nation requires thoughtful deliberation and vision. Grantmakers, especially those with a focus on health, play a unique role in helping support community innovation that can advance health. However, without a clear focus on what they are trying to effect, the direction they want to go with their investment, and how to accomplish their goals, how will the grant-making community ever know if it is making a difference and if it is improving health? The United States, now more than ever, needs clear direction to create more comprehensive solutions to fragmented problems. Grantmakers play an essenti...
Source: Health Affairs Blog - September 28, 2017 Category: Health Management Authors: Benjamin F. Miller and Tyler Norris Tags: GrantWatch Population Health costs Health Philanthropy Health Promotion and Disease PreventionGW Mental Health Policy Social Determinants of Health substance use wellness Source Type: blogs

De-Medicalizing Death
There’s been an unexpected, and excellent, consequence to California’s new medical aid-in-dying law. For many terminally ill patients, immersion in the process of securing lethal drugs ultimately renders them unnecessary. How did this come about? Passed by the California legislature in late 2015, the End of Life Option Act allows physicians to prescribe a lethal concoction of drugs to some patients with terminal illnesses who meet certain criteria. The law, commonly described as providing “medical aid in dying,” took effect on June 9, 2016. It stipulates only that the requesting patient be considere...
Source: Health Affairs Blog - September 28, 2017 Category: Health Management Authors: Jessica Nutik Zitter Tags: End of Life & Serious Illness California critical care End of Life Option Act intensive care unit medical aid in dying Palliative Care Source Type: blogs

ACA Round-Up: Graham-Cassidy ’ s Demise, Pressures On 2018 Open Enrollment, And New HHS Draft Strategic Plan
On September 26, 2017, the Republican Senate leadership announced that the Senate would not hold a vote on the Graham-Cassidy bill, the last attempt to repeal or amend the Affordable Care Act under the 2017 budget resolution. After Senator Collins announced that she would not support the legislation, joining Senators Paul and McCain who had already announced their opposition, it became clear that it lacked the 50 votes necessary to pass. There is some discussion of trying again to address health reform in the 2018 budget resolution, which would otherwise be devoted solely to changes in the tax code. CMS Decisions On Renewa...
Source: Health Affairs Blog - September 27, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA repeal and replace freedom of religion guaranteed issue and renewal open enrollment period Source Type: blogs