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  • Redefining and Reaffirming Managed Care for the 21st Century - The Commonwealth Fund
    the care experience From Management to Engagement Blumenthal and Squires call for a retooling of managed care to adapt to the shifting landscape in health care They believe that process should begin with a review of the main domains of managed care Benefits management which applies to managed care organizations that serve as both insurer and provider Such organizations should use clinical benefits management to exclude or discourage services that are proven unsafe or ineffective Financial incentives also can nudge patients toward the most effective services Clinical management which involves using strategies that result in better coordinated high value services These include managing conditions between office visits deploying patient registries and employing care teams addressing nonmedical factors related to health and applying shared decision making These techniques are likely to be easier and more successful when supported by an infrastructure that allows information sharing and collaboration Patient engagement critical for all patients but particularly those with health problems Health information technology can support engagement through online portals that allow patients to connect with providers remotely Another strategy is improving transparency by giving patients reliable information on quality and costs Conclusion Despite the tension between the concepts of care management and patient engagement managed care is still appealing to consumers and to clinicians who need tools to help manage patients chronic illnesses Read the commentary e Alerts and Newsletter Sign up Publication Details Publication Date April 16 2015 Authors David Blumenthal M D David Squires Contact David Blumenthal M D President The Commonwealth Fund E mail db cmwf org Summary Writer Deborah Lorber Citation D Blumenthal and D Squires Redefining and Reaffirming Managed Care for the 21st Century American Journal of Managed Care published online April 15 2015 View the commentary Related Publications May 3 2016 Envisioning a Digital Health Advisor

    Original URL path: http://authoring.commonwealthfund.org/publications/in-brief/2015/apr/redefining-and-reaffirming-managed-care (2016-04-30)
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  • Keeping Personal Health Information Safe: The Importance of Good Data Hygiene - The Commonwealth Fund
    of Research found 949 data breaches of health information between 2010 and 2013 affecting 29 1 million patient records In an editorial The Commonwealth Fund s David Blumenthal and Deven McGraw of Manatt Phelps Phillips reflected on the study s implications Study Findings in Context A nationwide electronic health information system has the potential to improve care and provide a rich source of data for researchers But such a system will be difficult to implement if patients fear their data are being compromised and either resist sharing or withhold important sensitive information Health care organizations clinicians and insurers can help While some data breaches are the result of malicious hacking more than 80 percent happen because organizations fail to follow good data hygiene like encrypting health information Policymakers also can help by revisiting the Health Insurance Portability and Accountability Act HIPAA which was enacted before the Internet and leaves substantial gaps in protection Conclusions Loss of trust in an electronic health information system can undermine efforts to improve health and health care in the United States Threats to the safety of health care data should receive more focused attention from public and private stakeholders Read the editorial e Alerts and Newsletter Sign up Publication Details Publication Date April 14 2015 Authors David Blumenthal M D and Deven McGraw Contact David Blumenthal M D President The Commonwealth Fund E mail db cmwf org Summary Writer Deborah Lorber Citation D Blumenthal and D McGraw Keeping Personal Health Information Safe The Importance of Good Data Hygiene Journal of the American Medical Association April 14 2015 313 14 1424 View full article Related Publications May 3 2016 Envisioning a Digital Health Advisor April 21 2016 Implementing New York s DSRIP Program Implications for Medicaid Payment and Delivery System Reform Related Topics Health Care Delivery

    Original URL path: http://authoring.commonwealthfund.org/publications/in-brief/2015/apr/keeping-personal-health-information-safe (2016-04-30)
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  • Lessons from the East: China's Rapidly Evolving Health Care System - The Commonwealth Fund
    to rural villages across the country After market reforms in 1984 the state stopped paying community health workers A now largely uninsured population was forced to bear the full economic cost of illness Medical professionals functioned like private entrepreneurs The resulting public backlash spurred another major shift China s health system today provides modest but comprehensive health insurance to 95 percent of residents who access care through an extensive network of primary care clinics Lessons from China The Commonwealth Fund s David Blumenthal and coauthor William Hsiao of the Harvard School of Public Health identify important insights from China s radical health system experimentation In low income countries and perhaps in high income ones as well community health workers like China s barefoot doctors can significantly improve the health status of local populations Relying on pure market forces to fund and distribute health care can put a heavy financial burden on patients and can lead to social instability One legacy of China s market experiment is a widespread perception that physicians put their economic welfare ahead of patients interests This has complicated China s efforts to create a health care workforce that leaders and the public trust Physician professionalism may be an underappreciated element of effective modern health care systems the authors note Conclusions China has experimented boldly with diverse approaches to national health care While its leaders have made missteps their most recent attempts are now yielding gains notably in establishing a solid primary care foundation The Chinese health system will be interesting to watch as it continues to evolve and improve Read the article e Alerts and Newsletter Sign up Publication Details Publication Date April 2 2015 Authors David Blumenthal M D William C Hsiao Contact David Blumenthal M D President The Commonwealth Fund E mail db cmwf

    Original URL path: http://authoring.commonwealthfund.org/publications/in-brief/2015/apr/lessons-from-chinas-changing-health-system (2016-04-30)
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  • Testimony: The Affordable Care Act at Five Years - The Commonwealth Fund
    Care Act is helping to reduce the number of Americans who are uninsured and improving access to health care Currently more than 25 million people are estimated to have health insurance under the provisions of the ACA About 11 7 million have selected a plan through the insurance marketplaces 8 8 million through the federal website healthcare gov and 2 8 million through state based marketplaces An additional 10 8 million have enrolled in Medicaid or the Children s Health Insurance Program or CHIP Finally nearly 3 million more young adults are covered under their parent s plan compared to 2010 As a result the number of uninsured adults has fallen This week the U S Department of Health and Human Services reported that 16 4 million previously uninsured people had gained coverage since the law passed in 2010 Similar gains in coverage have been documented in a number of government and private sector surveys Furthermore groups that historically have been most likely to lack insurance young men and women and adults with low or moderate incomes have experienced among the greatest gains in coverage These gains have occurred across racial and ethnic groups Read the full testimony e Alerts and Newsletter Sign up Downloads Testimony Exhibits pdf Exhibits ppt Publication Details Publication Date March 19 2015 Authors David Blumenthal M D Contact David Blumenthal M D President The Commonwealth Fund E mail db cmwf org Citation D Blumenthal The Affordable Care Act at Five Years Invited testimony Senate Finance Committee United States Senate March 19 2015 Related Publications May 3 2016 Envisioning a Digital Health Advisor April 28 2016 High Maps Test 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

    Original URL path: http://authoring.commonwealthfund.org/publications/testimonies/2015/mar/aca-at-five-years (2016-04-30)
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  • Bending the Curve on Patient Safety? - The Commonwealth Fund
    these preliminary findings hold up the question becomes Why Why after years of frustration is the safety logjam now breaking As is often the case the answer seems to be that an improved understanding of safety problems along with public and private actions are coming together to make a difference To name a few possible contributors Public policies The Partnership for Patients 80 percent of the nation s hospitals are participating in a quality improvement collaborative created under the Affordable Care Act ACA The Partnership focuses on reducing hospital acquired conditions and readmissions Value based payments Again with a boost from the ACA hospitals Medicare payments are now tied to their performance including penalties for having high rates of hospital acquired conditions The direct effects of payment incentives on safety have likely been small but they have certainly drawn providers attention to safety issues Safety research Scientific studies often the result of publicly funded research have shown that certain initiatives such as the use of checklists and associated bundles of clinical interventions can make a huge difference in reducing complications of care Private actions Private payers and employers have moved behind results based payment systems Catalyst for Payment Reform has shown a dramatic recent increase in the proportion of private payments to hospitals and other providers that are linked to quality and safety performance Privately managed programs that accredit hospitals now require greater attention to patient safety Continuing advocacy by consumer groups health care opinion leaders medical journals and other voluntary groups has kept up pressure on health care providers to improve their safety records With so many overlapping contributors isolating the effects of each becomes very difficult not least because they may be mutually reinforcing This may seem like an academic problem but it could have big consequences in the current health care environment First the Center for Medicare and Medicaid Innovation CMMI which is behind a number of innovative safety enhancing efforts has the authority to experiment with new payment and delivery models To implement the reforms widely the center needs to prove that they save money and improve quality and or safety That will require isolating the various reforms individual effects Second like the CMMI itself a number of the public programs associated with recent improvements in patient safety were created under the ACA which the U S House of Representatives just voted to repeal for the 56th time While wholesale repeal of all the ACA s provisions doesn t seem likely the law s future remains uncertain That uncertainty could reduce the vigor with which providers around the country pursue the safety mandates in the ACA Here is where it would be very useful to have convincing data on the effects of each patient safety program so we could judge the consequences of repealing slowing or failing to scale existing initiatives Lacking that evidence however perhaps we can fall back on common sense The federal government acts aggressively with broad support to attack a wide range

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2015/feb/patient-safety (2016-04-30)
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  • Medicare at 50—Moving Forward - The Commonwealth Fund
    out of pocket costs compelling many beneficiaries to purchase supplemental Medigap coverage or if they qualify turn to Medicaid for help These costs which consume 14 percent of household income on average are a significant burden for poor beneficiaries and those with high health needs Incremental Reform As the authors note Medicare payment continues to be based predominantly on a fee for service model that rewards providers for the volume and complexity of service provided By modifying these built in incentives payment reform seeks to encourage the greater integration and coordination of services needed for effective care Payment and organizational reforms currently being pursued include Value based purchasing Since 2003 Medicare has been experimenting with ways to reward providers for improvements in quality and cost Despite results that have been mixed at best the intuitive appeal of this approach is reflected in the Affordable Care Act which requires Medicare to adopt value based purchasing for physicians hospitals skilled nursing facilities and home health Financial incentives alone however may not be sufficient to alter provider behavior Blended payment Already used by some private insurers and state Medicaid agencies blended payment combines four elements a fee for service payment a monthly per patient care management fee for patients served by an advanced primary care practice quality based bonuses and shared savings Early results show some promise and Medicare is testing the approach in primary care Bundled payment By setting a fixed price for a suite or bundle of services for treating a specified condition payers hope to improve the coordination and efficiency of care A Medicare initiative begun in 2013 is testing four bundled payment models but it is still too early to assess impacts on cost or quality Accountable care organizations ACOs The Medicare Shared Savings Program and the more demanding Pioneer ACO pilot reward groups of providers that assume accountability for the cost and quality of care they deliver and enable them to share in the savings achieved Early results are promising Global payment By providing advance payment to cover all or most of a patient s care needs a global payment system can help to support the preventive services care coordination and nonmedical services necessary for optimal health and cost outcomes Comprehensive Reform Premium support Advocates of a market based approach to health insurance have called for restructuring Medicare as a premium support program Under a plan passed in 2014 as part of the House budget resolution beneficiaries would receive a defined subsidy to purchase a standard benefit package from private plans or traditional Medicare both of which would compete in a new Medicare marketplace While federal spending is projected to be lower under this approach beneficiaries could end up spending substantially more out of pocket depending on the size of the subsidy Critics argue that the proponents of premium support place undue faith in the power of a private Medicare health insurance market to motivate health plans to meet beneficiaries needs for high quality efficient services Moreover many

    Original URL path: http://authoring.commonwealthfund.org/publications/in-the-literature/2015/jan/medicare-at-50-moving-forward (2016-04-30)
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  • Medicare at 50—Origins and Evolution - The Commonwealth Fund
    included Similar to private insurance carriers Medicare paid physicians based on prevailing local rates and reimbursed hospitals for reasonable costs Impact on Coverage and Care Despite its initial limitations Medicare has had a major impact on the lives of millions While 48 percent of the elderly lacked health coverage in 1962 today just 2 percent do And while the 15 year increase in life expectancy at age 65 achieved between 1965 and 1984 cannot be wholly attributed to Medicare without its coverage many elderly Americans would simply not have had access to the medical advances that also have contributed to rising longevity Beneficiaries rate their coverage highly Compared with people under 65 who are covered by employer insurance or an individual plan people with Medicare indicate they are less likely to have problems getting needed care and to have burdensome medical bills and negative insurance experiences Medicare s Evolution While many changes made to Medicare over the decades mirror those occurring throughout U S health care generally others have blazed trails for the rest of the health care system in the United States and even in the rest of the world the authors say Major changes have included Extending eligibility in 1972 to nonelderly individuals who qualify for Social Security disability payments after a two year wait or have end stage renal disease two groups with very high health costs who historically had extreme difficulty finding coverage Adding a prescription drug benefit Part D in 2003 as part of the Medicare Modernization Act Strongly advocated by President George W Bush the benefit is voluntary and available only from private plans Other beneficiaries have similar coverage from Medicaid retiree plans or other sources though about 12 percent continue to lack any prescription drug coverage Introducing a range of payment reforms to control Medicare spending which has grown from 0 7 percent of the gross domestic product GDP in 1970 to 3 5 percent today These include the Prospective Payment System which pays hospitals on the basis of diagnosis related groups or DRGs an innovation since taken up by many private payers in the U S as well as countries around the world Establishing a private managed care plan option in 1982 The option was later expanded and payment rates increased to the point where plans under what is now called Medicare Advantage are paid more than it would cost to cover the same beneficiaries under traditional Medicare Although the Affordable Care Act ACA has reduced these payments the future role of private plans in Medicare continues to be a source of partisan controversy Requiring that hospitals nursing homes and other providers including as of 2007 physicians report information about their care processes and outcomes These data are made publicly available online Developing models to promote high quality evidence based care and reducing incentives to provide more services regardless of their value to patients Challenges The ACA contains key reforms intended to address some of Medicare s ongoing challenges Among these reforms

    Original URL path: http://authoring.commonwealthfund.org/publications/in-the-literature/2015/jan/medicare-at-50-origins-and-evolution (2016-04-30)
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  • IPAB: Ditching the Dog That Didn't Bark - The Commonwealth Fund
    2020 since the ACA took other bites out of hospital fees But otherwise IPAB would have pretty free reign When the ACA passed it looked like IPAB would have plenty to do Medicare costs had exceeded IPAB s spending thresholds in 21 of the previous 25 years The Congressional Budget Office projected that the panel would save 15 5 billion over 10 years Then three things happened First Senate Republicans made it clear they would filibuster any IPAB appointees who need Senate confirmation Second even after the Senate changed its rules to require only 51 votes to confirm presidential appointees the President never nominated any IPAB members Third it turned out IPAB wasn t needed which is likely why the President decided not to expend any political capital trying to create it Medicare spending growth has quite unexpectedly slowed dramatically over the past several years staying under IPAB s thresholds As the exhibit below shows per beneficiary Medicare spending is not currently projected to exceed the IPAB thresholds until 2022 Nevertheless IPAB is philosophically suspect among critics of the federal government To detractors its unusually broad authority seems like government overreach The fact that Medicare costs are currently rising too slowly to trigger IPAB intervention is no guarantee costs won t rise faster in the future From this standpoint critics likely feel it s better to kill the monster before it ever sees the light of day Another reason for ACA critics to prioritize repealing IPAB is that it could be a cheap win ACA supporters are unlikely to fall on their swords defending the board since its value is still only theoretical In the complex health care chess game about to unfold in the next Congress expect IPAB to be in play Whether it will remain on the board

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2015/jan/ipab-ditching-the-dog (2016-04-30)
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