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  • Eric C. Schneider, M.D. - The Commonwealth Fund
    he held the RAND Distinguished Chair in Health Care Quality In 2009 he was the first director of RAND s Boston office building a highly successful multidisciplinary health services research team From 1997 he was faculty of Harvard Medical School and Harvard School of Public Health where he taught health policy and quality improvement in health care and practiced primary care internal medicine at the Jen Center for Primary Care at Brigham and Women s Hospital in Boston Dr Schneider has held several leadership roles including editor in chief of the International Journal for Quality in Health Care co chair of the Committee for Performance Measurement of the National Committee for Quality Assurance member of the editorial board of the National Quality Measures and Guidelines Clearinghouses sponsored by the Agency for Healthcare Research and Quality as a member of the scientific advisory board of the Institute for Healthcare Improvement as chair of the Performance Measurement Committee of the American College of Physicians and as a methodologist on the executive committee of the Physician Consortium for Performance Improvement of the American Medical Association Dr Schneider holds a B S cum laude in Biology from Columbia University an M Sc from the University of California Berkeley and an M D from the University of California San Francisco He is an elected fellow of the American College of Physicians Fund Publications by Eric C Schneider M D 2016 Envisioning a Digital Health Advisor May 3 2016 The Best Way to Share Health Records An App in the Patient s Hands February 23 2016 2015 Primary Care Physicians in Ten Countries Report Challenges Caring for Patients with Complex Health Needs December 7 2015 Provider Mergers Will Patients Get Higher Quality or Higher Costs November 20 2015 Fostering a High Performance Health System That Serves Our Nation s Sickest and Frailest October 29 2015 A Difference in Difference Analysis of Changes in Quality Utilization and Cost Following the Colorado Multi Payer Patient Centered Medical Home Pilot October 23 2015 Measuring Medicare Quality and Spending A New Comparative Tool July 14 2015 Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care June 1 2015 Strengthening Primary Care Amid the Hype June 1 2015 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 29 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 29 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 29 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 29 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 28 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 28 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 28 2014 Structural Capabilities in Small and Medium Sized Patient Centered Medical Homes July 28 2014 Practice Environments and Job Satisfaction in Patient Centered Medical Homes July 15 2014 Practice

    Original URL path: http://authoring.commonwealthfund.org/about-us/staff-contact-information/executive-managers/staff-contact-folder/schneider-eric (2016-04-30)
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  • Onil Bhattacharyya, M.D. - The Commonwealth Fund
    at Women s College Hospital as well as an associate professor in the Department of Family and Community Medicine and Health Policy Management and Evaluation at the University of Toronto Bhattacharyya is co lead of BRIDGES Building Bridges to Integrate Care an Ontario Ministry funded initiative to incubate and evaluate new models of care for complex chronic disease He is co lead of the Toronto Health Organization Performance Evaluation group T HOPE which works with management and medical students to study social enterprises in health in low and middle income countries He was a Takemi Fellow at the Harvard School of Public Health and has an M D from the University of Montreal and a Ph D in health services research from the University of Toronto Project Abstract How can health organizations improve care address emerging challenges and take advantage of emerging opportunities that could transform health care Organizations can operate at 3 horizons 1 improving existing processes 2 develop new business models or 3 develop new models that could disrupt your current business An emerging challenge like the care of high cost high needs patients has required a broad change in how care is provided the business model An emerging opportunity is consumer facing information technology IT solutions which may fundamentally change the relationship between patients and providers This study will explore how leading institutions have addressed these two areas as examples of horizon 2 searching for new business models and 3 exploring disruption of current models It will begin with a review of potential processes from other industries that can be explored in in depth case studies in health care Case studies will be conducted on organizations that have successfully redesigned care for high cost high need patients and engaged with consumer facing IT I will sample purposively

    Original URL path: http://authoring.commonwealthfund.org/about-us/experts/bhattacharyya-onil (2016-04-30)
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  • Ashley Williams - The Commonwealth Fund
    current research addresses the implementation of the Affordable Care Act s market reforms and health insurance exchanges Before joining CHIR Ms Williams served as a law clerk with the Federal National Mortgage Association Fannie Mae While there she engaged in extensive legal research regarding compliance with federal and state regulations and provided assistance in drafting corporate legal documents Ms Williams is a member of the State Bar of Texas She holds her J D from Howard University School of Law and a B A magna cum laude from Howard University While in law school Ms Williams won numerous awards for her skills in legal reasoning research and writing health law and employee benefits Fund Publications by Ashley Williams 2016 Obama Administration Moves Forward with New Continuity of Care Protections How Will They Affect Existing State Laws April 13 2016 Repeal of Small Business Provision of the ACA Creates Natural Experiment in States March 22 2016 Innovation Waivers and the ACA As Federal Officials Flesh Out Key Requirements for Modifying the Health Law States Tread Slowly February 17 2016 2015 Federal and State Policymakers Work to Ensure Continuity of Health Care for Consumers December 18 2015 State Efforts to Reduce Consumers Cost Sharing for Prescription Drugs November 16 2015 States Revisit Insurer Benefit Requirements But Have Little Data on Consumers Experiences October 27 2015 State Decisions on Allowing Mid Sized Employers to Delay a Move to the Small Group Insurance Market June 9 2015 Some Health Insurers Canceling Noncompliant Policies But Consumers Are More Informed of Coverage Options February 2 2015 2014 Marketplace Coverage Renewals Variation in State Approaches May Affect Consumers Finances December 15 2014 The Extended Fix for Canceled Health Insurance Policies Latest State Action November 21 2014 e Alerts and Newsletter Sign up Mission Statement Board of Directors

    Original URL path: http://authoring.commonwealthfund.org/about-us/experts/williams-ashley (2016-04-30)
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  • Kevin Lucia - The Commonwealth Fund
    Look for Financing Stability in Shifting Landscape May 14 2015 Implementing the Affordable Care Act State Regulation of Marketplace Plan Provider Networks May 5 2015 The Affordable Care Act CO OP Program Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets March 12 2015 After a Slow Start Federal Small Business Health Insurance Marketplace Offers New and Improved Functions February 19 2015 Some Health Insurers Canceling Noncompliant Policies But Consumers Are More Informed of Coverage Options February 2 2015 Insurance Premium Surcharges for Smokers May Jeopardize Access to Coverage January 13 2015 2014 Implementing the Affordable Care Act State Approaches to Premium Rate Reforms in the Individual Health Insurance Market December 29 2014 Marketplace Coverage Renewals Variation in State Approaches May Affect Consumers Finances December 15 2014 State Based Marketplaces Offer More Health Plan Choices for 2015 Coverage December 1 2014 The Extended Fix for Canceled Health Insurance Policies Latest State Action November 21 2014 State Marketplace Approaches to Financing and Sustainability November 6 2014 Implementing the Affordable Care Act Revisiting the ACA s Essential Health Benefits Requirements October 31 2014 Major Policy Changes Take a Backseat to IT During a Transitional Year for Health Insurance Marketplaces October 15 2014 After Halbig Considerations for States Revisiting the Option to Establish a State Based Marketplace August 14 2014 Implementing the Affordable Care Act State Action to Reform the Individual Health Insurance Market July 7 2014 State Restrictions on Health Reform Assisters May Violate Federal Law June 25 2014 Implementing the Affordable Care Act State Action to Establish SHOP Marketplaces March 14 2014 Federal Court Ruling Casts Doubt on State Power to Restrict Health Reform Navigators February 18 2014 Implementing the Affordable Care Act The State of the States January 31 2014 The Affordable Care Act s Disclosure Rules Can

    Original URL path: http://authoring.commonwealthfund.org/about-us/experts/lucia-kevin (2016-04-30)
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  • Federal and State Policymakers Work to Ensure Continuity of Health Care for Consumers - The Commonwealth Fund
    treatment for up to 90 days or whenever the patient s treatment is complete whichever is sooner The proposal defines an active course of treatment as including for example care for an acute or life threatening condition or the second or third trimester of pregnancy The proposal also requires insurers to provide advance notice to patients when a provider is being terminated from the network Unlike the NAIC model law and many state laws however the federal rule does not limit the continuity of care protection to the patients of those providers that agree to accept the plan s in network payment rates In other words under many state laws for enrollees to take advantage of this protection their doctor or hospital must agree to continue to accept the plan s reimbursement rates and meet other contractual requirements such as a requirement to report quality data Longstanding State Laws Vary Our preliminary review of state laws finds that 45 states have enacted a requirement that insurers provide continuity of care for enrollees Of those 19 states have more expansive protections than the federal proposal in that the protection also applies when a consumer switches to a new insurance carrier with a different provider network State laws also place some boundaries around the continuity of care protection Thirty states limit access to continuity of care to patients of those providers that agree to accept the terms and conditions required by the plan Consumers have difficulty taking advantage of a protection if they don t know about it so like the federal rule and NAIC model act 30 of the 45 states with continuity of care protections require insurers to notify members when a provider will be terminated from the network usually within 30 days Such notices give consumers and their caregivers and providers time to research new provider options and help prevent potential gaps in care A Minimum Standard for Consumer Protections Comments are due on the proposed federal rule by December 21 2015 The diversity among the state rules affecting who can take advantage of continuity of care protections and under what circumstances suggests that setting a federal minimum standard of protection will be important In determining the final federal policy on continuity of care regulators should examine the experience of states with longstanding requirements including those that have more robust protections than outlined in the federal proposal In particular the federal proposal could go further by extending the protection to consumers who change plans which is currently available in 19 states Some insurers may have concerns that these type of requirements force them to enter into relationships with providers that charge too much or do not meet their quality standards At the state level however this protection is often limited to the patients of providers who agree to accept the plan s rates and contract terms Some assurance of continuity of care could be particularly important for consumers enrolled in plans through the health insurance marketplaces For these enrollees

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2015/dec/federal-state-policymakers-ensure-care-continuity (2016-04-30)
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  • Experts - The Commonwealth Fund
    Resources Grantee Resources Experts e Alerts and Newsletter Sign up Mission Statement Board of Directors Staff Contact Information Annual Reports Financial Reports Governance and Policies Privacy and Editorial Policies Foundation History Foundation Management and Performance Newsroom Events Job Opportunities Mission The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access improved quality and greater efficiency particularly for society s most vulnerable

    Original URL path: http://authoring.commonwealthfund.org/about-us/experts (2016-04-30)
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  • Repeal of Small-Business Provision of the ACA Creates Natural Experiment in States - The Commonwealth Fund
    gender and health status rating discrimination and the requirement to cover a minimum package of essential health benefits to larger employers Supporters of the ACA s small business or SHOP marketplaces also hoped that the influx of larger businesses could boost overall enrollment and help ensure the program s sustainability However as 2016 approached some stakeholders began to lobby for repeal of the expanded definition citing concerns about market disruption One study commissioned by the Blue Cross Blue Shield Association estimated that premiums for midsize employers with between 51 and 99 employees could rise by as much as 18 percent an increase that would largely be borne by employers with younger and healthier workers who benefit from the preferential rates permitted in the large group market Such increases could in turn give employers with relatively young and healthy workers a greater incentive to self fund their plans Self funding taking on the full risk of paying employees health claims could help these businesses lower their costs but their plans also would be exempted from most federal and state insurance rules that would otherwise apply to health insurance sold in the small group market If that happened in significant numbers employers remaining in the regulated small group market would be in an older sicker risk pool This could lead to even greater premium increases over the long term State Decisions on Small Group Market Expansion States are often referred to as the laboratories of democracy In this case because the PACE Act has given them flexibility to set the size of their small group markets their decisions can help test whether concerns about price increases and self funding will come to fruition To date only four states California Colorado New York and Vermont have expanded their small group market to include groups of 100 or fewer employees All other states have chosen to return to the small group market definition of 50 or fewer The four states that expanded their small group markets did so in part because the provision was incorporated into their state law These states were among those that in the wake of the ACA enacted legislation integrating the suite of new market reforms into their state insurance code As a result rolling back the ACA s small group market expansion requires legislative action For example Virginia was among the states that had a state law expanding the market to 100 at the start of 2016 but the legislature enacted emergency legislation in January to bring the market size back down to groups of 50 or fewer Looking Forward At present the impact of states decisions to expand or not to expand their small group markets is uncertain In the four states expanding their markets dire predictions of large rate increases do not yet appear to have come to pass with average premium rates generally rising at levels consistent with pre ACA trends For example in Colorado average small group market premiums increased only 3 17 percent over

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2016/mar/repeal-of-small-business-provision-of-the-aca (2016-04-30)
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  • Why Are Many CO-OPs Failing? How New Nonprofit Health Plans Have Responded to Market Competition - The Commonwealth Fund
    among the six CO OPs we studied Maine s CO OP was the only one that did not rent all or part of a provider network from another insurance carrier This kind of outsourcing limits CO OPs ability to control costs and manage service quality Renegotiating vendor contracts and building their own networks are top priorities for CO OP leaders Marketing The ACA prohibits CO OPs from using federal start up loans for marketing Most CO OP executives reported that the statutory restriction was a hindrance but not an insurmountable barrier CO OPs were creative with their marketing campaigns raising funds from partners and taking advantage of community events to educate the public about the new marketplaces and their products Benefit design A critical early decision for the CO OPs was whether to offer the richest platinum level of coverage on the marketplaces Of the six CO OPs studied half offered a platinum plan in their first year But because their lower out of pocket costs make platinum plans attractive to consumers with significant health needs these CO OPs concluded that they attracted a sicker mix of enrollees than other plans Of the three CO OPs we studied that offered platinum plans in 2014 all subsequently reversed that decision Pricing strategies Setting the initial and subsequent prices of their products may have been the most important decisions CO OPs faced However unlike their competitors CO OPs lacked historical claims and market data to help them estimate their costs The outcome of the CO OPs pricing strategy often depended on the pricing behavior of their largest competitor usually the Blue Cross Blue Shield BCBS plan CO OPs that priced their plans generally lower than the BCBS carrier gained significant market share those with plans generally priced higher than the BCBS carrier had significantly less enrollment than projected High vs low enrollment Over half of the CO OPs fell short of their enrollment targets in 2014 making it difficult for them to cover fixed costs and ultimately to generate the premium revenue to pay back their federal loan obligations However CO OPs with higher than expected enrollment faced grave challenges too as they struggled to build capacity under time pressure and manage cash flow The ACA s premium stabilization programs The ACA includes three programs designed to help keep premiums stable These programs are particularly critical to the viability of new carriers with limited capital such as the CO OPs Yet the delays and lower than expected payments under these programs have worked against small insurers For example companies had to wait 21 months before receiving a payment Adjusting to market conditions CO OPs recalibrated pricing to reflect market positioning and enrollees health needs Those with low enrollment in 2014 cut prices to capture market share in 2015 those with high enrollment and higher than expected costs increased premiums By contrast Maine s CO OP kept premiums relatively stable reflecting their belief that they priced their plans appropriately in year one Policy

    Original URL path: http://authoring.commonwealthfund.org/publications/fund-reports/2015/dec/why-are-co-ops-failing (2016-04-30)
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