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  • Reflecting on Health Reform: Holiday Reading and the Affordable Care Act - The Commonwealth Fund
    common and totally predictable over Normandy during the early morning hours Most troops missed their drop zones They and their equipment were scattered over the Normandy peninsula The huge Allied naval armada bombarded the Germans for only 30 minutes before the landing though experience in the Pacific had demonstrated that many hours or even days of shelling were required to reduce entrenched defenses prior to an amphibious assault At Omaha Beach where Americans took horrific casualties landing craft were dispatched 11 miles offshore instead of the planned seven This exposed defenseless infantry in tossing rolling boats to enemy fire far longer than expected At Omaha Beach 27 of 34 tanks sank as they were unloaded short of the beach despite inflated skirts intended to keep them afloat Their crews died as did many infantry who desperately needed their protection on the beach from enemy fire Many of the amphibious DUKW boats the Duck boats now commonly used for tours in Boston and other American cities carrying artillery and troops capsized after launch because they were overloaded and in any case totally unseaworthy Both the artillery and the infantry were lost Individual and small group improvisation and heroism averted disaster for the Allies on the morning of June 6 1944 and in the weeks that followed On that first day the Allies established a small beachhead but fell miles short of their D Day objectives Only in late July did they finally overcome German resistance to break out of Normandy and head into greater France However during bombing that preceded the breakout thrust Allied aircraft inflicted hundreds of casualties on friendly forces when they mistakenly dropped payloads short of enemy lines History doesn t repeat itself it only rhymes There are big differences in the circumstances and the tasks that faced

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/jan/history-lessons (2016-04-30)
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  • Health Care Spending—A Giant Slain or Sleeping? - The Commonwealth Fund
    s David Cutler weighed in on the debate History of Health Care Spending Quick view Growth in national health care spending escalated rapidly during the 1960s following enactment of Medicare and Medicaid and remained high throughout the 70s and 80s Presidents Nixon Carter and Reagan tried different strategies to curb costs but none had any real impact In the 90s employers and insurers turned to managed care Although this approach met with some initial success rising costs returned in part because of the managed care backlash and the mergers taking place in the health care industry Causes and Consequences of Health Care Cost Increases During the past 50 years the major factor in cost growth has been the development and diffusion of new medical technologies from cardiac procedures to prescription drugs to advances in imaging Estimates suggest about half the annual increase in U S health care spending has resulted from the introduction of new technologies Rising prices for health care services have been an important factor as well given that the U S does not set or negotiate prices with providers or pharmaceutical companies as many other countries do The aging of the population and the obesity epidemic have had modest effects while waste throughout our health system in the form of redundant tests unnecessary procedures and inefficiencies in insurance administration has had a larger impact Recently however new expensive blockbuster drugs are being developed at a decidedly slower pace This trend along with the spread of tiered formularies in prescription drug plans has helped lower annual pharmaceutical spending from 10 1 percent in 1993 2003 to 2 3 percent in 2003 2012 The diffusion and development of medical technologies appears to be slowing too On the demand side many people face very high cost sharing which discourages use of health services On the supply side providers are facing restrictions on utilization and incentives to prescribe less care Both public and private purchasers have introduced reforms such as penalties for preventable readmissions which encourage more efficient care And payment reforms such as accountable care and bundled payments have shown early evidence of savings Strategies to Curb Health Care Costs If cost increases return to their historical pattern the United States is projected to spend 5 trillion on health services in 2022 placing a tremendous burden on the government and forcing higher taxes or cutbacks in spending on other high priority areas like education In the private sector these increases would cut into wage gains for all employees Rationing services by reducing benefits and increasing cost sharing is one option for containing costs But the authors point to another Almost without exception recent studies of health care costs have recommended discarding the current fee for service payment system in favor of having providers share risk for the cost and quality of services they write Such arrangements could include capitation or partial capitation global budgeting or accountable care organizations All these approaches financially reward providers for avoiding unnecessary care and delivering

    Original URL path: http://authoring.commonwealthfund.org/publications/in-the-literature/2013/dec/health-care-spending-giant-slain-or-sleeping (2016-04-30)
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  • Reflecting on Health Reform: ACA Dates that Matter - The Commonwealth Fund
    now December 24 for the federal website but a few states have later deadlines and paid your premium in time at the administration s urging many insurers are allowing a grace period through January 10 for the federally run marketplaces and some states have also moved this date you could enjoy the subsidized coverage available under the ACA But if you miss these so called deadlines you still have until March 31 to sign up for coverage to avoid a penalty For the millions of Americans who are uninsured or who could have enrolled in improved insurance through a state or federal exchange missing these deadlines merely means you failed to make yourself better off as soon as you possibly could BUT YOU WILL BE NO WORSE OFF THAN YOU WERE BEFORE There are also some dates that are consequential but have received less attention or have receded from the headlines NOVEMBER 2014 This is when the Obama administration promises online enrollment for the Small Business Health Options Program SHOP in the 34 states where the federal government is operating the small business marketplaces for companies with fewer than 50 workers For now small businesses in these states can apply via paper application or an insurance broker or navigator Online access is available already in most of the 17 states and the District of Columbia that are operating their own SHOP exchanges JANUARY 1 2015 The date by which employers with 50 or more employees will become liable for a tax penalty if they are not offering health insurance that meets minimum standards and an employee becomes eligible for subsidized private coverage through the marketplaces The changing dates associated with the ACA are troubling to some since they suggest confusion and even mismanagement by the Obama administration It would obviously be reassuring if every declared date were honored and announced rules and intentions never changed On the other hand I m doing some long delayed repairs in my home The contractor said the work would be done by Thanksgiving but there were unanticipated problems We re hoping now for Christmas I ll be happy if it s done by mid January but the key thing is whether a year from now I m satisfied with the result Health insurance is obviously way more important to millions of Americans than any home repair project could ever be But few things in life go exactly as planned and it would be totally astonishing if the implementation of massive reforms to a sector accounting for 20 percent of our economy rolled out without a bump or a detour We should keep that in mind as we think about those changing ACA deadlines Tags health insurance Affordable Care Act Medicaid health insurance marketplace Reflecting on Health Reform Add to My Library Print Please enable JavaScript to view the comments powered by Disqus blog comments powered by Disqus e Alerts and Newsletter Sign up Publication Details Publication Date December 23 2013 Authors David Blumenthal M

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/dec/aca-dates-that-matter (2016-04-30)
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  • Reflecting on Health Reform: A Balanced View of the Affordable Care Act - The Commonwealth Fund
    a toxic political environment and other factors Poor messaging by the President In retrospect President Obama should have prepared the public better for the inevitability that some Americans would be left worse off by the law because of higher insurance prices or the need to switch health plans Failure to prepare fully in advance for adverse impacts of the implementation of the ACA There may have been more such preparation than meets the eye but if for example the administration had anticipated that private health plans might be cancelled the policy response could have been waiting on the shelf Instead there was a last minute scramble under the media spotlight KEY ACCOMPLISHMENTS Provision of health insurance to 7 8 million young Americans covered under a parent s health plan who likely would not have been able to do so prior to the law s passage including 3 million who were previously uninsured more than 200 000 Americans covered through state marketplaces as of November 25 2013 and 26 794 covered through the federal marketplace as of November 2 2013 Refunds of 2 1 billion to consumers in 2012 because their insurers administrative costs and profits exceeded ACA limits Guaranteed free coverage of essential preventive care for Americans covered by Medicare or private insurance Elimination of the so called doughnut hole or coverage gap for prescription drugs under Part D of Medicare Implementation of significant payment and organizational reforms including a The deployment of 250 innovative accountable care organizations ACOs now serving an estimated 4 million people An ACO is a partnership between an insurer and a group of providers formed to share in savings generated by meeting quality and cost targets b An apparent reduction in preventable readmissions to hospitals among Medicare patients as a result of new incentives for hospitals c Increased attention by hospitals to preventing health care acquired infections d A vast nationwide hospital safety improvement program Thousands of experiments with new ways to deliver care to the nation s most vulnerable and high cost consumers of health care launched under the new Center for Medicare and Medicaid Innovation A possible role in slowing the health care cost growth rate to its lowest level in 50 years a trend that if it persists could greatly reduce the federal deficit and free up funds for other vital public purposes The accompanying exhibits provide a more complete listing of these and other established or possible effects of the ACA The breadth of the ACA s impact so far clearly shows the discussion of the successes and failures of the ACA needs to extend well beyond the narrow focus on website functioning enrollment in the federal website and the cancellation of some health plans Tags access to care health insurance Affordable Care Act health spending payment reform health insurance marketplace Reflecting on Health Reform Add to My Library Print Please enable JavaScript to view the comments powered by Disqus blog comments powered by Disqus e Alerts and Newsletter Sign up

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/dec/resisting-the-rush-to-judge-the-affordable-care-act (2016-04-30)
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  • Reflecting on Health Reform—The Presidential Health Care Curse: Why Do They Bother? - The Commonwealth Fund
    complexity of policies or adequacy of coverage the U S consumer gets a bad deal The system is not only bad but getting worse Every year more people lose insurance as they or their usually small employers get priced out of the health insurance market by rising premiums The Commonwealth Fund biennial health insurance survey shows that 55 million Americans are now uninsured and equally telling another 30 million are underinsured meaning that they spend more than 10 percent of their income on medical expenses despite having health care coverage 5 percent if their income is under 200 percent of poverty The U S has more uninsured and underinsured citizens than the entire population of Germany where by the way private insurance organizations compete no one is uninsured or underinsured and the economy is thriving The individual and small group insurance markets in the United States now ground zero in the ACA rollout war are particularly dysfunctional and were imploding prior to the enactment of the law In these markets adults report paying high premiums and facing high deductibles and copayments for plans that are often insurance in name only they lack prescription drug and dental coverage exclude services covered for subscribers in larger groups and limit annual payouts Not surprisingly consumers in the individual market spend a larger share of their income on out of pocket costs and experience medical debt and bill problems at higher rates than those with employer based insurance And people with these problematic policies are in some ways the lucky ones Prior to reform insurers had the unfettered ability to set premiums based on an individual s age and health history creating financial barriers that were difficult or impossible to overcome for many older adults or those with chronic health problems A 2011 Fund survey found nearly half of those who tried to purchase individual coverage never ended up buying a policy with 80 percent of those who tried to buy it saying the premium was too high the deductibles and copayments were too high or the plan did not cover a preexisting condition Individual and small group insurance policies are products with no future unless those markets are reformed to make coverage affordable and to protect consumers against insurance that while seemingly cheap provides no meaningful protection against the cost of illness Private insurers recognize this fact which is why they have been such steadfast though quiet supporters of the ACA and the marketplaces it is trying to create Reforming the individual and small group markets is precisely the purpose of the ACA marketplaces and their regulations which set a floor under the quality of individual and small group policies It is these minimum standards and expanded consumer protections that many pre reform individual and small group market policies did not meet The new regulations have prompted insurers to notify many subscribers that such plans would not be available beginning next year Policies meeting new minimum requirements will cost some currently insured individuals

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/nov/the-presidential-health-care-curse (2016-04-30)
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  • Reflecting on Health Reform: A Tale of Two IT Procurements - The Commonwealth Fund
    signed contract The winner was usually picked from a group of companies with considerable experience working the federal procurement process If we weren t happy with the firm or with their later performance there was virtually nothing we could do about it Getting out of this shotgun marriage meant months of litigation during which the funds would be frozen and the work itself would grind to a halt After I left the federal government I became Chief Health Information and Innovation Officer at Partners Health System a large Harvard affiliated integrated health system in Boston There I was responsible for managing another procurement the choice of a new electronic health record EHR for the organization s many hospitals clinics and clinicians This was one of the largest capital projects in Partners history The experience was very different I led an expert team of clinicians IT professionals financial analysts clinical managers materials management professionals and external consultants who spent months comparing the EHRs and companies that were finalists in our selection process The vendors CEOs and senior leadership met with our CEO and senior leadership to get a sense of whether there would be mutual rapport and trust To see the EHRs in action we visited other customers who were using the products The vendors came to Partners and demonstrated their EHRs to hundreds of clinicians IT professionals and managers who then voted on which they preferred That s not all A Partners team visited their headquarters and interviewed their key staff Our technologists and programmers consulted with theirs to assess in detail their skill and vision for their product We evaluated the companies culture financial plans and likely stability over time After we selected a leading candidate we spent weeks going over the contract line by line with IT professionals lawyers and contracting experts The Partners procurement process may not be perfect but the federal process is clearly broken I have no personal knowledge of how it worked in the case of the federal website but I can t imagine that it was up to the task of managing the subtle technologically complex and unprecedented challenge of putting together a consumer friendly website that would seamlessly connect multiple legacy state and federal databases that were never designed to work together Why is the federal procurement process so dysfunctional Mostly because the public seems not to trust government officials The process is designed to protect against conflict of interest and fraud When faceless interchangeable contracting officers manage the process behind closed doors companies find it difficult to cozy up to federal officials for the purpose of influencing outcomes There is something to be said for these boundaries when it comes to routine procurements such as furniture transportation services maintenance and cleaning But when it comes to the incredibly complex technical work that is required in the IT space a process in which the people overseeing a project don t have a chance to interact with potential vendors in advance is a

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/nov/a-tale-of-two-procurements (2016-04-30)
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  • The Impact of Health Information Technology and e-Health on the Future Demand for Physician Services - The Commonwealth Fund
    HIT as well as electronic health and mobile health applications might affect future demand for physicians Key Findings If a range of health information technologies were to be fully implemented in 30 percent of community based physicians offices including interoperable EHRs clinical decision support provider order entry and patient web portals with secure messaging demand for physicians would be reduced by about 4 percent to 9 percent through gains in efficiency Delegating more care to nurse practitioners and physician assistants could if accompanied by HIT support reduce demand for physicians by 4 percent to 7 percent Similarly if generalist physicians provided more of the care now being provided by specialists demand for specialists would decline by 2 percent to 5 percent Use of HIT could also help address regional shortages of physicians by allowing 12 percent of care to be delivered remotely or asynchronously that is through visits conducted in separate locations and at different points in time These estimated impacts could more than double if comprehensive HIT systems were fully implemented by 70 percent of community based physicians Addressing the Problem T he current knowledge base provides substantial evidence supporting the premise that consumer and provider IT systems will significantly affect the way office based care is delivered in the future which in turn will have a strong impact on future demand for physicians the authors write As such future predictions of the adequacy of physician supply should take these changes into account In addition this research also highlights the need to train the next generation of clinicians to make HIT proficiency one of their essential skills In the future physician practices may look to employ computer scientists with clinical degrees and online consumer navigators as well as computer savvy doctors and nurses About the Study The authors reviewed

    Original URL path: http://authoring.commonwealthfund.org/publications/in-the-literature/2013/nov/the-impact-of-health-information-technology-on-physician-services (2016-04-30)
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  • Americans' Experiences in the Health Insurance Marketplaces: Results from the First Month - The Commonwealth Fund
    to My Library Print Overview Conducted October 9 27 2013 the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a nationally representative sample of adults who are potentially eligible for the health reform law s new insurance coverage options whether private plans or expanded Medicaid Among the survey s key findings 60 percent of potentially eligible adults are aware of the new marketplaces as a place where they might shop for coverage 17 percent reported visiting the marketplaces in October to shop for a health plan about one of five visitors were ages 19 to 29 and one of five visitors enrolled in a plan Reflecting the technical problems that have plagued the federal marketplace and some state marketplace websites 37 percent of those who did not enroll in coverage cited those technical difficulties as a reason A majority of survey respondents however appear determined to gain coverage over the next few months e Alerts and Newsletter Sign up Downloads Data Brief and Toplines Chartpack Chartpack Publication Details Publication Date November 4 2013 Authors Sara R Collins Petra W Rasmussen Michelle M Doty Tracy Garber David Blumenthal M D Summary Writer Christopher Hollander Citation S R Collins P W Rasmussen M M Doty T Garber and D Blumenthal Americans Experiences in the Health Insurance Marketplaces Results from the First Month The Commonwealth Fund November 2013 Related Topics Health Care Coverage State Health Policy and Medicaid Related Publications November 4 2013 Commonwealth Fund Affordable Care Act Tracking Survey July 9 2014 Commonwealth Fund Affordable Care Act Tracking Survey April June 2014 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 including low income people the uninsured minority Americans young

    Original URL path: http://authoring.commonwealthfund.org/publications/data-briefs/2013/nov/americans-experiences-marketplaces (2016-04-30)
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