Workplace Wellness Programs, Healthy Behaviors and Health Reform

Unhealthy behavior is costing America billions in health care expenditures, and making us less healthy as a people. Many large employers, recognizing the impact on the health of their workers and the companies’ bottom lines, offer financial incentives to their employees to exercise regularly, improve their diets, lose weight and quit smoking, among other things. Many employers cite substantial savings from these programs in their health coverage costs.

Affordability and Health Reform: If We Mandate, Will They (and Can They) Pay?

The health reform proposals being considered in both houses may impose responsibilities on both individuals and employers to have, and help pay for, coverage. Subsidies for some small businesses and for individuals with incomes up to 400 percent of the federal poverty level have been proposed. But will individuals and businesses be able to pay the amounts required of them above the subsidies? If those costs are onerous, Congress may exempt many people from the coverage requirement or significantly reduce the penalties for noncompliance.

Children’s Health Coverage: Medicaid, CHIP, and Next Steps

Medicaid and the Children’s Health Insurance Program (CHIP) play a crucial role in the U.S. health insurance system by providing coverage for more than one in four children. The number of children in CHIP is at an all-time high, having grown 15 percent over the past year alone. About half of Medicaid’s enrollees are children. And yet, more than 8 million children remain uninsured today, 70 percent of whom are eligible for Medicaid or CHIP.

Rural Health: Laying the Foundation for Health Reform

Health care delivery poses unique challenges in rural communities. Provider shortages are particularly acute in rural America, where levels of educational achievement are generally lower and there are fewer opportunities to receive medical training. Unemployment and uninsurance rates are higher in rural areas than elsewhere. Join us for a discussion about how some aspects of pending reform proposals — coverage expansions, subsidies, delivery system improvements and health information technology including telemedicine — may have a substantial impact on rural health care.

Public Opinion on Health Reform: What Do the Polls Mean?

Public support for health reform waxes and wanes depending, not only on what’s being proposed in the reform proposals, but also on who asks the question and how it is asked. Some recent polls indicate a majority of Americans support health care reform now; is that still the case? Do people want to pay for covering the uninsured – and if so, how much? What do seniors think about paying for health reform partly through changes to Medicare? Some polls indicate that most people like their physician but not the system. What if health reform means changing the system Americans now enjoy?

Where You Live Matters: Results from The Commonwealth Fund Commission on a High Performance Health System’s 2009 State Scorecard

The cost and quality of health care, as well as access to care and health outcomes, continue to vary widely among states according to the Commonwealth Fund Commission on a High Performance Health System’s second state scorecard. The report, Aiming Higher: Results from the 2009 State Scorecard on Health System Performance, is a follow-up to the Commission’s 2007 State Scorecard report; ranking states on 38 indicators in the areas of access, prevention/treatment quality, avoidable hospital use and costs, healthy lives, and equity.

The Uninsured: What Do the New Numbers Mean for Health Reform?

As Congress hashes out proposals to expand coverage to tens of millions of uninsured Americans, the latest count of the number of uninsured is a significant factor. Though some believe economic recovery is underway, Americans are still losing jobs by the hundreds of thousands each month. With the loss of jobs, so goes health insurance. How does this reality affect health reform and the notion of building on the current system? Has the complexion of who is uninsured changed? What has been the role of public programs in the recession?

Ask the Experts About Reform: Where Are We Now and Where Are We Headed?

Before the Congressional summer recess began, four committees approved major reform bills; negotiations continue among some members of another. Now Congress returns having heard an earful from constituents about health care. We are clearly at a crucial stage in our consideration of how, and to what extent, we should reshape our health care system. What is the status of major reform bills?

Expanding Access to Care: More than Just an Insurance Card?

Health care access, particularly access to primary care, is on the minds of all who are following health reform efforts in Congress. President Obama has said that expanding access to health care to more Americans is one of the main goals of reform. Democrats and Republicans from both houses agree that any reform plan must increase access. But how can that goal be accomplished, particularly in a time when reducing health care costs and increasing quality are also priorities?

Show Me the Money: Options for Financing Health Reform

As the key congressional committees draft health reform legislation, they are keenly mindful of the costs of various provisions. Congress will look to an array of options, including both savings from the health care system and new revenues, to finance coverage expansions and reforms to both the delivery system and insurance markets. What options hold the most promise? How do the Congressional Budget Office (CBO) and the Office of Management and Budget (OMB) go about “scoring” various financing options? Are there credible options for financing reform? Is there room for bipartisan cooperation in paying for reform? This July 31 briefing, cosponsored by The Commonwealth Fund, addressed these and related questions.

Healing Mind and Body: Behavioral Health and Reform

The health reform debate has heated up, featuring proposals from both the House and Senate. However, little of the discussion has focused on the area of mental health and substance use disorders. More than 33 million Americans are treated annually for mental health and substance use disorders. Mental illness and substance use disorders can have a profound impact on a person’s overall health and well-being. The passage of the Wellstone-Domenici Mental Health Parity and Addiction Equity Act in 2008 indicated that access to mental health and substance use disorder services is a priority. Yet there are concerns that the cost of accessing this care could rise as mental health parity regulations are implemented concurrent with the possibility that health reform legislation might include expansion of access to mental health services.

Scoring Savings: How Can Quality Improvement Reduce Health Care Costs?

As the health reform debate heats up in summertime Washington, discussions center around how to make our current system more efficient, provide better value for the dollars spent, and extend coverage to those without it. The Senate Finance Committee options papers and the House tri-committee report devote whole sections to proposals to reduce health care costs. These proposals consider ways to find savings from working more efficiently, and slowing the growth curve — savings that could help pay the substantial cost of comprehensive health reform.

Health Reform for New Health Reform Reporters

For reporters who normally cover topics other than health reform, today’s reform debates can mean playing catch-up. They may be facing a new vocabulary – public plan option, health insurance cooperative, employer mandate, individual mandate. Maybe they’re trying to figure out what all this means for readers, viewers or listeners.

Making the Case for Prevention: Tales from the Field

To improve the health of communities and the general population, an array of health reformers, states and businesses alike are all looking to a range of prevention measures such as chronic disease management, alcohol and smoking cessation, and obesity programs. The hope is that these measures will also improve value and control costs.

Getting Healthy: Looking Beyond Health Care

Where we live, learn, work and play can have an enormous influence on our health and well being. Yet millions of working men and women and their families face almost insurmountable barriers to better health on a daily basis. Many of these hurdles can’t be cleared simply by choosing a healthy path. For example, many inner city and rural families have virtually no access to healthful foods. Many neighborhoods are unsafe for walking, let alone exercise. Children who do not receive high-quality services and education run a higher risk of becoming less healthy adults.

Health Insurance Exchanges: See How They Run

Various proposals to expand coverage to uninsured Americans and reform the health insurance market include the establishment of a health insurance exchange. The most widely discussed example of such an exchange is in Massachusetts, and it arrived recently with Massachusetts’ 2007 health reform efforts. Many are looking to the Connector, as the Massachusetts program is known, to inform their discussions of a national insurance exchange. But is that the only model?

Public Plan Option: Fair Competition or a Recipe for Crowd-Out?

One of the various proposals to expand coverage to the more than 45 million uninsured Americans is referred to as the “public plan option.” Though proposed only as part of a broader effort to expand coverage, the option is viewed in varying lights. Some see it as a tool for providing consumers affordable coverage by stimulating competition on the basis of quality and efficiency. Others see it as unfair competition for private insurers and, in the extreme, as a path to a single-payer system.

Pathways to Universal Coverage: Payment Reform Strategies for Containing Costs

Provider payment policy is a hot topic again with the Medicare physician payment system due for a fix and value-based payment and other cost containment/quality schemes on the table as part of the health reform debate. This briefing sponsored by the Alliance and The Commonwealth Fund examined cost containment options in payment reform.

Medicare 101

Medicare covers nearly 45 million beneficiaries, including 38 million seniors and 7 million younger adults with permanent disabilities. The program is expected to cost the federal government approximately $477 billion in 2009, accounting for 13 percent of federal spending and 19 percent of total national health expenditures.

Long-Term Care: Exploring the Possibilities

Almost every day, we learn of a new hearing or briefing about ways to improve our health care system. The White House, Congress, advocates and stakeholders are fully engaged. The elephant in the room during those discussions is long-term care. Despite being so large, it suffers from the possibility of being ignored. This March 9 forum, supported by the SCAN Foundation, brought together opinion leaders and stakeholders to explore options for the future of long-term care in the reform debate. Participants considered key policy questions on how to move from testing models at the edges to implementing feasible options through health reform.

Covering the Uninsured: Options for Reform

Forty-five million Americans were uninsured in 2007. They may have worked for an employer that didn’t offer coverage, or were eligible for coverage on the job but could not pay their share of the premiums. Perhaps they were denied coverage in the individual market. Whatever the reason for not having coverage, their lack of insurance limited their access to care, contributed to poorer health outcomes, and may have led to personal bankruptcy.

Community Health Centers: Their Post-Stimulus Role in Health Reform

Community health centers (CHCs) play a key role in the U.S. health care safety net. They provide primary health care and other health services for medically underserved populations, including 1 in 8 Medicaid beneficiaries, 1 in 7 uninsured persons, 1 in 3 people in poverty, 1 in 10 minorities, and 1 in 9 rural Americans.

Medicaid: The Essentials

As a state-run program with broad federal guidelines, Medicaid covers health and long-term care services for scores of millions of low-income Americans. Conversations are well underway about the role of Medicaid as a vehicle for economic stimulus, and about its role in health coverage expansion proposals. In that context, a grounding in current Medicaid basics will be essential to congressional health staff, reporters covering health issues and others concerned about health coverage.

Children’s Health Coverage: A Primer

Medicaid and the State Children’s Health Insurance Program (SCHIP) play a crucial role in the U.S. health insurance system by providing coverage for more than one in four children. During 2005, about 29 million children were enrolled in Medicaid at some point in the year and more than 6 million were covered through SCHIP. Though more than 65 percent of children in the U.S. are covered by private insurance (most through their parents’ employers), Medicaid and SCHIP have helped to increase health care coverage for millions of children.

Medicaid as Stimulus: A Tonic for What Ails the Economy?

Because of the way Medicaid is financed, a recession means double trouble. States have reduced revenue, and thus less money to spend on Medicaid, just as more people are losing their jobs and their health coverage, and need the program. States have little choice but to cut Medicaid spending. Unlike the federal government, they are required by their constitutions to balance their budgets annually, and Medicaid is one of the largest budget components.

How Wide Has the Window Opened for Health Reform?

Now that we know the next occupants of the White House and the composition of the next Congress, many Americans expect to see an effort to enact significant reform of America’s health system. Congress isn’t waiting for the White House green light. Sens. Ron Wyden and Bob Bennett, as well as Sen. Max Baucus have already released health reform plans. Sen. Edward Kennedy is poised to do so.

Tax Treatment of Health Insurance: A Primer

The United States tax system subsidizes the purchase of employer-sponsored health insurance for more than 160 million non-elderly people at a “cost” of approximately $200 billion a year. This tax subsidy is a major reason why most Americans have health insurance coverage through either their own employer or that of a family member. In recent months, the tax treatment of health insurance has gained a lot of attention – both during the presidential campaign and in health reform debates in Congress.

Lessons on Coverage from Abroad: How Do the Dutch, German and Swiss Health Care Systems Do It?

The pre-election debate put health care reform ideas front and center. Now policymakers have to deal with translating theory into action under challenging economic conditions. Why completely reinvent the wheel when there are existing universal coverage systems that may have components the U.S. can learn from? This briefing, cosponsored by The Commonwealth Fund, provided an in-depth look at the very different approaches of Switzerland, Germany and Holland to providing near-universal coverage to their citizens.

Massachusetts Health Reform: A Giant Step Toward Universal Coverage?

The upcoming presidential election and the domestic economic scene have captured the top-of-mind attention of both voters and the media. But not far below the top is a profound concern about health care. Will I lose my job and with it my health insurance? Can I afford the ever-increasing costs of rising premiums, higher deductibles and copays? Which candidate’s health plan will best alleviate my concerns?

Primary Care Innovation: The Patient-Centered Medical Home

It is widely accepted that the U.S. health care system, although touted by some as the “best system in the world,” has room for improvement. Many people have no regular health care provider. Care is often fragmented and lacks coordination, which compromises quality and efficiency. Incentives for providers have not caught up with the demographics of chronic care. Some 75 percent of Medicare spending is on beneficiaries with five or more chronic conditions – and those people see an average of 14 different physicians a year.

Low-Income Adults: Can Medicaid Fill the Coverage Gap?

If you think that all poor Americans can get health coverage through Medicaid, think again. Except in a few states with federal waivers, adults must not only meet income and asset requirements, but must fit into a category of persons for which coverage is available.

Latino Health and National Health Reform

By 2050, the U.S. Latino population, already the nation’s largest minority group, will triple in size and will account for most of the population growth in the U.S. over the next four decades. Hispanics will make up almost three out of every 10 people in the U.S. by 2050. This growth will have important implications for health care in the U.S., and for national health reform.

Dental Health: Nurturing the Health Care System’s Neglected Stepchild

The recent deaths of two children due to preventable dental conditions focused attention on the importance of improving access to dental coverage for low-income Americans. With SCHIP reauthorization on the horizon and the chance that elements of last year’s vetoed SCHIP proposal—which included provisions for dental care—may be revived, oral health issues are front and center.

Making the Grade: Improving the U.S. Health System

The U.S. health care system is often touted as a model for the rest of the world. We are clearly a leader in costs, but how well are we performing in return for our high investment? How do we do compare to benchmarks of achievable performance? And is performance getting better?

Innovations in Patient Care: Lessons from the Field

With the health reform discussion in full swing, improving value for the money we spend on health care is an essential part of the debate. Nurses can play a prominent role in improving quality. A growing body of research points to the positive impact of nurses on coordinating care, reducing hospital readmissions and improving clinical outcomes – all with a potential to reduce costs.

Health Information Technology and Its Future: More Than the Money

Health information technology (IT) wins many honorable mentions. It is viewed by respected analysts and presidential candidates in both parties as a tool with the potential to save lives, improve efficiency and increase the overall quality of our health care delivery system.

Using Medicare as Part of Coverage Expansion?

A new proposal by The Commonwealth Fund suggests, as a major component of moving toward coverage for all, a Medicare-like program that uninsured adults below the age of 65 could purchase voluntarily. Reform proposals offered by Senators Clinton and Obama as part of their presidential campaigns feature similar options, as do some state reform plans.

Racial and Ethnic Disparities: States and Feds to the Rescue?

With a substantial body of evidence showing that racial and ethnic minorities receive poorer quality care than others, state and federal policy makers are looking for ways to reduce disparities. Some states have begun to experiment with strategies for reducing health disparities.

Comparative Effectiveness: Can We Get Better Health Value for the Dollars We Spend?

Comparative effectiveness research holds out the tantalizing prospect of making it easier for patients and their doctors to choose the best treatment, thus improving quality. At the same time, it could also justify denying or reducing payment for a host of treatments or procedures that may be clinically ineffective or unworthy of their high price.

Helping 125 Million Americans: Improving Care for Chronic Conditions

An estimated 125 million individuals in the United States have a chronic illness, disability or functional limitation. Chronic diseases are the number one cause of death and disability in the United States and account for three quarters of the nation’s health spending.

Health Information Technology and Privacy: Is There a Path to Consensus?

Promoting health information technology (IT) has been a common thread in the campaigns of the 2008 presidential candidates’ health reform proposals. It is proposed as a means of achieving efficiency, improving quality and cutting costs in the delivery of health care. In addition, there is bipartisan support in both houses of Congress for expanding health IT. Yet, one bill that would do so remains stalled in the House, another in the Senate.

Health Reform Lessons Learned: Veterans of 1993-94 Offer Advice to Today’s Reformers

No matter who wins the White House and control of Congress in November, health reform legislation will likely be a front-burner issue for both House and Senate in 2009. The debates about reform, and the behind-the-scenes meetings, of 1993 and 1994 produced a wealth of knowledge on what should be done differently the next time Congress takes up this issue. What derailed health reform in 1994? What tactical and strategic decisions, in areas such as timing and content, affected the outcome? What part did outside groups play? How should the issue be approached differently the next time around? What are the appropriate roles for congressional and executive branch leadership in getting reform done? This briefing, cosponsored with the Robert Wood Johnson Foundation, addressed these and related questions.

Health Reform Do’s and Don’ts: Veterans of the Early 90s’ Health Reform Debate Offer Advice to Today’s Reformers

Many of today’s reporters are too young to remember the last time Congress vigorously debated health coverage for all – 1993 and 94. For other reporters, that period feels “like yesterday.” Whichever camp a person is in, that debate produced a wealth of knowledge on what should be done differently the next time Congress takes up national health reform, a time that could be coming soon after the next election.

Medicare Part D: What Now, What Next?

Close to 24 million Medicare beneficiaries enrolled in Part D coverage for prescription drugs in the first two enrollment cycles. According to the Centers for Medicare and Medicaid Services (CMS), more than 75 percent of beneficiaries are satisfied with the program. However, evidence suggests that seniors who were uncovered in 2005 benefited more than other enrollees in 2006. HHS has announced that more than 90 percent of Medicare beneficiaries in a stand-alone prescription drug plan will have access to at least one plan with a lower premium in 2008[1]; and the third open enrollment period is now upon us – November 15 through December 31, 2007.

State Coverage Initiatives: Will Moving Toward Universal Coverage Make the System Work Better for Everyone?

There is mounting evidence that the U.S. system is often financially inefficient and delivers poor quality. There is also research suggesting that having so many people without insurance can adversely affect the quality of care for everyone, even those with insurance. A new report by The Commonwealth Fund sets forth principles for providing universal coverage in ways that could promote a high performance health care system. Several states are already trying to reform their health care systems.

Changing the Culture and Improving Quality: Innovations in Long-Term Care

Culture change in the long-term care world involves many players – residents, administrators, workers, lawmakers, policy analysts – sharing a common vision. One such vision attracting attention has been developed by a group of citizens, providers and advocates known as Pioneers who are exploring alternatives to traditional nursing facilities. Their goal: facilities that are resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources.

Employer-Based Coverage: Shore It Up or Ship It Out?

Employer-sponsored coverage rates have been steadily falling, from 66 percent of non-elderly Americans in 2000 to slightly below 60 percent in 2006. Experts cite rising premium costs and workforce changes as factors driving the erosion in such coverage.

Health Care and the ’08 Election: A Preview

As presidential candidates of both major parties woo the American public, particularly in early caucus and primary states, they are gravitating toward a common public concern: the U.S. health care system. Potential voters are well aware of rising premiums and higher out of pocket costs to families, the impact of high health care costs on America’s economic competitiveness and on federal and state budgets, and the ever-growing number of uninsured – now nearly 45 million. A Kaiser Family Foundation poll released in March shows that health care ranks as the second most important issue that the public would like discussed by presidential candidates for the 2008 election.

Quality Care and Comfort at the End of Life: Changes Needed?

The American health system is focused on curing, and spends billions of dollars on treatment at the end of life. But now more than 40 million adult Americans suffer with life-altering, chronic health conditions. They and their families are often more concerned with pain management, comfort care, and coordinating care as they transition from setting to setting. As people live longer with grave chronic illness are they getting quality care? Where in the delivery of care spectrum should palliative care come into play? Sponsored by the Alliance and the Robert Wood Johnson Foundation.

State Health Initiatives: What’s Next?

New initiatives are cropping up in one state after another aimed at helping the uninsured. The most comprehensive efforts have been in Massachusetts, Vermont and Maine. California Gov. Arnold Schwarzenegger has attracted national attention for his plan to cover virtually all in that state, and legislative leaders have their own plans. But many other states are also moving toward expanded coverage.

Which Way To Turn? Options for Rebuilding the Gulf Region’s Health Infrastructure

More than two years after hurricane Katrina devastated the Gulf region and destroyed large swaths of New Orleans, local and federal officials are trying to determine the appropriate approach to rebuilding the health care system. Prior to Katrina, Louisiana’s health care infrastructure was a two-tiered system. The middle class relied largely on the private health care system while the poor relied on a state-sponsored hospital network known as the “Charity” system.

Medicare 101: What You Really Need to Know

Medicare covers nearly 44 million beneficiaries who are elderly, including 37 million seniors and 7 million younger adults with permanent disabilities, and end stage renal disease. The program cost the federal government approximately $375 billion in 2006, accounting for 13 percent of federal spending. Why is Medicare important for congressional staffers to know about?

Medicaid 101: A Primer on the Health Insurance Program for Low-Income Americans

Medicaid is a joint state and federal program. It covers nearly 55 million individuals – children, adults with children, elderly and disabled individuals and cost nearly $300 billion in combined state and federal spending in 2006. Whom does Medicaid serve? What benefits does Medicaid cover? How is it financed? What is the nature of the federal and state partnership?

Health Coverage Revisited: Exploring Options for Expansion

Providing health insurance coverage to the 46 million Americans without it has been receiving more attention in recent months. Several polls have shown rising public interest in the topic. Coverage is fast becoming an issue in the 2008 presidential campaign, for both Democrats and Republicans. President Bush offered an uninsured proposal in his January State of the Union address. Bills dealing with the uninsured have been introduced by members of Congress from both parties. A number of states have also laid out ambitious coverage plans.

SCHIP and Beyond: Improving Health Care Coverage and Quality for Children

Dollar for dollar, providing better health care for children represents one of the best returns on investment available in the U.S. This involves not only better monitoring of quality and making quality improvements, but also enrolling eligible children in health programs such as SCHIP and Medicaid. And it means ensuring that health care systems – including safety net providers and health insurers – are responsive to the unique health needs of children.

Reaching Out: Enrolling and Keeping Kids in the SCHIP Program

By some estimates, almost three-fourths of America’s nine million uninsured children are eligible for either State Children’s Health Insurance Program (SCHIP) or Medicaid. As Congress begins debating the reauthorization of the program in earnest, policymakers are examining what is keeping these children from enrolling.

SCHIP: Let the Discussions Begin

Authorization for SCHIP expires this September, and, in the coming months, Congress will be debating the program’s extension. Established in 1997 with an authorized 10-year funding level of $40 billion, SCHIP’s accomplishments in providing coverage to an estimated six million children are now widely acknowledged. SCHIP pursues its relatively simple goal – broader coverage for low- and moderate-income children – through a relatively complicated structure. So before key decisions can be made about the program’s future, it is important to have a baseline understanding of what makes the program work.

Pay-for Performance and Medicare: Moving from the Drawing Board to the Doctor’s Office

As the nation’s largest payer for health care services, the Medicare program has a major effect on payments to providers. Its ability to align incentives through pay-for-performance will have implications for the health delivery system at large. A recent Institute of Medicine report made recommendations for implementation of “P4P” under Medicare.

Health Legislation 2007-2008: What’s Possible?

Suddenly, Capitol Hill is talking about health issues again. Incoming House Speaker Nancy Pelosi promises that Democrats will roll back the prohibition against the federal government negotiating drug prices on behalf of Medicare beneficiaries. (A Kaiser Family Foundation poll released today found broad bipartisan support for this idea.) Incoming Senate Majority Leader Harry Reid says one of his three top priorities will be more funding for stem cell research. Others want to revisit the importation of prescription drugs from Canada. Additionally, the 110th Congress will consider whether to continue the State Children’s Health Insurance Program in its present form.

Prospects for Health Care: Where Will New Congressional Leadership Take Us?

Come January, we can expect to see some new approaches to health legislation. Sen. Harry Reid, incoming Senate majority leader, says one of his top three priorities will be more funding for stem cell research. House Speaker-to-be Nancy Pelosi wants a vote early on to roll back the prohibition against the federal government negotiating prescription drug prices for Medicare beneficiaries. And these are just two of the health issues likely to be debated in the new Congress. The White House too will have a definite voice in the debates to come.

Who Cares What Patients Think?

The growing complexity of our health care system, and time demands on providers, can cause patients’ non-obvious needs to get lost in the shuffle. Sometimes, the result can be less-than-optimal care. In response, providers are trying to be more responsive to patients’ cultural traditions, family situations, personal preferences and values. Some have tagged this movement “patient-centered care.”

State Health Reform Initiatives: Are There Lessons for Federal Policymakers?

Polls consistently show that addressing problems in our health care system remains a top concern for most Americans. But while major health care reform efforts have stalled in Washington, many states are attempting to address the rising number of uninsured on their own. This briefing focused on such efforts in three states – Massachusetts, Vermont and Utah.

46.6 Million and Counting: A Look Behind the Number of Uninsured Americans

The Census Bureau’s recently released figure on the number of uninsured in 2005 is 46.6 million, an increase of 1.3 million people over 2004. Two new studies by John Holahan and Bowen Garrett of the Urban Institute offer in-depth analyses of the economic and demographic factors that underlie this troubling statistic.

Measuring Up: A Comprehensive Scorecard for America’s Health System

A new assessment by The Commonwealth Fund finds that deficiencies in the nation’s health care system cost 100,000 to 150,000 lives and $50 to $100 billion annually. The scorecard compares national averages for the U.S. to national and international benchmarks for 37 indicators. The U.S. received a composite score of 66 out of 100. On one quality measure, mortality, the U.S. ranked 14th out of 19 countries.

Balancing the Promise and Cost of Biotechnology

Biotechnology accounts for only one percent of insurers’ costs, but those costs are growing at a double digit rate. As science produces increasingly sophisticated and expensive medical products and procedures based on the manipulation of living organisms, payers will increasingly struggle with managing their use.

Treatment of Severe Chronic Illness: What Explains Cost and Quality Variations? Should We Be Concerned?

Some Medicare beneficiaries receive significantly more hospital-based services during the last two years of life than do other beneficiaries. The number of physician visits for Medicare beneficiaries can also vary greatly. What accounts for this variation? Do patients receiving more services tend to get better care, or not? Should policymakers take steps to more closely examine the relationship between spending and the volume of services provided at different facilities?

Reviewing Prescription Drug Coverage: Policies and Practices Across Several Health Systems

The Medicare prescription drug program offers coverage for prescription drugs through competing private plans, within a framework established by law and through rules established by the Centers for Medicare and Medicaid Services. In contrast, other countries, including Australia, the UK, and Canada, provide similar prescription drug programs, but within different regulatory structures.

Improving Coverage Stability For Kids in Medicaid and SCHIP

One byproduct of the patchwork system of public and private health insurance coverage in the United States is that individuals can gain or lose health insurance as they gain or lose jobs, or gain or lose eligibility for public programs. This phenomenon, known as “churning,” can lead to gaps in health insurance coverage and unnecessary administrative costs for state governments that have to process the same individuals repeatedly.

Helping the Medicare Savings Programs Get Savings to Seniors

The Medicare Savings Programs provide assistance with premiums — and in some instances, cost sharing requirements — to Medicare beneficiaries of limited income and resources who do not qualify for full Medicaid benefits. Medicare Part B premiums currently amount to over $1,000 annually — which can be a large sum for some beneficiaries.

Medicare Advantage: Early Views and Trendspotting

Although it’s best known for introducing the Medicare prescription drug program, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 also made a number of changes to the Medicare managed care program – Medicare Advantage. Among the aims: Keep managed care plans from leaving the program by offering higher payments, and give beneficiaries more reasons to consider joining.

Rewarding Quality Performance: The Multidisciplinary Approach

In today’s health care system it is clear that there needs to be a multidisciplinary approach toward improving quality. Nurses are on the front lines of implementing this quality improvement. By using the highest quality measurements and optimizing the delivery of care, those outside the nursing community would understand the importance of their role in quality performance.

The Massachusetts Health Plan: How Did They Do It?

On April 4, the Massachusetts legislature approved a plan that requires all adults to purchase health insurance by July 2007, or face a fine. The plan is projected to expand coverage to 95 percent of the state’s uninsured residents over the next three years.

Ideas for Making Health Insurance More Affordable for Small Businesses

Congress has actively considered whether and how to reorganize the health insurance market for small businesses. In Spring 2006, the Senate debated a legislative proposal, offered by Senators Michael Enzi and Benjamin Nelson, which centers on Small Business Health Plans (SBHPs). SBHPs are a new category of group health plans sponsored by bona-fide professional and other associations. The House has debated and approved related legislation on association health plans.

Patient Safety: Why It’s Getting More Visibility

The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).

Where Are HSAs and High-Deductible Health Plans Headed?

Health savings accounts (HSAs) offered in conjunction with high-deductible health plans are on an upswing nationally. Simply stated, HSAs require an individual to use his or her own money (or money set aside by an employer for the individual’s use) to pay for medical expenses up to a fairly substantial deductible, at which point traditional insurance coverage begins. Established by the Medicare Modernization Act, the minimum deductible this year for individuals is $1,050; for families, $2,100.

Beyond the $10 Aspirin: How Well Does Our Hospital Financing System Work?

As health care tabs rise, every American feels the impact – on personal finances, company budgets, state coffers and federal entitlement programs. Rising demands for services from an aging population, medical advances, and quality imperatives all impact health care costs. Within this context, it is important to understand how various sectors of our health care system price services and account for costs.

Balancing the Equation: Ending Disparities in Health Care Delivery for Racial and Ethnic Minorities

Disparities in health care have been well documented: Nonwhites have higher rates of infant mortality, death from heart disease, incidence of diabetes and HIV/AIDS and are less likely to receive appropriate immunization than are whites. A recent study in the Journal of Racial and Ethnic Disparities indicates that between 1991 and 2000, five times as many lives could have been saved by ending health disparities than were saved by innovations in health technology over the same period.

Making Sense of Medicare’s Drug Benefit: Information and Resources to Help Beneficiaries

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Exploring Realistic Coverage Options for the Uninsured

The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).