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  • The Effects of Health Insurance on Health: What We Can Expect from the Affordable Care Act - The Commonwealth Fund
    more recent study by Benjamin Sommers M D and colleagues compared the effects of Medicaid expansions in three states with neighboring states that did not expand their programs It found that the expansions were associated with significant reductions in mortality and increases in self reported health status How then do we explain the results of the Oregon Medicaid study First the study examined the effects of coverage over a relatively short period of time 17 months on average In contrast Sommers and colleagues examined the effects of state Medicaid expansions over a 10 year period Similarly several studies have used the longitudinal Health and Retirement Survey to examine the effects of gaining Medicare at age 65 among people who were insured continuously prior to that time compared with those who spent time uninsured before enrolling Most of these studies found gains in health over multiple years among people who had been previously uninsured compared with those who had always had coverage Second the benefits of health insurance may take the form of changes in trends in health status rather than absolute improvements even over longer periods For example the study by J Michael McWilliams M D and colleagues at Harvard Medical School and Brigham and Women s Hospital found that prior to age 65 health status among older adults who were intermittently uninsured declined at a faster rate than among the continuously insured and was significantly worse at age 65 However this trend changed after age 65 previously uninsured adults who gained Medicare reported stabilization in their health status Third the sample of adults examined in the Oregon study may have been too healthy and the number of outcome measures too small to discern immediate health effects from gaining coverage an issue noted by the authors Only 16 percent of study participants in the control group had high blood pressure 14 percent had high cholesterol and 5 percent had elevated blood sugar levels In contrast the McWilliams study examined a larger set of measures and focused on people with diagnoses of hypertension heart disease stroke or diabetes More than three of five 61 adults in the study cohort had at least one of these diagnoses before age 65 The gains in health among adults in the study were concentrated among those with these conditions The results from the Oregon study do not contradict previous research but do show that our expectations concerning the immediate effects of gaining health coverage should be tempered especially for relatively healthy populations The Congressional Budget Office projects that 14 million people will become newly insured next year under the Affordable Care Act and 25 million will gain coverage by 2016 These historic gains in health insurance coverage are likely to have variable effects on the health of newly insured people over the next several years with the sickest and the oldest realizing more immediate changes in health status But even those changes may not show up as dramatic improvements in health but rather as the

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/jun/the-effects-of-health-insurance-on-health (2016-04-30)
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  • Health Information Technology: The Gateway to Progress - The Commonwealth Fund
    about the care of individual patients important as that is Aggregated in various ways health care data can be used to compare the performance of clinicians hospitals and health systems and thereby to hold them accountable for the cost and quality of care they provide With proper privacy and security protections that information can also support groundbreaking research to detect the value and risks of medications the interactions between patients behavior and their health and the comparative effectiveness of health care interventions Locked away in millions of tons of paper on the shelves of doctors offices and in the basements of hospitals is a vital untapped resource for improving the health and welfare of Americans And there is only one way to mobilize that resource to digitize it And there is only one practical way to digitize it by using EHRs whatever their current deficiencies That is what the HITECH program is about Getting these vast troves of unused information into digital form to enable the essential transformation of health care that cannot otherwise occur The meaningful use program as the new federal effort is known offers extra payments to doctors and hospitals that participate in Medicare and Medicaid if they begin using electronic health records to improve the care they deliver Those who don t attain meaningful use by 2015 will face financial penalties The cost of the program is estimated at up to 27 billion over 10 years less than one tenth of 1 percent of what the nation will spend on health care over that period The program has already had an impact Between 2008 and 2012 the proportion of U S physicians with basic EHRs more than doubled from 17 percent to 39 6 percent U S Department of Health and Human Services Secretary Kathleen Sebelius announced that as of May 2013 more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using EHRs Perhaps the most important change has been psychological The nation s doctors increasingly accept that moving into the digital age is inevitable and essential But change is hard and rapid change no matter how essential is almost always imperfect As DesRoches and her colleagues demonstrate physicians are just beginning to realize the potential of EHRs In the first phases of adoption of most new technologies users typically simply transpose the new tool into old workflows which creates temporary inefficiencies until processes are reexamined and redesigned We saw this in the early 20th century when it took close to 20 years for manufacturers to understand how to realize the benefits of electricity Initially factories simply replaced the waterwheels and steam engines with new large electric motors but kept in place inefficient belt and pulley systems to transmit power from the central power source Electricity s potential was realized only after manufacturers totally reengineered factory processes and substituted many small motors throughout a factory so they could generate power where and when it

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/jun/health-information-technology (2016-04-30)
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  • Implementing the Affordable Care Act's Health Coverage Provisions - The Commonwealth Fund
    uninsured and underinsured adults with incomes above the subsidy thresholds who must buy coverage on their own will be guaranteed an offer of comprehensive coverage regardless of any preexisting condition and a premium that will predominantly reflect the value of their health plan rather than their individual health status Implementation status Implementation of the Affordable Care Act has been in full swing since the law passed in 2010 The federal government has issued nearly all regulations and guidance necessary to meet the October 1 deadline for open enrollment Sixteen states and the District of Columbia have received conditional approval to operate their own insurance marketplaces and seven states have received conditional approval to run their marketplaces in partnership with the federal government The federal government will fully operate marketplaces in 27 states 1 Both the Department of Health and Human Services and states are soliciting applications for health plans that will be sold through the marketplaces with certification in the federal exchanges expected in early September States and the federal government are working hard to ensure the marketplaces will be open for enrollment on October 1 And outreach activities to educate Americans about the new insurance options will likely gain momentum through the summer in all 50 states Kaiser Family Foundation s latest poll underscores the importance of these efforts 42 percent of adults are unaware of the Affordable Care Act and its provisions Indeed the Congressional Budget Office is predicting gradual gains in enrollment as awareness grows its latest estimates show that 7 million people will enroll in the health plans through the exchanges in 2014 increasing to 13 million in 2015 22 million in 2016 and 24 million by 2017 Exhibit 1 The biggest near term risk to realizing the law s coverage potential is last summer s Supreme Court decision that allowed states to opt in or out of the law s Medicaid expansion In states that opt out of the expansion people earning above the poverty level about 23 000 for a family of four will be eligible for subsidized private coverage though the new marketplaces However when the law was written it was assumed that most poor families would be eligible for the Medicaid expansion no similar provision was made for the poorest families to gain subsidized private coverage So for states that do not participate in the expansion there currently will be no new subsidized insurance option for these families So far 22 states and the District of Columbia have announced that they will expand their Medicaid programs and at least three states are exploring alternative approaches to expanding their programs Exhibit 2 About 25 states are either undecided or have decided not to participate in the expansion In many of these states residents are already more likely to be uninsured Remaining Coverage Gaps Even if all states participate in the Medicaid program many people may continue to lack health insurance In particular the law does not allow coverage of undocumented immigrants through Medicaid

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/may/implementing-the-coverage-provisions (2016-04-30)
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  • Putting Aside Preconceptions—Time for Dialogue Among Primary Care Clinicians - The Commonwealth Fund
    compared with 80 159 and 157 respectively in the United Kingdom France and Germany What the Study Found An editorial by The Commonwealth Fund s David Blumenthal and Melinda Abrams explores one approach to addressing the primary care workforce shortage using nurse practitioners to provide a wide range of primary care services According to research cited by the authors nurse practitioners also known as advanced practice nurses or APNs provide care comparable to that provided by primary care physicians as measured by health outcomes use of resources and cost In some respects such as communication with patients seeking urgent care they perform better than physicians However the authors also note that PCPs and APNs receive different training and have different skill sets Moreover patients vary in their preferences regarding who provides their primary care Blumenthal and Abrams recommend a flexible approach to crafting primary care workforce policy one that is responsive to the changing roles of health care professionals and to changes in the organization and financing of health care They also suggest that policymakers rely upon objective data on the competencies of professionals rather than rigid state laws to regulate providers roles and that patients be given a voice in the debate Conclusions Unless physicians and nurses collaborate to improve primary care neither will be happy with the outcome the authors write We urgently need a facilitated open dialogue about the roles of PCPs and APNs that includes representatives of the public e Alerts and Newsletter Sign up Publication Details Publication Date May 16 2013 Authors David Blumenthal M D Melinda K Abrams Summary Writer Deborah Lorber Citation D Blumenthal and M K Abrams Putting Aside Preconceptions Time for Open Dialogue Among Primary Care Clinicians New England Journal of Medicine published online May 16 2013 View Full Article Related

    Original URL path: http://authoring.commonwealthfund.org/publications/in-brief/2013/may/putting-aside-preconceptions (2016-04-30)
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  • In Pursuit of Better Care at Lower Costs: The Value of Cross-National Learning - The Commonwealth Fund
    us what is possible As work by the Institute of Medicine World Health Organization and The Commonwealth Fund has demonstrated our nation lags other countries on most dimensions of performance despite the significant resources we devote to health care While there are pockets of excellence in our health system that are admired worldwide the notion that we have the best health care in the world is completely untenable We know we can do better Fortunately international research has the potential to generate insights into how to manage shared problems Despite differences in our political cultures and approaches to financing and organizing our health systems most developed nations deal with similar issues and rely on similar solutions at the grass roots where clinicians give and patients receive care The problems include finding optimal methods for treating chronic conditions coordinating care in fragmented systems and ensuring that care is affordable and respects patients values and preferences For the most part we also use similar resources to deal with these issues health professionals with similar training often using the same textbooks and literature a common body of evidence based approaches to care and a shared array of drugs and devices With shared problems and similar tools only so many solutions make sense It is clear that the United States now has a unique opportunity to inform our sister nations in the health sector No other country in the world has tried a health system overhaul such as the one we are attempting with the implementation of the Affordable Care Act and associated public and private efforts to improve health system performance In the U S today innovative payment and delivery system changes are rolling out at a rapid pace and millions of new patients will be eligible for health insurance next year The audacity of these changes is magnified by the sheer size of our health system Total health spending in the United States was 2 7 trillion in 2011 If that activity were separated into its own sovereign nation it would constitute the fifth largest economy in the world behind only the United States China Japan and Germany In no other sector does U S spending so dwarf the economic output of most developed nations The dramatic changes in our health care system are worth close observation and both drawing from and contributing to the body of international health policy research will be an important responsibility for health services researchers and policymakers going forward Importing and adapting promising innovations tools and practices from our international peers can improve our performance Similarly exporting the lessons we learn as we undergo dramatic health system transformation may help improve outcomes and experiences abroad The Commonwealth Fund remains committed to participating in such efforts at cross national learning and shared progress Tags Affordable Care Act health spending international health policy 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/apr/the-value-of-cross-national-learning (2016-04-30)
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  • Testimony—Stabilizing and Strengthening Medicare in the Context of Broader Health Reform - The Commonwealth Fund
    Medicare but across the entire U S health system This path builds on the Affordable Care Act and continues to lead away from our current fee for service reimbursement system with a set of initiatives that reward providers consumers and payers for choices that improve outcomes and use resources efficiently We know this approach is viable as many innovative changes of this type are already beginning to emerge on the health system landscape as the reform law is implemented and both public and private stakeholders act on the increasing awareness that reengineering health care is preferable to rationing it The federal government largely through the efforts of the new Center for Medicare and Medicaid Innovation CMMI is undertaking innovative initiatives not only in Medicare but also in Medicaid as well as in partnerships between the two programs and between public and multiple private payers Last week CMMI announced 300 million in funding for 25 states working to reform their health care delivery systems and contain costs Arkansas Maine Massachusetts Minnesota Oregon and Vermont are at the leading edge of the movement to implement a health care innovation plan that utilizes multipayer payment reform and innovative service delivery models Many other state level initiatives are under way and already beginning to return real savings to government programs and the patients they serve including The Missouri Health Home initiative a program that integrates behavioral health and primary care and has resulted in a 16 percent reduction in per Medicaid beneficiary costs The Illinois Medicaid Medical Home Program which has reduced hospitalizations by 18 percent lowered emergency room ER visits by 9 percent and resulted in 569 million in cost savings by using primary care case management The Indiana Right Choices program an initiative that focuses on improving care for frequent users of hospital emergency rooms and has reduced use by 72 percent The care transition model a program deployed in more than three dozen states including the Visiting Nurse Service of New York which has reduced hospital admissions by 54 percent 30 day hospital readmissions by 24 percent and ER visits by 27 percent Meanwhile several private sector organizations are also at the forefront of reengineering care to lower costs and improve outcomes including Geisinger Health System in Pennsylvania through its ProvenHealth Navigator medical home model has realized an 18 percent reduction in hospital admissions a 36 percent reduction in hospital readmissions and significant improvement on several quality indicators related to chronic care management Appleton Medical Center and Theda Clark Medical Center in northeastern Wisconsin have redesigned acute care processes using Lean methodologies and achieved cost per case reductions of 15 percent to 28 percent and lower length of stay and readmissions rates Virginia Mason Medical Center in Seattle a health care delivery organization has partnered with health plans and employers to develop standardized approaches to common conditions decreasing the use of advanced imaging by 23 percent increasing the availability of same day appointments and achieving 91 percent patient satisfaction Blue Cross

    Original URL path: http://authoring.commonwealthfund.org/publications/testimonies/2013/feb/stabilizing-and-strengthening-medicare (2016-04-30)
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  • A Tale of Two Angels - The Commonwealth Fund
    of hospitals with the same The Debate Should EHR Incentives Continue In an essay for the Annals of Internal Medicine David Blumenthal M D former National Coordinator for Health Information Technology and current Commonwealth Fund president enters the debate over whether the federal government s investment has been justified or whether the meaningful use standards are too low and the program has been too slow in promoting EHR interoperability Blumenthal s view is that the debate is premature He notes that the program is not even two years old and that the Secretary of Health and Human Services recently put forth more advanced standards and requirements that could lay the foundation for major advances in interoperability At the same time Blumenthal acknowledges the legitimacy of calls for proof that health care providers are fulfilling all meaningful use requirements Good governance requires a constant balancing of active innovation and accountability he writes Conclusions Blumenthal believes that the meaningful use program deserves the benefit of the doubt for a few years until the program has a chance to show what it can do It is true that current EHRs are imperfect but their installation constitutes the first step toward creating the modern electronic health information system that is essential to health care transformation While federal officials and participating health care providers must always be mindful of the need to be careful stewards of taxpayer dollars the development of advanced information systems capable of reengineering health care to meet growing demand Blumenthal says should be allowed to continue e Alerts and Newsletter Sign up Publication Details Publication Date February 11 2013 Authors David Blumenthal M D Summary Writer Christopher Hollander Citation D Blumenthal A Tale of Two Angels Annals of Internal Medicine e published Feb 12 2013 View Full Article Related Publications May

    Original URL path: http://authoring.commonwealthfund.org/publications/in-brief/2013/feb/a-tale-of-two-angels (2016-04-30)
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  • A Strong Foundation for Improving U.S. Health Care - The Commonwealth Fund
    some important personal ways I have benefited from her guidance as well Decades ago as a medical student and graduate student I discovered health care policy through reading her lucid and compelling books on national health insurance health care costs and health care poverty Fortunately for all of us Karen will continue her scholarly work on Medicare and health system reform at Johns Hopkins University And fortunately for The Commonwealth Fund it will enjoy the continuing support and leadership of its prestigious and dedicated board chaired by James R Tallon Jr president of the United Hospital Fund of New York as well as the talents of its professional staff The work of Board and staff members over the past decade along with that of the Commission helped to shape the debate that led to the establishment of the Affordable Care Act It also has informed many other improvements in health care policy and delivery from new ways to measure health care quality and affordability to innovative programs to reduce readmissions and create patient centered primary care practices and nursing homes The Commonwealth Fund s professional staff are largely responsible for its distinctive products such as its scorecards on national state and local health system performance its studies of the uninsured and underinsured its unique international work on comparative costs and quality of health care in the developed world its Mongan Commonwealth Fund Fellowship in Minority Policy training minority health care leaders and its Harkness Fellowship in Health Care Policy and Practice bringing future health care leaders from nine countries to the U S for a year of study Despite past achievements however it is natural to ask at a time of leadership transition What now What will be different at The Commonwealth Fund going forward Such questions are particularly pertinent at a time of fundamental transition in our health care system We now know that the Affordable Care Act will be implemented and as a result millions will obtain coverage for the first time new mechanisms to control health spending will take effect and innovation will accelerate as we experiment with new approaches to pay for and deliver health care These questions are too important to answer without deep study and broad consultation Over the next months I intend to learn all I can about the Fund and its grantees and to reflect on how we can make the very best use of our resources to make the daily health care of Americans as good and efficient as it can possibly be In the process I will be consulting widely with health care thinkers and leaders throughout the U S with other health care philanthropies and with The Commonwealth Fund s board and its excellent staff I hope our readers will also share their thoughts on these issues I will be back to you in the very near future to share our findings Whatever those are you can be confident about one thing The Commonwealth Fund s work will continue

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/jan/strong-foundation (2016-04-30)
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